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Title: A History of Epidemics in Britain, Volume II (of 2) - From the Extinction of Plague to the Present Time
Author: Creighton, Charles, 1847-1927
Language: English
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A HISTORY OF EPIDEMICS IN BRITAIN.

London: C. J. Clay and Sons,
Cambridge University Press Warehouse,
Ave Maria Lane.
and
H. K. Lewis,
136, Gower Street, W.C.

Cambridge: Deighton, Bell and Co.
Leipzig: F. A. Brockhaus.
New York: Macmillan and Co.


A HISTORY OF EPIDEMICS IN BRITAIN.

by

CHARLES CREIGHTON, M.A., M.D.,

Formerly Demonstrator of Anatomy in the University of Cambridge.

VOLUME II.

From the Extinction of Plague to the present time.



Cambridge:
At the University Press.
1894

[All Rights reserved.]

Cambridge:
Printed by C. J. Clay, M.A. and Sons,
At the University Press.



PREFACE.


This volume is the continuation of ‘A History of Epidemics in Britain from
A.D. 664 to the Extinction of Plague’ (which was published three years
ago), and is the completion of the history to the present time. The two
volumes may be referred to conveniently as the first and second of a
‘History of Epidemics in Britain.’ In adhering to the plan of a systematic
history instead of annals I have encountered more difficulties in the
second volume than in the first. In the earlier period the predominant
infection was Plague, which was not only of so uniform a type as to give
no trouble, in the nosological sense, but was often so dramatic in its
occasions and so enormous in its effects as to make a fitting historical
theme. With its disappearance after 1666, the field is seen after a time
to be occupied by a numerous brood of fevers, anginas and other
infections, which are not always easy to identify according to modern
definitions, and were recorded by writers of the time, for example
Wintringham, in so dry or abstract a manner and with so little of human
interest as to make but tedious reading in an almost obsolete phraseology.
Descriptions of the fevers of those times, under the various names of
_synochus_, _synocha_, nervous, putrid, miliary, remittent, comatose, and
the like, have been introduced into the chapter on Continued Fevers so as
to show their generic as well as their differential character; but a not
less important purpose of the chapter has been to illustrate the condition
of the working classes, the unwholesomeness of towns, London in
particular, the state of the gaols and of the navy, the seasons of dearth,
the times of war-prices or of depressed trade, and all other vicissitudes
of well-being, of which the amount of Typhus and Relapsing Fever has
always been a curiously correct index. It is in this chapter that the
epidemiology comes into closest contact with social and economic history.
In the special chapter for Ireland the association is so close, and so
uniform over a long period, that the history may seem at times to lose its
distinctively medical character.

As the two first chapters are pervaded by social and economic history, so
each of the others will be found to have one or more points of distinctive
interest besides the strictly professional. Smallpox is perhaps the most
suitable of all the subjects in this volume to be exhibited in a
continuous view, from the epidemics of it in London in the first Stuart
reigns to the statistics of last year. While it shares with Plague the
merit, from a historical point of view, of being always the same definite
item in the bills of mortality, it can be shown to have experienced, in
the course of two centuries and a half, changes in its incidence upon the
classes in the community, upon the several age-periods and upon town and
country, as well as a very marked change relatively to measles and
scarlatina among the infective scourges of infancy and childhood. For
certain reasons Smallpox has been the most favoured infectious disease,
having claimed an altogether disproportionate share of interest at one
time with Inoculation, at another time with Vaccination. The history of
the former practice, which is the precedent for, or source of, a whole new
ambitious scheme of prophylaxis in the infectious diseases of men and
brutes, has been given minutely. The latter practice, which is a radical
innovation inasmuch as it affects to prevent one disease by the
inoculation of another, has been assigned as much space in the chapter on
Smallpox as it seems to me to deserve. Measles and Whooping-cough are
historically interesting, in that they seem to have become relatively more
prominent among the infantile causes of death in proportion as the public
health has improved. Whooping-cough is now left to head the list of its
class by the shrinkage of the others. It is in the statistics of Measles
and Whooping-cough that the principle of population comes most into view.
The scientific interest of Scarlatina and Diphtheria is mainly that of
new, or at least very intermittent, species. Towards the middle of the
18th century there emerges an epidemic sickness new to that age, in which
were probably contained the two modern types of Scarlet Fever and
Diphtheria more or less clearly differentiated. The subsequent history of
each has been remarkable: for a whole generation Scarlatina could prove
itself a mild infection causing relatively few deaths, to become in the
generation next following the greatest scourge of childhood; for two whole
generations Diphtheria had disappeared from the observation of all but a
few medical men, to emerge suddenly in its modern form about the years
1856-59.

The history of Dysentery, as told by the younger Heberden, has been a
favourite instance of the steady decrease of a disease in London during
the 18th century. I have shown the error in this, and at the same time
have proved from the London bills of mortality of the 17th and 18th
centuries that Infantile Diarrhoea, which is now one of the most important
causes of death in some of the great manufacturing and shipping towns, was
formerly still more deadly to the infancy of the capital in a hot summer
or autumn. Asiatic Cholera brings us back, at the end of the history, to
the same great problem which the Black Death of the 14th century raised
near the beginning of it, namely, the importation of the seeds of
pestilence from some remote country, and their dependence for vitality or
effectiveness in the new soil upon certain favouring conditions, which
sanitary science has now happily in its power to withhold. I have left
Influenza to be mentioned last. Its place is indeed unique among epidemic
diseases; it is the oldest and most obdurate of all the problems in
epidemiology. The only piece of speculation in this volume will be found
in the five-and-twenty pages which follow the narrative of the various
historical Influenzas; it is purely tentative, exhibiting rather the
_disjecta membra_ of a theory than a compact and finished hypothesis. If
there is any new light thrown upon the subject, or new point of view
opened, it is in bringing forward in the same context the strangely
neglected history of Epidemic Agues.

Other subjects than those which occupy the nine chapters of this volume
might have been brought into a history of epidemics, such as Mumps,
Chickenpox and German Measles, Sibbens and Button Scurvy, together with
certain ordinary maladies which become epidemical at times, such as
Pneumonia, Erysipelas, Quinsy, Jaundice, Boils and some skin-diseases.
While none of these are without pathological interest, they do not lend
themselves readily to the plan of this book; they could hardly have been
included except in an appendix of _miscellanea curiosa_, and I have
preferred to leave them out altogether. It has been found necessary, also,
to discontinue the history of Yellow Fever in the West Indian and North
American colonies, which was begun in the former volume.

I have, unfortunately for my own labour, very few acknowledgements to make
of help from the writings of earlier workers in the same field. My chief
obligation is to the late Dr Murchison’s historical introduction to his
‘Continued Fevers of Great Britain.’ I ought also to mention Dr Robert
Willan’s summary of the throat-distempers of the 18th century, in his
‘Cutaneous Diseases’ of 1808, and the miscellaneous extracts relating to
Irish epidemics which are appended in a chronological table to Sir W. R.
Wilde’s report as Census Commissioner for Ireland. For the more recent
history, much use has naturally been made of the medical reports compiled
for the public service, especially the statistical.

_September, 1894._



CONTENTS.


                                                                    PAGE

  CHAPTER I.

  TYPHUS AND OTHER CONTINUED FEVERS.

  The Epidemic Fever of 1661, according to Willis                      4

  Sydenham’s epidemic Constitutions                                    9

  Typhus Fever perennial in London                                    13

  The Epidemic Constitutions following the Great Plague               17

  The Epidemic Fever of 1685-86                                       22

  Retrospect of the great Fever of 1623-25                            30

  The extinction of Plague in Britain                                 34

  Fevers to the end of the 17th Century                               43

  Fevers of the seven ill years in Scotland                           47

  The London Fever of 1709-10                                         54

  Prosperity of Britain, 1715-65                                      60

  The Epidemic Fevers of 1718-19                                      63

  The Epidemic Fevers of 1726-29: evidence of Relapsing Fever         66

  The Epidemic Fever of 1741-42                                       78

  Sanitary Condition of London under George II.                       84

  The Window-Tax                                                      88

  Gaol-Fever                                                          90

  Circumstances of severe and mild Typhus                             98

  Ship-Fever                                                         102

  Fever and Dysentery of Campaigns: War Typhus, 1742-63              107

  Ship-Fever in the Seven Years’ War and American War                111

  The “Putrid Constitution” of Fevers in the middle third of the
  18th Century                                                       120

  Miliary Fever                                                      128

  Typhus Fever in London, 1770-1800                                  133

  Typhus in Liverpool, Newcastle and Chester in the last quarter
  of the 18th century                                                140

  Fever in the Northern Manufacturing Towns, 1770-1800               144

  Typhus in England and Scotland generally, in the end of the
  18th century                                                       151

  Fevers in the Dearth of 1799-1802                                  159

  Comparative immunity from Fevers during the War and high
  prices of 1803-15                                                  162

  The Distress and Epidemic Fever (Relapsing) following the Peace
  of 1815 and the fall of wages                                      167

  The Epidemic of 1817-19 in Scotland: Relapsing Fever               174

  The Relapsing Fever of 1827-28                                     181

  Typhoid or Enteric Fever in London, 1826                           183

  Return of Spotted Typhus after 1831: “Change of Type.” Distress
  of the Working Class                                               188

  Enteric Fever mixed with the prevailing Typhus, 1831-42            198

  Relapsing Fever in Scotland, 1842-44                               203

  The “Irish Fever” of 1847 in England and Scotland                  205

  Subsequent Epidemics of Typhus and Relapsing Fevers                208

  Relative prevalence of Typhus and Enteric Fevers since 1869        211

  Circumstances of Enteric Fever                                     216


  CHAPTER II.

  FEVER AND DYSENTERY IN IRELAND.

  Dysentery and Fever at Londonderry and Dundalk, 1689               229

  A generation of Fevers in Cork                                     234

  Famine and Fevers in Ireland in 1718 and 1728                      236

  The Famine and Fever of 1740-41                                    240

  The Epidemic Fevers of 1799-1801                                   248

  The Growth of Population in Ireland                                250

  The Famine and Fevers of 1817-18                                   256

  Famine and Fever in the West of Ireland, 1821-22                   268

  Dysentery and Relapsing Fever, 1826-27                             271

  Perennial Distress and Fever                                       274

  The Great Famine and Epidemic Sicknesses of 1846-49                279

  Decrease of Typhus and Dysentery after 1849                        295


  CHAPTER III.

  INFLUENZAS AND EPIDEMIC AGUES.

  Retrospect of Influenzas and Epidemic Agues in the 16th and
  17th centuries                                                     306

  The Ague-Curers of the 17th Century                                315

  The Peruvian Bark Controversy                                      320

  The Influenza of 1675                                              326

  The Influenza of 1679                                              328

  The Epidemic Agues of 1678-80                                      329

  The Influenza of 1688                                              335

  The Influenza of 1693                                              337

  The Influenza of 1712                                              339

  Epidemic Agues and Influenzas, 1727-29                             341

  The Influenza of 1733                                              346

  The Influenza of 1737                                              348

  The Influenza of 1743                                              349

  Some Localized Influenzas and Horse-colds                          352

  The Influenza of 1762                                              356

  The Influenza of 1767                                              358

  The Influenza of 1775                                              359

  The Influenza of 1782                                              362

  The Epidemic Agues of 1780-85                                      366

  The Influenza of 1788                                              370

  The Influenza of 1803                                              374

  The Influenza of 1831                                              379

  The Influenza of 1833                                              380

  The Influenza of 1837                                              383

  The Influenza of 1847-48                                           389

  The Influenzas of 1889-94                                          393

  The Theory of Influenza                                            398

  Influenza at Sea                                                   425

  The Influenzas of Remote Islands                                   431


  CHAPTER IV.

  SMALLPOX.

  Retrospect of earlier epidemics                                    434

  Smallpox after the Restoration                                     437

  Sydenham’s Practice in Smallpox                                    445

  Causes of Mild or Severe Smallpox                                  450

  Pockmarked Faces in the 17th Century                               453

  The Epidemiology continued to the end of the 17th century          456

  Smallpox in London in 1694: the death of the Queen                 458

  Circumstances of the great Epidemic in 1710                        461

  Inoculation brought into England                                   463

  The popular Origins of Inoculation                                 471

  Results of the first Inoculations; the Controversy in England      477

  Revival of Inoculation in 1740: a New Method                       489

  The Suttonian Inoculation                                          495

  Extent of Inoculation in Britain to the end of the 18th Century    504

  The Epidemiology continued from 1721                               517

  Smallpox in London in the middle of the 18th century               529

  The Epidemiology continued to the end of the 18th century          535

  The range of severity in Smallpox, and its circumstances           544

  Cowpox                                                             557

  Chronology of epidemics resumed from 1801                          567

  The Smallpox Epidemic of 1817-19                                   571

  Extent of Inoculation with Cowpox or Smallpox, 1801-1825           582

  The Smallpox Epidemic of 1825-26                                   593

  A generation of Smallpox in Glasgow                                597

  Smallpox in Ireland, 1830-40                                       601

  The Epidemic of 1837-40 in England                                 604

  Legislation for Smallpox after the Epidemic of 1837-40             606

  Other effects of the epidemic of 1837-40 on medical opinion        610

  The age-incidence of Smallpox in various periods of history        622


  CHAPTER V.

  MEASLES.

  Derivation and early uses of the name                              632

  Sydenham’s description of Measles in London, 1670 and 1674         635

  Measles in the 18th century                                        641

  Increasing mortality from Measles at the end of the 18th century   647

  Measles in Glasgow in 1808 and 1811-12: Researches of Watt         652

  Measles in the Period of Statistics                                660


  CHAPTER VI.

  WHOOPING-COUGH.

  Earliest references to whooping-cough                              666

  Whooping-cough in Modern Times                                     671

  Whooping-cough as a Sequel of other Maladies                       674


  CHAPTER VII.

  SCARLATINA AND DIPHTHERIA.

  Nosological difficulties in the earlier history                    678

  The Throat-distemper of New England, 1735-36                       685

  Angina maligna in England from 1739                                691

  An epidemic of Throat-disease in Ireland, 1743                     693

  Malignant Sore-throat in Cornwall, 1748                            694

  Fothergill’s Sore-throat with Ulcers, 1746-48                      696

  “Scarlet Fever” at St Albans, 1748                                 698

  Epidemics of Sore-throat with Scarlet rash in the period
  between Fothergill and Withering                                   699

  Scarlatina anginosa in its modern form, 1777-78                    708

  History of Scarlatina after the Epidemic of 1778                   713

  Scarlatina (1788) and Diphtheria (1793-94) described by the
  same observer                                                      715

  Scarlatinal Epidemics, 1796-1805                                   719

  Scarlatina since the beginning of Registration, 1837               726

  Reappearance of Diphtheria in 1856-59                              736

  Conditions favouring Diphtheria                                    744


  CHAPTER VIII.

  INFANTILE DIARRHOEA, CHOLERA NOSTRAS, AND DYSENTERY.

  Summer Diarrhoea of Infants in London, 17th century                748

  Summer Diarrhoea of Infants, 18th century                          754

  Modern Statistics of Infantile Diarrhoea                           758

  Causes of the high Death-rates from Infantile Diarrhoea            763

  Cholera Nostras                                                    768

  Dysentery in the 17th and 18th centuries                           774

  Dysentery in the 19th century                                      785


  CHAPTER IX.

  ASIATIC CHOLERA.

  Asiatic Cholera at Sunderland in October, 1831                     796

  Extension of Cholera to the Tyne, December, 1831                   802

  The Cholera of 1832 in Scotland                                    805

  The Cholera of 1832 in Ireland                                     816

  The Cholera of 1832 in England                                     820

  The Cholera of 1848-49 in Scotland                                 835

  The Cholera of 1849 Ireland                                        839

  The Cholera of 1849 in England                                     840

  The Cholera of 1853 at Newcastle and Gateshead                     849

  The Cholera of 1854 in England                                     851

  The Cholera of 1853-54 in Scotland and Ireland                     855

  The Cholera of 1865-66                                             856

  The Antecedents of Epidemic Cholera in India                       860

  Note on Cerebro-Spinal Fever                                       863



CHAPTER I.

TYPHUS AND OTHER CONTINUED FEVERS.


It was remarked by Dr James Lind, in 1761, that a judicious synopsis of
the writings on fevers, in a chronological sense, would be a valuable
book: it would bring to light, he was fain to expect, treasures of
knowledge; “and perhaps the influence of a favourite opinion, or of a
preconceived fancy, on the writings of some even of our best instructors,
such as Sydenham and Morton, would more clearly be perceived[1].” Lind
himself was the person to have delivered such a history and criticism. He
was near enough to the 17th century writers on fevers to have entered
correctly into their points of view; while so far as concerned the
detection of theoretical bias or preconceived fancies, he had shown
himself a master of the art in his famous satire upon the “scorbutic
constitution,” a verbal or mythical construction which had been in great
vogue for a century and a half, and was still current, at the moment when
Lind destroyed it, in the writings of Boerhaave and Haller. A judicious
historical view of the English writings on fevers, such as this 18th
century critic desired to see, may now be thought superfluous. The
theories, the indications for treatment, the medical terms, have passed
away and become the mere objects of a learned curiosity. But the actual
history of the old fevers, of their kinds, their epidemic prevalence,
their incidence upon rich or poor, upon children or adults, their
fatality, their contagiousness, their connexion with the seasons and other
vicissitudes of the people--all this is something more than curious.

Unfortunately for the historian of diseases, he has to look for the
realities amidst the “favourite opinions” or the “preconceived fancies” of
contemporary medical writers. Statements which at first sight appear to be
observations of matters of fact are found to be merely the necessary
truths or verbal constructions of some doctrine. One great doctrine of the
17th and 18th centuries was that of obstructions: in this doctrine, as
applied to fevers, obstructions of the mesentery were made of central
importance; the obstructions of the mesentery extended to its lymphatic
glands; so that we come at length, in a mere theoretical inference, to
something not unlike the real morbid anatomy of enteric fever. Another
great doctrine of the time, specially applied by Willis to fevers, was
that of fermentations and acrimonies. “This ferment,” says a Lyons
disciple of Willis in 1682, “has its seat in the glandules of the velvet
coat of the stomach and intestines described by Monsieur Payer[2].” But
the Lyons physician is writing all the while of the fevers that have
always been common in the Dombes and Bresse, namely intermittents; the
tertian, double tertian, quotidian, quartan, or double quartan paroxysm
arises, he says, from the coagulation of the humours by the ferment which
has its seat in the glandules described by M. Payer, even as acids cause a
coagulation in milk, the paroxysm of ague continuing, “until this sharp
chyle be dissipated and driven out by the sweat or insensible
perspiration.” The lymphatic follicles of the intestine known by the name
of Payer, or Peyer, were then the latest anatomical and physiological
novelty, and were chosen, on theoretical grounds, as the seat of
fermentation or febrile action in agues. On the ground of actual
observation they were found about a century and a half after to be the
seat of morbid action in typhoid fever.

While there are such pitfalls for the historian in identifying the several
species of fevers in former times, there are other difficulties of
interpretation which concern the varieties of a continued fever, or its
changes of type from generation to generation. Is change of type a reality
or a fiction? And, if a reality, did it depend at all upon the use or
abuse of a certain regimen or treatment, such as blooding and lowering, or
heating and corroborating? A pupil of Cullen, who wrote his thesis in
1782 upon the interesting topic of the change in fevers since the time of
Sydenham[3], inferred that the great physician of the Restoration could
not have had to treat the low, putrid or nervous fevers of the middle and
latter part of the 18th century, otherwise he would not have resorted so
regularly to blood-letting, a practice which was out of vogue in continued
fevers at the time when the thesis was written, as well as for a good many
years before and after. Fevers, it was argued, had undergone a radical
change since the time of Sydenham, in correspondence with many changes in
diet, beverages and creature comforts, such as the greatly increased use
of tea, coffee and tobacco, and of potatoes or other vegetables in the
diet, changes also in the proportion of urban to rural population, in the
use of carriages, and in many other things incident to the progressive
softening of manners. In due time the low, putrid, nervous type of typhus
fever, which is so much in evidence in the second half of the 18th
century, ceased to be recorded, an inflammatory type, or a fever of strong
reaction, taking its place; so that Bateman, of London, writing in 1818,
said: “The putrid pestilential fevers of the preceding age have been
succeeded by the milder forms of infectious fever which we now witness”;
while Armstrong, Clutterbuck, and others, who had revived the practice of
blood-letting in fevers shortly before the epidemic of 1817-18, claimed
the comparatively slight fatality and short duration of the common fever
of the time as an effect of the treatment. After 1831, typhus again became
low, depressed, spotted, not admitting of the lancet; on which occasion
the doctrine of “change of type” was debated in the form that the older
generation of practitioners still remember.

Thus the task of the historian, whose first duty is to ascertain, if he
can, the actual matters of fact, or the realities, in their sequence or
chronological order, is made especially difficult, in the chapter on
continued fevers, by the contemporary influence of theoretical pathology
or “a preconceived fancy,” by the ascription of modifying effects to
treatment, whether cooling or heating, lowering or supporting, and, most
of all, by the absence of that more exact method which distinguishes the
records of fever in our own time. Nor can it be said that the work of
historical research has been made easier in all respects, by the exact
discrimination and perfected diagnosis to which we are accustomed in
present-day fevers. In the years between 1840 and 1850, the three grand
types of fever then existing in Britain, namely, spotted typhus, enteric,
and relapsing fever, were at length so clearly distinguished, defined and
described that no one remained in doubt or confusion. Thereupon arose the
presumption that these had always been the forms of continued fever in
Britain, and that the same fevers, presumably in the same relative
proportions to each other, might have been left on record by the
physicians of former generations, if they had used the modern exactness
and minuteness in observing both clinical history and anatomical state,
which were seen at their best in Sir William Jenner. It would simplify
history, indeed it would make history superfluous, if that were really the
case. There are many reasons for believing that it was not the case. As
Sydenham looked forward to his successors having experiences that he never
had, so we may credit Sydenham with having really seen things which we
never see, not even those of us who saw the last epidemics of relapsing
fever and typhus. It is due to him, and to his contemporaries and nearest
successors, to reciprocate the spirit in which he concludes the general
chapter on epidemics prefatory to his annual constitutions from 1661 to
1676:

    “I am far from taking upon myself the credit of exhausting my subject
    in the present observations. It is highly probable that I may fail
    even in the full enumeration of the epidemics. Still less do I warrant
    that the diseases which during the years in question have succeeded
    each other in the sequence about to be exhibited shall remain the same
    in all future years. One thing most especially do I aim at. It is my
    wish to state how things have gone lately; how they have been in this
    country, and how they have been in this the city which we live in. The
    observations of some years form my ground-work. It is thus that I
    would add my mite, such as it is, towards the foundation of a work
    that, in my humble judgment, shall be beneficial to the human race.
    Posterity will complete it, since to them it shall be given to take
    the full view of the whole cycle of epidemics in their mutual
    sequences for years yet to come[4].”


The epidemic fever of 1661, according to Willis.

On the very threshold of the period at which the history is resumed in
this volume, we find a minute account by Willis of an epidemic in the year
1661, which at once raises the question whether a certain species of
infectious fever did really exist at that time which exists no longer, or
whether Willis described as “a fever of the brain and nervous stock” what
we now call enteric fever. Willis’s fever corresponds in every respect to
the worm fever, the comatose fever, the remittent fever of children, the
acute fever with dumbness, the convulsive fever, which was often recorded
by the medical annalists and other systematic observers as late as the
beginning of the 19th century[5]. It ceased at length to be recorded or
described, and it has been supposed that it was really the infantile or
children’s part of enteric fever, which had occurred in former times as
now[6]. The epidemic fever which Willis saw in the summer of 1661, after a
clear interval of two years from the great epidemics of agues, with
influenzas, in 1657-59, is called by him “a certain irregular and
unaccustomed fever[7].” It was not, however, new to him altogether; for he
had seen the same type, and kept notes of the cases, in a particular
household at Oxford in 1655, as well as on other occasions. It was an
epidemical fever “chiefly infestous to the brain and nervous stock.” It
raged mostly among children and youths, and was wont to affect them with a
long and, as it were, a chronical sickness. When it attacked the old or
middle-aged, which was more rarely, it did sooner and more certainly kill.
It ran through whole families, not only in Oxford and the neighbouring
parts, “but in the countries at a great distance, as I heard from
physicians dwelling in other places.” Among those other witnesses, we
shall call Sydenham; but meanwhile let us hear Willis, whose account is
the fullest and least warped by theory.

    Its approach was insidious and scarce perceived, with no immoderate
    heat or sharp thirst, but producing at length great debility and
    languishing, loss of appetite and loathing. Within eight days there
    were brain symptoms--heavy vertigo, tingling of the ears, often great
    tumult and perturbation of the brain. Instead of phrensy, there might
    be deep stupidity or insensibility; children lay sometimes a whole
    month without taking any notice of the bystanders, and with an
    involuntary flux of their excrements; or there might be frequent
    delirium, and constantly absurd and incongruous chimaeras in their
    sleep. But in men a fury, and often-times deadly phrensy, did succeed.
    If, however, neither stupidity nor great distraction did fall upon
    them, swimmings in the head, convulsive movements, with convulsions of
    the members and leaping up of the tendons did grievously infest them.
    In almost all, there were loose and stinking motions, now yellow, now
    thin and serous; vomiting was unusual; the urine deep red. The
    sufferers in this prolonged sickness wasted to a skeleton, with no
    great heat or evacuations to account for the wasting. Some, at the end
    of the disease, had a severe catarrh. In others, with little infection
    of the head, soon after the beginning of the fever a cruel cough and a
    stinking spittle, with a consumptive disposition, grew upon them, and
    seemed to throw them suddenly into a phthisis, from which, however,
    they recovered often beyond hope. In some there were swellings of the
    glands near the hinder part of the neck, which ripened and broke, and
    gave out a thin stinking ictor for a long time. “I have also seen
    watery pustules excited in other parts of the body, which passed into
    hollow ulcers, and hardly curable. Sometimes little spots and
    _petechiales_ appeared here and there.” But none of the spots were
    broad and livid, nor were there many malignant spots.

    Willis then gives several cases clinically, in his usual manner. The
    first is of a strong and lively young man, who was sick above two
    months and seemed near death, but began to mend and took six weeks to
    recover, sweating every night or every other night of his convalescent
    period. The second case, aged twelve, was restored to health in a
    month. Numbers three and four were children of a nobleman, who both
    died, the convulsive type being strongly marked; one of the two was
    examined after death, and found to have several sections of the small
    intestine telescoped, but all the abdominal viscera free from
    disease[8], the lungs engorged, the vessels of the brain full, much
    water in the sub-arachnoid space, and more than half a pint in the
    lateral ventricles.

    In farther illustration of this type of fever, epidemic in 1661,
    Willis goes back to his notes of a sporadic outbreak of what he thinks
    was the same disease in a certain family at Oxford in the winter of
    1653-4[9]: “yea I remember that sometime past very many laboured with
    such a fever.” In the family in question, five children took the fever
    one after another during a space of four months, two of the cases
    proving fatal; the domestics also took it, and some strangers who came
    in to help them, “the evil being propagated by contagion.” The cases
    in the children are fully recorded[10], the following being some of
    the symptoms:

    In case 1, aged seven, the illness began at the end of December, 1653
    (or 1655): there were contractions of the wrist tendons, red spots
    like fleabites on his neck and other parts, drowsiness, and
    involuntary passage of the excrements. At the end of a fortnight, a
    flux set in and lasted for four days; next, after that, a whitish
    crust or scurf, as it were chalky, began to spread over the whole
    cavity of his mouth and throat, which being often in a day wiped away,
    presently broke forth anew. He mended a little, but had paralysis of
    his throat and pharynx, was reduced to a living skeleton, but at
    length got well.

    Case 2, a brother, aged nine, had frequent loose and highly putrid
    motions on the eleventh day; and next day, the flux having ceased, the
    most severe colic, so that he lay crying out day and night, his belly
    swollen and hard as a drum, until, on the 24th day, he died in an
    agony of convulsions.

    Case 3, a brother, aged 11, was taken with similar symptoms on the
    13th February, and died on the 13th day.

    Case 4, a sister, was taken ill in March, with less marked symptoms,
    and recovered slowly, having had no manifest crisis.

    Case 5, a boy of the same family, and the youngest, fell ill about the
    same time as No. 4, and after the like manner, “who yet, a looseness
    arising naturally of itself, for many days voiding choleric and
    greenish stuff, was easily cured.”

    Then comes a general reference to the domestics and visitors, who fell
    sick of the same and all recovered.

The prolonged series of cases in the household of this “venerable man”
appears to have made a great impression upon Willis, as something new in
his experience, as well as in the experience of several other physicians
who gave their services. That it was malignant he considers proved “ex
contagio, pernicie, macularum pulicularum apparentia, multisque aliis
indiciis.” He adds that he had seen the same disease sporadically at other
times; and again “I remember that formerly several laboured under such a
fever.” Those cases were all previous to the general prevalence of the
fever which he identifies with them in the summer of 1661, under the name
of a “fever of the brain and spinal cord.”

The signs given by Willis are as nearly as may be the signs of infantile
remittent fever, or worm fever, or febris synochus puerorum, or hectica
infantilis, or febris lenta infantum, or an acute fever with dumbness, of
which perhaps the first systematic account in this country was given by Dr
William Butter of Lower Grosvenor Street, in 1782[11]. It is, he says,
both a sporadical and an epidemical disease, “and when epidemical it is
also contagious.” The age for it is from birth up to puberty; but “similar
symptoms are often observed in the disorders of adults.” Morton, writing
in 1692-94, clearly points to the same fever under the name of worm fever
(febris verminosa). He adds it at the very end of his scheme of fevers, as
if in an appendix, having been unable to find a place for it in any of his
categories owing to its varying forms--hectic, acute, intermittent,
continued, συνεχής, inflammatory, but for the most part colliquative or
σύνοχος, “and malignant according to the varying degrees of the venomous
miasm causing it[12].” Butter also recognizes its varying types: it has
many symptoms, but they seldom all occur in the same case; there are three
main varieties--the acute, lasting from eight to ten days up to two or
three weeks; the slow, lasting two or three months; and the low, lasting
a month or six weeks. The slow form, he says, is only sporadic; the low is
only epidemic, and is never seen but when the acute is also epidemical; it
is rare in comparison with the latter, and not observed at all except in
certain of the epidemical seasons. Waiving the question whether the
remittent fever of children, thus systematically described, was not a
composite group of maladies, of which enteric fever of children was one,
we can hardly doubt that Willis found a distinctive uniform type in the
epidemic of 1661, in Oxford as he saw it himself, in other parts of
England by report. It had symptoms which were not quite clearly those of
enteric fever: spots, like fleabites, on the neck and other parts,
swelling and suppuration of the glands in the hinder part of the neck,
effusion of fluid on the brain and in the lateral ventricles, and the
intestine free from disease[13].

Confirming Willis’s account for Oxford, is the case of Roger North, when a
boy at Bury St Edmunds Free School in 1661, as related by himself in his
‘Autobiography[14].’ Being then “very young and small,” after a year at
school he had “an acute fever, which endangered a consumption.” Elsewhere
he attributes his bad memory with “confusion and disorder of thought,” to
that “cruel fit of sickness I had when young, wherein, I am told, life was
despaired of, and it was thought part of me was dead; and I can recollect
that warm cloths were applied, which could be for no other reason, because
I had not gripes which commonly calls for that application.” That “great
violence of nature,” while it had impaired his mental faculties, had
sapped his bodily vigour somewhat also, of which he gives a singular
illustration.

This special prevalence of epidemic fevers in the summer and autumn of
1661 is noticed also by the London diarists.

Evelyn says that the autumn of 1661 was exceedingly sickly and wet[15].
Pepys has several entries of fever[16]. On 2 July, 1661: “Mr Saml. Crewe
died of the spotted fever.” On 16 August: “At the [Navy] Office all the
morning, though little to do; because all our clerks are gone to the
burial of Tom Whitton, one of our Controller’s clerks, a very ingenious
and a likely young man to live as any in the office. But it is such a
sickly time both in the city and country everywhere (of a sort of fever)
that never was heard of almost, unless it was in a plague-time. Among
others the famous Tom Fuller [of the ‘Worthies of England’] is dead of it;
and Dr Nichols [Nicholas], Dean of St Paul’s; and my Lord General Monk is
very dangerously ill.” On 31 August: “The season very sickly everywhere of
strange and fatal fevers.” On 15 January, 1662: “Hitherto summer weather,
both as to warmth and every other thing, just as if it were the middle of
May or June, which do threaten a plague (as all men think) to follow; for
so it was almost the last winter, and the whole year after hath been a
very sickly time to this day.”

The great medical authority of the time is Sydenham. His accounts of the
seasons and reigning diseases of London extend from 1661 to 1686, so that
they begin with the year for which Willis described the epidemic fever
“chiefly infestous to the brain and nervous stock,” popularly called the
new disease. But Sydenham did not describe the epidemic in the same
objective way that Willis did. He records a series of “epidemic
constitutions of the air,” the particular constitution of each year being
named from the epidemic malady that seemed to him to dominate it most. It
was, perhaps, because it had to conform to Sydenham’s “preconceived
fancy,” as Lind said, that his account of the dominant type of fever in
1661 differs somewhat from that given by Willis.


Sydenham’s epidemic Constitutions.

Sydenham adopted the epidemic constitutions from Hippocrates, as he did
much else in his method and practice. In the first and third books of the
‘Epidemics,’ Hippocrates describes three successive seasons and their
reigning diseases in the island of Thasos, as well as a fourth
plague-constitution which agrees exactly with the facts of the plague of
Athens as described by Thucydides. The Greek term translated
“constitution” is κατάστασις, which means literally a settling,
appointing; ordaining, and in the epidemiological sense means the type of
reigning disease as settled by the season. The method of Hippocrates is
first to give an account of the weather--the winds, the rains, the
temperature and the like,--and then to describe the diseases of the
seasons[17]. Sydenham followed his model with remarkable closeness. The
great plague of London has almost the same place in his series of years
that the plague-constitution, the fourth in order, has in that of
Hippocrates. It looks, indeed, as if Sydenham had begun with the year
1661, more for the purpose of having several constitutions preceding that
of the plague than because he had any full observations of his own to
record previous to 1665. He is also much influenced by the example of
Hippocrates in giving prominence to the intermittent type of fevers. It
was remarked by one of our best 18th century epidemiologists, Rogers of
Cork, and with special reference to Sydenham’s “intermittent
constitutions,” that fevers proper to the climate of Thasos were not
likely to be identified in or near London excepted by a forced
construction.

_Sydenham’s Constitutions._

  -----------------------------------------------------------------------
      |                         | Total |      | Fever |        |       |
      |       Constitutions     | deaths|Plague|  and  |Smallpox|Measles|
      |                         |   in  |      |Spotted|        |       |
      |                         | London|      | Fever |        |       |
  ----|-------------------------|-------|------|-------|--------|-------|
  1661|“Intermittent”           | 16,665|    20| 3,490 |  1,246 |  188  |
  1662|  constitution: with a   | 13,664|    12| 2,601 |    768 |   20  |
  1663|  continued fever        | 12,741|     9| 2,107 |    411 |   42  |
  1664|  throughout.            | 15,453|     5| 2,258 |  1,233 |  311  |
      |                         |       |      |       |        |       |
  1665|Constitution of plague   | 97,306|68,596| 5,257 |    655 |    7  |
  1666|  and pestilential fever.| 12,738| 1,998|   741 |     38 |    3  |
      |                         |       |      |       |        |       |
  1667|Constitution of smallpox,| 15,842|    35|   916 |  1,196 |   83  |
  1668|  with a continued       | 17,278|    14| 1,247 |  1,987 |  200  |
  1669|  “variolous” fever.     |}      |      |       |        |       |
      |                         |}19,432|     3| 1,499 |    951 |   15  |
  1669|Constitution of dysentery|}      |      |       |        |       |
  1670|  and cholera nostras,   | 20,198|     0| 1,729 |  1,465 |  295  |
  1671|  with a continued fever.| 15,729|     5| 1,343 |    696 |   17  |
  1672|  Measles in 1670.       | 18,230|     5| 1,615 |  1,116 |  118  |
      |                         |       |      |       |        |       |
  1673|Constitution of          | 17,504|     5| 1,804 |    853 |   15  |
  1674|  “comatose” fevers.     | 21,201|     3| 2,164 |  2,507 |  795  |
  1675|Influenza in 1675.       | 17,244|     1| 2,154 |    997 |    1  |
  1676|                         | 18,732|     2| 2,112 |    359 |   83  |
      |                         |       |      |       |        |       |
  1677|Not recorded.            | 19,067|     2| 1,749 |  1,678 |   87  |
      |                         |       |      |       |        |       |
  1678|Return of the            | 20,678|     5| 2,376 |  1,798 |   93  |
  1679|  “intermittent”         | 21,730|     2| 2,763 |  1,967 |  117  |
  1680|  constitution, absent   | 21,053|     0| 3,324 |    689 |   49  |
      |  since 1661-64.         |       |      |       |        |       |
      |                         |       |      |       |        |       |
  1681|“Depuratory” fevers,     | 23,951|     0| 3,174 |  2,982 |  121  |
  1682| or dregs of the         | 20,691|     0| 2,696 |  1,408 |   50  |
  1683| intermittents.          | 20,587|     0| 2,250 |  2,096 |   39  |
  1684|                         | 23,202|     0| 2,836 |  1,560 |    6  |
      |                         |       |      |       |        |       |
  1685|Constitution of a        | 23,222|     0| 3,832 |  2,496 |  197  |
  1686| “new” continued fever.  | 22,609|     0| 4,185 |  1,062 |   25  |

      --------
      |Griping
      | in the
      |  Guts
      |
      |-------
      | 1,061
      |   835
      |   866
      | 1,146
      |
      | 1,288
      |   676
      |
      | 2,108
      | 2,415
      |
      | 4,385
      |
      | 3,690
      | 2,537
      | 2,645
      |
      | 2,624
      | 1,777
      | 3,321
      | 2,083
      |
      | 2,602
      |
      | 3,150
      | 2,996
      | 3,271
      |
      |
      | 2,827
      | 2,631
      | 2,438
      | 2,981
      |
      | 2,203
      | 2,605

The foregoing is a Table of Sydenham’s epidemic constitutions from 1661 to
1686, compiled from his various writings, with the corresponding
statistics from the London Bills of Mortality.

I give this Table both as a convenient outline and in deference to the
great name of Sydenham. But we should be much at fault in interpreting the
figures of the London Bills, or the history of epidemic diseases in the
country at large, if we had no other sources of information than his
writings. Only some of the figures in the Table concern us in this
chapter; plague has been finished in the previous volume, smallpox,
measles and “griping in the guts” are reserved each for a separate
chapter, as well as the influenzas and epidemic agues which formed the
chief part of the “strange” or “new” fevers. If this work had been the
Annals of Epidemics in Britain, it would have been at once proper and easy
to follow Sydenham’s constitutions exactly, and to group under each year
the information collected from all sources about all epidemic maladies.
But as the work is a history, it proceeds, as other histories do, in
sections, observing the chronological order and the mutual relations of
epidemic types as far as possible; and in this section of it we have to
cull out and reduce to order the facts relating to fevers, beginning with
those of 1661.

Cases of fever, says Sydenham, began to be epidemic about the beginning of
July 1661, being mostly tertians of a bad type, and became so frequent day
by day that in August they were raging everywhere, and in many places made
a great slaughter of people, whole families being seized. This was not an
ordinary tertian intermittent; indeed no one but Sydenham calls it an
intermittent at all, and he qualifies the intermittence as follows:

    “Autumnal intermittents do not at once assume the genuine type, but in
    all respects so imitate continued fevers that unless you examine the
    two respectively with the closest scrutiny, they cannot be
    distinguished. But, when by degrees the impetus of the ‘constitution’
    is repelled and its strength reined in, the fevers change into a
    regular type; and as autumn goes out, they openly confess themselves,
    by casting their slough (_larva abjecta_) to be the intermittents that
    they really were from the first, whether quartans or tertians. If we
    do not attend to this diligently” etc. And again, in a paragraph which
    does not occur in the earlier editions, he writes as follows in the
    context of the “Intermittent Fevers of the years 1661-1664:”

    “It is also to be noted that in the beginning of intermittent fevers,
    especially those that are epidemic in autumn, it is not altogether
    easy to distinguish the type correctly within the first few days of
    their accession, since they arise at first with continued fever
    superadded. Nor is it always easy, unless you are intent upon it, to
    detect anything else than a slight remission of the disease, which,
    however, declines by degrees into a perfect intermission, with its
    type (third-day or fourth-day) corresponding fitly to the season of
    the year.”

The intermittent character of these fevers seems to have struck Sydenham
himself in a later work as forced and unreal. Writing in 1680, when the
same kind of fevers were prevalent, after the epidemic agues of 1678 and
1679, he calls them “depuratory,” and says that “doubtless those
depuratory fevers which reigned in 1661-64 were as if the dregs of the
intermittents which raged sometime before during a series of years,” i.e.
the agues of 1657-59[18].

Theory or names apart, Sydenham’s account of the fatal epidemic fever of
the summer and autumn of 1661, comes to nearly the same as Willis’s.
Without saying expressly, as Willis does, that the victims were mostly
children or young people, he speaks in one place of those of more mature
years lying much longer in the fever, even to three months, and he
specially mentions the same sequelae of the fever in children that Willis
mentions, and that Roger North remembered in his own case--namely that
they sometimes became hectic, with bellies distended and hard, and often
acquired a cough and other consumptive symptoms, “which clearly put one in
mind of rickets.” He refers also to pain and swelling of the tonsils and
to difficulty of swallowing, which, if followed by hoarseness, hollow
eyes, and the _facies Hippocratica_, portended speedy death. Among the
numerous other _accidentia_ of the fever, was a certain kind of mania.
Among the symptoms were phrensy, and coma-vigil; diarrhœa occurred in some
owing, as he thought, to the omission of an emetic at the outset; hiccup
and bleeding at the nose were occasional.

But, although Sydenham must have had the same phenomena of fever before
him that Willis had, the epidemic being general, according to the
statements of both, one would hardly guess from his way of presenting the
facts, that the fever was what Willis took it to be--a slow nervous fever,
with convulsive and ataxic symptoms, specially affecting children and the
young. Both Willis and Sydenham recognised something new in it; the common
people called it, once more, the “new disease,” and Pepys calls it a “sort
of fever,” and “strange and fatal fevers.”

As Sydenham maintains that the same epidemic constitution continued until
1664 (although the fever-deaths in London are much fewer in 1662-3-4 than
in the year 1661, which was the first of it), we may take in the same
connexion Pepys’s account of the Queen’s attack of fever in 1663. The
young princess Katharine of Portugal, married to Charles II. in 1662, had
the beginning of a fever at Whitehall about the middle of October, 1663;
Pepys enters on the 19th that her pulse beat twenty to eleven of the
king’s, that her head was shaved, and pigeons put to her feet, that
extreme unction was given her (the priests so long about it that the
doctors were angry). On the 20th he hears that the queen’s sickness is a
spotted fever, that she was as full of the spots as a leopard: “which is
very strange that it should be no more known, but perhaps it is not so.”
On the 22nd the queen is worse, 23rd she slept, 24th she is in a good way
to recovery, Sir Francis Prujean’s cordial having given her rest; on the
26th “the delirium in her head continues still; she talks idle, not by
fits, but always, which in some lasts a week after so high a fever, in
some more, and in some for ever.” On the 27th she still raves and talks,
especially about her imagined children; on the 30th she continues
“light-headed, but in hopes to recover.” On 7th December, she is pretty
well, and goes out of her chamber to her little chapel in the house; on
the 31st “the queen after a long and sore sickness is become well again.”


Typhus fever perennial in London.

Sydenham says that a continued fever, the symptoms of which so far as he
gives them suggest typhus, was mixed with the masked intermittent, (or the
convulsive fever of children, as in Willis’s account), in every one of the
years 1661-4; and that statement raises a question which may be dealt with
here once for all. Fever in the London bills is a steady item from year to
year, seldom falling below a thousand deaths and in the year 1741, during
a general epidemic of typhus, rising to 7500. The fevers were a composite
group, as we have seen, and shall see more clearly. But the bulk of them
perennially appears to have been typhus fever. Where the name of “spotted
fever” is given there can be little doubt. Every year the bills have a
small number of deaths from “spotted fever,” and the number of them
always rises in the weekly bills in proportion to the increase of “fever”
in general, sometimes reaching twenty in the week when the other fevers
reach a hundred. It would be a mistake to suppose that only the fevers
called spotted were typhus, the other and larger part being something
else. The more reasonable supposition is that the name of spotted was
given by the searchers in cases where the spots, or vibices or petechiae
of typhus were especially notable. If a score, or a dozen or half-a-dozen
deaths in a week are set down to spotted fever, it probably means that a
large part of the remaining hundred, or seventy, or fifty cases of “fever”
not called spotted were really of the same kind, namely typhus. In the
plague itself, the “tokens,” which were of the same haemorrhagic nature as
the larger or more defined spots of typhus, were exceedingly variable[19].
One of the synonyms of typhus (the common name in Germany) is spotted
typhus; but the spots were of at least two kinds, a dusky mottling of the
skin and more definite spots, sometimes large, sometimes like fleabites.

Assuming that the cases specially called “spotted” in the London Bills
were only a part of all that might have been called by the same name in
the wider acceptation of the term (as in Germany), it is a significant
fact that there are few of the weekly bills for a long series of years in
the 17th and 18th centuries without some of the former. Such a case as
that of Mr Samuel Crewe, brother of Lord Crewe, who died of the “spotted
fever” on 2 July, 1661, probably means that there were more cases of the
same kind in the poorer parts of the town, from which no account of the
reigning sicknesses ever came unless it were the number of deaths in the
bills. The conditions of endemic typhus were there long before we have
authentic accounts, towards the end of the 18th century, of that disease
being ever present in the homes of the lower classes. In the time of
Sydenham, and even in the time of Huxham two generations after, there was
no thought of the unwholesome domestic life graphically described by
Willan and others, as a cause of typhus--the overcrowding, the want of
ventilation, the foul bedding and the excremental effluvia.

If there had been any reason to suppose that the London of the
Restoration, or of the time of Queen Anne, or of the first Georges had
enjoyed better public health in its crowded liberties and out-parishes
than we know it to have done from the time when the authentic accounts of
Lettsom and other dispensary physicians begin, then one might err in
assuming the perennial existence of typhus fever and in assigning to that
cause the bulk of the deaths under the heading of “fevers” in the Parish
Clerks’ bills. But the public health was undoubtedly worse in the earlier
period. A writer as late as the year 1819, who is calling for that reform
of the dwellings of the working classes in London which was soon after
carried out, namely the construction of regular streets instead of mazes
of courts and alleys, speaks of the “silent mortality” that went on in the
latter[20]. It was still more silent in earlier times, when the west end
of London knew nothing of what was passing in the east end[21].

In all matters of public health, after the somewhat romantic interest in
plague had ceased, the poorer parts of London were for long an unexplored
territory. Dr John Hunter, who had been an army physician and was
afterwards in practice in Mayfair, began about the year 1780 to visit the
homes of the poor in St Giles’s or other parishes near him, and was
surprised to find in them a fever not unlike the hospital typhus of his
military experience. I quote at this stage only a sentence or two[22].

    “It may be observed, that though the fever in the confined habitations
    of the poor does not rise to the same degree of violence as in jails
    and hospitals, yet the destruction of the human species occasioned by
    it must be much greater, from its being so widely spread among a class
    of people whose number bears a large proportion to that of the whole
    inhabitants. There are but few of the sick, so far as I have been able
    to learn, that find their way into the great hospitals in London.” I
    shall defer the subject of the dwellings of the working class in
    London until a later stage.

The “constitution” in Sydenham’s series which succeeded the febrile one of
1661-64 was “pestilential fever.” It began in the end of 1664, lasted into
the spring of 1665, and passed by an easy transition into the plague
proper. The bills for those months have very large weekly totals of deaths
from “fever,” as well as a good many deaths from “spotted fever,” before
they begin to have more than an occasional death from plague. It is this
particular form of typhus fever that Bateman had in mind when he wrote, in
1818, “We never see the pestilential fever of Sydenham and Huxham”;
although Willan, who preceded him at the Carey Street dispensary,
described in 1799 a fever of so fatal a type that it gave rise to the
rumour that the plague was back in London. The term “pestilential” was
technically applied to a kind of fever a degree worse than the
“malignant.”

Willis, the earliest of the Restoration authorities on fevers, had three
names in an ascending scale of severity--putrid, malignant and
pestilential. The putrid fevers were what we might call idiopathic,
engendered within the body in some way personal to the individual from
“putrefaction” or fermentation of the humours; all the intermittents were
included in that class, and the theory of their cure by bark was that the
drug corrected putridity. In the malignant and pestilential, an altogether
new element came in--the τὸ θεῖον of Hippocrates, the mysterious something
which we call infection; and of these two infectious fevers, the malignant
was milder than the pestilential[23].

Morton drew out the scale of fevers in an elaborate classification, of
which only the last section of continued contagious fevers concerns us at
present[24]:

            {                        {Fever mostly with sweats and
            {Simple Malignant Fever  {other signs of malignity, but
            {                        {without buboes, carbuncles,
            {                        {petechiae or miliary rash.
  Synochus  {
            {                        {Fever with petechiae, purple
            {Pestilential Fever      {spots, miliaria, morbillous rash
            {                        {on the chest.
            {
            {Plague                  {With buboes, carbuncles and
            {                        {black spots.

The order in this Table was also the order in time: the fever of 1661,
which Willis calls malignant, remained as the constitution of the years
following until the end of 1664; then began the pestilential, which passed
definitely in the spring of 1665 into the plague proper. Willis, Sydenham
and Morton, differing as they did on many points of theory and treatment,
all alike taught the scale of malignity in fevers and plague, and all used
the language of “constitutions.” The Great Plague of 1665 was, in their
view, the climax of a succession of febrile constitutions of the air,
being attended by much pestilential fever and followed by a fever which
Morton places in the milder class of συνεχής.


The epidemic Constitutions following the Great Plague.

During the ten or twelve years following the Great Plague of London, the
epidemic maladies which Sydenham dwelt most upon as the reigning types
will appear on close scrutiny to have been on the whole proper to the
earlier years of life. This cannot be shown in the simple way of figures;
for the ages at death from the several maladies, although they were in the
books of the Parish Clerks, were not published.

There was some continued fever every year, which we may take to have been
chiefly the endemic typhus of a great city, and there were also deaths
among adults due to those reigning epidemics which fell most on the young.
In 1667 and 1668 the leading epidemic was smallpox, with a continued fever
towards the end of the period which Sydenham called “variolous,” for no
other reason, apparently, than that it was part of a variolous
constitution. In the autumn of 1669, and in the three years following, the
epidemic mortality was peculiarly infantile, in the form of diarrhoea or
“griping in the guts,” with some dysentery of adults, and some measles in
1670. From 1673 to 1676, the constitution was a comatose fever, which
chiefly affected children, with a sharp epidemic of measles in the first
half of 1674, attended by a very high mortality from all causes, and a
severe smallpox in the second half of 1674, attended by a much lower
mortality from all causes. There was also an influenza for a few weeks in
1675. In 1678 the “intermittent” constitution returned, having been absent
for thirteen years, and continued through 1779-80, until its “strength was
broken.” In 1681 smallpox was unusually mortal, the deaths being more than
in any previous year. Most of these constitutions fall to be dealt with
fully in other chapters: but as we are here specially concerned with the
succession to the plague, it is to be noted how largely the epidemic
mortality in London fell upon the age of childhood for a number of years
after the Great Plague of 1665. It was observed both by English and
foreign writers that the next epidemic following the Black Death of
1348-49, namely, that of 1361 in England and of 1359-60 in some other
parts of Europe, fell mostly upon children and upon the upper classes of
adults. There is doubtless some particular application of the population
principle in the earlier instance as in the later, but not the same
application in both. The conditions at the beginning of the three hundred
years’ reign of plague in Britain were different from those at the end of
it. The increased prevalence of smallpox in the generation before the last
great outburst of plague, and the infantile or puerile character of the
epidemic fever of 1661, as described by Willis, show that the incidence of
infectious mortality had already begun to shift towards the age of
childhood. It looks as if the conditions of population, intricate and
obscure as they must be confessed to be, were somehow determining what the
reigning infectious maladies, with their special age-incidence, should be.
Such a gradual change is the more probable for the reason that infectious
mortality came in due time to be mostly an affair of childhood. The
plague, which was the great infection of the later medieval and earlier
modern period, was peculiarly fatal to adult lives; on the other hand, the
mortality from infectious diseases in our own time falls in much the
larger ratio upon infants and children. It looks as if this change, now so
obvious, had begun before the end of plague in Britain, having become more
marked in the generation following its extinction. The direct successor of
plague, so far as concerns age-incidence and nosological affinity, was the
pestilential or malignant typhus, which came into great prominence in
1685-86, in circumstances that seemed to contemporaries to forebode a
return of the plague. But before we come to that, there remains a little
to be said of some other fevers, especially of the comatose fever of
1673-76, which was largely an affair of childhood.

Pepys says that he went on 3 May, 1668, to Old Street (St Luke’s) to see
Admiral Sir Thomas Teddiman, “who is very ill in bed of a fever,” and, in
a later entry, that he “did die by a thrush in his mouth” on the 12th of
May. Next year, 1669, Pepys and his wife went on tour through several
parts of Europe, and had hardly returned to their house in Seething Lane
when the lady fell ill of a fever; on 2nd November, it was “so severe as
to render her recovery desperate,” and on 10th November she died, in her
29th year,--a surprising sequel, as her husband felt, to a “voyage so full
of health and content.” These two years, for which we have a sample of the
London fevers, were marked in the Netherlands by epidemics of fevers which
are among the most extraordinary in the whole history. At Leyden in 1669
the fever reached such a height as to cut off 7000--a mortality which
would not have been surprising if the disease had been plague; but it was
not plague, it wanted the buboes, carbuncles &c., was longer in its
course, and, strangest of all, affected the upper classes far more
severely than the poor, so much so “that of seventy men administering the
public affairs, scarcely two were left[25],” while, according to Fanois,
who was the Leyden poor’s doctor, the lower classes, “protected as it were
by having survived the simpler forms of fever,” suffered from this
malignant epidemic far less than the rich[26]. The mortality is said to
have risen as high as three-fourths of the attacks. At Haarlem the burials
in a week rose to three or four hundred (which was a fair week’s average
for London itself in an ordinary season), the epidemic lasting four months
and leaving hardly one family untouched. Among the symptoms were extreme
praecordial anxiety, weight at the pit of the stomach, constant nausea and
loathing, vomiting, in part bilious but chiefly “pituitous,” thirst and
restless tossing. It was attended by an affection of the throat and
mouth--an angina with aphthae or thrush of the palate. The pools and other
sources of water for domestic use were unusually stagnant that summer in
Holland, and were commonly blamed for the epidemic; but Fanois points out
that at Haarlem and Emden, where similar fevers raged, “salubriores non
desunt aquae[27].”

After such an instance as the Leyden fever of 1669, nothing is incredible
in the records of fever subsequent to the extinction of plague. Turning to
Sydenham’s account of the continued fever which occurred in London during
the same season, the latter half of 1669, as well as in the three years
following, we find that it was characterized rarely by diarrhoea or
sweats, commonly by pain in the head, by a moist white tongue which
afterwards became covered by a dense skin, and by a greater tendency than
Sydenham had ever seen to aphthae (the “thrush in the mouth” of Admiral
Teddiman in 1668) when death threatened--the same being a “deposition from
the blood of foul and acrid matter upon the mouth and throat.” But London
in 1668 and 1669 suffered little from fevers in comparison to Leyden,
Haarlem and other Dutch towns, its high mortality in the summer and autumn
of 1669 being from infantile diarrhoea, cholera nostras and dysentery.

Sydenham’s continued fever from 1673 to 1676 (he was absent from his
practice in 1677 owing to ill health) was a malady which affected adults
as well as children, but, it would appear, the latter especially. The only
characteristic case given is of a boy of nine who did not begin to mend
until the thirtieth day. Many recovered in a fortnight, while others were
not clear of the fever in a month. On account of the remarkable stupor
which almost always attended it, Sydenham called the fever of this
constitution a comatose fever. It began with sharp pains in the head and
back, pains in the limbs, heats and chills, etc. His account of the
comatose state is exactly like that given by Willis for the fever of
children in 1661--profound stupor, sometimes for a week long, so profound
in some as to pass into absolute aphonia (the “acute fever with dumbness”
of later writers), while others would talk a few words in their sleep, or
would seem to be angry or perturbed by something (the chimaeras mentioned
by Willis) and would then become tranquil again; when roused to take
physic or to drink they would open the eyes for a moment and then fall
back into stupor. When they began to mend, they would crave for absurd
things to eat or drink. During convalescence the head, through weakness,
could not be kept straight but would incline first to one side and then to
the other[28].

The years 1678-1680 witnessed remarkable epidemics of ague, such as had
occurred on several occasions before, the last in the years 1657-59. They
engross so much of Sydenham’s writing, especially in connexion with the
Peruvian-bark controversy, that we hear little of any other fever until
the great epidemic of continued fever, or typhus, in 1685-6. But he does
mention briefly that the interval between the decline of the agues in 1680
and the beginning of the “new fever” of 1685, was occupied by “continued
depuratory” fevers--depuratory of the dregs of the preceding intermittent
constitution, and comparable in that respect to the fevers of 1661-64
which followed the agues of 1657-59[29].

Sydenham’s term “depuratory” does not help us much; but we learn something
from Morton as to what fevers were prevalent, besides the epidemical
intermittents, in the years preceding the epidemic of 1685-86. Morton
classes them as continued συνεχής (_Synocha_), by which he means something
less malignant than _Synochus_. A fever which began in the milder form
would often degenerate into the more malignant, the cause assigned, in the
usual recriminatory manner of the time between rival schools, being
mistaken treatment. But sometimes the fever was malignant from the outset,
with purple spots, petechiae, morbillous efflorescence, watery vesicles on
the neck and breast, buboes, and anthraceous boils. All these fevers, says
Morton, whether they were spurious forms of synocha, or malignant from the
outset, were sporadic, “neque contagione, ut in pestilentiali
constitutione, sese propagabant[30].” This points to their having been
part of that strange aguish epidemic of which an account is given in
another chapter. In Short’s abstracts of parish registers, the year 1680
seems to have been the most unhealthy of the series in country parishes,
and that is borne out by one Lamport, or Lampard, an empiric who practised
in Hampshire: “I will tell you somewhat concerning a malignant fever. In
the year ’80 or ’81 there were great numbers of people died of such
fevers, many whereby were taken with vomitings, etc., yet I had the good
fortune to cure eighteen in the parish of Aldingbourn, not one dying, in
that great compass, of that disease[31].” The moral is that the empiric
recovered his cases, whereas the regular faculty lost theirs; which means
that the fevers were of various degrees, some aguish, some typhus, as in
the exactly similar circumstances a century after, 1780-85.

In the London Bills from 1681 to 1684, the deaths from fever were many,
with some from “spotted fever” nearly every week, while the annual
mortalities from all causes were high. It is the more remarkable,
therefore, that Sydenham should have discovered, in the beginning of 1685,
the outbreak of a new fever, different from any that had prevailed for
seven years before. The explanation seems to be that a malignant typhus
fever, such as might have been discovered in any year in the crowded
parishes where the working classes lived, broke out at the Court end of
the town, where Sydenham’s practice lay.


The epidemic fever of 1685-86.

A letter of 12 March, 1685, says: “Sir R. Mason died this morning in his
lodging at Whitehall. A fever rages that proves very mortal, and gives
great apprehensions of a plague[32].” Sydenham also was reminded of the
circumstances preceding the Great Plague of London in 1665. In his first
account of the epidemic of fever in 1685[33], which began with a thaw in
February, he points out that the thaw in March, 1665, had been followed by
pestilential fever and thereafter by the plague proper. In a later
reference, when the epidemic of fever was in its second year (1686) he
says: “How long it may last I shall not guess; nor do I quite know whether
it may not be a certain more spirituous, subtle beginning, and as if
_primordium_, of the former depuratory fever (1661-64) which was followed
by the most terrible plague. There are some phenomena which so far incline
me to that belief[34].” However, no plague followed the malignant, if not
pestilential, fever of 1685-86. The reign of plague, as the event showed,
was over; the fever which had been on former occasions its portent and
satellite, came into the place of reigning disease. It is true that
Sydenham does not identify the fever of 1685-86 by name as pestilential
fever; on the contrary, he entitles his essay “De Novae Febris Ingressu.”
But the novelty of type was partly in contrast to the fevers immediately
preceding, which admitted treatment by bark, and its principal difference
from the pestilential fever of former occasions seems to have been that it
was not followed by plague[35]. Its antecedents and circumstances were
very much those of plague itself. Its mortality was greatest in the old
plague-seasons of summer and autumn, it had slight relation to famine or
scarcity, or to other obvious cause of domestic typhus. Sydenham can find
no explanation of the new constitution but “some secret and recondite
change in the bowels of the earth pervading the whole atmosphere, or some
influence of the celestial bodies.” He enlarges, however, on the character
of the seasons preceding, which would have affected the surface, if not
the bowels, of the earth, and the levels of the ground-water.

The winter of 1683-84 was one of intense frost; an ice-carnival was held
on the Thames during the whole of January. The long dry frost of winter
was followed by an excessively hot and dry summer, the drought being such
as Evelyn did not remember, and as “no man in England had known.” For
eight or nine months there had not been above one or two considerable
showers, which came in storms. The winter of 1684-85 set in early, and
became “a long and cruel frost,” more interrupted, however, than that of
the year before. The spring was again dry, and it was not until the end of
May 1685 that “we had plentiful rain after two years’ excessive drought
and severe winters[36].”

The two years of excessive drought, with severe winters, had their effect
upon the public health, as will appear from Short’s abstracts of parish
registers in town and country[37]; the years 1683-85 being conspicuous for
the excess of burials over baptisms:

_Country Parishes._

  Year   Registers   Registers with    Deaths in   Births in
         examined    excess of death     them        them

  1683      140            37             923         685
  1684      140            31             900         629
  1685      140            19             574         478
  1686      140            16             419         301
  1687      143            19             522         427
  1688      143            11             327         267

_Towns._

  1683       25             8            1398        1169
  1684       25             8            1243         865
  1685       25             4            1191         741
  1686       25             2             555         418
  1687       25             1             313         269
  1688       25             2             191         146

There is no clue to the forms of sickness that caused the excessive
mortality in country parishes and provincial towns. But in London it
appears from the Bills that the one great cause of the unusual excess of
deaths in 1684 was an enormous mortality from infantile diarrhoea, from
the end of July to the middle of September, during the weather which
Evelyn describes as excessively hot and dry with occasional storms of
rain.

It was in the second year of the long drought, February, 1685, that
Sydenham dated the beginning of his new febrile constitutions. The
mortality of 1685 was just twenty deaths more than in 1684 (23,222); but
fever (with spotted fever) and smallpox had each a thousand more out of
the total than in the year before. Sydenham says that the fever did not
spare children, which might be alleged of typhus at all times; but a fever
of the kind, even if it ran through the children of a household, seldom
cut off the very young, the mortality being in greatest part of adults and
adolescents. Excepting smallpox for the year 1685, infantile and
children’s maladies were not prominent during the constitution of the “new
fever;” the usual items of high infantile mortality, such as convulsions
and “griping in the guts” or infantile diarrhoea, were moderate and even
low. Hence, although the weekly fever-deaths in the following Table may
not appear sufficient for the professional and other interest that they
excited, it is to be kept in mind that they had been mostly of adult
lives. It is probable also that a good many of them had been among the
well-to-do, and perhaps at first in the West End; for there is nothing in
the height of the weekly bills for all London to bear out the remark of
the letter of 12 March, already quoted, “A fever rages that proves very
mortal and gives apprehensions of a plague.”

_Weekly Mortalities in London._

1685.

  Week                          Of spotted       Of      Of griping
  ending      Dead   Of fever      fever      smallpox   in the guts

  March  3     376       49          0           11          35
        10     458       73          2           30          31
        17     367       53          1           25          17
        24     441       63          3           33          27
        31     366       53          5           24          36
  April  7     421       47         10           28          30
        14     433       64          8           32          27
        21     473       66          6           47          45
        28     470       68          3           49          45
    May  5     385       50          6           35          39
        12     447       75          3           59          41
        19     437       79          4           58          43
        26     452       61          2           74          39
   June  2     469       65          8           65          36
         9     521       88         14           62          41
        16     499       91          9           66          34
        23     478       76         12           71          53
        30     526       82         13           84          45
   July  7     497       81          8           87          53
        14     478       82         11           78          51
        21     464       79         11           87          47
        28     488       62          6           68          54
   Aug.  4     493       82          5           86          51
        11     529      109         13           89          47
        18     580       74         13           99          71
        25     536       91          7           67          85
  Sept.  1     556       94         13           53         104
         8     539       82         10           81          77
        15     485       90          7           63          70
        22     459       90         10           37          51
        29     502      114          3           58          53
   Oct.  6     444      108         11           40          54
        13     445       89         13           61          38
        20     369       86          5           40          28
        27     379       73          7           29          45
   Nov.  3     443       96          8           55          43
        10     410       84          7           26          35
        17     432      103          8           35          39
        24     471      107          6           56          31
   Dec.  1     384       87          4           36          24
         8     452       98          8           49          24
        15     403       69          3           29          47
        22     438       99          2           34          27
        29     432       80          9           28          28

_Weekly Mortalities in London._

1686.

  Week                          Of spotted       Of      Of griping
  ending      Dead   Of fever      fever      smallpox   in the guts

   Jan.  5     394       80          5           28          29
        12     400       80          3           27          48
        19     396       67          5           36          32
        26     366       76          2           21          30
   Feb.  2     452       87          8           16          30
         9     416       78          5           37          30
        16     405       94          9           20          25
        23     419       74          7           16          40
  March  2     417       84          1           20          37
         9     455       95          6           18          30
        16     415       71         10           31          21
        23     453       78         11           22          46
        30     372       58          8           17          35
  April  6     392       80         11           13          27
        13     393       72          7           21          29
        20     420       61         10           26          37
        27     471       99          9           27          22
    May  4     429       78         21           28          46
        11     374       71          6           16          22
        18     395       69          5           17           3 (sic)
        25     395       66         11           24          36
   June  1     383       63          4           15          49
         8     404       66          6           26          38
        15     523       88          9           43          64
        22     503       99          9           25          73
        29     473       90         10           31          62
   July  6     430       71          6           18          62
        13     401       76          2           19          56
        20     464       87         14           24          74
        27     508       99          3           23          76
   Aug.  3     506       86          9           14          90
        10     493       74          7           14         104
        17     522       99          7           26         101
        24     536      115          5           18         104
        31     520       90          8           22          93
  Sept.  7     531       94          4           21         104
        14     498       84          6           18         110
        21     540      100          3           17         101
        28     443       90          5           13          67
   Oct.  5     425       81          4           13          60
        12     432       96          2            9          56
        19     391       73          1            9          33
        26     402       79          3           11          43
   Nov.  2     373       64          1           23          39
         9     456       85          1           19          31
        16     401       73          2            9          23
        23     359       61          4           10          54
        30     397       68          1            7          34
   Dec.  7     359       76          0            9          21
        14     438       60          0            8          46
        21     354       49          1            8          39
        28     356       53          2            9          32

Sydenham says that he regarded the new fever at first as nothing more than
the “bastard peripneumony” which he had described for previous seasons;
but he had soon cause to see that it wanted the violent cough, the racking
pain in the head during coughing, the giddiness caused by the slightest
movement, and the excessive dyspnoea of the latter (Huxham likewise
distinguished typhus from “bastard peripneumony”). The early symptoms of
the “new fever” were alternating chills and flushings, pain in the head
and limbs, a cough, which might go off soon, with pain in the neck and
throat. The fever was a continued one, with exacerbation towards evening;
it was apt to change into a phrensy, with tranquil or muttering delirium;
petechiae and livid blotches were brought out in some cases (Sydenham
thought they were caused by cordials and a heating regimen), and there
were occasional eruptions of miliary vesicles. The tongue might be moist
and white at the edges for a time, latterly brown and dry. Clammy sweats
were apt to break out, especially from the head. If the brain became the
organ most touched, the fever-heat declined, the pulse became irregular,
and jerking of the limbs came on before death.

Later writers, for example those who described the great epidemic fever of
1741, have identified the fever of 1685-86 with the contagious malignant
fever afterwards called typhus, and Murchison, in his brief retrospect of
typhus in Britain, has included it under that name. Sydenham mentions
petechiae and livid blotches in some cases, and the Bills give a good many
of the deaths in the worst weeks of the epidemic under the head of
“spotted fever.” It is not at first easy to understand why Sydenham should
have written an essay specially upon it, in September, 1686, to claim it
as a new fever[38] and not rather as the old pestilential
fever--“populares meos admonens de subingressu novae cujusdam
Constitutionis, a qua pendet Febris nova species, a nuper grassantibus
multum abludens.” It should be kept in mind that his motive was correct
treatment, and that the fashionable treatment of the day by Peruvian bark
was, in his judgment, unsuited to this fever, however much it may have
suited the epidemical intermittents of 1678-79 and the “depuratory” dregs
of them for several years after. Physicians, he says, had learned to drive
off by bark the fevers of the former constitution, from 1677 to the
beginning of 1685, even when the fever intermitted little and sometimes
when it intermitted not at all; and they saw an indication for bark in the
nocturnal exacerbations of the new fever. Sydenham found that even large
doses of bark did not free the patient from fever, and that restoration to
health under treatment with the bark was due “magis fortunato alicui morbi
eventu quam corticis viribus.” He seeks to establish the indications for
another treatment by setting forth the symptoms minutely; and as the
question of bark in fevers was the great medical question of the time,
this may well have been Sydenham’s motive for discovering in the epidemic
of 1685-6 a “new fever” although he does not say so in as many words. We
have a good instance of how the bark-craze was at this time influencing
the very highest circles of practice in the case of Lord Keeper Guildford,
in July, 1685, as related in another chapter.

It will be seen from the table of weekly deaths that the second of the two
hard winters was over before the fever began to attract notice. Sydenham
compares its beginning after the thaw in February, 1685, to the beginning
of the plague when the frost broke in March, 1665.

If it had been merely the typhus of a hard winter, of overcrowding
indoors, of work and wages stopped by the frost, and of want of fuel
(which things Evelyn mentions as matters of fact), it would have come
sooner than the spring of 1685. The Bills for years before have regularly
a good many deaths from fever, and always some from spotted fever; but
these may have come from parishes wholly beyond the range of Sydenham’s
practice. The fever began definitely for him in February, 1685, and was at
its worst in the old plague-seasons of summer and autumn. If the seasons
had any relation at all to it, the epidemic was a late effect of the long
drought, an effect which was manifested most when the rain came, in the
summer of 1685 and throughout the mild winter and normal summer of
1685-86. It must have been for that reason that Sydenham traced the source
of it to “some secret and recondite change in the bowels of the earth,”
rather than to a change in the sensible qualities of the air. One must
ever bear in mind that the physicians of the Restoration gave no thought
to insanitary conditions of living; in that respect the later Stuart
period seems to have been behind the Elizabethan or even the medieval; we
cannot err in assuming, behind all Sydenham’s speculative causes, a great
deal of unwholesomeness indoors. Sydenham’s fullest reference to the
subterranean sources of poisonous miasmata occurs in his tractate on Gout:

    “Whether it be that the bowels of the earth, if one may so speak,
    undergo various changes, so that by the accession of vapours exhaled
    therefrom the air is disturbed, or that the whole atmosphere is
    infected by a change which some peculiar conjunction of certain of the
    heavenly bodies induces in it;--the matter so falls out that at this
    or that time the air is furnished with particles that are adverse to
    the economy of the human body, just as at another time it is
    impregnated with particles of a like kind that agree ill with the
    bodies of some species of brute animals. At these times, as often as
    by inspiration we draw into the naked blood miasmata of this kind,
    noxious and inimical to nature, and we fall into those epidemical
    diseases which they are apt to produce, Nature raises a fever,--her
    accustomed means of vindicating the blood from some hostile matter.
    And such diseases are commonly called _epidemical_; and they are short
    and sharp because they have thus a quick and violent movement[39].”

It was Sydenham’s intimate friend Robert Boyle who worked out the
hypothesis of subterraneous miasmata as a cause of epidemic (and endemic)
diseases. An account of his theory will be found in the chapter on
Influenzas and Epidemic Agues. It may be said here that it needs only a
few changes, especially the substitution of organic for inorganic matters
in the soil, to bring it into line with the modern doctrine of miasmatic
infective disease as expounded by the Munich school.

It has not been usual to think of spotted fever, (or of influenzas), in
that connexion; but a telluric source of the epidemic constitution of
1685-86 was clearly Sydenham’s view; and as the fever came in
circumstances like those of the last great plague, and was thought at the
time to be the forerunner of another great plague, its connexion with
recondite decompositions in the soil, dependent on the phenomenal drought
of two whole years before, cannot be set aside as a possibility, the less
so that the fever, although of the type of typhus, was not a fever of
cold, hunger, and domestic distress, but mainly of the warm, or mild, or
soft weather following the long drought, and of many well-to-do-people, as
in the great Netherlands fever of 1669. My view of it is that it was the
modified successor of plague, the _pestis mitior_, which used to precede
and accompany the plague, now become the dominant constitution. The
authentic figures of its mortality come from London; but Sydenham says
that its “effects were felt far more in other places”; although Short’s
abstracts of parish registers, given above, do not indicate excessive
mortality throughout England.


Retrospect of the great Fever of 1623-25.

The most instructive instance of _pestis mitior_ in Britain is not the
pestilential fever which led up to the last plague (1665-6), but the great
epidemic of fever all over England and Scotland which reigned for two or
three years before the great outburst of plague in 1625. I go back to this
because it was not wholly or even mainly a famine fever (although it was
as general as one of the medieval famine-fevers), and because in that
respect it furnishes a close parallel to the fever of 1685-86, which I
regard as the successor of the plague. After this interlude in the
history, we shall proceed to consider the question of the final extinction
of plague.

    In Scotland the fever of 1622-23 was directly connected with famine,
    but in England it was not obviously so according to the records that
    remain. The dearth in Scotland began as early as the autumn of 1621:
    “Great skarsitie of cornes throw all the kingdome,” the harvest having
    been spoiled by wet weather and unheard of river floods; however,
    abundance of foreign victual came in, and the scarcity was got
    over[40]. In England the same harvest of oats was abundant, and
    probably yielded the “foreign victual” which relieved the Scots; but
    the price of wheat rose greatly[41]. It was the year following, 1622,
    that really brought famine and famine-sickness to Scotland, as the
    second of two bad harvests had always done. On 21 July, 1622, a fast
    was proclaimed at Aberdeen for “the present plague of dearth and
    famine, and the continuance thereof threatened by tempests,
    inundations and weets likely to rot the fruit on the ground[42].”

    In an entry of the Chronicle of Perth, subsequent to July, 1622, it is
    said: “In this yeir about the harvest and efter, thair wes suche ane
    universall seikness in all the countrie as the ellyke hes not bene
    hard of. But speciallie in this burgh, that no familie in all the
    citie was frie of this visitation. Thair was also great mortalitie
    amonge the poore.” From which it appears that the autumnal fever of
    1622 was among all classes in Scotland. The famine in Scotland became
    more acute in the spring and summer of 1623; the country swarmed with
    beggars, and in July, says Calderwood, the famine increased daily
    until “many, both in burgh and land, died of hunger.” At Perth ten or
    twelve died every day from Midsummer to Michaelmas; the disease was
    not the plague, but a fever[43]. At Dumfries 492 died during the first
    ten months of 1623, perhaps a ninth part of the inhabitants, about one
    hundred of the deaths being specially marked as of “poor[44].” The
    “malignant spotted fever” which caused numerous deaths in 1623 in
    Wigton, Penrith and Kendal is clearly part of the famine-fever of
    Scotland extending to the Borders and crossing them. This is a
    famine-fever of the old medieval type, like that of 1196 which,
    according to William of Newburgh “crept about everywhere,” always the
    same acute fever, putting an end to the miseries of the starving, but
    attacking also those who had food.

    The same spotted fever was all over England in 1623, but it did not,
    as in Scotland, come in the wake of famine. It is true that the
    English harvest of 1622 was a good deal spoiled; a letter of 25
    September says[45]: “Though the latter part of this summer proved so
    far seasonable, yet the harvest is scant, and corn at a great price by
    reason of the mildews and blasting generally over the whole realm,”
    rye being quoted a few weeks later at 7/- the bushel and wheat at
    10/-, although the average of wheat for the year, in Rogers’s tables,
    is not more than 51/1_d._ per quarter, while the average of next year
    falls to 37/8_d._ These were not famine-prices in England, and there
    is no evidence of general sickness directly after the harvest of 1622,
    when corn was dearest. Also, although the autumn of 1623 was a time of
    “continual wet” in England[46], the price of wheat remained moderate,
    and even low as compared with the rather stiff price of the winter of
    1622-23. But it was not until the summer and autumn of 1623 that the
    spotted fever became epidemic in England. Short’s abstracts of the
    registers of market towns show how sickly that year was:

        Year.    No. of     No. with    Buried   Baptised
                registers   excess of   in the    in the
                examined.   burials.    same.     same.

        1622      25           4          442       345
        1623      25          16         2254       439 (sic)
        1624      25           9          978       714
        1625      25           9          666       563

    In September, 1623, the corporation of Stamford made a collection “in
    this dangerous time of visitation,” and sent £10 of it to Grantham,
    the rest to go “to London or some other town, as occasion offered.” A
    London letter of 6 December, 1623, from Chamberlain to Carleton
    says[47]:--

    “Here is a contagious spotted or purple fever that reigns much, which,
    together with the smallpox, hath taken away many of good sort, as well
    as meaner people.” He then gives the names of notables dead of it, and
    adds: “Yet many escape, as the dean of St Paul’s [Dr Donne, who used
    the occasion to compile a manual of devotion] is like to do, though he
    were in great danger.” One of the Coke family writes early in January,
    1624, from London[48]: “Having two sons at Cambridge, we sent for them
    to keep Christmas with us, and not many days after their coming my
    eldest son Joseph fell suddenly into the sickness of the time which
    they call the spotted fever, and which after two days’ extremity took
    away his life.” From another letter it appears that one of his
    symptoms was “not being able to sleep,” the unmistakable vigil of
    typhus. Although there is no word of the epidemic continuing in
    Scotland in 1624, it was undoubtedly as prevalent in England in that
    year as the year before, and prevalent in country houses as well as
    in towns and cities. Thus, on 7 August, 1624, Chamberlain writes: “The
    [king’s] progress is now so far off that we hear little thence, but
    only that there be many sick of the spotted ague, which took away the
    Duke of Lennox in a few days. He died at Kirby,” a country house in
    Northamptonshire[49]. On 21 August he writes again: “This spotted
    fever is cousin-german to it [the plague] at least, and makes as quick
    riddance almost. The Lady Hatton hath two or three of her children
    sick of it at her brother Fanshaw’s in Essex, and hath lost her
    younger daughter, that was buried at Westminster on Wednesday night by
    her father; a pretty gentlewoman, much lamented.” A letter of 4
    September says there was excessive mortality in London, in great part
    among children (doubtless from the usual infantile trouble of a hot
    autumn, diarrhoea), while “most of the rest are carried away by this
    spotted fever, which reigns almost everywhere, in the country as ill
    as here.” Sir Theodore Mayerne, the king’s physician, confirms this,
    under date 20 August, 1624: the purple fever, he says, was “not so
    much contagious as common through a universal disposing cause,”
    seizing upon many in the same house, and destroying numbers, being
    most full of malignity[50]. It was clearly an inexplicable visitation.
    The summer was hot and dry, from which character of the season, says
    Chamberlain, “some have found out a far-fetched speculation, which yet
    runs current, and would ascribe it [the spotted fever] to the
    extraordinary quantity of cucumbers this year, which the gardeners, to
    hasten and bring forward, used to water out of the next ditches, which
    this dry time growing low, noisome and stinking, poisoned the fruit.
    But,” adds Chamberlain, “that reason will reach no farther than this
    [London] town, whereas the mortality is spread far and near, and takes
    hold of whole households in many places.” He then gives the names of
    several eminent persons dead of it, and speaks of others who were
    “still in the balance[51].” On 9 October, “the town continues sickly
    still,” and Parliament had been put off, “in consideration of the
    danger,” from 2 November, 1624, to 15 February, 1625. On Ash
    Wednesday, 1625, the Marquis of Hamilton died of the pestilent fever
    at Moor Park, Rickmansworth. Thus far there had been no plague; and if
    the spotted fever were cousin-german to the plague, as Chamberlain
    said, it was remarkable in this that it prevailed in the mansions of
    the rich in town and country and took off more victims among the upper
    classes than the plague itself even in its most terrific outbursts.
    However, a plague of the first rank followed in London and elsewhere
    in the summer and autumn of 1625.

    The cucumber-theory, above mentioned, shows how puzzled people must
    have been to account for the spotted fever, or “spotted ague” as it
    was also called, in 1624. Sir Theodore Mayerne did not think contagion
    from person to person could explain it, but referred it to “some
    universal disposing cause.” It is conceivable that the famine-fever of
    1622 and 1623 in Scotland and the Marches may have spread by contagion
    into England in the latter year; but in 1624 there is nothing said of
    fever in Scotland or of scarcity as a primary cause in England.

    Besides the famine-fever of Scotland in 1622-23, there was another
    associated thing which should not be left out of account. Before the
    famine and fever had begun in that country, the notorious Hungarian
    fever was raging in the Palatinate, and continued to rage for four
    years. “Hungarian fever” had become the dreaded name for war-typhus of
    a peculiar malignity and diffusive power. It had been so often
    engendered since the 16th century in campaigns upon Hungarian soil as
    to have become known everywhere under the name of that country. Its
    infection spread, also, everywhere through Europe; thus it is said to
    have even reached England in 1566, and again in 1589, although it is
    not easy to find English evidence of it for either year. It was this
    type of fever which broke out in the Upper Palatinate, occupied by
    troops of the Catholic powers, in 1620, and continued through the
    years 1621, 1622 and 1623; as the title of one of the essays upon this
    outbreak somewhat fantastically declares, it spread “ex castris ad
    rastra, ex rastris ad rostra, ab his ad aras et focos[52].” Was the
    epidemic constitution of “spotted ague” in England in 1623 and 1624
    derived from the centre of famine-fever in Scotland, or from the
    centre of camp-fever in the Palatinate? In the last years of James I.
    communications were frequent with the latter country, and there was of
    course much intercourse with Scotland.

The spotted fever or spotted ague of 1623-24, the plague of 1625, and the
country agues of the same autumn make really a more instructive series of
epidemic constitutions than any that fell under Sydenham’s observation, so
instructive, indeed, that it has seemed worth while to revert to it for
the sake of illustrating the doctrine of epidemics then in vogue. That
doctrine made little of contagion from person to person; yet the idea of
contagion was familiar, and had been so since medieval times. If we might
assume contagion to explain such cases as those that occurred in the
houses of squires and nobles, we might find a source of it either in the
famine-fever of Scotland or in the war-fever of the Palatinate. But the
teaching of the time was that it was in the air; and if the infective
principle had been generated either in Scotland or on the upper Rhine it
had diffused itself in some inscrutable way. The doctrine of epidemic
constitutions seems strange to us; but some of the facts that it was meant
to embrace are also strange to us. Were it not for an occasional reminder
from influenza, we should hardly believe that any fevers could have
travelled as the Hungarian fevers, the spotted fevers or “spotted agues”
of former times are said to have done.

On the other hand, we have now a scientific doctrine of the effects of
great fluctuations of the ground-water upon the production of telluric
miasmata, which may be used to rationalize the theory of emanations
adopted by Sydenham and Boyle. From this modern point of view the
remarkable droughts preceding the pestilential fevers and plagues of
1624-25 and 1665, and preceding the fever of 1685-86, which is the one
that immediately concerns us, may be not without significance.

The London fever of 1685-86 having been suspected at the time to be the
forerunner of a plague, as other such fevers in the earlier part of the
century had been, and no plague having ensued, the question arises most
naturally at this stage, why the plague should have never come back in
London or elsewhere in Britain after the great outbreak of 1665-66.


The extinction of Plague in Britain.

Plague had been the grand infective disease of Britain from the year of
the Black Death, 1348-9, for more than three centuries, down to 1666. The
last of plague in Scotland was in 1647-8, in the west and north-west of
England about 1650 (in Wales probably in 1636-8), in Ireland in 1650, and
in all other parts of the kingdom including London in 1666, the absolute
last of its provincial prevalence having been at Peterborough in the first
months of 1667[53], while two or three occasional deaths continued to
occur annually in London down to 1679. False reports of plague,
contradicted by public advertisement, were circulated for Bath in
1675[54], and for Newcastle in 1710[55]; while in London as late as 1799,
during a bad time of typhus fever, the occurrence of plague was
alleged[56].

It is not easy to say why the plague should have died out. It had been
continuous in England from 1348, at first in general epidemics, all over
the country in certain years, thereafter mostly in the towns, either in
great explosions at long intervals or at a moderate level for years
together. The final outburst in 1665, which was one of the most severe in
its whole history, had followed an unusually long period of freedom from
plague in London, and was followed, as it were, by a still longer period
of freedom until at last it could be said that the plague was extinct. In
some large towns it had been extinct, as the event showed, at a much
earlier date; thus at York the last known epidemic was in 1604, and it can
hardly be doubted that many other towns in England, Scotland and Ireland
would have closed their records of plague earlier than they did had not
the sieges and military occupations of the Civil Wars given especial
occasion for the seeds of the infection to spring into life. Plague seemed
to be dying out all over England and Scotland (in Ireland it is little
heard of except in connexion with the Elizabethan and Cromwellian
conquests) for some time before its final grand explosion in London in
1665.

In seeking for the causes of its decline and extinction we must keep
prominently in view the fact that the virus was brought into the country
from abroad as the Black Death of 1348-9. But for that importation it is
conceivable that there would have been no signal history of plague in
Britain. Its original prevalence was on a great scale, and there were
several other widespread epidemics throughout the rest of the 14th
century. In the first volume of this history I have collected evidence
that plague was endemic or steady for long periods of the 15th and 16th
centuries in London, with greater outbursts at intervals, and that in the
17th century it came chiefly in great explosions. Something must have
served to keep the virus in the country, and more especially in the towns,
until at length it was exhausted. An exotic infection, or one that had not
arisen from indigenous conditions, and would probably never have so
arisen, does not remain indefinitely in the country to which it is
imported. Thus Asiatic cholera, imported into Europe on six, or perhaps
five, occasions in the 19th century, has never become domesticated; and
yellow fever had a career in the southern provinces of Spain during some
twenty years only. Plague did become domesticated for about three
centuries in England, and for longer in some other countries of Europe;
but it died out at length, and it would almost certainly have died out
sooner had it not found in all European countries some conditions not
altogether unsuited to it. What were the favouring conditions?

If, as I believe, the virus of plague had its habitat in the soil, from
which it rose in emanations, and if it depended therein, both remotely for
its origin in some distant country, as well as immediately for its
continuance in all countries, upon the decomposition of human bodies, then
it is easy to understand that the immense mortalities caused by each
epidemic would preserve the seeds of the disease, or the crude matters of
the disease, in the soil. Buried plague-bodies would be the most obvious
sources of future plagues. But if the theory given of the Black Death be
correct, bodies dead of famine or famine-fever would also favour in an
especial way the continuance of the plague-virus in certain spots of
ground, although they would probably never have originated it in this
country. Moreover, the products of ordinary cadaveric decomposition would
be so much pabulum or nutriment for the continuance of the virus. But all
those things being constant, the continuance of plague would largely
depend upon the manner in which the dead, after plague, or after famine
and fever, or in general, were disposed of. The soil of all England in
1348-9 was filled with multitudes of the dead laid in trenches, and there
were several general revivals of plague in the fifty or sixty years
following. In London there were plague-pits opened in the suburbs in many
great epidemics during three centuries. Even when there was no epidemic
the dead were laid in the ground in such a manner that their resolution
was speedy, and the diffusion of the products unchecked. But it is
undoubted that greater care in the disposal of the dead did at length come
into vogue. Thus, in the Black Book of the Corporation of Tewkesbury there
is an entry under the year 1603, that all those dead of plague, “to avoid
the perill, were buried in coffins of bourde,” the disease having carried
off no fewer than 560 the year before (1602) and being then in its second
season.[57]. The reason given is “to avoid the peril,” and it is beyond
question that burial in a coffin did in fact delay decomposition (unless
in peculiar circumstances which need not be particularized), and kept the
cadaveric products from passing quickly and freely into the pores of the
ground. Again, if the burial were in such coffins as the Chinese commonly
use, the decomposition would proceed almost as slowly as if the body had
been embalmed, and with as little risk of befouling the soil. For a long
time in England such burials were the privilege only of the rich; but as
wealth increased by commerce they became the privilege of all classes; and
in the last great plague of London, as I said in my former volume, “even
at the worst time coffins would seem to have been got for most.” Defoe’s
account of the burials in heaps in plague-pits is so exactly like that of
Dekker for the plague of 1603, and of other contemporaries for the plague
of 1625, that one may reasonably suspect him to have used these earlier
accounts as his authority for the practice in 1665, which he had no
direct knowledge of. However, I do not contend that there were no such
burials in 1665; just as one learns from Dekker that the coffin-makers in
1603 were busily employed and grew rich, although he also describes how a
husband “saw his wife and his deadly enemy whom he hated” launched into
the pit “within a pair of sheets.” In ordinary times, as we learn from the
tables of burial-dues, there were poorer interments without coffins as
late as 1628, according to a document printed by Spelman, the name of the
parish being withheld, and even as late as 1672 in the parish of St
Giles’s, Cripplegate. Spelman’s object in writing in 1641 was to protest
against the mercenary practices of the clergy in the matter of burial,
recalling the numerous canons of the medieval Church directed against all
such forms of simony; and incidentally he mentions that it was testified
before the Commissioners that a certain parson “had made forty pound of
one grave in ten yeeres, by ten pounds at a time”[58]--a “tenancy of the
soil” short enough to satisfy even the so-called Church of England Burial
Reform Association. The use of coffins in the burial of the very poorest
is now so universal that we hardly realize how gradually it was
introduced. I am unable to say when burial in a sheet or cerecloth ceased;
but it became less and less the rule for the poorer classes throughout the
17th century. In 1666 was passed the Act for burial in woollen, which was
re-enacted more strictly in 1678[59]. The motive of it was to encourage
the native woollen manufactures, or to prevent the money of the country
from being expended on foreign-made linen; and its clauses ordained that
woollen should be substituted for linen in the lining of the coffin and in
the shrouding of the corpse, but that no penalty should be exacted for
burying in linen any that shall die of the plague. Whether it prohibited
in effect the use of linen cerecloths to enshroud corpses where no coffin
was used does not appear clearly from the terms of the Act; but, as the
intention was to discourage the use of linen, and to bring in the use of
woollen, for all purposes of burial, it is probable that it served to put
an end to coffinless burials altogether, wherever it was enforced,
inasmuch as the prescribed material was wholly unsuited for the purpose of
a cerecloth.

The history of the London plague-pit between Soho and the present Regent
Street shows that, after the last great plague of 1665-66, more caution
was used against infection from the buried plague-bodies. Macaulay says it
was popularly believed that the earth was deeply tainted with infection,
and could not be disturbed without imminent risk to human life; and he
asserts that no foundations were laid in the pest-field till two
generations had passed and till the spot had long been surrounded with
buildings, the space being left blank in maps of London as late as the end
of George I.’s reign[60].

After 1666 the old churchyards were not less crowded than before, but more
crowded, perhaps because coffined corpses occupied more space and decayed
more slowly. On 17 October, 1672, Evelyn paid a visit to Norwich: “I
observed that most of the churchyards (tho’ some of them large enough)
were filled up with earth, or rather the congestion of dead bodys one upon
another, for want of earth, even to the very top of the walls, and some
above the walls, so as the churches seemed to be built in pitts.” The same
day he had visited Sir Thomas Browne, the author of the famous essay on
urn burial or cremation, (suggested to him by the digging up of forty or
fifty funeral urns in a field at Old Walsingham). The essay is full of
curious learning and equally curious moralizing. But Sir Thomas, though a
physician, has not a word to say on so proximate a topic as the state of
the Norwich churchyards, which came under his eyes and perhaps under his
nose every day of his life[61].

The practice of burying in coffins, which came at length within the means
of all classes, may seem too paltry a cause to assign, even in part, for
so remarkable an effect as the absolute disappearance of plague after a
duration of more than three centuries. My view of the matter is that the
virus would have died out of itself had it not been continually augmented,
or fed by its appropriate pabulum, and that the gradual change in the mode
of interment helped to check such augmentation or feeding.

But the more elaborate interment of the dead was itself an index of the
greater spending power of the community, and it may be said that it was
the better condition of the people, and not this one particular thing in
it, which put an end to the periodical recurrences of plague. In all but
its earliest outbursts in the fourteenth, and perhaps the fifteenth
century, plague had been peculiarly an infection of the poor, being known
as “the poor’s plague.” Perhaps the chief reason why the richer classes
usually escaped it was that they fled from the plague-tainted place,
leaving the poorer classes unable to stir from their homes, exposed to the
infectious air, and all the more exposed that their habitual employments
and wages would cease, their sustenance become precarious, their condition
lowered, and their manners reckless. Again, it was not unusual for the
plague to break out in a season of famine or scarcity, during which the
ordinary risks of the labouring class would be aggravated. Famines ceased
(except in Ireland, where there had been comparatively little plague), and
scarcities became less common. The sieges and occupations of the Civil
Wars in the middle of the 17th century, which undoubtedly were the
occasion of the last outbursts of plague in many of the towns, were a
brief experience, followed by unbroken tranquillity. Whatever things were
tending to the removal of plague in all its old seats had free course
thereafter.

On the other hand, one may make too much of the increase of well-being
among the labouring class which coincided with the cessation of plague. As
a check upon population plague worked in a very remarkable way. In London,
as well as in towns like Newcastle and Chester, plague towards the end of
its reign arose perhaps once in a generation and made a clean sweep of a
fifth or a fourth part of the inhabitants, including hardly any of the
well-to-do. It destroyed, of course, many bread-winners and many that were
not absolutely sunk in poverty; but its broad effect was to cut off the
margin of poverty as if by a periodical process of pruning. The Lord Mayor
of London wrote to the Privy Council at the end of the great plague of
1625: “The great mortality, although it had taken many poor people away,
yet had made more poverty by decay of tradesmen”--a decay of trade which
they might reasonably expect to recover from before long. No such ruthless
shears was ever applied at intervals to the growing fringe of poverty in
after times. The poor were a more permanent residue, pressing more upon
each other; but they did not press more upon the rich, except through the
poor rate; on the contrary, the separation of classes became more marked.

Perhaps I ought to give an illustration of this, so as not to leave so
radical a change in the vague and disputable form of a generality. I shall
take the instance of Chester; its circuit of walls, remaining from the
Roman conquest, is something fixed for the imagination to rest upon amidst
changes within and without them.

    Passing over its medieval and its not infrequent Tudor experiences of
    epidemic sickness, let us come to the beginning of the 17th century.
    In two or three successive seasons from 1602 to 1605 it lost 1,313
    persons by plague, as well as about 250 from other causes. The
    population was then mostly within the walls, and probably did not
    exceed 5000. There was a shipping quarter on the west side, with
    egress by the Water-gate to the landing-places on the Dee; a millers’
    quarter, with corn-market and hostelries, on the south, connecting by
    the South gate and bridge with a hamlet across the river along the
    road to Wales; a Liberty or Freedom of the city outside the walls on
    the east, along the road to Warrington and Manchester, with a Bar, a
    short distance out, as in London, to mark the limit of the mayor’s
    jurisdiction; and on the north side, within the walls, the
    cattle-market and shambles, with the market for country produce, and a
    few straggling houses without the gate on the road leading to
    Liverpool. Chester was a characteristic county town, with its
    cathedral clergy, its garrison, its resident nobility and gentry, its
    professional classes, its tradesmen, market people and populace, with
    the addition of a shipping trade to Ireland and afterwards to foreign
    and colonial ports. Plague continuing from 1602 to 1605 cut off a
    fourth or a fifth of its population, and these the poorest. The gaps
    in the population would gradually have filled up, and the fringe of
    poverty grown again[62].

    The plague came again in 1647, and cut off 2053 in the short space of
    twenty-three weeks from 22 June to 30 November. The bills of it are
    extant[63], and show on what parishes the plague fell most. All the
    parishes were originally within the walls but one, St John’s, the
    ancient collegiate church of Mercia, built upon a rocky knoll in the
    south-east angle made by the walls with the river. The other nine
    parish churches and their graveyards were within the walls; but the
    parishes of three of them extended beyond the gates, just as the three
    parishes dedicated to St Botolph at the gates of London did. These
    three were St Oswald’s, which included the Liberty on the east side,
    Trinity, which included the shipping quarter on the west as well as
    the houses along the Liverpool road on the north, and St Mary’s, which
    included the millers’ suburb across the Dee on the south. Hollar’s
    map, made a few years after the plague of 1647, shows very few houses
    beyond the walls, except in the ancient Liberty on the east. But it
    will appear from the following table that the parishes which had
    extended beyond the walls must either have been very crowded close up
    to the walls (as the Gate parishes were always apt to be), or there
    must have actually been a greater population outside the gates than
    the contemporary map shows:

    _Burials from Plague in the several Parishes of Chester in 23 weeks,
    June 22-Nov. 30, 1647._

    _5 parishes wholly within the walls._

                     Total.   First   Worst (7th)
                              week.      week.

        St Peter       75        0        14
        St Bridget     85        7         9
        St Martin     173        9        23
        St Michael    133       26         9
        St Olave       59        3         5

    _3 parishes extending beyond the walls._

        St Oswald     396       11        37
        St Mary       314        5        20
        Trinity       232        1        32

    _1 parish wholly without the walls._

        St John       358        2        26
        Pesthouse     228        0        34
                     ----       --       ---
                     2053       64       209

    This was the last plague of Chester, but for a small outbreak in 1654.
    The next vital statistics that we get for the city are more than a
    century after, in 1774[64]. The population of 14,713 was then divided
    into two almost distinct parts, separated by the wall. The old city
    was being rebuilt, all but some ancient blocks of buildings held in
    the dead hand of the cathedral chapter; it was becoming a model 18th
    century place of residence for a wealthy and refined class, who were
    remarkably healthy and not very prolific, the parishes wholly within
    the walls having 3502 inhabitants. The poorer class had gone to live
    mostly outside the walls in new and mean suburbs, the three parishes
    at the Gates and extending now far beyond the walls, together with the
    original extramural parish of St John’s, having a population of
    11,211. There was no town in Britain where the separation of the rich
    from the poor was more complete; there was hardly another town of the
    size where the health of the rich was better; and although the health
    of the populace was not so bad as in the manufacturing towns of
    Lancashire and Cumberland, close at hand, yet it is hardly possible to
    find so great a contrast as that between the clean and wholesome
    residential quarter within the walls and the mean fever-stricken
    suburbs as described by Haygarth in 1774:

    “The inhabitants of the suburbs,” he says, “are generally of the
    lowest rank; they want most of the conveniences and comforts of life;
    their houses are small, close, crowded and dirty; their diet affords
    very bad nourishment, and their cloaths are seldom changed or
    washed.... These miserable wretches, even when they go abroad, carry a
    poisonous atmosphere round their bodies that is distinguished by a
    noisome and offensive smell, which is peculiarly disgustful even to
    the healthy and vigorous, exciting sickness and a sense of general
    debility. It cannot therefore be wondered that diseases should be
    produced where such poison is inspired with every breath.”

The case of Chester shows by broader contrasts than anywhere else the
change from the public health of plague-times to that of more modern
times. But it can hardly be said to show the populace better off than
before; it shows them changed into a proletariat, and separated from the
richer classes by walls several feet thick. Such, at least, was the result
after four generations of immunity from plague, a result which indicates,
as I have said, that we may easily make too much of the improved
well-being of the poorer classes as a cause of the cessation of plague.

An easy explanation of plague ceasing in London has long been current, and
just because it is an easy explanation it will probably hold the field for
many years to come. It is that the fire of 1666 burnt out the seeds of
plague. Defoe, writing in 1723, ascribed this opinion to certain “quacking
philosophers,” but he would hardly have said so if he could have foreseen
the respectable authority for it in after times. The plague had ceased in
most of its provincial centres after the Civil Wars, and in some of them,
such as York, from as early a date as 1604. It ceased in all the principal
cities of Western Europe within a few years of its cessation in London. In
London itself it ceased after 1666, not only in the City which was the
part burned down in September of that year, but in St Giles’s, where the
Great Plague began, in Cripplegate, Whitechapel and Stepney, where it was
always worst, in Southwark, Bermondsey and Newington, in Lambeth and
Westminster. Nor can it be said that the City was the source from which
the infection used to spread to the Liberties and out-parishes. All the
later plagues of London, perhaps even that of 1563, began in the Liberties
or out-parishes and at length invaded the City. The part of London that
was rebuilt after 1666 contained many finer dwelling-houses than before,
built of stone, with substantial carpentry, and elegantly finished in fine
and rare woods. The fronts of the new houses did not overhang so as to
obstruct the ventilation of the streets and lanes; but the streets, lanes,
alleys and courts were somewhat closely reproduced on the old foundations.
A side walk in some streets was secured for foot-passengers by means of
massive posts, which, with the projecting signs of houses and shops, were
at length removed in 1766. The improvements in the City after the fire
were mostly in the houses of the richer citizens. The City was the place
of residence of the rich, with perhaps as many poorer purlieus in close
proximity as the residential districts of London now have. But four-fifths
of London at the time of the fire were beyond the walls of the City. It is
in these extramural regions that the interest mostly lies for epidemical
diseases. They remain, says Defoe in 1723, “still in the same condition
they were in before.” Unfortunately we know little of their condition,
whether in the 17th century or in the 18th. But there must have been
something in it most unfavourable to health; for we find from the Bills of
Mortality that the cessation of plague made hardly any difference to the
annual average of deaths, the increase of population being allowed for.
This fact makes the disappearance of plague all the more remarkable.


Fevers to the end of the 17th century.

The epidemical seasons of 1685-86 were the last that Sydenham recorded; he
was shortly after laid aside from active work by gout, and died in 1689.
Morton, who made notes of fevers and smallpox until 1694, is more a
clinical observer than a student of “epidemic constitutions”; and although
his writings are of value to the epidemiologist, he does not help us to
understand the circumstances in which epidemic diseases prevailed more at
one time than another. To the end of the century there is no other medical
source of information, and little besides generalities to be collected
from any source. It is known that the years from 1693 to 1699 were years
of scarcity all over the kingdom, that the fever-deaths in London reached
the high figure of 5036 in 1694, and that there was a high mortality in
many country parishes and market towns during the scarcity. But there are
few particular illustrations of the type of epidemic sickness. There is,
therefore, little left to do but to give the figures, and to add some
remarks.

_Fever Deaths in the London Bills, 1687-1700._

                     Spotted  Deaths
            Fever    fever   from all
  Year     deaths    deaths   causes

  1687      2847      144     21460
  1688      3196      139     22921
  1689      3313      129     23502
  1690      3350      203     21461
  1691      3490      193     22691
  1692      3205      161     20874
  1693      3211      199     20959
  1694      5036      423     24109
  1695      3019      105     19047
  1696      2775      102     18638
  1697      3111      137     20292
  1698      3343      274     20183
  1699      3505      306     20795
  1700      3675      189     19443

_Tables from Short’s Abstracts of Parish Registers._

          Registers    Registers with     Deaths     Births
  Year    examined     excess of death   in them    in them

  _Country Parishes._

  1689       144             27            828        692
  1690       146             17            532        324
  1691       147             16            336        180
  1692       147             10            207        146
  1693       146             27            650        426
  1694       148             18            465        348
  1695       149             23            649        492
  1696       150             19            503        344
  1697       150             21            559        409
  1698       152             12            397        289
  1699       151             20            433        318
  1700       160             29            890        739

  _Market Towns._

  1689        25             12           1965       1415
  1693        25              5            417        338
  1694        25              6           1307        681
  1695        25              3            309        246
  1696        26              4           1020        708
  1697        26              2            109         80
  1698        26              4            575        423
  1699        26              7           1181        867
  1700        27              4            726        587

In the London figures the year 1694 stands out conspicuous by its deaths
from all causes, and by its high total of fevers. The fever-deaths began
to rise from their steady weekly level a little before Christmas, 1693,
and remained high all through the year 1694, with a good many deaths from
“spotted fever” in the worst weeks. Among the victims in London in
February was Sir William Phipps, Governor of New England: his illness
appeared at first to be a cold, which obliged him to keep his chamber; but
it proved “a sort of malignant fever, whereof many about this time died in
the city[65].” Pepys, writing to Evelyn on 10 August, 1694, calls it “the
fever of the season,” three being down with it at his house, but well
advanced in their recovery. In that week and in the week following, the
deaths in London from all causes touched the highest points of the year,
the deaths from fever and spotted fever being a full quarter of them.
Fever at its worst in London never made more than a quarter of the annual
deaths from all causes; so that, if we take it to have been the successor
of the plague, it operated in a very different way--with a greatly
lessened fatality of all that were attacked, with only a reminder of the
old special incidence upon the summer and autumn seasons, but with a
steadiness from year to year, and throughout each year, that made the
fever-deaths of a generation little short of one of those enormous totals
of plague-deaths that were rapidly piled up during a few months, perhaps
once or twice in a generation.

The following table from the London weekly Bills shows the progress of the
fever from the end of April, 1694, with the number of deaths specially
assigned to “spotted fever”:--

_London: Weekly Mortalities from fever and all causes, epidemic of 1694._

  Week              Spotted   All
  ending     Fever   fever   deaths

  April 24     90      15    427
  May    1     77      10    369
         8     89       9    413
        15     80       5    395
        22    101       3    428
        29     72       8    430
  June   5    112      12    469
        12    113      12    434
        19    113      11    430
        26     99      14    396
  July   3     94      11    423
        17     86      10    445
        24    115      13    507
        31     84      13    484
  Aug.   7     99      10    462
        14    110      20    530
        21    135      19    583
        28    111      20    510
  Sept.  5    115      16    505
        12    112      12    462
        18     98       9    504
        25    106       4    490
  Oct.   2    124       8    533
         9    125      10    553
        16    114       9    552
        23    104       3    511
        30    118       3    528
  Nov.   6     70       3    439
        10     89       7    453
        13    106       2    471
        20    117      13    538
        27     79       6    456
  Dec.   4     87       6    475
        11     87       3    407
        18     78       4    445
        25     66       3    394

The year 1694, to which the epidemic of malignant fever (as well as
malignant smallpox) belongs, was one of the series of “seven ill years” at
the end of the 17th century (1693-99). They were long noted, says Thorold
Rogers, “for the distress of the people and for the exalted profits of the
farmer.” The price of wheat in the autumn and winter of 1693 was the
highest since the famine of 1661. In 1697-8 corn was again dear and much
of it was spoilt. At Norwich in 1698 wheat was sold at 44_s._ a comb.

Harvests spoiled by wet weather or unseasonable cold appear to have been
the most general cause of the high prices of food. In London there was no
unusual sickness except in 1694; indeed the other years to the end of the
century show a somewhat low mortality, the year 1696, which Macaulay
marks as a time of severe distress among the common people owing to the
calling in of the debased coinage[66], had the smallest number of deaths
from all causes (18,638) since many years before, and for a century after
allowing for the increase of population. But the deaths from “fever” were
some three thousand every year, and the births, so far as registered,
were, as usual, far below the deaths.

It was in the country at large that the effects of the “seven ill years”
were chiefly felt. According to Short’s abstracts of parish registers,
there was unusual mortality at the beginning of the period and at the end
of it; in his Chronology he mentions spotted fever, bloody flux and agues
in 1693 (besides an influenza or universal slight fever recorded by
Molyneux of Dublin), and again in 1697 and 1698 “purples, quinsies,
Hungarian and spotted fever, universal pestilential spotted fever,” from
famine and bad food.

When we look for the evidence of this in England we shall have difficulty
in finding it. Short’s own abstracts give almost no colour to it; but
there are other figures from the parish registers, scattered through the
county histories and statistical works, which prove that the seven ill
years must have checked population. Thus at Sheffield in the ten years
1691-1700 there was the greatest excess of burials over baptisms in the
whole history of the town from 1561--namely, 2856 burials to 2221 baptisms
(688 marriages). At Minehead, Somerset, a parish of some 1200 people
occupied in weaving, the deaths and births were as follows in four years
of the decennium:

        Baptised. Buried.

  1691     57      75
  1694     34      55
  1695     47      48
  1697     35      65

A glimpse of spotted or pestilential fever in Bristol during the years of
distress at the end of the 17th century comes from Dr Dover, a man of no
academical repute, but at all events an articulate voice. Passing from an
account of the spotted pestilential fever at Guayaquil, “when I took it by
storm,” he goes on[67]:

    “About thirty-seven years since [written in 1732], this fever raged
    much in Bristol, so that I visited from twenty-five to thirty patients
    a day for a considerable time, besides their poor children taken into
    their workhouse, where I engaged myself, for the encouragement of so
    good and charitable an undertaking, to find them physick and give them
    advice at my own expense and trouble for the two first years. All
    these poor children in general had this fever, yet no more than one of
    them died of it of the whole number, which was near two hundred.”

--an experience of typhus in children which was strictly according to
rule. This had clearly been the occasion of a memorial addressed to the
Mayor and Aldermen of Bristol, in 1696, praying that a capacious workhouse
should be erected for children and the aged, which “will prevent children
from being smothered or starved by the neglect of the parish officers and
poverty of their parents, which is now a great loss to the nation[68].”

The year 1698 was the climax of the seven ill years. The spring was the
most backward for forty-seven years, the first wheat in the ear being seen
near London on 16th June. For four months to the end of August the days
were almost all rainy, except from the 18th to the 26th July. Whole fields
of corn were spoilt. In Kent there was barley standing uncut on 29th
September, and some lay in the swathe until December. Much of the corn in
the north of England was not got in until Christmas, and in Scotland they
were reaping the green empty corn in January[69].


Fevers of the seven ill years in Scotland.

It is from Scotland that we hear most of the effects of the seven ill
years in the way of famine and fever. Scotland was then in a backward
state compared with England; and its northern climate, making the harvest
always a few weeks later than in England, told especially against it in
the ill years. Fynes Morryson, in the beginning of the 17th century,
contrasts the Scotch manner of life unfavourably with the English, and Sir
Robert Sibbald’s account towards the end of that century is little better.
Morryson says, “the excesse of drinking was then farre greater in generall
among the Scots than the English.” Sibbald remarks[70] on the drinking
habits of the Scots common people: their potations of ale or spirits on
an empty stomach, especially in the morning, relaxed the fibres and
induced “erratic fevers of a bad type, bastard pleurisies, ... dropsies,
stupors, lethargies and apoplexies.” Morryson says: “Their bedsteads were
then like cubbards in the wall, with doores to be opened and shut at
pleasure, so as we climbed up to our beds. They used but one sheete, open
at the sides and top, but close at the feete, and so doubled[71].” Sibbald
says the peasantry had poor food and hard work, and were subject to many
diseases--“heartburn, sleeplessness, ravings, hypochondriac affections,
mania, dysentery, scrophula, cancer, and a dire troop of diseases which
everywhere now invades the husbandmen that were formerly free from
diseases.” _Causa a victu est._ Therefore consumption was common enough.
He has much to say of fevers,--of intermittents, especially in spring and
autumn, catarrhal fevers, nervous fevers, comatose fevers, with delirium,
spasms and the like symptoms, malignant, spotted, pestilential, hectic,
&c. The continued fevers ranged in duration from fifteen to thirty-one
days, recovery being ushered in with sweats, alvine flux and salivation.
Purple fevers had sometimes livid or black spots mixed with the purple
(mottling); in a case given, there were suppurations which appear to have
been bubonic. There had been no plague in Scotland since 1647-48; but
fevers, unless Sibbald has given undue prominence to them, would appear to
have filled its place among the adults.

Another writer of this period, from whom some information is got as to
fevers, was Dr Andrew Brown of Edinburgh. He is mainly a controversialist,
and is on the whole of little use save for the history of the treatment of
fevers. He came to London on a visit in 1687, attracted by the fame of
Sydenham’s method of curing fevers by antimonial emetics and by purgation:
“Returning home as much overjoyed as I had gotten a treasure, I presently
set myself to that practice”--of which he gave an account in his
‘Vindicatory Schedule concerning the New Cure of Fever[72].’ Continual
fever, he says, takes up, with its pendicles, the half of all the diseases
that men are afflicted with; and some part of what he calls continual
fever must have been spotted: “As concerning the eruption of spots in
fevers, these altogether resemble the marks made by stroaks on the skin,
and these marks are also made by the stagnation and coagulation of the
blood in the small channels [according to the doctrine of
obstructions].... They tinge the skin with blewness or redness.”

The bitter controversy as to the treatment of fevers led Brown into
another writing in 1699[73].

    “The fevers that reign at this time [it was towards the end of the
    seven ill years] are for the most part quick and peracute, and cut off
    in a few days persons of impure bodies. And as I have used this method
    by vomiting and purging in many, and most successfully at this time,
    so I have had lately considerable experience thereof in my own family:
    wherein four of my children and ten servants had the fever, and
    blessed be God, are all recovered, by repeated vomiting with
    antimonial vomits and frequent purgings, except two servants, the one
    having gotten a great stress at work, who bragging of his strength did
    contend with his neighbour at the mowing of hay, and presently
    sickened and died the sixth day, and whom I saw not till the day
    before he died, and found him in such a condition that I could not
    give him either vomit or purge: and the other was his neighbour who
    strove with him, being a man of most impure and emaciate body, who had
    endured want and stress before he came to my service, and who got not
    all was necessary because he had not the occasion of due attendance,
    all my servants being sick at the time[74].”

This account of the experience which Dr Andrew Brown had lately had among
his children and domestics in or near Edinburgh was written in 1699, and
may be taken as relating to part of the wide-spread sickliness of the
seven ill years in Scotland. Fletcher of Saltoun gives us a general view
of the deplorable state of Scotland at the end of the 17th century, which
was intensified by the succession of bad harvests[75]. The rents of
cultivated farms were paid, not in money, but in corn, which gave occasion
to many inequalities, to the traditional fraudulent practices of millers
and to usury. The pasture lands for sheep and black cattle had no shelters
from the weather, and no winter provision of hay or straw (roots were
unheard of until long after), “so that the beasts are in a dying
condition.” The country swarmed with vagrants (a hundred thousand, he
estimates, in ordinary times, but doubled in the dear years), who lived
and multiplied in incest, rioted in swarms in the nearest hills in times
of plenty, and in times of distress fell upon farmhouses in gangs of
forty or more, demanding food. Besides these there were a great many poor
families very meanly provided for by the Church boxes, who lived wholly
upon bad food and fell into various diseases. He had been credibly
informed that some families in the years of mere scarcity preceding the
climax of 1698-99 had eaten grains, for want of bread. “In the worst time,
from unwholesome food diseases are so multiplied among poor people that,
if some course be not taken, the famine may very probably be followed by a
plague[76].”

We owe some details of these calamities in Scotland to Patrick Walker, the
Covenanter, who records them to show how the prophecies of Divine
vengeance on the land, uttered during the Stuart persecutions by Cargill
and Peden, had been in due time fulfilled[77]:

    “In the year 1694, in the month of August, that crop got such a stroke
    in one night by east mist or fog standing like mountains (and where it
    remained longest and thickest the badder were the effects, which all
    our old men, that had seen frost, blasting and mildewing, had never
    seen the like) that it got little more good of the ground. In November
    that winter many were smitten with wasting sore fluxes and strange
    fevers (which carried many off the stage) of such a nature and manner
    that all our old physicians had never seen the like and could make no
    help; for all things that used to be proper remedies proved
    destructive. And this was not to be imputed to bad unwholesome
    victual; for severals who had plenty of old victual did send to
    Glasgow for Irish meal, and yet were smitten with fluxes and fevers in
    a more violent and infectious nature and manner than the poorest in
    the land, whose names and places where they dwelt I could instance.

    “These unheard-of manifold judgments continued seven years, not always
    alike, but the seasons, summer and winter, so cold and barren, and the
    wonted heat of the sun so much withholden, that it was discernible
    upon the cattle, flying fowls and insects decaying, that seldom a fly
    or gleg was to be seen. Our harvests not in the ordinary months, many
    shearing in November and December, yea some in January and February;
    the names of the places I can instruct. Many contracting their deaths,
    and losing the use of their feet and hands, shearing and working
    amongst it in frost and snow; and after all some of it standing still,
    and rotting upon the ground, and much of it for little use either to
    man or beast, and which had no taste or colour of meal. Meal became so
    scarce that it was at two shillings a peck, and many could not get it.

    “Through the long continuance of these manifold judgments deaths and
    burials were so many and common that the living were wearied with
    burying of the dead. I have seen corpses drawn in sleds. Many got
    neither coffins nor winding-sheet.

    “I was one of four who carried the corpse of a young woman a mile of
    way; and when we came to the grave, an honest poor man came and said,
    ‘You must go and help me to bury my son, he is lien dead this two
    days; otherwise I will be obliged to bury him in my own yard.’ We
    went, and there were eight of us had two miles to carry the corpse of
    that young man, many neighbours looking on us, but none to help us. I
    was credibly informed, that in the North, two sisters on a Monday’s
    morning were found carrying the corpse of their brother on a barrow
    with bearing-ropes, resting themselves many times, and none offering
    to help them.

    “I have seen some walking about at sunsetting, and next day at six
    o’clock in the summer morning found dead in their houses, without
    making any stir at their death, their head lying upon their hand, with
    as great a smell as if they had been four days dead; the mice or rats
    having eaten a great part of their hands and arms.

    “The nearer and sorer these plagues seized, the sadder were their
    effects, that took away all natural and relative affections, so that
    husbands had no sympathy with their wives, nor wives with their
    husbands, parents with their children, nor children with their
    parents. These and other things have made me to doubt if ever any of
    Adam’s race were in a more deplorable condition, their bodies and
    spirits more low, than many were in these years.”

    In the parish of West Calder, 300 out of 900 “examinable” persons
    wasted away.

    Some facts and traditions of the Seven Ill Years were recorded nearly
    a century after in the Statistical Account of Scotland. From the Kirk
    Session records of the parish of Fordyce, Banffshire, it did not
    appear “that any public measures were pursued for the supply of the
    poor, nor anything uncommon done by the Session except towards the
    end. The common distribution of the collections of the church amounted
    only to about 1_s._ 2_d._ or 1_s._ 4_d._ weekly.” The Kirk Session
    records bore witness to the numerous cases of immorality in the years
    before the famine that had been dealt with ecclesiastically, and to
    the entire and speedy cessation of such cases thereafter[78].

    The account for the parish of Keithhall and Kinkell, Aberdeenshire,
    says that “many died of want, in particular ten Highlanders in a
    neighbouring parish, that of Kemnay; so that the Session got a bier
    made to carry them to the grave, not being able to afford coffins for
    such a number[79].” In the upland parish of Montquhitter, in the same
    county, the dear years reduced the population by one half or more.
    Until 1709 many farms were waste. Of sixteen families that resided on
    the estate of Lettertie, thirteen were extinguished. The account of
    this parish contains several stories of the distress, with the names
    of individuals[80]. It is clear, however, that all the parishes of
    Scotland were not equally distressed. The county of Moray and “some of
    the best land along the east coast of Buchan and Formartine
    [Aberdeenshire] abounded with seed and bread;” but transport to the
    upland parishes was difficult[81].

We may take it that these experiences in the reign of William III. were
peculiar to Scotland; even Ireland, which had troubles enough of the same
kind in the 18th and 19th centuries, was at that time resorted to as a
place of refuge by the distressed Scots. Among the special and temporary
causes in Scotland were antiquated agricultural usage, an almost
incredible proportion of the people in a state of lawless vagrancy, such
as Henry VIII. and Elizabeth had to deal with a century and a half before,
a low state of morals, both commercial and private, a tyrannical
disposition of the employers, a sullen attitude of the labourers, and a
total decay of the spirit of charity. An ancient elder of the parish of
Fordyce, who kept some traditions of the dear years, remarked to the
minister: “If the same precautions had been taken at that time which he
had seen taken more lately in times of scarcity, the famine would not have
done so much hurt, nor would so many have perished.”

The evil of vagrancy, for which Fletcher of Saltoun saw no remedy but a
state of slavery not unlike that which Protector Somerset had actually
made the law of England for a couple of years, 1547-49, in somewhat
similar circumstances, gradually cured itself without a resort to the
practices of antiquity or of barbarism.

The union with England in 1707, by removing the customs duties and opening
the Colonial trade to Scots shipping (they had a share in the East India
trade already) gave a remarkable impulse to the manufacture of linen and
to commerce. Such was the demand for Scots linen that, it seemed to De
Foe, “the poor could want no employment”; and it may certainly be taken as
a fact that the establishment on a free basis of industries and foreign
markets gave Scotland relief from the pauperism and vagrancy, like those
of Ireland in the 18th and 19th centuries, that threatened for a time, and
especially in the Seven Ill Years, to retard the developement of the
nation.

       *       *       *       *       *

For several years after the period of scarcity or famine from 1693 to
1699, the history of fever in Britain presents little for special remark.

A book of the time was Dr George Cheyne’s _New Theory of Continual Fever_,
London, 1701. His theory is that of Bellini and Borelli, which accounted
for everything in fevers on mechanical principles, and ignored the
infective element in them. Cheyne does not even describe what the fevers
were; but in showing how the theory applies, he mentions incidentally the
symptoms--quick pulse, pain in the head, burning heat, want of sleep,
raving, clear or flame-coloured urine, and morbid strength. Equally
theoretical is the handling of the subject by Pitcairn. Freind, in his
essays on fevers[82], is mainly occupied with controversial matters of
treatment, except in connexion with Lord Peterborough’s expedition to
Spain in 1705, as we shall see in a section on sickness of camps and
fleets.

In the absence of clinical details from the medical profession, the
following from letters of the time will serve a purpose:

On 18 September, 1700, Thomas Bennett writes to Thomas Coke from Paris
giving an account of the fever of Coke’s brother: His fever is very
violent upon him, and he has a hickup and twitchings in his face; he is
especially ill in the night, and has now and then violent sweats. He raved
for eight days together and in all that time did not get an hour’s sleep.
He was attended by Dr Helvetius and other physicians. Lady Eastes, her
son, and most of her servants are sick, but they are all on the mending
hand; her steward is dead of a high fever, having been sick but five
days[83]. These are Paris fevers, the symptoms suggesting typhus,
especially the prolonged vigil in one of the cases. It is to be remarked
that they occurred among the upper classes; and it appears that the
universal fevers “of a bad type” in France in 1712 did not spare noble
houses nor even the palace of Louis the Great[84].

The following from the London Bills will show the prevalence of fever from
year to year[85].

         Dead of      Dead of         Dead of
  Year    Fever    Spotted Fever    all diseases

  1701     2902          68            20,471
  1702     2682          53            19,481
  1703     3162          74            20,720
  1704     3243          61            22,684
  1705     3290          41            22,097
  1706     2662          54            19,847
  1707     2947          42            21,600
  1708     2738          62            21,291
  1709     3140         118            21,800
  1710     4397         343            24,620
  1711     3461         142            19,833
  1712     3131          96            21,198
  1713     3039         102            21,057
  1714     4631         150            26,569
  1715     3588         161            22,232
  1716     3078         100            24,436
  1717     2940         137            23,446
  1718     3475         132            26,523
  1719     3803         124            28,347
  1720     3910          66            25,454


The London fever of 1709-10.

The “seven ill years” were followed by the fine summer and abundant
harvest (although hardly more than half the breadth was sown) of 1699.
Scarcity was not a cause of excessive sickness again until 1709-10;
although the harvest of 1703 was unfavourable. The price of wheat in 1702
was 25_s._ 6_d._ per quarter, and continued low for a number of years,
notwithstanding the war with France. In Marlborough’s wars there were no
war-prices for farmers, as in the corresponding circumstances a century
after; on the contrary, corn and produce of all kinds were so cheap that
farmers had difficulty in paying their rents. The bounty of five shillings
per quarter on exported wheat had given a great impulse to corn-growing,
so that the acreage of wheat sown was much more than the country in an
ordinary year required, partly, no doubt, because the bread of the poorer
classes was largely made from the coarser cereals. The period of abundance
was broken by the excessively severe winter of 1708-9, one of three
memorable winters in the 18th century. The frost lasted all over Europe
from October to March, and was followed by a greatly deficient crop in
1709. The following shows the rise of the price of the quarter of wheat in
England:

                       _s._  _d._

  1708    Lady-day      27    3
   "      Michaelmas    46    3
  1709    Lady-day      57    6
   "      Michaelmas    81    9
  1710    Lady-day      81    9

The export of corn was prohibited in 1709 and again in 1710.

An epidemic of fever began in London in the autumn of 1709 and continued
throughout 1710, in which year the fever-deaths reached the highest total
since 1694. But it was not altogether a fever of starvation or distress
among the poor, and perhaps not mainly so. There is always the dual
question in connexion with fever following bad seasons and high prices:
how much of it was due to the scarcity, and how much to those states of
soil and atmosphere upon which the failure of the crop itself depended. An
authentic case of the malignant fever which began to rage in London in the
autumn of 1709 will both serve to show the remarkable type of at least a
portion, if not the whole of the epidemic, and to prove its incidence upon
the houses of the rich.

    The case is recorded by Sir David Hamilton[86]:

    “About the 5th of October, 1709, the son of that worthy gentleman,
    William Morison, esquire, was seized with a fever; at which time, and
    for some weeks before, a malignant fever raged in London.” He had a
    quick and weak pulse, great difficulty or hindrance of speech, and a
    stupidity; “whereto were added tremors, and startings of the tendons,
    a dry and blackish tongue, a high-coloured but transparent urine and
    coming away for the most part involuntarily, and a hot and dry skin.”
    Dr Grew was called in, and prescribed alexipharmac remedies (cordials,
    sudorifics, etc.) “A few days after the patient’s skin was stained or
    marked with red and purple spots, and especially upon his breast, legs
    and thighs. These symptoms, although a little milder now and then,
    prevailed for fourteen days; after that the spots vanished, and the
    convulsive motions so increased that the young gentleman seemed ready
    to sink under them for several days together.” He was treated with the
    application of blisters, and with doses of bark. His strength and
    flesh were so wasted that the hip whereon he lay was seized with a
    gangrene. For ten or twelve days before his death, “he breathed and
    perspired so offensive a smell that they were obliged to smoke his
    chamber with perfumes; and even myself, whilst I inclined my body a
    little too near him, was, by receiving his breath into my mouth,
    seized all on a sudden with such a sickness and faintness that I was
    obliged to take the air in the open fields, and returning thence to
    drink plentifully of _mountain_ wine at dinner.” The examination after
    death was made by the celebrated anatomist Dr Douglas. There was still
    a heap of brown-coloured spots visible on the breast; “there was
    nothing contained in the more conspicuous vessels of the abdomen but
    grumes or clots of blackish blood, without any serum in the
    interstices.” Hamilton adds: “We too seldom dissect the bodies of
    those dying in fevers.”

The tremors, offensive sweats and offensive breath are distinctive of a
form of typhus that became common towards the middle of the century, and
was called putrid fever (not in the sense of Willis) or miliary fever from
the watery vesicles of the skin that often attended it. But although
Hamilton was writing on miliary fever (of the factitious variety) this
case is not given as an example, but is appended to his sixteen cases of
the latter, as an example of “a deadly fever with loss of speech from the
beginning.” Among earlier cases, those belonging to the epidemic of 1661
as described by Willis correspond closely with this case, which we may
take as representing part of the malignant fever that then raged in
London. We have an anatomical record from each; but in neither was there
sloughing of the lymph-follicles of the intestine, or of the mesenteric
glands, as in the enteric fever of our own time; while in both there were
red or purple spots on the breast or neck, and on the limbs. The “loss of
speech from the beginning” suggests Sydenham’s “absolute aphonia” in the
comatose fever of 1673-76, which resembled in other respects Willis’s
fever of the brain and nervous stock (mostly of children) in 1661. One of
the synonyms of “infantile remittent” was “an acute fever with
dumbness[87].” This seems to have been a common type of fever in the
latter part of the 17th century and early part of the 18th. Some likeness
to enteric fever may be found in it, but there is no warrant for
identifying it with that fever. Its main features may be said to have been
its incidence upon the earlier years of life, but not to the exclusion of
adult cases, its remarkable ataxic symptoms, which led Willis to refer it
to “the brain and nervous stock” (spinal cord), its comatose character,
its spots, occasional miliary eruption, ill-smelling sweats and other
foetid evacuations, its protracted course, and its hectic sequelae.

The weekly bills of mortality in London bear little evidence of unusual
prevalence of fever in 1709, except in the weeks ending 13 and 20
September, when the fever-deaths were 96 and 75 (including “spotted
fever”). But the unusual entry of “malignant fever” appears in three
weekly bills, 19 July, 9 August and 23 August, one death being referred to
it on each occasion. It was in the summer and autumn of 1710 that the
fever reached a height in London, being attended with a very fatal
smallpox. An essay on the London epidemic of 1710[88] is interesting
chiefly for recording a probable case of relapsing fever, a form which was
almost certainly part of the great febrile epidemic in London in 1727-29.

    Mrs Simon, aged 20, had a burning fever, stifling of her breath,
    frequent vomiting and looseness, foul tongue, loss of sleep,
    restlessness, intermitting, low and irregular pulse. This terrible
    fever disappeared on the fourth day, and she thought herself
    recovered. But on the seventh day from her being taken ill the fever
    returned, she was light-headed, did not know her relatives, and was
    fevered in the highest degree. It looked like a malignant fever, but
    there were no spots.

The following table shows the very high mortality from fever (as well as
from smallpox) in the epidemic to which the above case belonged.

_London: Weekly deaths from fever, smallpox and all causes._

1710.

  Week       Dead of       Dead of       Dead of       Dead of
  ending      fever     spotted fever    smallpox    all diseases

    May  2     103       [illegible]        99           571
         9      90             6            60           517
        16      84             7            71           502
        23      93            15            71           503
        30     106            11            83           550
   June  6      93             2            98           508
        13      79             8            84           509
        20     106            12            99           574
        27     105            15            86           503
   July  4     106             7            99           482
        11     107            13            97           467
        18     126            16            89           509
        25     109            13           105           562
   Aug.  1      91            12            79           444
         8      92            11            72           463
        15      98            10            58           459
        22     105            10            63           463
        29     111            16            71           495
  Sept.  5      76             4            63           414
        12[89] 107            12            57           520
        19     115             9            83           548
        26      81            11            46           456
   Oct.  3      98             9            45           469
        10      79            10            49           480
        17      90             5            41           477
        24     107             5            45           470
        31     106            14            51           421
   Nov.  7      71             6            55           425
        14      92             2            41           390
        21      70             4            25           345

Throughout England, in country parishes and in towns, the first ten years
of the 18th century were on the whole a period of good public health. In
Short’s abstracts of the parish registers to show the excess of deaths
over the births, those years are as little conspicuous as any in the long
series. It was a time when there was a great lull in smallpox, and
probably also in fevers. The figures for Sheffield may serve as an
example[90]. It will be seen from the Table that the burials exceeded the
baptisms in every decade from the Restoration to the end of the century;
after that for twenty years the baptisms exceeded the burials, the
marriages having increased greatly.

_Vital Statistics of Sheffield._

  Ten-year
  periods        Marriages     Baptisms     Burials

  1661-70           585          2086         2266
  1671-80           537          2240         2387
  1681-90           540          2595         2856
  1691-1700         688          2221         2856
  1701-10           942          3033         2613
  1711-20           991          3304         2765

Of particular epidemics, we hear of a malignant fever at Harwich in 1709.
Harwich was then an important naval station, and the fever may have arisen
in connexion with the transport of troops to and from the seat of war,
just as camp- and war-fevers appeared at various ports in the next war,
1742-48.

There were rumours of a plague at Newcastle in 1710, which were
contradicted by advertisement in the _London Gazette_[91]. But, as there
was so much plague in the Baltic ports in 1710 it is possible that the
Newcastle rumour may have been one of plague imported, and not a rumour
suggested by the mortality from some other disease.

To the same period of epidemic fever in London, about 1709-10, belongs
also a curiously localized epidemic in an Oxford college, which reminds
one somewhat of the circumstances of enteric fever in our time. It was
told to Dr Rogers of Cork twenty-five or twenty-six years before the date
of his writing (1734), by one who was a student at Oxford then: “There
broke out amongst the scholars of Wadham College a fever very malignant,
that swept away great numbers, whilst the rest of the colleges remained
unvisited. All agreed that the contagious infection arose from the
putrefaction of a vast quantity of cabbages thrown into a heap out of the
several gardens near Wadham College[92].”

The next epidemic of fever in London was in 1714. Like that of 1710, it
followed a great rise in the price of wheat, or perhaps it followed the
unseasonable weather which caused the deficient harvest. Before the Peace
of Utrecht wheat in England was as low as 33_s._ 9_d._ per quarter, in
1712, the peace next year sending it no lower than 30_s._ But at
Michaelmas, 1713, it rose with a bound to 56_s._ 11_d._, doubtless owing
to a bad harvest. The fever-deaths in London began to rise in the spring
of 1714, reaching a weekly total of 103 in the week ending 20 April. All
through the summer and autumn they continued very high, the weekly totals
exceeding, on an average, those of the year 1710, as in the foregoing
table, and having corresponding large additions of “spotted fever.” The
deaths from all causes in 1714 were a quarter more than those of the year
before, the epidemic of fever being the chief contributor to the rise.
This happened to be a very slack time in medical writing[93]; but, even in
the absence of such testimony as we have for earlier and later epidemics
of fever in London, we may safely conclude that the fever of 1714 was of
the type of pestilential or malignant typhus, beginning in early summer
and reaching a height in the old plague season of autumn.

A singular instance of what may be considered war-typhus belongs to the
winter of 1715-16. The political intrigues preceding and following the
death of Queen Anne in 1714 culminated in the Jacobite rising in Scotland
and the North of England in 1715. The Jacobites having been defeated at
Preston on 13 November, prisoners to the number of 450 were brought to
Chester Castle on the Sunday night before December 1st. A fortnight later
(December 15th), Lady Otway writes of the 450 prisoners in the Castle:

    “They all lie upon straw, the better and the worse alike. The king’s
    allowance is a groat a day for each man for meat, but they are almost
    starved for want of some covering, though many persons are charitable
    to the sick.” The winter was unusually severe, the snow lying “a yard
    deep.” Many prisoners died in the Castle by “the severity of the
    season,” many were carried off by “a very malignant fever.” On
    February 16th Lady Otway writes again:--“So much sickness now in our
    Castle that they dye in droves like rotten sheep, and be 4 or 5 in a
    night throne into the Castle ditch ffor ther graves. The feavour and
    sickness increaseth dayly, is begun to spread much into the citty, and
    many of the guard solidyers is sick, it is thought by inffection. The
    Lord preserve us ffrom plague and pestilence[94]!”


Prosperity of Britain, 1715-65.

The fifty years from 1715 to 1765 were, with two or three exceptions,
marked by abundant harvests, low prices and heavy exports of corn. This
was undoubtedly a great time in the expansion of England, a time of
fortune-making for the monied class, and of cheapness of the necessaries
of life.

The well-being and comfort of the middle class were undoubtedly great;
also there was something peculiar to England in the prosperity of towns
and villages throughout all classes. In the very worst year of the period,
the year 1741, Horace Walpole landed at Dover on the 13th September,
having completed the grand tour of Europe. Like many others, he was
delighted with the pleasant county of Kent as he posted towards London;
and on stopping for the night at Sittingbourne, he wrote as follows in a
letter:

    “The country town delights me: the populousness, the ease, the gaiety,
    and well-dressed everybody, amaze me. Canterbury, which on my setting
    out I thought deplorable, is a paradise to Modena, Reggio, Parma, etc.
    I had before discovered that there was nowhere but in England the
    distinction of _middling people_. I perceive now that there is
    peculiar to us _middling houses_; how snug they are[95]!”

Our history henceforth has little to record of malignant typhus fevers, or
of smallpox, in these snug houses of the middle class, although not only
the middle class, but also the highest class had a considerable share of
those troubles all through the 17th century. But the 18th century, even
the most prosperous part of it, from the accession of George I. to the
beginning of the Industrial Revolution in the last quarter or third of it,
was none the less a most unwholesome period in the history of England. The
health of London was never worse than in those years, and the vital
statistics of some other towns, such as Norwich, are little more
satisfactory. This was the time which gave us the saying, that God made
the country and man made the town. Praise of rural felicity was a common
theme in the poetry of the time, as in Johnson’s _London_:

  “There every bush with nature’s music rings,
   There every breeze bears health upon its wings.”

Both for the country and the town the history of the public health does
not harmonize well with the optimist views of the 18th century. The
historians are agreed that, under the two first Georges, during the
ministries of Walpole, the Pelhams and Pitt, the prosperity of Britain was
general. Adam Smith speaks of “the peculiarly happy circumstances of the
country” during the reign of George II. (1727-60). Hallam characterizes
the same reign as “the most prosperous that England had ever experienced.”
The most recent historian of England in the 18th century is of the same
opinion[96]. The novels of Fielding give us the concrete picture of the
period with epic fidelity, and the picture is of abundance and
prodigality. Agriculture and commerce with the Colonies, India and the
continent of Europe, were the sources of the country’s wealth. Farming and
stock-raising had been greatly improved by the introduction of roots and
sown grasses. In some country parishes the baptisms were three times the
burials. But the public health during this period will not appear in a
favourable light from what follows. More particularly there were three
occasions, about the years 1718, 1728 and 1741, when a single bad harvest
in the midst of many abundant ones brought wide-spread distress, with
epidemics of typhus and relapsing fever; from which fact it would appear
that the common people had little in hand. Thorold Rogers, among
economists, was of the opinion that the prosperity was all on the side of
the governing and capitalist classes, that the labourers were in
“irremediable poverty” and “without hope,” and that the law of parochial
settlement, with the artificial fixing of wages by the Quarter Sessions
and the bonuses out of the poor-rates, had the effect of keeping the mass
of the people on the land “in a condition wherein existence could just be
maintained[97].” I shall not attempt an independent judgment in economics,
but proceed to those illustrations of national well-being which belong to
my subject, leaving the latter to have their due weight on the one side of
economical opinion or on the other. Besides the economical question there
is of course also an ethical one. When the pinch came about 1766, there
was the usual diversity of opinion expressed on the “condition of England”
problem, one holding that the labourers were unfairly paid, another that
the nation had been made “splendid and flourishing by keeping wages low,”
and that the distress was due to “want of industry, want of frugality,
want of sobriety, want of principle” among the common people at large. “If
in a time of plenty,” wrote one austere moralist, “the labourers would
abate of their drunkenness, sloth, and bad economy, and make a reserve
against times of scarcity, they would have no reason to complain of want
or distress at any time[98].” But there must have been something wrong in
the economics and morals of their betters if it were the case that the
working class as a whole, and not merely a certain number of individuals
in it, was drunken, thriftless and slothful. The familiar proof of this is
the apathy of the Church, broken by the Methodist revival of religion.


The epidemic fevers of 1718-19.

In the fifty years from 1715 to 1765, the three worst periods of epidemic
fever in England and Scotland correspond closely to the three periods of
actual famine and its attendant train of sicknesses in Ireland, namely,
the years 1718-19, 1727-29, and 1740-42. The three divisions of the
kingdom suffered in common, Ireland suffering most. The first period,
1718-19, was an extremely slack tide in medical writing, insomuch that
hardly any accounts of the reigning maladies remain, except those by
Wintringham, of York, and Rogers, of Cork. The whole of the Irish history
of fevers and the allied maladies is dealt with in a chapter apart. Of the
Scots history, little is known for the first of the three periods beyond a
statement that there was a malignant fever and dysentery in Lorn,
Argyllshire, in January and February, 1717[99].

Wintringham gives the following account of the _synochus_, afterwards
called typhus, which attracted notice in the summer of 1718 and became
more common in the warm season of 1719: in each year it began about May,
reached its height in July and lasted all August, carrying off many of
those who fell into it.

    It began with rigors, nausea and bilious vomiting, followed by
    alternate heats and chills, with great lassitude and a feeling of
    heaviness: then thirst and pungent heat, a dry and brown tongue,
    sometimes black. The patient slept little, did not sweat, and was
    mostly delirious, or anxious and restless, tossing continually in bed.
    About the 12th day it was not unusual for profuse and exhausting
    diarrhœa to come on. In a favourable case the fever ended in a crisis
    of sweating about the 16th day. Those who were of lax habit,
    unhealthy, hysteric, or cachectic, were apt to have tremors, spasms
    and delirium, while others were so prostrated as to have no control
    over their evacuations, lying in a stupor and raving when roused out
    of it. In these the fever would continue to the 20th day; in some few
    it ended without a manifest crisis, and with a slow
    convalescence[100].

This applies to the city of York, but in what special circumstances we are
not told. However, it happens that a physician of York, two generations
after, in giving an account of the great improvement that had taken place
in its public health, throws some light on its old-world state: “The
streets have been widened in many places by taking down a number of old
houses built in such a manner as almost to meet in the upper stories, by
which the sun and air were almost excluded in the streets and inferior
apartments[101].”

In London the fever-deaths, with the deaths from all causes, rose
decidedly in 1718, and reached a very high figure in 1719, of which the
summer was excessively hot. One cause, at least, was want of employment,
especially among weavers in the East End[102]. But the epidemic fever of
1718-19 was not limited to the distressed classes; we have a glimpse of
it, under the name of “spotted fever,” in the family of the archbishop of
Canterbury:

“On Friday night the archbishop of Canterbury’s sixth daughter was
interred in our chancel, with four others preceding, she dying on Monday
after three days of the spotted fever. The fourth and seventh are
recovered, and hoped past danger[103].”

The following table shows the fever-mortalities for London, from 1718
onwards, and, for comparison, the excessive mortalities in the epidemics
of 1710 and 1714:

_London Mortalities from Fever, &c._

  Year    Fevers    Spotted fevers    Smallpox    All causes

  1710     4397           343           3138        24620
  1714     4631           150           2810        26569
  1718     3475           132           1884        26523
  1719     3803           124           3229        28347
  1720     3910            46           1442        25454
  1721     3331            84           2375        26142
  1722     3088            22           2167        25750
  1723     3321            51           3271        29197
  1724     3262            84           1227        25952
  1725     3277            59           3188        25523
  1726     4666            84           1569        29647
  1727     4728           102           2379        28418
  1728     4716            94           2105        27810
  1729     5235       [The entry        2849        29722
  1730     4011          ends.]         1914        26761
  1731     3225                         2640        25262
  1732     2939                         1197        23358
  1733     3831                         1370        29233
  1734     3116                         2688        26062
  1735     2544                         1594        23538
  1736     3361                         3014        27581
  1737     4580                         2084        27823
  1738     3890                         1590        25825
  1739     3334                         1690        25432
  1740     4003                         2725        30811

In country parishes, according to Short’s abstracts of registers, there
was no unusual sickness in 1718 and 1719. But in market towns the
mortality rose greatly in 1719, which had an excessively hot summer; and
that was the year when the _synochus_ or typhus described by Wintringham
reached its worst at York. The mortality kept high for several years after
1719.

_Market Towns._

          Registers    Registers with     Deaths     Births
  Year    examined    excess of deaths    in same    in same

  1716       30               8             1060        845
  1717       30               9             1485       1290
  1718       30               3              249        169
  1719       30               6             1737       1320
  1720       30              10             2186       1461
  1721       33               9             1294        952
  1722       33              11             1664       1345
  1723       33              14             2532       2176

The high mortalities in 1721-23 were mostly from smallpox, exact figures
of many of the epidemics in Yorkshire and elsewhere being given in the
chapter on that disease. The country parishes shared in its prevalence:

_Country Parishes._

          Registers    Registers with     Deaths     Births
  Year    examined    excess of deaths    in same    in same

  1721       174             35             793        586
  1722       175             35            1015        775
  1723       174             63            2021       1583

Besides smallpox, diarrhoeas and dysenteries in the autumn are given by
Wintringham as the reigning maladies, fever not being mentioned.


The Epidemic Fevers of 1726-29: evidence of Relapsing Fever.

The four years 1726-29 were a great fever-period in London, the deaths
having been as follows:

  Year    Fever deaths    All deaths

  1726        4666          29,647
  1727        4728          28,418
  1728        4716          27,810
  1729        5335          29,722

In the last of those years the entry in the annual bills becomes “fever,
malignant fever, spotted fever and purples.”

The following are the weekly maxima of fever deaths and deaths from all
causes during the four years, 1726-29; in nearly all the weeks the deaths
from “convulsions” (generic name for most of the maladies of infants)
contribute from a fourth to a third, or even more, of the whole mortality.

          Week       Fever      All
         ending      deaths    deaths
  1726
        Jan.  18        71       633
        March 15        81       678
        May   31       103       611
        June   7       106       607
        Aug.  30       102       711
        Sept.  6       116       680
              13       109       643
              20       109       648
  1727
        Aug.   8       103       577
              15       123       698
              22       132       730
              29       130       789
        Sept.  5       150       764
              12       134       795
              19       165       798
              26       163       715
        Oct.   3       150       684
  1728
        Feb.   6       112       748
              13       131       889
              20       121       850
              27       145       927
        March  5        93       733
        Aug.  27       138       525
        Sept.  3       131       562
        Dec.  10       122       734
  1729
        Sept.  9       109       676
        Nov.   4       213       908[104]
              11       267       993[104]
              18       166       783
        Dec.   9       132       779

These are high mortalities, whatever were the types of fever that caused
them. That the old pestilential fever of London was one of them we need
have no doubt. Dr John Arbuthnot, writing two or three years after, said,
“I believe one may safely affirm that there is hardly any year in which
there are not in London fevers with buboes and carbuncles [the distinctive
pestilential marks]; and that there are many petechial or spotted fevers
is certain[105].”

The essay of Strother also has a reference to “spotted fever” in its
title, although the text throws very little light upon it[106]. But, for
the rest, the “constitution” of 1727-29 is more than usually perplexing.
There was an influenza at the end of 1729, which can be separated from the
rest easily enough by the help of the London weekly bills of mortality;
and it is probable, unless Arbuthnot, Huxham and Rutty have erred in their
dates, that one or more epidemics of catarrhal fever had occurred before
that, in the years 1727 and 1728. The greatest difficulty is with a
certain “little fever,” or “hysteric fever,” or “febricula,” which gave
rise to some writing and a good deal of talk. Strother does not specially
treat of it, at least under that name, although he says that “many,
especially women, have been subject to fits of vapours, cold sweats,
apprehensions, and unaccountable fears of death; every small
disappointment dejected them, tremblings and weakness attended them,” etc.
(p. 116); and again, “never was a season when apoplexies, palsies and
other obstructions of the nerves did prevail so much as they do at
present, and have done for some time past” (p. 102); while he had
frequently seen hysterical and hypochondriacal symptoms, dejection of
spirits and the like remaining behind the fever (p. 109). For some years
before this, much had been heard in London of the vapours, the “hypo,” the
spleen, and the like, an essay by Dr Mandeville, better known by his
‘Fable of the Bees,’ having first made these maladies fashionable in the
year 1711[107].

In due time it began to be noticed that symptoms which many physicians
made light of as a “fit of vapours” were really the beginning of a fever.
Dr Blackmore, in an essay on the Plague written in 1721, admitted the
ambiguity:

    “For several days a malignant fever has so near a resemblance to one
    that is only hysterick, that many physicians and standers by, I am apt
    to believe, mistake the first for the last, and look upon a great and
    dangerous disease to be only the spleen, or a fit of the vapors, to
    the great hazard of the patient[108].”

In 1730, Dr William Cockburn, in a polemic against the physicians whom he
styles “the academical cabal” (because they objected to his secret
electuary for dysentery), professes to give a history of the mistakes of
the faculty in London over this “little fever,” or “hysteric fever,” which
often became dangerous[109]:

    “The present fever, with a variation in some of its symptoms, has now
    subsisted twelve years [or since 1718] not in England only, but all
    over Europe [Manningham says it was peculiarly English]. Few or no
    physicians suspected the reigning and popular disease to be a fever.
    Vapours, a nervous disease, and such general appellations it had from
    sundry physicians. Others, who discovered the fever, knew it was the
    low or slow fever, first mentioned by Hippocrates.... The last were
    represented as ignorant for calling the distemper a fever, and
    affixing to it the name ‘low’ or ‘slow,’ a slow fever being, in their
    adversaries’ opinion, altogether unheard of among physicians and never
    recorded in their books. Nothing was more monstrous than calling this
    distemper a fever, or confining persons afflicted with it to their
    bed, and dieting them with broth, or other liquid food of good
    nourishment, and what is easily concocted.... ‘You are not hot, you
    are not dry; you are in good temper; and therefore you have no fever’
    was the common language of the town.... They might have seen
    physicians practising for a destroying distemper, and yet, after seven
    years, they confess themselves ignorant of its very name.”

At length, he continues, Blackmore admitted the ambiguity of diagnosis,
while Mead, Freind and others, recognized that there was really such a
thing as a slow, nervous fever, by no means free from danger to life. It
is probably to this insidious fever that Strother refers:

    “Thus, having gone on for six or seven days in a train of indolence,
    they have been surprized on the seventh day, and have died on the
    eighth lethargick or delirious, whereas, if they had taken due care,
    the fever would have run its course in fifteen days or more.” It was
    the remissions, or intermissions, he explains, that often misled
    patients, by which he seems to mean the clear intervals between
    relapses. “Others, wearied out with relapses, have hoped their
    recovery would as certainly ensue as it had hitherto, and have
    deferred asking advice until it was too late.” These relapses, he
    thought, were brought on by venturing too soon into the air: “it is
    too well known that the fever has been cured, and patients have soon,
    after they have ventured into the air, relapsed and have again run the
    same circle of ill symptoms, if not worse than before.” Bark failed
    conspicuously in these “remittents:” “it is therefore incumbent on me
    to examine into the reason of this _new phenomenon_. I call it _new_,”
    he explains, because bark had hitherto succeeded. “Perhaps we may find
    reason to lay some blame on the air for the frequent relapses....
    Periodical comas have of late been common; so soon as the fit was
    over, the drowsiness abated till the fit returned.”

    Elsewhere he speaks of the frequent relapses as belonging to a
    “quartan,” under which diagnosis bark had been tried. The fevers were
    less apt to “relapse” when treated by mild cathartics. Another symptom
    of this fever was jaundice: “If jaundice breaks forth on the fourth
    day of a fever, it is much better than if it comes at the conclusion
    of a fever.... Jaundices are now very common after the cure of these
    fevers.”

These indications, dispersed throughout the rambling essay of Strother,
point somewhat plainly to relapsing fever[110]. But his theoretical
pathology comes in to obscure the whole matter. He explains everything by
obstructions. The jaundice was due to obstruction of the liver by
“styptics,” the hysteric symptoms to obstructions of the nerves; there
were also theoretical obstructions of the mesentery, part of the matter
being sometimes “thrown off into the mesenteric glands”; also
“congestions” or phlegmons of the liver, spleen and pancreas. But it is
when he comes to the bowels that his subjective morbid anatomy becomes
truly misleading. There is nothing to show that Strother examined a single
body dead of this fever. He says, however, in his _à priori_ way: “The
crisis of these slow fevers is generally deposited on the bowels.... The
lent fever is a symptomatical fever, arising from an inflammation, or an
ulcer fixed on some of the bowels. A lent fever, depending on some fixed
cause of the bowels, must be cured by having regard to those causes some
of which I shall enumerate”:--the first supposition being that the fever
depends on phlegmons by congestion of “the liver, spleen, pancreas, or the
mesentery”; the second, if it depends on extravasations in an equally
comprehensive range of viscera; the third, “if it depends on an ulcer,
then all vulneraries must be administered internally; but to speak truth,
when the viscera are ulcerated, there remains but small hope of life”; the
fourth supposition is worms, the fifth corruption of the humours. All
this is paper pathology. There is not a single precise fact relating to
ulcerated Peyer’s patches, or to swollen mesenteric glands, or to enlarged
spleen, which last would have been equally distinctive of relapsing as of
enteric fever; it is “the viscera” that are ulcerated, or congested, or
extravasated, or it is “some of the bowels,” or the pancreas and liver
obstructed as well as the spleen, the obstruction of the liver being
invoked to explain the highly significant jaundice.

It is not quite clear whether Strother’s fever with relapses and jaundice
corresponded exactly to the little fever, hysteric fever, or nervous fever
of the same years; but it is worthy of note that relapsing fever in
Ireland a century later was called febricula or the “short fever.” It was
not until 1746 that the excellent essay upon it by Sir Richard Manningham
was written. By that time a good deal was being said in various parts of
Britain of a slow, nervous, or putrid fever, Huxham, in particular,
identifying the nervous fever with Manningham’s febricula or little
fever[111]. Some have supposed that the nervous fever of the 18th century
included cases of enteric fever, if it did not stand for that disease
exclusively. Murchison takes Manningham’s essay to be “an excellent
description of enteric fever, under the title of febricula or little
fever, etc.[112]” The following are brief extracts from his description,
by which the reader will be able to form his own opinion on the question
of identity[113].

    At the beginning patients feel merely languid or uneasy, with flying
    pains, dryness of the lips and tongue but no thirst; in a day or two
    they find themselves often giddy, dispirited and anxious without
    apparent reason, and passing pale urine. They have transient fits of
    chilliness, a low, quick and unequal pulse, sometimes cold clammy
    sweats and risings in the throat. They go about until more violent
    symptoms come on, simulating those of quotidian, tertian or quartan
    fever; sometimes the malady simulates pleurisy. There may be attacks
    of dyspnoea, nausea and haemorrhage; the menses in women are checked.
    A loss of memory and a delirium occur at intervals for short periods.
    The malady is very difficult to cure and too often becomes fatal in
    the end. It will last thirty or forty days, unless it end fatally in
    stupor or syncope. A form of mania is a consequence of it, where it
    has been neglected or badly treated; “of late years this species of
    madness has been more than ordinarily frequent.” All sorts were liable
    to it, but mostly valetudinarians, delicate persons, and those in the
    decline of life; the fatalities were “especially among the opulent
    families of this great metropolis[114].”

This fever-period in London corresponds on the whole closely with a series
of unhealthy years in Short’s tables from the registers of market towns
and country parishes, and with high mortalities in the Norwich register.
It was not specially a smallpox period, as the last unhealthy year, 1723,
was. On the other hand the epidemiographists in Yorkshire, Devonshire and
Ireland dwell most upon fevers of the nature of typhus, some of which were
due to famine or dearth, and upon “agues.”

_Market Towns._

         Registers  No. with excess  Deaths    Births
  Year   examined      of deaths     in same   in same

  1727       33           19          3606      2441
  1728       34           23          4972      2355
  1729       36           27          6673      3494
  1730       36           16          3445      2529

_Norwich._

  Year        Buried      Baptized

  1728         1417          774
  1729         1731          843

_Country Parishes._

         Registers    With excess   Burials   Baptisms
  Year   examined     of burials    in same   in same

  1726      181           22           542       495
  1727      180           55          1368      1091
  1728      180           80          2429      1536
  1729      178           62          2015      1442
  1730      176           39          1302      1022
  1731      175           24           700       614

The best epidemiologists of the time were not in London, but at York,
Ripon, Plymouth, Cork and Dublin. Leaving the Irish history to a separate
chapter, we shall find in the annals of Wintringham, Hillary and Huxham a
somewhat detailed account of the fevers which caused the very high
mortalities of the years 1727-29, with an occasional glimpse of the
circumstances in which the fevers arose. Much of what follows relates to
the same nervous, hysteric or “putrid” fever, with or without relapses,
that has been described for London. Going back a little, Wintringham
says[115] that the continued fevers of 1720 were milder than those of the
year before (which were synochus or typhus) and were often languid or
nervous, with giddiness, stupor and nervous tremblings, a quick pulse, a
whitish tongue, no thirst, and sweats of the head, neck and chest: this
fever lasted twenty days or more, and ended in a general sweat. He had
mentioned the “languid nervous fevers” first in the years 1716 and 1717,
and he mentions them again as mixed with or following the synochus or
typhus of 1727-28.

In April, 1727, there were fevers prevalent, remitting and intermitting,
but with uncertain paroxysms; in May, a fever with pleuritic pains; in
July, a putrid fever in some, but the chief diseases of that month were
“remittents and intermittents,” which were often attended by cutaneous
eruptions, sometimes of dusky colour and dry, at other times full of clear
serum; which, “as they depended upon a scorbutic taint, tormented the sick
with pruritus.” The sick persons in these remittents were for the most
part drowsy and stupid, especially during the paroxysm; the fevers were
followed by lassitude, debility, languor of spirits and hysteric symptoms.

Hillary[116], who practised at Ripon, not far from Wintringham, at York,
records in 1726 the prevalence of remittents and intermittents: “some had
exanthematous eruptions towards the latter end of the disease, filled with
a clear or yellowish water, which went or dried away without any other
inconvenience to the sick but an uneasy itching for a few days”--just as
Wintringham had described a miliary fever for 1727. It is also under 1726
that he describes the same drowsy and nervous symptoms of Wintringham’s
summer fever of 1727:

    “Ancient and weak hysterical people had nervous twitchings and
    catchings, and were comatous and delirious; some were very languid,
    sick and faint, and had tremors; the young and robust, who had more
    full pulses, were generally delirious, unless it was prevented or
    taken off by proper evacuations and cooling medicines. I found
    blistering to be of very great service in this fever, and the sick
    were more relieved by it than ever I observed in any other fever
    whatever. People of lax, weak constitutions were very low and faint,
    and had frequent, profuse, partial sweatings, which most commonly were
    cold and clammy.” Huxham also, at the other end of England, says that
    in October and November, 1727, a slow nervous fever attacked not a
    few; and under the date of January, 1728, he confirms the Yorkshire
    experiences of the prevalence of angina.

There can be little doubt that England in 1727 was already suffering in a
measure from the distress that was acutely felt in Ireland; it was much
aggravated by the hard winter of 1728-29[117], but it had begun before
that and was doubtless the indirect cause of the great prevalence of
sickness. The exports of corn under the bounty system used to bring two or
three millions of money into the country in a year. But in 1727 there was
a debt balance of 70,757 quarters of wheat imported, and in 1728 the
import exceeded the export by 21,322 quarters, the price rising at the
same time from 4_s._ to 8_s._ per bushel[118]. Under the year 1727 Hillary
says:

    “Many of the labouring and poor people, who used a low diet, and were
    much exposed to the injuries and changes of the weather, died; many of
    whom probably wanted the necessary assistance of diet and medicines.”
    And after referring, under the winter of 1727-28, to the prevalence of
    a fatal suffocative angina, which fell, by a kind of metastasis, on
    the diaphragm or pleura, and sometimes on the peritoneum, he proceeds
    (p. 16):--

    “Nor did any other method, which art could afford, relieve them:
    insomuch that many of the little country towns and villages were
    almost stripped of their poor people, not only in the country adjacent
    to Ripon, but all over the northern parts of the kingdom: indeed I had
    no certain account of what distempers those who were at a distance
    died of, but suppose they were the same as those which I have
    mentioned, which were nearer to us. Bleeding, pectorals with
    volatiles, and antiphlogistic diluters and blistering, were the most
    successful. I observed that very few of the richer people, who used a
    more generous way of living, and were not exposed to the inclemencies
    of the weather, were seized with any of these diseases at this
    time.... The quartans were very subject to turn into quotidians, and
    sometimes to continual, in which the sick were frequently delirious.”

The Yorkshire accounts by Wintringham and Hillary for the second year of
this epidemic period, the year 1728, are very full, as regards the
symptoms or types of the fevers; but it would be tedious to cite them at
length, and unnecessary to do so unless to answer the not inconceivable
cavil that the fevers were not of the nature of typhus in one or other of
its forms. The chief point is that the second year, towards Midsummer,
brought a fever with the symptoms of _synochus_, and not rarely marked
with small red spots like fleabites or with purple petechiae. In the
autumn of 1729, Hillary noticed a fever of a slow type, which might go on
as long as thirty days and end without a perfect crisis--the nearest
approach to enteric fever in any of the descriptions. For the same years,
1727-29, Huxham, of Plymouth, describes languid fevers of the “putrid”
type, with profuse sweating, followed by typhus of a more spotted type.
Like the Yorkshire observer, Huxham mentions also “intermittents” as mixed
with the continued fevers.

The great prevalence of these fevers, “intermittents and other fevers,” in
the west of England in 1728-29 was known to Dr Rutty of Dublin, who speaks
especially of “the neighbourhoods of Gloucester and London, and very
mortal in the country places, but less in the cities.” This is confirmed
by Dover:

    “I happened to live in Gloucestershire in the years 1728 and 1729,
    when a very fatal epidemical fever raged to such a degree as to sweep
    off whole families, nay almost whole villages. I was called to several
    houses where eight or nine persons were down at a time; and yet did
    not so much as lose one patient where I was concerned[119].”

Some of the cases of nervous or putrid fever in the epidemics of 1727-29
appear to have been marked by relapses in the country districts as well as
in London. Huxham says under date of April, 1728, that those who had
wholly got rid of the putrid fever were exceedingly apt to have relapses.
Hillary does not mention relapses until March, 1733, when a fever, with
many hysterical symptoms, which succeeded the influenza of that year,
relapsed in several, “though seemingly perfectly recovered before.” But he
seems really to be contrasting relapsing fever and typhus when he points
out that, whereas the inflammatory type of fever in the first year of the
epidemic (1727) was greatly benefited by enormous phlebotomies, the fever
patients in the two seasons following, when the fever was more of the
nature of spotted typhus, could not stand the loss of so much blood, or,
it might be, the loss of any blood[120]. This was precisely the remark
made by Christison and others a century later, when the inflammatory
synocha, which often had the relapsing type very marked, changed to the
spotted typhus.

From the year 1731 we begin to have annual accounts (soon discontinued) of
the reigning maladies in Edinburgh, on the same plan as Wintringham’s,
Hillary’s and Huxham’s, with which, indeed, they are sometimes collated
and compared[121]. The fevers of Edinburgh and the villages near were as
various as those of Plymouth, according to Huxham, and singularly like the
latter. Thus, in the winter of 1731-32, there was much worm fever,
comatose fever, or convulsive fever among children, but not limited to
children, marked by intense pain in the head, raving in some, stupor in
others, tremulous movements, leaping of the tendons, and all the other
symptoms described by Willis for the fever of 1661, a fatal case of
October, 1732, in a boy of ten, recorded by St Clair one of the Edinburgh
professors, reading exactly like the cases of Willis already given[122].
St Clair’s case, which was soon fatal, had no worms; but in the general
accounts, both for the winter of 1731-32 and the autumn of 1732, it is
said that many of the younger sort passed worms, both _teretes_ and
_ascarides_, and recovered, the fatalities among children being, as usual,
few. In March and April, 1735, there were again “very irregular fevers of
children.” Huxham records exactly the same “worm-fever” of children at
Plymouth in the spring of 1734--a fever with pains in the head, languor,
anxiety, oppression of the breast, vomiting, diarrhoea, and a comatose
state (_affectus soporosus_), which attacked the young mostly, and was
often attended by the passage of worms. He gives the same account of the
seasons as Gilchrist--the years 1734 and 1735 marked by almost continual
rains, the country more squalid than had been known for some years[123].

But it is the nervous fever that chiefly engrosses attention both in
Scotland and in England. In 1735, Dr Gilchrist, of Dumfries, made it the
subject of an essay, returning to the subject a few years after[124]. “As
_our_ fever,” he says, “seems to be peculiar to this age, it is not a
little surprising that much more has not been said upon it.” He is not
sure whether its frequency of late years may not be owing to the manner of
living (it was the time of the great drink-craze, which Huxham also
connects with the reigning maladies) and to a long course of warm, rainy
seasons; the winters for some years had been warm and open, and the
summers and harvests rainy. It was only the poorer sort and those a degree
above them who were subject to this fever; he knew but few instances of it
amongst those who lived well, and none amongst wine-drinkers. It was in
some insidious in its approach; those who seemed to be in no danger the
first days for the most part died. In others the onset was violent, with
nausea, heat, thirst and delirium. Among the symptoms were looseness,
pains in the belly, local sweating, tickling cough, leaping of the
tendons. Sometimes they were in continual cold clammy sweats; at other
times profuse sweats ran from them, as if water were sprinkled upon them,
the skin feeling death cold.

At Edinburgh, from October, 1735, to February, 1736, the fever became very
common, and was often a relapsing fever.

    “The sick had generally a low pulse on the first two or three days,
    with great anxiety and uneasiness, and thin, crude urine. Delirium
    began about the fourth day, and continued until the fever went off on
    the seventh day. Sometimes the disease was lengthened to the
    fourteenth day. The approach of the delirium could always be foretold
    by the urine becoming more limpid, and without sediment.... A large
    plentiful sweat was the crisis in some. Others were exposed to
    relapses, which were very frequent, and rather more dangerous than the
    former fever[125].”

These evidences, beginning with Strother’s for London in 1728 and
extending to the Edinburgh record of 1735, must suffice to identify true
relapsing fever. In the chapter on Irish fevers we shall find clear
evidence of relapsing fever in Dublin in 1739, before the great famine had
begun.

Huxham’s account of the fevers at Plymouth, in Devonshire generally, and
in Cornwall about the years 1734-36 is of the first importance. It is
highly complex, owing to the prevalence of an affection of the throat, so
that one part of the constitution is “anginose fever.” This has been dealt
with in the chapter on Scarlatina and Diphtheria. Another part was true
typhus. In his account of the nervous fever we are introduced, as in the
Yorkshire annals, 1726-27, to a phenomenon that was almost distinctive of
the low, nervous or putrid fever from about 1750 to 1760 or longer,
namely, the eruption of red, or purple, or white watery vesicles, from
which it got the name of miliary fever. Huxham’s annals are full of this
phenomenon about the years 1734-36[126]. The red pustules, or white
pustules, with attendant ill-smelling sweats, are mentioned over and over
again. He thought them critical or relieving: “Happy was then the patient
who broke out in sweats or in red pustules.” These fevers are said to have
extended to the country parts of Devonshire, after they had ceased in
Plymouth, and to Cornwall in August, 1736. In Plymouth itself the type of
fever changed after a time to malignant spotted fever, synochus, or true
typhus.

The malignant epidemic seemed to have been brought in by the fleet; it had
raged for a long time among the sailors of the fleet lying at Portsmouth,
and had destroyed many of them. In March, 1735, it was raging among the
lower classes of Plymouth. About the 10th day of the fever, previously
marked by various head symptoms, there appeared petechiae, red or purple,
or livid or black, up to the size of vibices or blotches, or the eruption
might be more minute, like fleabites. A profuse, clammy, stinking sweat,
or a most foetid diarrhoea wasted the miserable patients. A black tongue,
spasms, hiccup, and livid hands presaged death about the 11th to 14th day.
So extensive and rapid was the putrefaction of the bodies that they had to
be buried at once or within twenty-four hours. It was fortunate for many
to have had a mild sweat and a red miliary eruption about the 4th or 5th
day; but for others the course of the disease was attended with great
risk. In April the type became worse, and the disease more general. There
was rarely now any constriction of the throat. Few pustules broke out; but
in place of them there were dusky or purple and black petechiae, and too
often livid blotches, with which symptoms very many died both in April and
May. In July this contagious fever had decreased much in Plymouth, and in
September it was only sporadic there. With a mere reference to Hillary’s
account of somewhat similar fevers at Ripon in 1734-5 (with profuse
sweats, sometimes foetid, great fainting and sinking of spirits, starting
of the limbs and beating of the tendons, hiccup for days, etc.[127]) we
may pass to a more signal historical event, the great epidemic of fever in
1741-42, of which the Irish part alone has hitherto received sufficient
notice[128].


The epidemic fever of 1741-42.

The harvest of 1739 had been an abundant one, and the export of grain had
been large. At Lady-day the price of wheat had been 31_s._ 6_d._ per
quarter, and it rose 10_s._ before Lady-day, 1740. An extremely severe
winter had intervened, one of the three memorable winters of the 18th
century. The autumn-sown wheat was destroyed by the prolonged and intense
frost, and the price at Michaelmas, 1740, rose to 56_s._ per quarter, the
exportation being at the same time prohibited, but not until every
available bushel had been sold to the foreigners. The long cold of the
winter of 1739-40 had produced much distress and want in London, Norwich,
Edinburgh and other towns. In London the mortality for 1740 rose to a very
high figure, 30,811, of which 4003 deaths were from fever and 2725 from
smallpox. In mid-winter, 1739-40, coals rose to £3. 10_s._ per chaldron,
owing to the navigation of the Thames being closed by ice; the streets
were impassable by snow, there was a “frost-fair” on the Thames, and in
other respects a repetition of the events preceding the London typhus of
1685-86. The _Gentleman’s Magazine_ of January, 1740, tells in verse how
the poor were “unable to sustain oppressive want and hunger’s urgent
pain,” and reproaches the rich,--“colder their hearts than snow, and
harder than the frost”; while in its prose columns it announces that “the
hearts of the rich have been opened in consideration of the hard fate of
the poor[129].” The long, hard winter was followed by the dry spring and
hot summer of 1740, during which the sickness (in Ireland at least) was of
the dysenteric type. In the autumn of 1740 the epidemic is said to have
taken origin both at Plymouth and Bristol from ships arriving with
infection among the men--at the former port the king’s ships ‘Panther’ and
‘Canterbury,’ at the latter a merchant ship. At Plymouth it was certainly
raging enormously from June to the end of the year--“febris nautica
pestilentialis jam saevit maxime,” says Huxham; it continued there all
through the first half of 1741, “when it seemed to become lost in a fever
of the bilious kind.” It was in the dry spring and very hot summer of 1741
that the fever became general over England. Wall says that it appeared at
Worcester at the Spring Assizes among a few; at Exeter also it was traced
to the gaol delivery; and it was commonly said that the turmoil of the
General Election (which resulted in driving Walpole from his long term of
power) helped its diffusion. But undoubtedly the great occasion of its
universality was a widely felt scarcity. The rise in the price of wheat
was small beside the enormous leaps that prices used to take in the
medieval period, having been at no time double the average low price of
that generation. It was rather the want of employment that made the pinch
so sharp in 1741. The weaving towns of the west of England were losing
their trade; of “most trades,” also, it was said that they were in
apparent decay, “except those which supply luxury[130].” Dr Barker, of
Sarum, the best medical writer upon the epidemic, says:

    “The general poverty which has of late prevailed over a great part of
    this nation, and particularly amongst the woollen manufacturers in the
    west, where the fever has raged and still continues to rage with the
    greatest violence, affords but too great reason to believe that this
    has been one principal source of the disease[131].”

He explains that the price of wheat had driven the poor to live on bad
bread. This is borne out by a letter from Wolverhampton, 27 November,
1741[132]. The writer speaks of the extraordinary havoc made among the
poorer sort by the terrible fever that has for some time raged in most
parts of England and Ireland. At first it seldom fixed on any but the poor
people, and especially such as lived in large towns, workhouses, or
prisons. Country people and farmers seemed for the most part exempt from
it, “though we have observed it frequently in villages near market towns”;
whereas, says the writer, the epidemic fevers of 1727, 1728 and 1729 were
first observed to begin among the country people, and to be some time in
advancing to large towns. This writer’s theory was that the fever was
caused by bad bread, and he alleges that horse-beans, pease and coarse
unsound barley were almost the only food of the poor. To this a Birmingham
surgeon took exception[133]. Great numbers of the poor had, to his
knowledge, lived almost entirely upon bean-bread, but had been very little
afflicted with the fever. Besides, every practitioner knew that the fever
was not confined to the poor. He pointed out that in Wolverhampton, whence
the bad-bread theory emanated, the proportion of poor to those in easier
circumstances was as six to one, poverty having increased so much by decay
of trade that many wanted even the necessaries of life. The Birmingham
surgeon was on the whole inclined to the theory of “the ingenious
Sydenham, that the disease may be ascribed to a contagious quality in the
air, arising from some secret and hidden alterations in the bowels of the
earth, passing through the whole atmosphere, or to some malign influence
in the heavenly bodies”--these being Sydenham’s words as applied to the
fever of 1685-6.

Barker, also, draws a parallel between the epidemic of 1741 and that of
1685-86: the Thames was frozen in each of the two winters preceding the
respective epidemics, and the spring and summer of 1740 and 1741 were as
remarkable for drought and heat as those of 1684 and 1685.

In London the deaths from fever in 1741 reached the enormous figure of
7528, the highest total in the bills of mortality from first to last,
while the deaths from all causes were 32,119, in a population of some
700,000, also the highest total from the year of the great plague until
the new registration of the whole metropolitan area in 1838. It will be
seen from the following table (on p. 81) of the weekly mortalities that
the fever-deaths rose greatly in the autumn, but, unlike the old plague,
reached a maximum in the winter.

The effects of the epidemic of typhus upon the weaving towns of the west
of England, in which the fever lasted, as in London, into the spring of
1742, were seen at their worst in the instance of Tiverton. It was then a
town of about 8000 inhabitants, having increased little during the last
hundred years. Judged by the burials and baptisms in the parish register
it was a more unhealthy place since the extinction of plague than it had
been before that. It was mostly a community of weavers, who had not been
in prosperous circumstances for sometime past. In 1735 the town had been
burned down, and in 1738 it was the scene of riots. The hard winter of
1739-40 brought acute distress, and in 1741 spotted fever was so prevalent
that 636 persons were buried in that year, being 1 in 12 of the
inhabitants. At the height of the epidemic ten or eleven funerals were
seen at one time in St Peter’s churchyard. Its population twenty years
after is estimated to have declined by two thousand, and at the end of the
18th century it was a less populous place than at the beginning[134].

_Mortality by Fever in London, 1741-42._

        Week              All
      ending     Fever   causes
  1741
      March 10    123     660
            17    103     564
            24    112     624
            31    105     573
       April 7    123     670
            14    128     687
            21     89     580
            28    123     622
         May 5    104     495
            12    141     587
            19    129     573
            26    153     600
        June 2    138     512
             9    138     483
            16    115     536
            23    127     494
            30    154     513
        July 7    149     523
            14    162     551
            21    130     485
            28    151     621
        Aug. 4    128     512
            11    142     541
            18    172     636
            25    192     665
       Sept. 1    171     675
             8    190     691
            15    182     760
            22    199     748
            29    189     733
       Oct.  6    207     784
            13    192     787
            20    232     793
            27    234     850
       Nov.  3    250     835
            10    228     772
            17    182     670
            24    214     806
       Dec.  1    224     768
             8    203     748
            15    191     761
            22    179     775
            29    180     702
  1742
        Jan. 5    221     893
            12    184     760
            19    151     724
        Feb. 2    132     675
             9    103     533
            16    108     675
            25    103     641

_Effects of the Epidemic of 1741-42 on Provincial Towns. (Short’s
Abstracts of Parish Registers.)_

                  With burials
       Registers   more than   Baptisms in  Burials in
  Year  examined   baptisms     the same     the same

  1740    27          6           1409         1940
  1741    27         14           3787         6205
  1742    26          6           1721         3345

Other parts of the kingdom may be represented by Norwich, Newcastle and
Edinburgh. The record of baptisms in Norwich is almost certainly
defective; in only two years from 1719 to 1741, is a small excess of
baptisms over burials recorded, namely, in 1722 and 1726, while in a third
year, 1736, the figures are exactly equal. In 1740 there are 916 baptisms
to 1173 burials, and in 1741, 851 baptisms to 1456 burials; while in 1742,
owing to an epidemic of smallpox, the deaths rose to 1953, or to more than
double the recorded births[135]. The distress was felt most in East Anglia
in 1740. Blomefield, who ends his history in that year, says there was
much rioting throughout the kingdom, “on the pretence of the scarcity and
dearness of grain.” At Wisbech Assizes fourteen were found guilty, but
were not all executed. In Norfolk two were convicted and executed
accordingly. At Norwich the military fired upon the mob and killed seven
persons, of whom only one was truly a rioter[136]. It was also in the
severe winter of 1739-40 that the distress began in Edinburgh. The mills
were stopped by ice and snow, causing a scarcity of meal; the harvest of
1740 was bad, riots took place in October, and granaries were
plundered[137]. The deaths from fever were many in 1740, but were nearly
doubled in 1741, with a significant accompaniment of fatal dysentery[138]:

_Edinburgh Mortalities, 1740-41._

(Population in 1732, estimated at 32,000.)[139]

                 1740    1741
  All causes     1237    1611
                 ----    ----
  Consumption     278     349
  Fever           161     304
  Flux              3      36
  Smallpox        274     206
  Measles         100     112
  Chincough        26     101
  Convulsions      22      16

The last four items are of children’s maladies, for which Edinburgh was
worse reputed even than London.

At Newcastle the deaths in the register in 1741 were 320 more than in
1740, in which year they were doubtless excessive, as elsewhere. But there
is a significant addition: “There have also been buried upwards of 400
upon the Ballast Hills near this town[140].”

The symptoms of the epidemic fever of 1741-42 are described by Barker, of
Salisbury, and Wall, of Worcester[141]. It began like a common cold, as
was remarked also in Ireland. On the seventh day spots appeared like
fleabites on the breast and arms; in some there were broad purple spots
like those of scurvy. Miliary eruptions were apt to come out about the
eleventh day, especially in women. In most, after the first six or seven
days, there was a wonderful propensity to diarrhoea, which might end in
dysentery. The cough, which had appeared at the outset, went off about the
ninth day, when stupor and delirium came on. Gilchrist, of Dumfries,
describes the fever there in November, 1741, as more malignant than the
“nervous fever” which he had described in 1735. It came to an end about
the fourteenth day; the sick were almost constantly under a coma or
raving, and they died of an absolute oppression of the brain; a profuse
sweat about the seventh day was followed by an aggravation of all the
symptoms[142]. An anonymous writer, dating from Sherborne, uses the
occasion to make an onslaught upon blood-letting[143].


Sanitary Condition of London under George II.

The great epidemic of fever in 1741-42 was the climax of a series of years
in London all marked by high fever mortalities. If there had not been
something peculiarly favourable to contagious fever in the then state of
the capital, it is not likely that a temporary distress caused by a hard
winter and a deficient harvest following should have had such effects.
This was the time when the population is supposed to have stood still or
even declined in London. Drunkenness was so prevalent that the College of
Physicians on 19 January, 1726, made a representation on it to the House
of Commons through Dr Freind, one of their fellows and member for
Launceston:

    “We have with concern observed for some years past the fatal effects
    of the frequent use of several sorts of distilled spirituous liquor
    upon great numbers of both sexes, rendering them diseased, not fit for
    business, poor, a burthen to themselves and neighbours, and too often
    the cause of weak, feeble and distempered children, who must be,
    instead of an advantage and strength, a charge to their country[144].”

“This state of things,” said the College, “doth every year increase.”
Fielding guessed that a hundred thousand in London lived upon drink alone;
six gallons per head of the population per annum is an estimate for this
period, against one gallon at present. The enormous duty of 20_s._ per
gallon served only to develope the trade in smuggled Hollands gin and
Nantes brandy. In the harvest of 1733 farmers in several parts of Kent
were obliged to offer higher wages, although the price of grain was low,
and could hardly get hands on any terms, “which is attributed to the great
numbers who employ themselves in smuggling along the coast[145].”

The mean annual deaths were never higher in London, not even in plague
times over a series of years, the fever deaths keeping pace with the
mortality from all causes, and, in the great epidemic of typhus in 1741,
making about a fourth part of the whole. The populace lived in a bad
atmosphere, physical and moral. As Arbuthnot said in 1733, they “breathed
their own steams”; and he works out the following curious sum:

    “The perspiration of a man is about 1/34 of an inch in 24 hours,
    consequently one inch in 34 days. The surface of the skin of a
    middle-sized man is about 15 square feet; consequently the surface of
    the skin of 2904 such men would cover an acre of ground, and the
    perspir’d matter would cover an acre of ground 1 inch deep in 34 days,
    which, rarefi’d into air, would make over that acre an atmosphere of
    the steams of their bodies near 71 foot high.” This, he explains,
    would turn pestiferous unless carried away by the wind; “from whence
    it may be inferred that the very first consideration in building of
    cities is to make them open, airy, and well perflated[146].”

In the growth of London from a medieval walled city of some forty or sixty
thousand inhabitants to the “great wen” of Cobbett’s time, these
considerations had been little attended to so far as concerned the
quarters of the populace. The Liberties of the City and the out-parishes
were covered with aggregates of houses all on the same plan, or rather
want of plan. In the medieval period the extramural population built rude
shelters against the town walls or in the fosse, if it were dry, or along
the side of the ditch. The same process of squatting at length extended
farther afield, with more regular building along the sides of the great
highways leading from the gates. Queen Elizabeth’s proclamation of 1580
was designed to check the growth of London after this irregular fashion;
but as neither the original edict nor the numerous copies of it, reissued
for near a hundred years, made any provision for an orderly expansion of
the capital, these prohibitions had merely the effect of adding to the
hugger-mugger of building, “in odd corners and over stables.” The
outparishes were covered with houses and tenements of all kinds, to which
access was got by an endless maze of narrow passages or alleys; regular
streets were few in them, and it would appear from the account given by
John Stow in 1598 of the parish of Whitechapel that even the old country
highway, one of the great roads into Essex and the eastern counties, had
been “pestered[147].” The “pestering” of the field lanes in the suburban
parishes with poor cottages is Stow’s frequent theme[148]. The borough of
Southwark, as part of the City, may have been better than most: “Then from
the Bridge straight towards the south a continual street called Long
Southwark, built on both sides with divers lanes and alleys up to St
George’s Church, and beyond it through Blackman Street towards New Town or
Newington”--the mazes of courts and alleys on either side of the Borough
Road which may be traced in the maps long after Stow’s time. So again in
St Olave’s parish along the river bank eastwards from London
Bridge--“continual building on both sides, with lanes and alleys, up to
Battle Bridge, to Horsedown, and towards Rotherhithe.” In the Western
Liberty, the lanes that had been laid out in Henry VIII.’s time, Shoe
Lane, Fetter Lane and Chancery Lane, served as three main arteries to the
densely populated area between Fleet Street and Holborn, but for the rest
it was reached by a plexus or _rete mirabile_ of alleys and courts,
notorious even in the 19th century. In like manner Drury Lane and St
Martin’s Lane were the main arteries between High Holborn and the Strand.
One piazza of Covent Garden was a new centre of regular streets, to which
the haberdashers and other trades were beginning to remove from the City,
for greater room, about 1662. The Seven Dials were a wonder when they were
new, about 1694, and had the same intention of openness and regularity as
in Wren’s unused design for the City after the fire. The great speculative
builder of the Restoration was Nicholas Barbone, son of Praise-God
Barbones. He built over Red Lion Fields, much to the annoyance of the
gentlemen of Gray’s Inn[149], and his manner of building may be inferred
from the following:

    “He was the inventor of this new method of building by casting of
    ground into streets and small houses, and to augment their number with
    as little front as possible, and selling the ground to workmen by so
    much per foot front, and what he could not sell build himself. This
    has made ground-rents high for the sake of mortgaging; and others,
    following his steps, have refined and improved upon it, and made a
    superfoetation of houses about London[150].”

In these mazes of alleys, courts, or “rents” the people were for the most
part closely packed. Overcrowding had been the rule since the Elizabethan
proclamation of 1580, and it seems to have become worse under the Stuarts.
On February 24, 1623, certain householders of Chancery Lane were indicted
at the Middlesex Sessions for subletting, “to the great danger of
infectious disease, with plague and other diseases.” In May, 1637, one
house was found to contain eleven married couples and fifteen single
persons; another house harboured eighteen lodgers. In the most crowded
parishes the houses had no sufficient curtilage, standing as they did in
alleys and courts. When we begin to have some sanitary information long
after, it appears that their vaults, or privies, were indoors, at the foot
of the common stair[151]. In 1710, Swift’s lodging in Bury Street, St
James’s, for which he paid eight shillings a week (“plaguy deep” he
thought), had a “thousand stinks in it,” so that he left it after three
months. The House of Commons appears to have been ill reputed for smells,
which were specially remembered in connexion with the hot summer of the
great fever-year 1685[152].

The newer parts of London were built over cesspools, which were probably
more dangerous than the visible nuisances of the streets satirized by
Swift and Gay. There were also the “intramural” graveyards; of one of
these, the Green Ground, Portugal Street, it was said by Walker, as late
as 1839; “The effluvia from this ground are so offensive that persons
living in the back of Clement’s Lane are compelled to keep their windows
closed.” But that which helped most of all to make a foul atmosphere in
the houses of the working class, an atmosphere in which the contagion of
fever could thrive, was the window-tax. It is hardly possible that those
who devised it can have foreseen how detrimental it would be to the public
health; it took nearly a century to realize the simple truth that it was
in effect a tax upon light and air.


The Window-Tax.

Willan, writing of fever in London in 1799, mentions that even the
passages of tenement houses were “kept dark in order to lessen the
window-tax,” and the air therefore kept foul[153]. Ferriar, writing of
Manchester in the last years of the 18th century, mentions, among other
fever-dens, a large house in an airy situation which had been built for a
poor’s-house, but abandoned: having been let to poor families for a very
trifling rent, many of the windows and the principal entrance were built
up, and the fever then became universal in it[154]. The Carlisle typhus
described by Heysham for 1781 began in a house near one of the gates,
tenanted by five or six very poor families; they had “blocked up every
window to lessen the burden of the window-tax[155].” John Howard’s
interest having been excited in the question of gaol-fever, he noted the
effects of the window-tax not only in prisons but in other houses. The
magistrates of Kent appear to have paid the tax for the gaols in that
county from the county funds; but in most cases the burden fell on the
keepers of the gaols.

    “The gaolers,” says Howard, “have to pay it; this tempts them to stop
    the windows and stifle their prisoners;” and he appends the following
    note: “This is also the case in many work-houses and farm-houses,
    where the poor and the labourers are lodged in rooms that have no
    light nor fresh air; which may be a cause of our peasants not having
    the healthy ruddy complexions one used to see so common twenty or
    thirty years ago. The difference has often struck me in my various
    journeys[156].”

Such impressions are known to be often fallacious; but in the history of
the window-tax, which we shall now follow, it will appear that there was a
new law, with increased stringency, in the years 1746-1748, corresponding
to the “twenty or thirty years ago” of Howard’s recollection.

The window-tax was originally a device of the statesmen of the Revolution
“for making good the deficiency of the clipped money.” By the Act of 7 and
8 William and Mary, cap. 18, taking effect from the 25th March, 1696,
every inhabited house owed duty of two shillings per annum, and, over and
above such duty on all inhabited houses, every dwelling-house with ten
windows owed four shillings per annum, and every house with twenty
windows eight shillings. In 1710 houses with from twenty to thirty windows
were made to pay ten shillings, and those with more than thirty windows
twenty shillings. Various devices were resorted to to check the evasions
of bachelors, widows and others. A farmer had to pay for his servants,
recouping himself from their wages. A house subdivided into tenements was
to count as one; which would have made the tax difficult to gather except
from the landlord. The machinery of collection was a board of
commissioners, receivers-general and collectors.

But in the 20th of George II. (1746) the basis of the law was changed. The
tax was levied upon the several windows of a house, so much per window, so
that it fell more decisively than before upon the tenants of
tenement-houses, and not on the landlords. The two-shillings house duty
was continued; but the window-tax became sixpence per annum for every
window of a house with ten, eleven, twelve, thirteen or fourteen windows,
or lights, ninepence for every window of a house with fifteen, sixteen,
seventeen, eighteen or nineteen windows, and one shilling for every window
of a house with twenty or more windows. An exemption in the Act in favour
of those receiving parochial relief was decided by the law officers of the
Crown not to apply to houses with ten or more windows or lights, which
would have included most tenement-houses; on the other hand they ruled
that hospitals, poor-houses, workhouses, and infirmaries were not
chargeable with the window duty. To remove doubts and check evasions
another Act was made in 21 George II. cap. 10. All skylights, and lights
of staircases, garrets, cellars and passages were to count for the purpose
of the tax; also certain outhouses, but not others, were to count as part
of the main dwelling whether they were contiguous or not. The 11th
paragraph of the Amendment Act shows how the law had been working in the
course of its first year: “No window or light shall be deemed to be
stopped up unless such window or light shall be stopped up effectually
with stone or brick or plaister upon lath,” etc.

This remained the law down to 1803, when a change was made back to the
original basis of rating houses as a whole, according to the number of
their windows, the rate being considerably raised and fixed according to a
schedule. The tax for tenement houses was at the same time made
recoverable from the landlord. The window-tax thus became a form of the
modern house-tax, rated upon windows instead of upon rental, and so lost a
great part of its obnoxious character.

The law of 1747-48, which taxed each window separately, and was enforced
by a galling and corrupt machinery of commissioners, receivers-general and
collectors paid by results, could not fail to work injuriously; for light
and air, two of the primary necessaries of life, were in effect taxed.
Even rich men appear to have taken pleasure in circumventing the
collectors[157]. But it was among the poor, and especially the inhabitants
of tenement houses, that the effect was truly disastrous; a tax on the
skylights of garrets and on the lights of cellars, staircases and
passages, taught the people to dispense with them altogether. Towards the
end of the 18th century the grievance became now and then the subject of a
pamphlet or a sermon.


Gaol-Fever.

Besides these ordinary things favouring contagious epidemic fever both in
town and country, there were two special sources of contagion, the gaols
and the fleets and armies. I shall take first the state of the gaols,
which has been already indicated in speaking of the window-tax. In the
opinion of Lind, a great part of the fever, which was a constant trouble
in ships of the navy, came direct from the gaols through the pressing of
newly discharged convicts.

The state of the prisons in the first half of the 18th century was
certainly not better than Howard found it to be a generation after; it was
probably worse, for the administration of justice was more savage. About
the beginning of the century, many petitions were made to Parliament by
imprisoned debtors, complaining of their treatment, and a Bill was
introduced in 1702. Sixty thousand were said to be in prison for
debt[158]. On 25 February, 1729, the House of Commons appointed a
committee “to inquire into the state of the gaols of this Kingdom”; but
only two prisons were reported on, the Fleet and the Marshalsea, in
London, the inquiries upon these being due to the energy of Oglethorpe,
then at the beginning of his useful career. The committee found a
disgraceful state of things:--wardens, tip-staffs and turnkeys making
their offices so lucrative by extortion that the reversion of them was
worth large sums, prisoners abused or neglected if they could not pay,
some prisoners kept for years after their term was expired, the penniless
crowded three in a bed, or forty in one small room, while some rooms stood
empty to await the arrival of a prisoner with a well-filled purse. On the
common side of the Fleet Prison, ninety-three prisoners were confined in
three wards, having to find their own bedding, or pay a shilling a week,
or else sleep on the floor. The “Lyons Den” and women’s ward, which
contained about eighteen, were very noisome and in very ill repair. Those
who were well had to lie on the floor beside the sick. A Portuguese debtor
had been kept two months in a damp stinking dungeon over the common sewer
and adjoining to the sink and dunghill; he was taken elsewhere on payment
of five guineas. In the Marshalsea there were 330 prisoners on the common
side, crowded in small rooms. George’s ward, sixteen feet by fourteen and
about eight feet high, had never less than thirty-two in it “all last
year,” and sometimes forty; there was no room for them all to lie down,
about one-half of the number sleeping over the others in hammocks; they
were locked in from 9 p.m. to 5 a.m. in summer (longer hours in winter),
and as they were forced to ease nature within the room, the stench was
noisome beyond expression, and it seemed surprising that it had not caused
a contagion; several in the heat of summer perished for want of air.
Meanwhile the room above was let to a tailor to work in, and no one
allowed to lie in it. Unless the prisoners were relieved by their friends,
they perished by famine. There was an allowance of pease from a casual
donor who concealed his name, and 30 lbs. of beef three times a week from
another charitable source. The starving person falls into a kind of
hectic, lingers for a month or two and then dies, the right of his corpse
to a coroner’s inquest being often scandalously refused[159]. The prison
scenes in Fielding’s _Amelia_ are obviously faithful and correct.

Oglethorpe’s committee had done some good since they first met at the
Marshalsea on 25th March, 1729, not above nine having died from that date
to the 14th May; whereas before that a day seldom passed without a death,
“and upon the advancing of the spring not less than eight or ten usually
died every twenty-four hours.” Two of the chief personages concerned were
found by a unanimous vote of the House of Commons to have committed high
crimes and misdemeanours; but when they were tried before a jury on a
charge of felony they were found not guilty.

About a year after these reports to the Commons there was a tragic
occurrence among the Judges and the Bar of the Western Circuit during the
Lent Assizes of 1730. The Bridewell at Taunton was filled for the occasion
of the Assizes with drafts of prisoners from other gaols in Somerset,
among whom several from Ilchester were said to have been more than
ordinarily noisome. Over a hundred prisoners were tried, of whom eight
were sentenced to death (six executed), and seventeen to transportation.
As the Assize Court continued its circuit through Devon and Dorset several
of its members sickened of the gaol fever and died: Piggot, the
high-sheriff, on the 11th April, Sir James Sheppard, serjeant-at-law, on
13th April at Honiton, the crier of the court and two of the Judge’s
servants at Exeter, the Judge himself, chief baron Pengelly, at Blandford,
and serjeant-at-law Rous, on his return to London, whither he had posted
from Exeter as soon as he felt ill[160]. It is said that the infection
afterwards spread within the town of Taunton, where it arose, “and carried
off some hundreds”; but the local histories make no mention of such an
epidemic in 1730, and no authority is cited for it[161]. Something of the
same kind is believed to have happened at a gaol delivery at Launceston
in 1742, but the circumstances are vaguely related, and it does not appear
that any prominent personage in the Assize Court died on the
occasion[162].

The great instance of a Black Assize in the 18th century, comparable to
those of Cambridge, Oxford and Exeter in the 16th[163], was that of the
Old Bailey Sessions in London in April, 1750. It has been fully related by
Sir Michael Foster, one of the justices of the King’s Bench, who had
himself been on the bench at the January sessions preceding, and was the
intimate friend of Sir Thomas Abney, the presiding judge who lost his life
from the contagion of the April sessions[164].

    “At the Old Bailey sessions in April, 1750, one Mr Clarke was brought
    to his trial; and it being a case of great expectation, the court and
    all the passages to it were extremely crowded; the weather too was
    hotter than is usual at that time of the year[165]. Many people who
    were in court at this time were sensibly affected with a very noisome
    smell; and it appeared soon afterwards, upon an enquiry ordered by the
    court of aldermen, that the whole prison of Newgate and all the
    passages leading thence into the court were in a very filthy
    condition, and had long been so. What made these circumstances to be
    at all attended to was, that within a week or ten days at most, after
    the session, many people who were present at Mr Clarke’s trial were
    seized with a fever of the malignant kind; and few who were seized
    recovered. The symptoms were much alike in all the patients, and in
    less than six weeks time the distemper entirely ceased. It was
    remarked by some, and I mention it because the same remark hath
    formerly been made on a like occasion [Oxford, 1577], that women were
    very little affected: I did not hear of more than one woman who took
    the fever in court, though doubtless many women were there.

    “It ought to be remembered that at the time this disaster happened
    there was no sickness in the gaol more than is common in such places.
    This circumstance, which distinguisheth this from most of the cases of
    the like kind which we have heard of, suggesteth a very proper
    caution: not to presume too far upon the health of the gaol, barely
    because the gaol-fever is not among the prisoners. For without doubt,
    if the points of cleanliness and free air have been greatly neglected,
    the putrid effluvia which the prisoners bring with them in their
    clothes etc., especially where too many are brought into a crowded
    court together, may have fatal effects on people who are accustomed to
    breathe better air; though the poor wretches, who are in some measure
    habituated to the fumes of a prison, may not always be sensible of any
    great inconvenience from them.

    “The persons of chief note who were in court at this time and died of
    the fever were Sir Samuel Pennant, lord mayor for that year, Sir
    Thomas Abney, one of the justices of the Common Pleas, Charles Clarke,
    esquire, one of the barons of the exchequer, and Sir Daniel Lambert,
    one of the aldermen of London. Of less note, a gentleman of the bar,
    two or three students, one of the under-sheriffs, an officer of Lord
    Chief Justice Lee, who attended his lordship in court at that time,
    several of the jury on the Middlesex side, and about forty other
    persons whom business or curiosity had brought thither.”

The same thing was remarked here as at Exeter in 1586 that those who sat
on the side of the Court nearest to the dock were most attacked by the
infection[166]. When the cases of fever began to occur, after the usual
incubation of “a week or ten days,” there was much fear of the infection
spreading, so that many families, it is said, retired into the
country[167]. But Pringle wrote on 24 May, “However fatal it has been
since the Sessions, it is highly probable that the calamity will be in a
great measure confined to those who were present at the tryal[168];” and
Justice Foster gives no hint of anyone having taken the fever who was not
present in court.

The tragedy of gaol-fever at the Old Bailey in 1750 secured increased
attention to the subject of scientific ventilation. The great bar to fresh
air indoors throughout the 18th century was the window-tax. It bore
particularly hard on prisoners, for the gaolers had to pay the window-tax
out of their profits, and they naturally preferred to build up the
windows. Scientific ventilation of gaols was something of a mockery in
these circumstances; but it is the business of science to find out cunning
contrivances, and ingenious ventilators were devised for Newgate, the
leading spirit in this work being the Rev. Dr Hales, rector of a parish
near London, and an amateur in physiology at the meetings of the Royal
Society.

A ventilating apparatus had been erected at Newgate about a year before
the fatal sessions of 1650, but it does not seem to have answered. It
consisted of tubes from the various wards meeting in a great trunk which
opened on the roof. A committee of the Court of Aldermen in October 1750
resolved, after consulting Pringle and Hales, to add a windmill on the
leads over the vent, and that was done about two years after. Pringle, who
inspected the ventilator on 11 July, 1752, says that a considerable
stream of air of a most offensive smell issued from the vent; and it
appeared that no fewer than seven of the eleven carpenters who were
working at the alterations on the old ventilator caught gaol-fever (of the
petechial kind), which spread among the families of some of them[169].
Pringle and Hales were of opinion that the wards furnished with tubes were
less foul than the others; and they claimed, on the evidence of the man
who took care of the apparatus, that only one person had died in the gaol
in two months, whereas, before the windmill was used, there died six or
seven in a week[170]. But Oglethorpe had claimed an improvement of the
same kind at the Marshalsea in 1729 merely from having the prisoners saved
from hunger; and Lind, who was a most matter-of-fact person, did not think
that the ingenious contrivances for ventilation had answered their
end[171].

Howard’s visitations of the prisons, which began in 1773 and were
continued or repeated during several years following, brought to light
many instances of epidemic sickness therein, which was nearly always of
the nature of gaol-typhus. The following is a list compiled from his
various reports, the two or three instances of smallpox infection being
given elsewhere.

    _Wood Street Compter, London._ About 100 in it, chiefly debtors.
    Eleven died in beginning of 1773; since then it has been visited by Dr
    Lettsom at the request of the aldermen.

    _Savoy, London._ On 15 March, 1776, 119 prisoners. Many sick and
    dying. Between that date and next visit, 25 May, 1776, the gaol-fever
    has been caught by many.

    _Hertford._ Inmates range from 20 to 30. In the interval of two
    visits, the gaol-fever prevailed and carried off seven or eight
    prisoners and two turnkeys. (The interval probably corresponded to the
    admission of an unusual number of debtors.)

    _Chelmsford._ Number of inmates varies from 20 to 60, about one-half
    debtors. A close prison frequently infected with the gaol-distemper.

    _Dartford, County Bridewell._ A small prison. About two years before
    visit of 1774 there was a bad fever, which affected the keeper and his
    family and every fresh prisoner. Two died of it.

    _Horsham, Bridewell._ The keeper a widow: her husband dead of the
    gaol-fever.

    _Petworth, Bridewell._ Allowance per diem a penny loaf (7½ oz.). Th.
    Draper and Wm. Godfrey committed 6 Jan., 1776: the former died on 11
    Jan., the other on 16th. Wm. Cox, committed 13 Jan., died 23rd. “None
    of these had the gaol-fever. I do not affirm that these men were
    famished to death; it was extreme cold weather.” After this the
    allowance of bread was doubled, thanks to the Duke of Richmond.

    _Southwark, the new gaol._ Holds up to 90 debtors and felons. “In so
    close a prison I did not wonder to see, in March, 1776, several felons
    sick on the floors.” No bedding, nor straw. The Act for preserving the
    health of prisoners is on a painted board.

    _Aylesbury._ About 20 prisoners. First visit Nov., 1773, second Nov.,
    1774: in the interval six or seven died of the gaol-distemper.

    _Bedford._ About twenty years ago the gaol-fever was in this prison;
    some died there, and many in the town, among whom was Mr Daniel, the
    surgeon who attended the prisoners. The new surgeon changed the
    medicines from sudorifics to bark and cordials; and a sail-ventilator
    being put up the gaol has been free from the fever almost ever since.
    (This was the gaol which is often said to have started Howard on his
    inquiries when he was High Sheriff.)

    _Warwick._ Holds up to fifty-seven. The late gaoler died in 1772 of
    the gaol-distemper, and so did some of his prisoners. No water then;
    plenty now.

    _Southwell, Bridewell._ A small prison. A few years ago seven died
    here of the gaol-fever within two years.

    _Worcester._ Has a ventilator. Mr Hallward the surgeon caught the
    gaol-fever some years ago, and has ever since been fearful of going
    into the dungeon; when any felon is sick, he orders him to be brought
    out.

    _Shrewsbury._ Gaol-fever has prevailed here more than once of late
    years.

    _Monmouth._ At first visit in 1774, they had the gaol-fever, of which
    died the gaoler, several of his prisoners, and some of their friends.

    _Usk (Monmouth) Bridewell._ The keeper’s wife said that many years ago
    the prison was crowded, and that herself, her father who was then
    keeper, and many others of the family had the gaol-fever, three of
    whom, and several of the prisoners, died of it.

    _Gloucester, the Castle._ Many prisoners died here in 1773; and always
    except at Howard’s last visit, he saw some sick in this gaol. A large
    dunghill near the stone steps. The prisoners miserable objects: Mr
    Raikes and others took pity on them.

    _Winchester._ The former destructive dungeon was down eleven steps,
    and darker than the present. Mr Lipscomb said that more than twenty
    prisoners had died in it of the gaol-fever in one year, and that the
    surgeon before him had died of it.

    _Liverpool._ Holds about sixty, offensive, crowded. Howard in March,
    1774, told the keeper his prisoners were in danger of the gaol-fever.
    Between that date and Nov., 1775, twenty-eight had been ill of it at
    one time.

    _Chester, the Castle._ Dungeon used to imprison military deserters.
    Two of them brought by a sergeant and two men to Worcester, of which
    party three died a few days after they came to their quarters. (For
    fever in this prison in 1716 see the text, p. 60.)

    _Cowbridge._ The keeper said, on 19 August, 1774, that many had died
    of the gaol-fever, among them a man and a woman a year before, at
    which time himself and daughter were ill of it.

    _Cambridge, the Town Bridewell._ In the spring of 1779, seventeen
    women were confined in the daytime, and some of them at night, in the
    workroom, which has no fireplace or sewer. This made it extremely
    offensive, and occasioned a fever or sickness among them, which so
    alarmed the Vice-Chancellor that he ordered all of them to be
    discharged. Two or three of them died within a few days.

    _Exeter, the County Bridewell._ Between first visit in 1775 and next
    on 5 Feb., 1779, the surgeon and two or three prisoners have died of
    the gaol-fever. In 1755 a prisoner discharged from the gaol went home
    to Axminster, and infected his family, of whom two died, and many
    others in that town afterwards.

    _Exeter, the High Gaol for felons._ Mr Bull, the surgeon, stated that
    he was by contract excused from attending in the dungeons any
    prisoners that should have the gaol-fever.

    _Winchester, Bridewell._ Close and small. Receives many prisoners from
    other gaols at Quarter Sessions. It has been fatal to vast numbers.
    The misery of the prisoners induced the Duke of Chandos to send them
    for some years 30 lbs. of beef and 2 gallon loaves a week.

    _Devizes, Bridewell._ Two or three years ago the gaol-fever carried
    off many. An infirmary added since then.

    _Marlborough._ The rooms offensive. Saw one dying on the floor of the
    gaol-fever. One had died just before, and another soon after his
    discharge.

    _Launceston._ Small, with offensive dungeons. No windows, chimneys, or
    drains. No water. Damp earthen floor. Those who serve there often
    catch the gaol-fever. At first visit, found the keeper, his assistant
    and all the prisoners but one sick of it (on 19 Feb., 1774, eleven
    felons in it). Heard that, a few years before, many prisoners had died
    of it, and the keeper and his wife in one night. A woman confined
    three years by the Ecclesiastical Court had three children born in the
    gaol.

    _Bodmin, Bridewell._ Much out of repair. The night rooms are two
    garrets with small close-glazed skylight 17 in. × 12 in. A few years
    ago the gaol-fever was very fatal, not only in the prison but also in
    the town.

    _Taunton, Bridewell._ Six years ago, when there was no infirmary
    provided, the gaol-fever spread over the whole prison, so that eight
    died out of nineteen prisoners.

    _Shepton Mallet._ Men’s night room close, with small window. So
    unhealthy some years ago that the keeper buried three or four in a
    week.

    _Thirsk._ Prisoners had the gaol-fever not long ago.

    _Carlisle._ During the gaol-fever which some years ago carried off
    many of the prisoners, Mr Farish, the chaplain, visited the sick every
    day.

I shall add some medical experiences of gaol-fever in London from the
notes of Lettsom[172]:--

    May, 1773. A person released from Newgate “in a malignant or
    jail-fever” was brought into a house in a court off Long Lane,
    Aldersgate Street; soon after which fourteen persons in the same
    confined court were attacked with a similar fever: one died before
    Lettsom was called in, one was sent to hospital, eleven attended by
    him all recovered, though with difficulty. Two deaths in Wood Street
    Compter: 1. Rowell, an industrious, sober workman, who had supported
    for many years a wife and three children; some of these having been
    lately sick, he fell behind with his rent, a little over three
    guineas; he offered all he had (more than enough) to the landlord, but
    the latter preferred to throw the man and his family into the Compter,
    where Rowell died of fever. 2. Russell, once a reputable tradesman on
    Ludgate Hill, fell into a debt of under three guineas, sent to the
    Compter with his wife and five children, took fever and died; attended
    in his sickness in a bare room by his eldest daughter, elegant and
    refined, aged seventeen; his son, aged fourteen, took the fever and
    recovered.

There was one Black Assize at this period, at Dublin in April 1776. A
criminal, brought into the Court of Sessions without cleansing, infected
the court and alarmed the whole city. Among others who died of the
contagion were Fielding Ould, High Sheriff, the counsellors Derby, Palmer,
Spring and Ridge, Mr Caldwell, Messrs Bolton and Eriven, and several
attorneys and others whose business it was to attend the court[173].

There were two notorious outbreaks of malignant fever among foreign
prisoners of war, one in 1761[174] and another in 1780[175], the first
among French and Spaniards at Winchester and Portchester, the second among
Spaniards at Winchester.

Howard found so little typhus in the gaols in his later visits that it
seemed as if banished for good. But it was heard of frequently about
1780-85--at Maidstone, at Aylesbury, at Worcester, costing the lives of
some of the visiting physicians.


Circumstances of severe and mild Typhus.

The circumstances of the gaol distemper bring out one grand character of
typhus which will have to be stated formally before we go farther.
Ordinary domestic typhus was not a very fatal disease. Haygarth says that
of 285 attacked by it in the poorer quarters of Chester in the autumn of
1774, only twenty-eight died. Ferriar, in Manchester, had sometimes an
even more favourable experience than that: “The mortality of the epidemic
was not great, ... out of the first ninety patients whom I attended, only
two died.” This was before the House of Recovery was opened; so that the
low mortality was of typhus in the homes of the people.

The fever was often an insidious languishing, without great heat, and
marked most by tossing and wakefulness, which might pass into delirium;
when it went through the members of a family or the inmates of a house,
there would be some cases concerning which it was hard to say whether they
were cases of typhus or not. Misery and starvation brought it on, and
often it was itself but a degree of misery and starvation. “I have found,”
says Ferriar, “that for three or four days before the appearance of
typhus in a family consisting of several children, they had subsisted on
little more than cold water.” “It has been observed,” says Langrish, “that
those who have died of hunger and thirst, as at sieges and at sea, etc.,
have always died delirious and feverish.” The fever was on the whole a
distinct episode, but in many cases it had no marked crisis. “Those women
who recovered,” says Ferriar, “were commonly affected with hysterical
symptoms after the fever disappeared;” and again: “Fevers often terminate
in hysterical disorders, especially in women; men, too, are sometimes
hysterically inclined upon recovering from typhus, for they experience a
capricious disposition to laugh or cry, and a degree of the globus
hystericus.” These were probably the more case-hardened people, inured to
their circumstances, their healthy appetite dulled by the practice of
fasting or “clemming,” or by opium, and their blood accustomed to be
renovated by foul air. If the limit of subsistence be approached
gradually, life may be sustained thereat without any sharp crisis of
fever, or with only such an interlude of fever as differs but little from
a habit of body unnamed in the nosology.

The worst kind of typhus, often attended with delirium, crying and raving,
intolerable pains in the head, and livid spots on the skin, ending fatally
perhaps in two or three days, or after a longer respite of stupor or
waking insensibility, was commonly the typhus of those not accustomed to
the minimum of well-being--the typhus of hardy felons newly thrown into
gaol, of soldiers in a campaign crowded into a hospital after a season in
the open air, of sailors on board ship mixing with newly pressed men
having the prison atmosphere clinging to them, of judges, counsel,
officials of the court and gentlemen of the grand jury brought into the
same atmosphere with prisoners at a gaol-delivery, of the wife and
children of a discharged prisoner returned to his home, of the
gaol-keeper, gaol-chaplain, or gaol-doctor, of the religious and
charitable who visited in poor localities even where no fever was known to
be, and most of all of country people who crowded to the towns in search
of work or of higher wages or of a more exciting life.

It was in these circumstances that the most fatal infections of typhus
took place. Such extraordinary malignancy of typhus happened often when
the type of sickness (if indeed there was definite disease at all) among
the originally ailing failed to account for it; it was the great
disparity of condition that accounted for it. There were, however, more
special occasions when a higher degree of malignancy than ordinary was
bred or cultivated among the classes at large who were habitually liable
to typhus. But even the old pestilential spotted fever which used to
precede, accompany, and follow the plague itself, was fatal to a
comparatively small proportion of all who had it. Thus, towards the end of
the great London plague of 1625, on 18th October, Sir John Coke writes to
Lord Brooke: “In London now the tenth person dieth not of those that are
sick, and generally the plague seems changed into an ague[176].” One in
ten is probably too small a fatality for the old pestilential fever; but
that is the usually accepted proportion of deaths to attacks in the typhus
fever of later times. The rate of fatality is got, naturally, by striking
an average. But in truth an aggregate of typhus cases, however homogeneous
in conventional symptoms or type-characters, was not always really
homogeneous. We have seen that ninety cases of typhus could occur in the
slums of Manchester with only two deaths. On the other hand there were
outbreaks of gaol-fever in which half or more of all that were attacked
died; and I suspect that the average fatality in typhus of one in ten was
often brought up by an admixture of cases of healthy and well-conditioned
people who caught a much more malignant type of fever from their contact
with those inured to misery. To strike an average is in many instances a
convenience and a help to the apprehension of a truth; but for the average
to be instructive, the members of the aggregate must be more or less
comparable in their circumstances. It has been truly said that there is no
common measure between Lazarus and Dives as regards their subjective views
of things; it is not a little strange to find that they are just as
incommensurable in their risk of dying from the infection of typhus fever.
The rule seems to be that the degree of acuteness or violence of an attack
of typhus was inversely as the habitual poor condition of the victim. In
adducing evidence of the tragic nature of typhus infection conveyed across
the gulf of misery to the other side, I shall endeavour to keep strictly
to the scientific facts, leaving the moral, if there be a moral (and it is
not always obvious), to point itself.

Let us take first the common case of country-bred people migrating to the
towns. Any lodging in a crowded centre of industry and trade would be
high-rented compared with the country cottage which they had left, and
they would naturally gravitate to the slums of the city.

    “Great numbers of the labouring poor,” says Ferriar of Manchester,
    “who are tempted by the prospect of large wages to flock into the
    principal manufacturing towns, become diseased by getting into dirty
    infected houses on their arrival. Others waste their small stock of
    money without procuring employment, and sink under the pressure of
    want and despair.... The number of such victims sacrificed to the
    present abuses is incredible.” And again:

    “It must be observed that persons newly arrived from the country are
    most liable to suffer from these causes, and as they are often taken
    ill within a few days after entering an infected house, there arises a
    double injury to the town, from the loss of their labour, and the
    expense of supporting them in their illness. A great number of the
    home-patients of the Infirmary are of this description. The horror of
    these houses cannot easily be described; a lodger fresh from the
    country often lies down in a bed filled with infection by its last
    tenant, or from which the corpse of a victim to fever has only been
    removed a few hours before[177].”

Two instances from the same author will show the severe type of the fever.

    The tenant of a house in Manchester, who was herself ill of typhus
    along with her three children, took in a lodger, a girl named Jane
    Jones, fresh from the country. The lodger fell ill, but the fact was
    kept concealed from the visiting physician until her screams
    discovered her: “She was found delirious, with a black fur on the lips
    and teeth, her cheeks extremely flushed, and her pulse low, creeping,
    and scarcely to be counted.” Treatment was of no use; she “passed
    whole nights in shrieking,” and in her extremity, she was saved, as
    Ferriar believed, by affusions of cold water. Another case, exactly
    parallel, proved fatal in three days:

    “In 1792 I had two patients ill of typhus in an infected
    lodging-house. I desired that they might be washed with cold water;
    and a healthy, ruddy young woman of the neighbourhood undertook the
    office. Though apparently in perfect health before she went into the
    sick chamber, she complained of the intolerable smell of the patients,
    and said she felt a head-ache when she came down stairs. She sickened,
    and died of the fever in three days[178].”

These are instances of country-bred people, plunging abruptly into the
fever-dens of cities and catching a typhus severe in the direct ratio of
their ruddy, healthy condition. Another class of cases is that of persons
carrying the atmosphere of a gaol into the company of healthy and
otherwise favourably situated people. Howard gives a case: at Axminster a
prisoner discharged from Exeter gaol in 1755 infected his family with the
gaol-distemper, of which two of them died, and many others in that town.
The best illustrations of the greater severity and fatality of typhus
among the well-to-do come from Ireland, in times of famine, and will be
found in another chapter. But it may be said here, so that this point in
the natural history of typhus fever may not be suspected of exaggeration,
that the enormously greater fatality of typhus (of course, in a smaller
number of cases) among the richer classes in the Irish famines, who had
exposed themselves in the work of administration, of justice, or of
charity, rests upon the unimpeachable authority of such men as Graves, and
upon the concurrent evidence of many.


Ship-Fever.

The prevalence of fevers in ships of war and transports from the
Restoration onwards can be learned but imperfectly, and learned at all
only with much trouble. Sir Gilbert Blane, who was not wanting in aptitude
and had the archives of the Navy Office at his service, goes no farther
back than 1779, from which date an account was kept of the causes of death
in the naval hospitals. But the deaths on board ships of the fleet were
not systematically recorded until 1811, when the Board of Admiralty
instructed all commanders of ships of war to send to the Naval Office an
annual account of all the deaths of men on board[179]. The sources of
information for earlier periods are more casual.

The war with France, which dated from the accession of William III. and
continued until the Peace of Ryswick in 1697, led to numerous conflicts
with French and Spaniards in the West Indies, and to naval expeditions
year after year. The loss of life from sickness in the British ships for a
few years at the end of the century was such as can hardly be realized by
us. Some part of it happened on the outward voyages, but by far the
greater part of it was from the poison of yellow fever which had entered
the ships in the anchorages of West Indian colonies. It was probably to
that cause that the enormous mortality in the fleet under Sir Francis
Wheeler was owing. After some ineffective operations against the French in
the Windward Islands in the winter of 1693-4, he sailed for North America
with the intention of attacking Quebec. This he failed to do, having
sailed from Boston for home on the 3rd of August without entering the St
Lawrence. The reason of the failure was probably the extraordinary
fatality which Cotton Mather, of Boston, professes to have heard from the
admiral himself, namely, that he lost by a malignant fever on the passage
from Barbados to Boston 1300 sailors out of 2100, and 1800 soldiers out of
2400[180].

Another instance comes from Carlisle Bay, Barbados. The slave ship
‘Hannibal’ arrived there in November, 1694, during a disastrous epidemic
of yellow fever. Phillips, the captain, whose journal of the voyage is
published[181], had great difficulty in saving his crew from being pressed
into the king’s ships, which were short of men owing to the yellow fever.
Captain Sherman, of the ‘Tiger,’ who convoyed the ‘Hannibal’ and other
merchantmen back to England in April, 1695, told Phillips that he buried
six hundred men out of his ship during the two years that he lay at
Barbados, though his complement was but 220, “still pressing men out of
the merchant ships that came in, to recruit his number in the room of
those that died daily.”

These and other similar experiences of yellow fever in the West Indies,
which might be collected from the naval history, do not come properly into
this chapter; and I pass from them to ship-fever proper, having indicated
how much of the loss of life abroad was due to yellow fever.

Some light is thrown upon the state of health on board ships of war on the
home station by Dr William Cockburn, physician to the fleet, afterwards
the friend of Swift, who calls him “honest Dr Cockburn.” He had a secret
remedy for dysentery, which he succeeded in getting adopted by the
Admiralty, greatly to his own emolument for many years after. Dining on
board one of the ships at Portsmouth, in 1696, with Lord Berkeley of
Stratton, he brought up the subject of his electuary, and arranged for a
public trial of it next day on board the ‘Sandwich.’ An uncertain number,
which looks to have been about seven in Cockburn’s own account, but became
seventy in the pamphlet which advertised the electuary after his death,
were available for the trial and were speedily cured. Cockburn’s three
essays on the health of seamen[182] leave no doubt as to the extensive
prevalence of scurvy and the causes thereof; while his references to
“malignant fever,” although they are, as usual, brought in to illustrate
some doctrinal or theoretical point, give colour to the belief that
ship-typhus may have been as common then as we know it to have been in the
ships at Portsmouth and Plymouth, on the more direct testimony of Huxham
in 1736, and of Lind twenty years later.

A naval surgeon of the time of William III. and Anne, was induced by his
enthusiasm for blood-letting in fevers to record some of his experiences
on board ship[183]. It was usually the lustiest, both of the young, strong
and healthy people, and likewise of the elder sort, that died of fevers,
the symptoms which proved so mortal having been delirium, phrenitis, coma
or stupor, whether they occurred in the συνόχοι (of Sydenham) or in the
συνεχεῖς (of the same author):

    “I had observed in a ship of war whose complement was near 500, in a
    Mediterranean voyage in the year 1694, where we lost about 90 or 100
    men, mostly by fevers, that those who died were commonly the young,
    but almost always the strongest, lustiest, handsomest persons, and
    that two or three escaped by means of such [natural] haemorrhagies,
    which were five or six pounds of blood”--the point being that the
    amount of blood drawn by phlebotomy should be in proportion to the
    robustness and body-weight of the patient.

In 1703 and 1704 he was surgeon to two of Her Majesty’s ships “where a
delirium, stupor and phrenitis” were found as symptoms of the fevers. In
the summer of 1704, cruising in the latitudes of Portugal and Spain, the
men brought on board from Lisbon unripe lemons with which they made great
quantities of punch. This was the evident cause of a cholera morbus and
dysentery: “after this we had a pretty many taken with the _synochus
putris_, and some with the _causus_” [malignant fever]. Most of these
fevers went off by a crisis in sweating, “which was so large I had good
reason to believe it judicatory.” In several the fevers left on the 9th,
10th or 11th day, and in almost all by the 14th. “About the latter end of
July, and in August, there were many taken with a delirium and stupor or
coma, and some with the phrenitis in their fever.” Among the symptoms was
one which we find described for fevers on board ship on the West Coast of
Africa at the same time--“soreness all over as if from blows with a cane,”
a symptom afterwards associated with dengue. “Sometimes the bones (as they
term it) don’t pain them much.” In some cases there were petechial spots
as well as a stupor. In the month of August “the fevers with a stupor and
phrenitis” came on apace. The treatment was to take ten ounces of blood
every day from the second to the eighth day of the fever, to give tartar
emetic in five-grain doses at the outset, and to administer cathartic
glysters in the second half of the fever. “Seeing the lustiest men now ran
no more hazard of their lives than any other who were usually taken with
this fever, nor indeed so much, in the beginning of September I resolved,
after all the phlebotomy was done in these fevers, to try the cathartic
sooner.” Many of these who had accustomed themselves to the liberal use of
spirituous liquors miscarried in the phrenitis.

White left the navy in 1704 and settled in practice at Lisbon, where he
saw much fever. He had seen epidemics break out in British ships of war at
anchor in the Tagus, crowded with men and prisoners. One case he mentions
in a Lisbon woman, with continual synochus, stupor, and petechiae on the
fifth day: “This was contagious, for she got it by going often to assist a
gunner of a man-of-war, who came to her house with this distemper upon
him: for many at the same time on board that ship were sick of that
disease.” Among the causes of fever on board ship he mentions the effluvia
of the bilge-water.

    Exposed to these emanations were “a multitude of people breathing and
    constantly perspiring in a close place, such as a ship’s _allop_ or
    lower deck next the hould, where is the entry to a certain vacant
    space near the ship’s center, which leadeth to the bottom, for
    gathering all the water together which the ship draweth by leakage,
    and is called the well. Several times there is occasion for some
    people to go down to examine the quantity of the water, and in some
    ships to bore an augur hole to let in as much as will preserve a good
    air. I have often known two or three men killed at a time, as it is
    said; and the reason may be understood from what I said of the general
    effects of that fluid in ordinary fever [he is now writing on heat
    apoplexy], where there is not above two or three inches, but just as
    much as may make a surface, almost equal to the square of the well, of
    stagnant salt water which had been a long while in gathering; and the
    air over the whole _allop_ extremely rarified, and here not at all
    ventilated[184].”

We owe it to the accident of the celebrated Dr Freind having accompanied
Lord Peterborough’s expedition to Spain in 1705 that some account has been
preserved of the sickness among the troops ashore and afloat[185].

The expedition of some 8000 men being then in its second year, fever and
dysentery were by far the most common diseases, so common that “we can
hardly turn, whether at sea or in camp, without finding them as if our
inseparable companions and as if domesticated among us.” In the summer of
the previous year there had been much fever both in the ships of the fleet
and in the camp before Barcelona: “It was of the continual kind, though it
usually remitted in the day time, and seemed to approach nearly to the
stationary one which Sydenham has described in the years 1685 and 1686.”
He then gives symptoms, which were on the whole those of the hospital
fever to be afterwards described from Pringle’s medical account of the
campaigns in 1743-48. Persons of a robust habit were affected more than
others, and more severely, and carried off sooner. The others were
generally taken away by a lingering death. “Some, when the fever seemed to
have been wholly gone off lay four or five days without pain or sickness,
though weak; afterwards being suddenly seized with convulsions of the
nerves they in a short time expired”--perhaps the phenomenon of relapse,
which Lind recorded for ship-fever fifty years after and was seen among
the troops landed from Corunna in 1809. In some few the parotids, or
abscesses formed about the groin, carried off the disease.

    He then gives the case of a lieutenant on board the ‘Barfleur.’ At
    first he was restless and delirious; on the 7th and 8th days he had
    _subsultus tendinum_; on the 8th day his tongue was sometimes fixed,
    and his eyes sparkled; on the 9th day, he was wholly deprived of his
    understanding; he pulled off the fringe of the bed and plucked the
    flocks; when he had before faultered in his speech, he was sometimes
    seized with hiccough. But on the 10th day, after 12 oz. of blood had
    been drawn from the jugular vein, his delirium went off on a sudden,
    and he began to mend, making a perfect recovery.

Until the middle of the 18th century there are few other notices of
ship-fever, but it is probable that Huxham’s accounts of a very malignant
typhus among the crews of ships of war at Plymouth in 1735 (as well as at
Portsmouth according to report), and again in 1741, are to be taken as
samples of what might have been recorded on many occasions[186].


Fever and Dysentery of Campaigns: War Typhus, 1742-63.

The war in Ireland after the accession of William III. produced two
remarkable instances of war-sickness, which are fully given in another
chapter. The campaigns of Marlborough against the armies of Louis XIV.,
from 1704 to the Treaty of Utrecht in 1713, appear to have found no
historian from the medical side, nor does the duke refer to these matters
in his dispatches or letters, beyond a remark in a letter to his wife from
near Munich, 30 July, 1704, a fortnight before the battle of Blenheim:
“There having been no war in this country for above sixty years, these
towns and villages are so clean that you would be pleased with them[187].”

The war of 1742-48, in which George II. joined Austria against France,
produced the first good accounts of war typhus, on land and on board ship,
in the writings of Pringle[188]. After the battle of Dettingen, 27 June,
1743, the men were exposed all night in the wet fields; during the next
eight days five hundred of them were attacked with dysentery, and in a few
weeks near half the army were either ill of it or had recovered from it.
The dysentery continued all July and part of August, while the army lay at
Hanau. The village of Feckenheim, a league from the camp, was used as a
hospital, some 1500 being quartered in it, most of them ill at first of
dysentery. The latrines appear to have been ill designed and badly kept.
“A malignant fever began among the men, from which few escaped: for
however mild or bad soever the flux was for which the person was sent to
hospital, this fever almost surely supervened. The petechial spots,
blotches, parotids, frequent mortifications, and the great mortality,
characterized a pestilential malignity: in this it was worse than the true
plague.... Of 14 mates employed about the hospital five died; and,
excepting one or two, all the rest had been ill and in danger. The
hospital lost nearly half of the patients; but the inhabitants of the
village of Feckenheim, where the sick were, having first received the
bloody flux, and afterwards the fever by contagion, were almost utterly
destroyed[189].” The survivors from the sick troops in Feckenheim were
removed to Neuwied, where they were relieved; “but the rest, who were
mixed with them, caught the infection.” The mixed troops were sent still
down the Rhine in bilanders, during which voyage “the fever became so
virulent that above half the number died in the boats, and many of the
remnant soon after their arrival.” A parcel of tents sent in these
bilanders to the Low Countries were given to a Ghent tradesman to refit;
he employed twenty-three journeymen upon them, “but these unhappy men were
quickly seized with this fever, whereof seventeen died.” They had no
other communication with the infected but through the tents.

“These,” says Pringle, “are instances of high malignity. The common course
of the infection is slow, and only catching to those constantly confined
to the bad air. Sometimes one will have this fever about him for several
days before it confines him to his bed; others I have known complain for
weeks of the same symptoms without any regular fever at all; and some,
after leaving the infectious place, have afterwards fallen ill of
it[190].”

After the battle of Fontenoy on 11 May, 1745, the army was in good health:
“the smallpox was the only new disease; it came with the recruits from
England, but did not spread; and indeed we have never known it of any
consequence in the field.”

On the Jacobite rebellion breaking out in Scotland later in the same year,
some of the returning troops were ordered to disembark at Newcastle, Holy
Island and Berwick. They had a long voyage, so that a kind of remitting
fever which some of them had acquired in the autumn in the Low Countries
was “by the crowds and the foul air of the hold soon converted into the
jail distemper and became infectious.” At Newcastle most of the nurses and
medical attendants of the extemporized hospital were seized with it, of
whom three apothecaries, four apprentices and two journeymen died. But the
most remarkable experience was on Holy Island. Of ninety-seven men taken
out of the ships there, ill of the gaol-fever, forty died, “and the people
of the place receiving the infection, in a few weeks buried fifty, the
sixth part of the inhabitants of that island.” At Nairn and Inverness
there was a singular experience in the spring of 1746. The ships which
brought Houghton’s brigade to Nairn carried also thirty-six deserters to
be tried by court-martial at the headquarters at Inverness: these men had
deserted to the French in Flanders, had been found on board of a captured
French transport carrying men to aid the Pretender, and had been thrown
into gaol in England till an opportunity arose of sending them to their
trial. Three days after the landing at Nairn of the force with which these
deserters sailed, six of the officers were seized with fever and many of
the men, of whom eighty were left sick at Nairn; in the ten days that the
regiment remained at Inverness it sent one hundred and twenty more to
hospital, ill of the same fever, which became frequent also among the
inhabitants of the town. “Though the virulence of the distemper diminished
afterwards in their march to Fort Augustus and Fort William, yet the corps
continued sickly for some time.” From the middle of February, 1746, when
the army crossed the Forth, to the end of the campaign, there were two
thousand sick in hospital, including wounded, of which number near three
hundred died, mostly of the contagious fever[191].

After the Peace of Aix-la-Chapelle in 1748, the English troops embarked at
Willemstad for home; “but the wind being contrary, several of the ships
lay above a month at anchor, and, after all, meeting with a tedious and
stormy passage, during which the men kept mostly below deck, the air was
corrupted and produced the jail or hospital fever.” The ships that came to
Ipswich were in the worst state, about four hundred men having been landed
sick there, most of them ill of this contagious fever. The infection was
at first as active and the mortality as great on shore as on board; but
the virulence of the fever was at length subdued by dispersing the sick
and convalescents as much as possible[192].

Monro gives a similar account of the camp sickness among the British
troops during the campaigns in North Germany in 1760-63. In the autumn of
1760, before he joined the forces, there had been much malignant fever and
dysentery: the camp at Warburg was near the battlefield (31 July, 1760),
where many of the dead were scarce covered with earth; there were also
many dead horses, and in a time of heavy rains, the camp, with the
neighbouring villages and fields, was filled with the excrements of a
numerous army. Not only the soldiers, but the inhabitants of the country,
who were reduced to the greatest misery and want, were infected, and whole
villages almost laid waste. When Monro joined at Paderborn in January,
1761, he found the hospitals overcrowded, and the malignancy of the fever
thereby much increased, so that a great many died. “The 1st and 3rd
regiments suffered most, owing to all the sick of each regiment being put
into a particular hospital by themselves, which kept up the infection, so
that they lost one-third of those left ill of this fever, and many of the
nurses and people who attended them were seized with it.” He distributed
the sick men of the Coldstreams among the houses in the town, and lost few
in comparison with the 1st and 3rd regiments. The contagion, under this
bold policy, did not spread.

Two points in the symptoms are noteworthy: first the occurrence of
suppurating buboes of the groins and armpits in several; and, secondly,
the frequency of round worms.

    “In this fever it was common for patients to vomit worms, or to pass
    them by stool, or, what was more frequent, to have them come up into
    the throat or mouth, and sometimes into their nostrils, while they
    were asleep in bed, and to pull them out with their fingers. The same
    thing happened to most of the British soldiers brought to the
    hospitals for other feverish disorders as well as this.”

He cannot explain the commonness of round worms in the sick, unless it was
from the great quantity of crude vegetables and fruits eaten, and the bad
water. Patients in convalescence often suffered from deafness, and from
suppurating parotids. Some had frequent relapses into the fever, “which
seemed to be owing to the irritation of these insects,” namely the worms.
Most of those who fell into profuse, kindly, warm sweats recovered, the
sweats lasting from twelve to forty-eight hours, and carrying off the
fever. He never saw any miliary eruptions, and only sometimes petechiae,
or small spots, or marbling as in measles[193].


Ship-Fever in the Seven Years’ War and American War.

Ship-fever would appear to have been at its worst after the middle of the
18th century. Dr James Lind joined Haslar Hospital in 1758, and brought to
the naval medical service the same high qualities which Pringle and Monro
brought to that of the army[194]. The smaller ships, such as the ‘Saltash’
sloop, the ‘Richmond’ frigate, and the ‘Infernal’ bomb were full of fever
of the most malignant kind; of 120 men in the ‘Saltash,’ 80 were infected
with a contagion much more virulent and dangerous than that in the
guard-ships. The explanation was that the smaller ships were receiving
vessels for the larger ships, and were manned from the gaols; drafts from
them carried the infection to the guard-ships and to the ships fitting out
for foreign service. Malignant fever also arose on the voyage home from
America[195]. In September and October 1758, after the reduction of
Louisburg, several of the ships arriving at Spithead were infected with a
malignant fever; three hundred men were received from them at Haslar
Hospital (some with scurvy), of whom twenty-eight died. The ‘Edgar,’
having been manned at the Nore from gaols, sailed for the Mediterranean,
and lost sixty men from fever and scurvy. The ‘Loestoffe,’ having lain in
the St Lawrence for eight months in perfect health, took on board six
convalescent men from Point Levi Hospital before sailing for home; in
forty-eight hours, fifty out of her two hundred men were seized with
fevers and fluxes, and six died on the voyage home. The ‘Dublin’ on the
homeward voyage from Quebec buried nineteen, and on her arrival reported
ninety men sick of fever, fluxes and scurvy. The ‘Neptune’ was said to
have lost one hundred and sixty men in a few months, and reported 136
sick. The ‘Cambridge,’ with 650 men in health, sent three of her crew to
the ‘Neptune’ laid up, to prepare her for the dock; of these three, one on
the fifth day became spotted and died, and another narrowly escaped with
life. The ‘Diana’ developed fever during a rough passage home from
America. The ‘St George,’ having sailed from Spithead in 1760, met with
rough weather and had to return on account of sickness. On the other hand,
Hawke’s fleet of twenty ships of the line with fourteen thousand men,
which defeated the French in November 1759, kept the Bay of Biscay for
four months in the most perfect health.

From 1 July, 1758, to 1 July, 1760, there were 5743 admissions to Haslar
Hospital, the chief diseases being as follows:

  Fevers         2174
  Scurvy         1146
  Consumption     360
  Rheumatism      350
  Fluxes          245

Of the fevers some were of an intermittent type, but by far the most were
continued ship-typhus. Relapses were common, even to the sixth or seventh
time. The fever varied a good deal in malignity, but never produced
buboes, livid blotches or mortifications, and seldom parotids. Twenty-four
men received from January to March 1760 out of the ‘Garland’ had most of
them petechial spots accompanied with other symptoms of malignity, and of
these, five died or 20 per cent. But of 105 received during the same
months from the ‘Postilion’ and ‘Liverpool’ only eight died, and those
mostly of a flux. The infection had little tendency to spread among the
attendants at Haslar. In the first six months only one nurse died; in
1759, two labourers and two nurses died, one of the nurses by infection,
having concealed some infected shirts under her bed, the other by decay of
nature. Of more than a hundred persons employed in various offices about
the sick there died only those five in the course of eighteen months.

    Although Lind’s account of ship-fever in the British navy is bad
    enough, he has collected some far worse particulars of foreign ships.
    Febrile contagion destroyed two-thirds of the men in the Duc
    d’Anville’s fleet at Chebucto (now Halifax), in 1746, the complete
    destruction of which was afterwards accomplished by the scurvy. It was
    ship-fever which ravaged the Marquis d’Antin’s squadron in 1741, the
    Count de Roquesevel’s in 1744, and the Toulon squadron in 1747. He
    takes the following from Poissonnier’s _Traité de Maladies des Gens de
    Mer_: The fleet commanded by M. Dubois de la Mothe sailed in 1757 from
    Rochefort for Louisburg, Canada, having some men sickly. The ships
    touched at Brest, and sent 400 ashore sick. They sailed from Brest on
    3 May, and arrived at Louisburg on 28 June. There was then sickness in
    only two ships, but in a short time it appeared in all the fleet. On
    14 October the fleet sailed from Louisburg for home, embarking one
    thousand sick, and leaving four hundred supposed dying. In less than
    six days from sailing most of the thousand sick were dead. When the
    fleet arrived at Brest on 22 November there were few seamen well
    enough to navigate the ships; 4000 men were ill, the holds and decks
    being crowded with the sick. The hospitals at Brest were already
    occupied, two ships from Quebec shortly before having sent a thousand
    men to them. Fifteen hospitals were soon filled, attended by five
    physicians and one hundred and fifty surgeons. Two hundred almoners
    and nurses fell victims. The infection passed to the lower class of
    the citizens, the havoc became general, and houses everywhere were
    filled with the dying and the dead. At length it got among the
    prisoners in the hulks. This dreadful infection began to abate in
    March, 1758, and ceased in April, having carried off in less than five
    months upwards of 10,000 people in the hospitals alone, besides a
    great number of the Brest townspeople. The stench was intolerable. No
    person could enter the hospitals without being immediately seized with
    headache; and every kind of indisposition quickly turned to fatal
    fever, as in the old plague times. The state of the bodies showed the
    degree of malignity that had been engendered: the lungs were engorged
    with blood, and looked gangrenous; the intestines often contained a
    green offensive liquor, and sometimes worms. Lind’s other instances
    are chiefly of the Dutch East Indiamen that anchored at Spithead with
    fever on board. In Nov., 1770, the ‘Yselmonde’ bound to Batavia, came
    to anchor at Spithead, and buried a number of men every day; two
    custom-house officers caught the fever and died. He gives two other
    instances of Dutch ships bound to Batavia, which came in to
    Portsmouth with fever[196]. The Dutch were said to send annually 2000
    soldiers to Batavia, and to lose three-fourths of them by the
    ship-fever before they arrived. In 1769 Lind saw ship-fever in the
    Russian fleet at Spithead.

Brownrigg, of Whitehaven, gives a good instance of the diffusion of typhus
in a newly-commissioned ship of war, and thence to the civil population,
which bears out Lind’s favourite notion that the gaols and the press-gang
had far-reaching effects. In the year 1757 a sloop of war had been hastily
manned at the Nore to protect the shipping between the Irish and
Cumberland ports. She reached Whitehaven in May, with fever on board. The
men were landed and lodged in small houses. Brownrigg found about forty
lying on the floor of three small rooms, very close together, many of them
in a dying state; seven days after he was himself seized with fever, and
had a narrow escape with life. The ship’s surgeon died of it, his mate
recovered with difficulty, two surgeons of the town died of it, and two
more in Cockermouth. The contagion spread widely among the inhabitants of
Whitehaven, Cockermouth and Workington[197].

Lind showed to Howard in one of the wards of Haslar Hospital a number of
sailors ill of the gaol fever; it had been brought on board their ship by
a man who had been discharged from a prison in London, and it spread so
much that the ship had to be laid up[198].

With the outbreak of the American War we begin to hear of still more
disastrous epidemics of fever in the English fleets. Some instances from
Robertson’s full collection must suffice[199]. The ‘Nonsuch’ left England
in March, 1777, and fifty of her men were carried off by fever before
December; in that month, the ‘Nonsuch,’ ‘Raisonable’ and ‘Somerset’ had
each from 130 to 150 men on the sick list, chiefly fever in the
‘Somerset,’ and scurvy in the other two. In April, 1778, the ‘Venus,’ with
a crew of 240, was at Rhode Island very sickly; the surgeon told Robertson
that they had lost about fifty men of fever, which still continued to rage
on board: they became sickly from being crowded with prisoners and
cruising with them on board in bad weather. The ‘Somerset’ had buried 90
men of the fever since she left England, 70 of them being of the best
seamen. On arriving at Spithead in October, 1779, Robertson found much
fever in the Channel Fleet which had lately come in, especially in the
‘Canada,’ ‘Intrepid,’ ‘Shrewsbury,’ ‘London’ and ‘Namur,’ three or four of
which were put past service, so much were they disabled by sickness. At
Gibraltar Hospital from 12 January to 31 March, 1780, there were admitted
570 men from twenty-seven ships, of whom 57 died; of 110 sick from the
‘Ajax,’ 18 died; of 437 Spanish prisoners, 37 died. Next year, in May,
1781, at Gibraltar, the ‘Bellona’ had buried 27 men since she left
England, and had 108 on the sick list. The ‘Cumberland’ had buried 15; of
the ‘Marlborough’s’ men, 40 had died at the hospital. Robertson had to
purchase at his own expense vegetable acids, fruit and vegetables for the
sick.

    Some statistics remain of the loss of men in the navy by sickness in
    the Seven Years’ War (1756-62) and in the American War[200]. The House
    of Commons had ordered a return of the number of seamen and marines
    raised and lost in the former; but the return was too general to be of
    much use, the number “lost” having included all those men who had been
    sent to hospital and never returned to their ships, all those who had
    been discharged as unserviceable, and all deserters. The number raised
    was 184,899, and the number “lost” 133,708, besides 1512 killed. The
    Return by the Navy Board for the period of the American War was more
    specific, showing only the number of the dead and killed.

    _Seamen and Marines raised, dead or killed, during the American War,
    29 Sept., 1774, to 29 Sept., 1780_:

        Year   Raised    Dead  Killed

        1774      345      --      --
        1775    4,735      --      --
        1776   21,565    1679     105
        1777   37,457    3247      40
        1778   31,847    4801     254
        1779   41,831    4726     551
        1780   28,210    4092     293
              -------  ------    ----
              175,990  18,545    1243

Fully a tenth part of the men raised were lost by sickness. Fever was the
chief sickness, and as it happened rarely that more than one in ten cases
of fever died, it will be easy to form an approximate estimate of the
proportion of all the men raised for the ships that were on the sick list
at one time or another with fever--nearly the whole, one might guess.

During the three last years of the period Haslar Hospital was constantly
full of typhus fever. Admiral Keppel’s fleet arrived at Spithead on 26
October, 1778, and soon began to be infected with contagious fever; before
the end of December, 3600 men had been sent to Haslar, which could make up
at a pinch 1800 beds. But the great epidemic at Portsmouth was the next
year, 1779, when the very large Channel Fleet under Sir Charles Hardy came
in. During the month of September, 2500 men were received into hospital,
and more than 1000 ill of fevers remained on board for want of room in the
hospitals. In the last four months of 1779, 6064 sick were sent to Haslar,
which had 2443 patients on 1 January, 1780. There was an additional
hospital at Foston, holding 200, as well as two hospital ships holding
600. The infection was virulent during the winter, when Portsmouth was
crowded with ships; and in the first five months of 1780, when 3751 cases
of fever were admitted during the decline of the epidemic, one in eight
died. The following shows how much fever preponderated at Haslar Hospital
in 1780. In 8143 admissions on the medical side, the chief forms of
sickness were as follows[201]:

        Continued Fevers     5539
        Scurvy               1457
        Rheumatism            327
        Flux                  240
        Consumption           218
        Smallpox               42

    Blane gives the instance of the ‘Intrepid,’ one of the Channel Fleet
    under Hardy in 1779: “Almost the whole of her crew either died at sea
    or were sent to the hospital upon arriving at Portsmouth. This ship,
    after refitting, was pretty healthy for a little time; but probably
    from the operation of the old adhering infection, she became extremely
    sickly immediately after joining our fleet and sent 200 men to the
    hospital after arriving in the West Indies. Most of these were ill of
    dysentery[202].” During a voyage of three weeks of the ‘Alcide’ and
    ‘Torbay’ from the Windward Islands to New York in September, 1780,
    nearly a half of the men were unfit. In the ‘Alcide’ it was a fever
    that raged, in the ‘Torbay’ it was a dysentery[203].

These experiences of fever in the ships of the Royal navy continued to the
end of the 18th century. In Trotter’s time, as in Lind’s, receiving ships
were a source of contagion to others, one ship of the kind, the
‘Cambridge’ having diffused fever among many ships of the Channel Fleet by
men drafted from her[204].

Ship typhus was also an incident of the voyages of the East India
Company’s ships, which nearly always carried troops. In the voyage of the
‘Talbot,’ 22 March--25 August, 1768, with 240 persons on board, “towards
the end of July a fever of a very bad kind made its appearance, attended
with delirium, low pulse, petechiae or livid vibices and hæmorrhages from
the nose, of which one died and three or four escaped hard.” The sick were
isolated, and the infection did not spread. Such outbreaks of typhus were
not uncommon at sea, although the loss of life from them was small beside
that from the fevers of Madagascar, Sumatra, Batavia and Bengal. The ship
typhus usually began on board among the soldiers. The most notable point
is that relapses were common, as Lind also observed at Haslar Hospital;
some on board the ‘Lascelles’ in 1783 (150 attacks among 151 soldiers) had
relapsed seven times. It does not appear, however, that the best class of
merchantmen suffered greatly from fevers. Dr Clark, who compiled a report
of the practice in fevers in the ships of the East India Company from 1770
to 1785, had reason to congratulate the Company on the general healthiness
of their fleet:

    “When ships set out at a proper season, when they are not too much
    crowded, when the weather is favourable, and no mismanagement appears,
    fewer lives are lost in these long voyages than in the most healthy
    country villages. And in perusing the medical journals I have the
    peculiar pleasure of finding that many ships have arrived in India
    without the loss of a single life by disease,” e.g. the ‘Valentine’ in
    1784, seven months out, with 300 souls, no deaths, and the
    ‘Barrington’ in 1789, no deaths outward bound[205].

On the other hand, these English reports give incidentally the most
unfavourable accounts of the Dutch East Indian ships. Three Dutch ships,
then in Praya Bay, St Jago (Cape de Verde Islands), had buried 70 to 80
men each, and had some hundreds of sick on board. Another report says:
“Before we left Table Bay several Dutch ships arrived, some of which had
buried 80 people in the voyage from Holland. None lost less than 40 men. I
am informed that some of their ships last year buried 200 men”--the causes
of the sickness being overcrowding, filth, and the slowness of the
voyages. One experience of the very worst kind happened to an English
expedition consisting of the 100th regiment, the 98th regiment, the second
battalion of the 42nd, and four additional companies. They had formed part
of the force for the reduction of the Cape of Good Hope, whence they
re-embarked for Bombay. During the voyage from Saldanha Bay a contagious
fever and scurvy broke out among the troops, who were crowded and badly
clothed; dead men were thrown overboard by dozens, and the regiments were
reduced to a third of their original numbers. Six officers of the 100th
regiment died, and an equal if not greater proportion of those of the 98th
and 42nd.

The other chief occasion of ship typhus was the emigration to the American
and West Indian colonies from Britain and Ireland. The Irish emigration
was especially active from the beginning of the 18th century, owing to
rack-renting and other causes. Madden[206] professed to know that
one-third of the Irish who went to the West Indies (perhaps he should have
included Carolina) perished either on the voyage or by diseases caught in
the first weeks after landing; and as we know that typhus attended the
Irish emigration in the 19th century, we may infer that the same was the
cause of mortality in the 18th.

The trouble from ship-fever in the navy was so great all through the 18th
century that many ingenious shifts were tried to overcome it. Towards the
end of the century, the favourite device was fumigation with the vapour of
mineral acids; one such plan, for which the Admiralty paid a good sum,
ended in the burning of several ships to the water’s edge. An earlier plan
was ventilation of the hold and ’tween decks by means of Sutton’s
pipes[207], which found a strong advocate in the Rev. Stephen Hales, of
the Royal Society[208].

Twice in the course of a paper to that learned body[209] he asserts that
the noxious, putrid, close, confined, pestilential air of ships’ holds and
’tween decks “has destroyed millions of mankind”; on the other hand,
according to the testimony of a captain of the navy, Sutton’s pipes had
kept his ship free from fever. Lind caps this with the case of H.M.S.
‘Sheerness,’ bound to the East Indies. She was fitted with Sutton’s pipes,
the dietary being at the same time so arranged that the men had salt meat
only once a week. After a very long passage of five months and some days
she arrived at the Cape of Good Hope without having had one man sick. “As
the use of Sutton’s pipes had been then newly introduced into the king’s
ships, the captain was willing to ascribe part of such an uncommon
healthfulness in so long a run to their beneficial effects; but it was
soon discovered that, by the neglect of the carpenter, the cock of the
pipes had been all this while kept shut[210].”

Ship-fever was at length got rid of by more homely and more radical means
than scientific ingenuity. Lind had shown one root of the evil to lie in
the pressing of men just out of gaol. Admiral Boscawen, by his unaided
wits, discovered another means of checking it. He avoided the mixing of
fresh hands with crews seasoned to their ships, unless when some evident
utility or necessity of service made it proper; “and upon this principle
he used to resist the solicitation of captains, when they requested to
carry men from one ship to another when changing their command[211].”
Towards the end of the 18th century many reforms were made in the naval
service--in the dietary, in the allowance of soap, in keeping the bilges
clean, in the use of iron and lead instead of timber; so that Blane dates
from the year 1796 a new era in the health of the navy[212].


The “Putrid Constitution” of Fevers in the middle third of the 18th
Century.

Resuming the history of fevers among the people at large from the great
typhus epidemic of 1741-42 to the end of the century, we find the
conditions somewhat different in the earlier and later divisions of the
period. The time of prosperity, when England exported large quantities of
wheat in every year except two or three, is reckoned from 1715 to 1765;
after the latter date England gradually ceased to be an exporting country,
owing to various causes, including the increase of pasture farming and the
growth of industrial populations in the northern counties. The year 1765
marks the beginning of what has been called the Industrial Revolution; and
it is also an important point of time in the history of the fevers of the
country, for it is in the generation after that we obtain all the best
information on what may be called industrial typhus, in the writings of a
group of physicians who were at once philanthropic and exact. But there
was an earlier period of fever, which is somewhat difficult to the
historian. It is perhaps the last period in which Sydenham’s language of
“epidemic constitutions” seems to be appropriate, whether it be that the
writers of the time were still under his influence, or because the
prevalent maladies could not well be accounted for in any other way. The
constitution in question was a “putrid” one. It coincided with the great
outburst of putrid or gangrenous sore-throat, to be described elsewhere;
and it included an extensive prevalence of fevers which were also called
putrid or nervous, and sometimes called miliary. Fevers of the same kind,
and with the same miliary rash, are described by earlier writers, such as
Huxham. Perhaps the most correct view of the matter is to consider this
type of fever as corresponding roughly to the middle third of the century,
and as having been interrupted by the typhus epidemic of 1741-42, during a
time of special distress. Besides the great outburst of putrid or
malignant sore-throat, there was also a disastrous murrain of cattle for
several years; and at Rouen there was a remarkable fever which some
English writers of the time took to be the highest manifestation of the
same “putrid” constitution that they discovered also in the English and
Irish fevers.

    The fever at Rouen which Le Cat specially described to the Royal
    Society was an outbreak from the end of November, 1753, to February,
    1754. This outbreak was only one of a series; but as it attacked a
    great number of persons of distinction and made great havock among
    them, it attracted unusual notice and was regarded as something new,
    the rumour spreading over Europe that Rouen had been visited by
    plague. The same fever, however, had occurred there in previous years;
    and allied forms of sickness, of the same gangrenous character,
    including gangrenous sore-throat, could be traced back for twenty or
    thirty years. It will suffice to mention of these the malignant fever
    which appeared in 1748 and continued in 1749, 1750 and 1751. There was
    a fixed pain in the head, pain about the heart, a low fever with
    delirium, often miliary eruptions, continual faint sweating,
    drowsiness, scanty or suppressed urine, abdominal distension. After
    death the stomach was found “inflamed” at places, as well as the small
    intestine. In some cases there were ulcerations which almost
    penetrated the coats. The lungs were engorged with blood. In one case,
    of a young woman aged twenty, the mesentery was filled with obstructed
    glands and the intestines mortified in different places. In another,
    almost the whole mesentery was mortified and there was an anthrax or
    carbuncle at the upper fore part of the armpit. At the same time some
    cases of smallpox, with miliary eruption, also had ulcerations of the
    stomach, with inflammatory spots on other parts of it and of the
    intestine, the mesenteric glands being enlarged and hard. Some of the
    cases at the Hôtel Dieu in 1750 were traced to infection from bales of
    horse-hair; but the type of the disease in those cases did not differ
    essentially from that of other cases. Some rapidly fatal cases in the
    winter of 1752-53 had suppurative inflammation about the heart. (In
    1739 there had been deaths from continued fever at the Hôtel Dieu,
    after an illness of six or seven days, marked by frequent faintings,
    small abscesses being found after death in the substance of the heart
    near the auricles.) The fever among the upper classes in the winter of
    1753-54 was marked, in its most mortal form, by lowness, continued
    fever, pain in the head, cough, sore-throat, nausea, dry black tongue,
    delirium, sweats, stupor, some oppression of the heart, spitting of
    blood, sometimes swelling of the belly, these symptoms being followed
    often by miliary eruption, and sometimes by a slight flux with blood.
    Many were affected with a dejection of spirits, and with a feeling of
    terror which made them tremble at the ordinary sound of the voice. The
    fever ran a full course of thirty or forty days (the miliary eruption
    coming about the 21st day), while death usually ensued about the 25th.
    The appearances after death were remarkable (many bodies were opened):
    “In some a part of the villous coat of the stomach and of the small
    guts was inflamed; and the rest of these organs were filled with an
    eruption of the miliary crystalline kind, except that it was larger;
    and there was likewise an obstruction in the glands of the mesentery.
    In others a strong inflammation had seized the whole stomach and a
    small portion of the oesophagus, but the intestines were free.... In
    those cases where the delirium had continued long and violent, we
    found either ulceration on the stomach, or its villous coat separated,
    together with a great inflammation, and even some gangrenous spots, on
    the other coats of that organ.” Some recovered by critical abscesses.
    Others who escaped death by the poison carried its terrible effects
    for many months; their limbs and joints were feeble, and they were
    troubled with vertigo, lassitude and fears[213].

Exactly covering the period of these fevers at Rouen, there were low
putrid fevers in London, in Worcestershire, in Ireland, and among the
English colonists in Barbados. It was certainly not a mere fashion in
medicine which produced the accounts of a similar fever, for these
accounts came from places far apart and were independent of each other. Dr
Fothergill, of Lombard Street, published in the _Gentleman’s Magazine_
every month for five years a short account of the weather and prevalent
diseases of London, beginning with April, 1751, and ending with December,
1755. He had the weekly bills of mortality before him, and he makes
various comments upon them; but his accounts of prevalent diseases are
from his own observation and by way of illustrating the bills. His first
reference to a fever is under October, 1751: “A slow continual fever, with
acute pain in the forehead: not many attacked, few mortally.” The year
1752 was remarkably free from fevers until November, when we read of a
fatal fever which had rheumatic symptoms at first (as at Rouen in 1744),
attacking the head later, with coma-vigil and a dark-coloured ichor on the
tongue and lips. It continued into January and February, 1753, proving
fatal to several. In the summer and autumn months there were fevers of the
low, depressed kind, sometimes called “remittents,” with copious sweats,
or “slow, remitting, dangerous fever,” or “slow, treacherous, remittent
fever, too often fatal.” The references to it are most numerous in the
months from November, 1753, corresponding to Le Cat’s Rouen narrative. It
was slow and imperceptible in its approach, the sick often going about ill
for a week before seeking advice; it was attended with profuse sweats
which never relieved, and was fatal to many. It continued more or less
through the summer, and from August, 1754, it is again prominent. In
September, it was the most alarming form of disease, and was then commonly
vehement in its access, with lassitude, and pain in the head and back;
unrelieving sweats are again mentioned, with dry tongue, delirium,
coma-vigil, and death about the 14th-15th day. Fothergill was at a loss to
know whether he should order blood to be drawn, owing to the low depressed
nature of the fever. In February, 1755, the fever is still “too much of
the nature of those which prevailed in the preceding months to allow a
repetition of bleeding.” In April it is called the petechial and miliary
fever, the miliary eruption being of a white sort with a very noisome
scent; the petechial spots turned livid, black and gangrenous; few
patients escaped who had been sweated at the beginning. The fever was
truly malignant, the patient restless from the outset, the sweats
weakening. Fothergill’s last entries of it are important, under the months
of May and June, 1755. In May, 1755, the fevers were “for the most part
allied to that dangerous remittent which has for some years past more or
less prevailed in different places of this kingdom.” In June: “It does not
appear that either in the hospitals or any part of the city a disease has
broken out of so dangerous a nature as has been reported. The same kind of
fever that has long continued in this city with some small variations in
its type, still remains, but it is by no means more frequent than it has
been in the preceding months, nor is it attended with more unfavourable
symptoms.”

It is impossible to say how general over England this fever may have been
in the years 1751-57. Our fullest accounts come from Worcestershire; but
the putrid fever is heard of more widely. Thus a short Latin piece in the
_Gentleman’s Magazine_, dated 14 April, 1755, is on the putrid fever
lately epidemic, and not yet extinct, in some parts of the county of
Somerset and adjoining places; its signs were contagiousness, pains of the
head and loins, nausea and vomiting, diarrhoea, quick weak pulse, purple
spots, delirium and coma[214]. Grainger, writing from Edinburgh in 1753,
declares his motive for publishing an account of the anomalous fever of
the Netherlands in 1746-48 to be that the same had lately been raging over
almost the whole of Britain.

We have some particulars for Kidderminster, which can hardly have been
exceptional for an industrial town, and according to the accounts were
true also for villages and market towns near. Kidderminster was, in the
year 1756, a town of about four thousand inhabitants, mostly hand-loom
weavers of worsted and silk. There were no power-looms anywhere in England
at that time; and the condition of the Kidderminster weavers’ houses was
doubtless what that of the Tiverton community had been fifteen years
before. Many of the weavers, we are told, are lodged in small nasty
houses, for the most part crowded with looms and other utensils[215]. Many
of these houses were built on a low flat of the river Stour, whence rose
putrid vapours after floods. Its situation had served to render the town
specially unhealthy before, as in the epidemic of 1727-29[216].

The first notice by Dr Johnstone is of a low miliary fever from Midsummer
1752 to the end of the year. This was a comparatively mild affair,
although it carried off several. But after Christmas it was succeeded by a
fever which would then have been classed as of the putrid kind. The first
great season was in 1753, it ceased in the fine years 1754-55, but came
back in 1756 and 1757. It began with languor, lowness, flutterings,
faintness, vague pains in the limbs, a low quick pulse, giddiness and
slight sickness. Some had a propensity to loose stools and to profuse
hurtful sweats; some bled at the nose, others coughed and spit blood; some
had pain in the throat, and crimson-red tongue, the sweat and breath of
the sick had a strong, offensive, putrid smell. In some of the worst cases
livid petechiae, large livid blotches, and dark brown spots occurred over
the trunk and limbs. The successful treatment was by mineral acids, bark,
port wine, and vesication. “This malignant fever was very often (though
not constantly) complicated with, and in general bore great analogy to the
malignant sore-throat which at this time prevailed in many parts of
England.” The fever which prevailed during that remarkable year (1753) was
very evidently contagious, for whole families were either all together or
one after another seized with it. One of the most distinctive symptoms was
a tendency to trembling of the whole body, as well as leaping of the
tendons at the wrists. In some the tonsils were beset with aphthous
sloughs, and towards the decline there would be aphthae of the mouth, but
symptomatic only, and not the dominant lesion as in the ulcerous
sore-throat. About the 15th day the fever was generally at its height. The
miliary eruptions were critical to the few that had them; the flat livid
petechiae appeared at all times of the disorder. Johnstone then compares
the fever with that described by Le Cat at Rouen in the winter of the same
year; and although he had been unable to satisfy his curiosity by opening
any body dead of the fever, he felt sure that these dreadful symptoms
arose from some affection of the stomach and small guts, at first
erysipelatous, afterwards gangrenous, and at last truly sphacelous.

Johnstone’s statement that the putrid fever in Worcestershire in 1752-53
was often complicated with and bore great analogy to the malignant
sore-throat is borne out by Huxham’s accounts for Plymouth during the same
season:

    “In all sorts of fevers,” he writes, “there was a surprising
    disposition to eruptions of some kind or other [including miliary], to
    sweats, soreness of throat and aphthae.” It is hardly possible to make
    out all his cases of “malignant anginose fever” to have been scarlet
    fever with sore-throat. Thus there occurred stench, swelling, and
    samious haemorrhages “commonly in those that died of malignant
    anginose fever above described. I have known the whole body swell
    vastly, even to the ends of the fingers and toes, with a cadaveric
    lividity, though almost quite cold, and an intolerable stench, even
    before the person was actually dead, blood issuing at the same time
    from the ears, nose, mouth and guts[217].”

The first years of this putrid or miliary fever were not seasons of
scarcity, there having been no failure of the crops since 1741 (unless in
Ireland, in the province of Ulster mostly, in 1744); on the contrary, many
of the seasons had been unusually fine and abundant, the exports from
England of wheat, barley, malt and rye in the three years 1748, 1749 and
1750 amounting to four million quarters. Prices were at the same time
favourable to the poorer classes[218]. But there had been a destructive
murrain for several years (30,000 cows are said to have died in Cheshire
in 1751), and the harvest of 1756 was a failure.

To the month of February, 1756, the season had been very forward, but the
early promise of spring was blighted by cold, a wet summer and autumn
ensued, the fruit crop was ruined, and the corn harvest spoiled by long,
heavy rains. A dearth, bread-riots, &c. ensued[219]; but it is to be noted
that the revival of the dangerous malignant contagious fever began at
Kidderminster as early as April, becoming much worse after harvest. “Many
for weeks or months laboured under an uncommon depression of spirits, felt
their strength abate, with great lassitude, and very often a great
proneness to faint away.” As the summer advanced the fever became truly
epidemic not only in Kidderminster but in many other parts of the West and
North-west of England.

    It went through whole families, who succumbed either all together or
    one member after the other, and was carried from place to place by the
    attendants on the sick. “It prevailed chiefly in poor families, where
    numbers were lodged in mean houses, not always clean, but sordid and
    damp. It seemed to affect such poor families most where there was
    reason to think a sufficiency of the necessaries of life, on account
    of the dearth, had for some time been scantily supplied; yet the other
    poor persons, given to the intemperate use of malt liquors and ardent
    spirits, were observed to be very much liable to its influence. And
    not a few persons in easy circumstances of life were affected with
    this fever like others.”

Frost in October checked it, and then measles of a malignant type had its
turn among the children, the whooping-cough succeeding the measles. From
November to Christmas the putrid fever, which chiefly affected persons
from ten to fifty, and more women than men, returned with increased force.
In fatal cases, the face was ghastly, sunken and livid (the facies
Hippocratica), the patient sweated profusely, but seldom became cold till
death was at hand. There was an abominable cadaverous stench in the
breath, perspiration and stools. In these cases death took place from the
12th to the 14th day.

The intense and long frost of the opening months of 1757 nearly put a stop
to the fever at Kidderminster.

    “But in other neighbouring villages and market towns it has since the
    spring hitherto (Dec. 1757) been very frequent in places that were
    little affected with it last year. The families of the poorer sort of
    people universally are the most subject to it. And it is observable
    that the fever in some places first broke out in the parish
    workhouses, and from thence spread among the neighbouring people with
    great malignity. Wherever it has appeared it has given very apparent
    and fatal evidence of its infectious nature[220].”

Parliament was summoned to meet in December, 1756, on account of the
dearth, which formed the topic of the Speech from the throne. The export
of corn (which had reached a million quarters a year not long before) was
prohibited, and the use of grain in distilling stopped for two months. The
distress was more acute in 1757, and was enhanced by the greed of
corn-dealers and millers, who used French bolting-mills to grind the mere
husks of wheat, pease, rye and barley together into meal. Short, who
practised at Sheffield, says that the fever in October and November, 1757,
“was neither so rife nor fatal as in 1741[221].” It raged fiercely in
several towns at a distance, “where it went by the name of the miliary
fever,” and was mostly among the poor, half-starved in the dearth of
1756-57. It is heard of again in the district of Cleveland in the winter
of 1759-60, where it seems to have been mostly a disease of children
complicated with sore-throat, and allied more to scarlet fever than to the
putrid fever of adults[222]. But at Sunderland, near at hand, there was
spotted fever at the same time, and in Newcastle there was dysentery.

The accounts of fever in Ireland in the same period as in England (see
chapter II.) are not without value, as showing that the “putrid” or
nervous type of fever, contrasting with the ordinary typhus of the
country, had been remarked there also. Rutty and Sims describe, during a
certain period, the symptoms of the low, putrid fever, sometimes with
miliary eruptions, identifying it both by name and in character with the
fever then prevalent in England. The most significant thing in Rutty’s
annals is that there occurred in the midst of the low, putrid fever with
miliary pustules in 1746, a more acute fever, ending after five or seven
days in a critical sweat, and relapsing. The same fever, not very fatal,
reappeared in 1748. Sims brings the history of the nervous or putrid or
miliary fever in Ireland (Tyrone) continuously down to the year 1772, as
elsewhere related. The remarkable phenomenon of tremors or shakings, which
most witness to, was seen by him in perfection in the year 1771:

    The tremulousness of the wrists, he says, extended to all the body,
    “insomuch that I have seen the bed-curtains dancing for three or four
    days, to the no small terror of the superstitious attendants, who, on
    first perceiving it, thought some evil spirit shook the bed. This
    agitation was so constant a concomitant of the fever as to be almost a
    distinguishing symptom.” These were not the shakings of an ague, for
    there might be no intermission for days[223].

Perhaps the most surprising testimony to the existence of an “epidemic
constitution” of slow, continued nervous fever comes from the island of
Barbados. Hillary, who had kept a record of the prevalent diseases at
Ripon, continued the same when he settled in Barbados in 1751[224]. There
can be no doubt as to the appearance of this fever in February 1753, its
prevalence all over the island for eighteen months, and its disappearance
in September 1754, when, as he writes, “It now totally disappeared and
left the island, and, I think, has not been seen in it since” (1758). He
gives the same account of it as the observers in England and Ireland,
except that he does not describe miliary eruptions and describes jaundice
in convalescent children. It was insidious in its onset (as in London),
the patient often keeping afoot five or six days; the symptoms included
pains in the head, vertigo, torpor, lassitude, vigil, delirium, faintings,
partial sweats, involuntary evacuations, gulpings, tremors, twitchings,
catchings, coma and convulsions. Recovery was marked by copious equable
sweats and plentiful spitting. “This slow, nervous fever was certainly
infectious, for I observed that many of those who visited, and most of
them that attended the sick in their fever were infected by it, and got
the disease, and especially those who constantly attended them and
performed the necessary offices of the sick.” It was last heard of in the
remoter parts of the island.


Miliary Fever.

It will have been observed in the foregoing accounts of the predominant
fevers of the years (roughly) from 1750 to 1760 that there was often a
miliary eruption, but that it was far from constant. The constant things
were the lowness, depression, ill-smelling sweats, tremors of the whole
body or of the wrist-tendons, and other nervous or ataxic symptoms. But we
hear more of a miliary eruption in connexion with that than with any other
period of fevers in the history; and this was the time when a controversy
arose as to whether there was in reality a distinctive kind of fever
marked by miliary eruption. Some of the school of Boerhaave contended that
the phenomenon of miliary vesicles was due solely to the heating and
sweating treatment of the alexipharmac physicians. De Haën and others
answered that miliary fever was a natural form, independent of the mode of
treatment. The Boerhaavian contention may be admitted as good for such
miliary fevers as were described under that name in 1710 by Sir David
Hamilton[225]; nearly the whole of his sixteen cases appear to have been
made miliary by treatment, in so far as they became miliary at all. What
this physician did was to foretell the approach of miliary symptoms in
various maladies (about one-half of the cases being of lying-in women, and
the rest various), and then to prescribe Gascoign’s powder, Goa stone,
Gutteta powder, Venice treacle or other diaphoretics, along with diluents
and the application of blisters; the miliaria appeared about the breast,
neck, and clefts of the fingers in due course (tenth to fourteenth day).

So far as his clinical cases are concerned, the late appearance of miliary
vesicles, lasting a few days, is sufficiently explained by the powerful
drenches administered; and it can hardly be doubted that much of what was
called miliary fever was of that factitious kind. But even in Hamilton’s
essay we find indications of a real miliary type of fever; thus he
mentions a class of cases which look to be the same as those described by
Johnstone, Rutty, Sims and others forty years after--cases with
wakefulness, depression, tremblings of the tongue and hands, convulsive
movements and delirium. He mentions also a complication of this with
sore-throat in 1704, which destroyed many.

As to the association of miliary eruption with the low putrid fever so
characteristic of the sixth decade of the 18th century, it is asserted by
too many and in too various circumstances for any doubt as to its reality.
There is nothing to show that the alexipharmac treatment was the one
always used; and it is not certain that some in Ireland and elsewhere who
had miliary eruption received any medical treatment at all. Again, miliary
vesicles, not always with perspiration, were commonly found in the
relapsing fever of Irish emigrants in London during the great famine of
Ireland in 1846-47, by which time the powerful drenches of the
alexipharmac treatment had been long disused[226]. The controversy as to
the reality of miliary fever was one of the kind usual in medicine:
certain physicians, of whom Hamilton in 1710 was an obvious instance, took
up an untenable position; they were answered according to the weakness of
their argument; and that has been held in later times to be an answer to
all who alleged the existence of a type of fever marked by miliary
eruptions. There can be no question as to a low, “putrid” kind of fever in
which miliary eruptions were usual; but offensive sweats were perhaps
more usual, whence the name of putrid in a literal sense, different from
the theoretical sense of Willis; more constant also were the starting of
tendons, the tremors and shakings, together with very varied hysteric
symptoms, from which the fevers received the name of nervous. Dr John
Fordyce in his ‘History of a Miliary Fever’ (1758) really describes under
that name the symptoms of the low, nervous, putrid fever, often attended
with miliary vesicles, which had been the common type in England in the
years immediately preceding, and was a common type for some time after,
although less is heard of the miliary eruptions in the later history[227].

About the last quarter of the 18th century medical writers were inclined
to drop the names of nervous and putrid as distinctive of certain fevers.
Pringle, in his edition of 1775, says he had been careful to avoid the
terms nervous, bilious, putrid and malignant, which conveyed either no
clear idea or a false one. Armstrong, another army physician, writing in
1773, says: “Nervous, putrid, bilious, petechial or miliary, they are all
of the malignant family; and in this great town [London] these are almost
the only fevers that have for many years prevailed, and do so still, to
the great destruction of mankind. For inflammatory fevers ... have for
many years been remarkably rare[228].” Dr John Moore becomes sarcastic
over the variety of names given to continued fever, some such generic name
as Cullen’s “typhus,” then newly introduced, being what he desired[229].

Haygarth, writing of the Chester fevers in 1772, said that the miliary
fever had been “supposed” endemic there for more than thirty years past,
but he thought it probable that the eruption had generally, or always,
been fabricated “by close, warm rooms, too many bed-cloaths, hot medicines
and diet.” He had seen only one case in the epidemic that year, and he
believed its rarity at that time was due to the treatment by fresh air and
by “such regimen and medicines as are cooling and check
putrefaction[230].” We shall see later that Percival, for Manchester,
contents himself with saying that miliary fevers, which were formerly very
frequent in that town and neighbourhood, now [1772] rarely occur[231]. In
Scotland as late as 1782 the type was still nervous or low, and hardly
ever inflammatory[232].

_Mortalities in London from fever and all causes._

        Fever     All
  Year  deaths   deaths

  1741   7528    32169
  1742   5108    27483
  1743   3837    25700
  1744   2670    20606
  1745   2690    21296
  1746   4167    28157
  1747   4779    25494
  1748   3981    23069
  1749   4458    25516
  1750   4294    23727
  1751   3219    21028
  1752   2070    20485
  1753   2292    19276
  1754   2964    22696
  1755   3042    21917
  1756   3579    20872
  1757   2564    21313
  1758   2471    17576
  1759   2314    19604
  1760   2136    19830
  1761   2475    21063
  1762   3742    26326
  1763   3414    26148
  1764   3942    23202
  1765   3921    23230
  1766   3738    23911
  1767   3765    22612
  1768   3596    23639
  1769   3430    21847
  1770   3214    22434

It is singular to observe that in the five successive years in this period
with lowest fever-deaths and deaths from all causes, the years 1757-61
England was at war on the Continent. A similar low fever-mortality
corresponded with the wars under Marlborough and Wellington.

The era of agricultural prosperity in England, which had its only
considerable interruptions in the years 1727-29 and 1740-42, may be said
to have met with a more serious check from the bad harvest of 1756. There
was a recurrence of agrarian troubles in 1764-67, partly through actual
scarcity caused by the extreme drought of 1764, partly through the pulling
down of cottages and the discouragement of country villages, which
Goldsmith has pathetically described in his poem of the time. Short says
that the country in 1765 was in general very healthy but for children’s
diseases. “In some parts the putrid fever roamed about from place to place
in the highest degree of putrefaction, so as several dead bodies were
obliged to be buried the same day as they died.” The price of provisions
was excessive, meal riots broke out, and the export of corn was stopped,
Parliament having been summoned for the occasion in November, 1766[233].
In 1769, at the time of the formation of Chatham’s ministry, the same
train of incidents recurred,--bread-riots, flour-mills wrecked, corn and
bread seized by the populace and sold at low prices, collisions with the
military, the gaols full of prisoners[234]. The long period of cheapness,
having lasted half a century, was coming to an end. Moralists and
economists had much to say as to the meaning of the national distress
which began to be felt in the sixties. Want of industry, want of
frugality, want of sobriety, want of principle, said one, had brought
trouble on the working class. “The tumults that have lately arisen in many
counties of England are no other than the murmurs of the people, which
have been heard for some years, bursting forth at last into riot and
confusion.” The English, it seems, had returned to their old medieval
taste for the best food they could get; they would not give up the finest
bread, although the Irish lived on potatoes, and the French on turnips and
cabbage: “The ploughman, the shepherd, the hedger and ditcher, all eat as
white bread as is commonly made in London, which occasions a greater
consumption of wheat.” Women must have tea and snuff, though children go
naked and starved. Another writes: “The poorest people will have the
finest or none.” The enclosures had made a want of tillage. “What must
become of our poor, destitute of work for want of tillage?” The country
had for the most part been sickly, labourers scarce, and the farmers not
able to get their usual quantity threshed out. The profligacy of the poor,
profane swearing, etc., are remarked upon[235].

In the last thirty years of the 18th century the accounts of fever in
England became more detailed as to its circumstances, and more numerically
precise. I shall accordingly bring together all that I can find relevant
to fever in London, Liverpool, Newcastle and Chester, and thereafter in
those towns, such as Manchester, Leeds, and others in the North, which
were specially touched in their public health by the movement known as the
Industrial Revolution.


Typhus Fever in London, 1770-1800.

In the London bills of mortality the item of fevers diminishes steadily
during the latter part of the 18th century, the deaths from all causes
diminish, the births come nearer to the number of the deaths, and in three
years of the last decade they exceed them. This statistical result is
doubtless roughly correct; but the bills were becoming more and more
inadequate to the whole metropolitan area; and even for the original
parishes which they included they have not the same value for fever in the
later period as they had for plague at their beginning[236]. On the other
hand, from about the year 1770 we begin to have more exact medical
accounts of fever in London, which are not indeed numerically exhaustive,
but good as samples of what was going on. Whatever improvement there was
in the prevalence of typhus fever touched the richer classes. The Paving
Act of 1766 is credited with having improved the health of the City, and
there were many new streets and squares being built in the west end that
were, of course, free from typhus. It is to these desirable residential
quarters that the eulogies of Sir John Pringle[237], Dr John Moore[238]
and others apply. The slums of London were as yet unimproved, and but
little known to the physicians. Lettsom, who was one of the first of his
class to visit among the poor in their homes, has much to say of typhus
fever; but he is emphatic that it was nearly all an infection of the poor.
“In the airy parts of this city,” he writes in 1773, “and in large, open
streets, fevers of a putrid tendency rarely arise.... In my practice I
have attentively observed that at least forty-eight out of fifty of these
fevers have existed in narrow courts and alleys.” The same is remarked by
Currie for Liverpool, by Clark for Newcastle, by Percival and Ferriar for
Manchester, by Haygarth for Chester, and by Heysham for Carlisle.

The quarters of the rich had gradually become detached from those of the
poor. I have shown this more especially for Chester, where the old walls
made a clear division; but it was general in the second half of the 18th
century[239].

Medical practice lay mostly among the richer classes; the physicians knew
little of the state of health in the cellars and tenement-houses of large
towns. Those physicians who did know how much typhus fever there was in
these purlieus had to enter a caveat against the incredulity of the rest.
Dr Currie of Liverpool, whose facts I shall give in their place, protested
that he was not exaggerating; a protest the more necessary that a
contemporary of his own, Mr Moss, a middle-class practitioner, who wrote a
book specially on the medical aspects of Liverpool, declares that fever is
“rare” in that city, while Currie was treating from his dispensary a
steady average of three thousand cases of typhus every year. In the same
years, in February, 1779, a physician to the army, Dr John Hunter, who had
commenced practice in Mayfair, found on visiting in the homes of the
poorer classes in the west of London cases of fever for which he had no
other name than the gaol or hospital fever of his military experience; it
was so much a novelty to him, apart from campaigns or transport ships,
that he gave an account of his discovery of domestic typhus to the College
of Physicians[240]. At length he found so many cases steadily winter after
winter that he had them sent to the infirmary of the Marylebone Workhouse.
The practitioners who knew most of the sicknesses of the poor were such as
Robert Levett, Dr Samuel Johnson’s dependant, who lived with the doctor
in the house in Gough Square. Levett had been a waiter in a Paris
coffee-house frequented by the medical fraternity, and had acquired a
taste for and perhaps some knowledge of the healing art. He made his
modest living by the small fees or articles of food and drink which his
poor patients gave him. He had only to issue from the back of Gough Square
by the courts and alleys behind Fleet Street, and he would find in the
region between Chancery Lane and Shoe Lane hundreds of families seldom
visited by a physician or by a qualified surgeon-apothecary. The good
Levett was only one of a class. There had always been such humble medical
attendants of the poor in London. An Act of the third year of Henry VIII.
was directed against them at the instance of the privileged practitioners;
but the regular faculty is said to have proved in the sequel both greedy
and incompetent, and after thirty years there came another Act, couched in
terms that the bluff king himself might have indited (31-32 Henry VIII.),
which asserts those qualities of the profession in so many words, and
establishes the right of any subject of the king to practise minor surgery
and the medicine of simples upon his or her neighbours. That Act is still
part of the law of England, and under it Levett exercised a statutory
right, perhaps without knowing it[241]. There were many other regions of
courts and alleys all round the City on both sides of the water, which
must have been medically served by such as Levett, if served at all. It
was there that typhus was found and at length clinically described by
competent physicians, among the earliest of whom was Lettsom.

The General Dispensary in Aldersgate Street having been started in 1770
with one physician, Lettsom was chosen additional physician in 1773, and
threw himself into the work with great zeal[242]. In the first twelvemonth
he saw many cases of fever, as in the following table:

_Lettsom’s practice in Fevers at the Aldersgate Dispensary._

                                     1773

    Febris      April  May  June  July  Aug.  Sept.  Oct.  Nov.  Dec.

  hectica         2     2     4    13     4     2      3     4     9
  inflammatoria  --    --    --    --    --    --     --     1     1
  intermittens    3     1     7     1     1     1      1    --     2
  nervosa         4     3     4    14     7    11      4     5     1
  putrida        14    19    14    25    14    21     34    22    11
  remittens       6    10     5     4     3     6      7     3    12
  simplex vel    --     2     1     6     2     5      4     5    --
    diarium

                       1774
                                     Total in
    Febris        Jan.  Feb.  March  12 months  Died

  hectica          12    18    13       86        3
  inflammatoria     1    --     2        5       --
  intermittens      1     2     2       22       --
  nervosa           1     5     4       65        3
  putrida           6     7     5      192        8
  remittens        13    10     3       82       --
  simplex vel      --    --     4       29       --
    diarium

The nervous, putrid and remittent fevers, belonging, to the same group,
make up the bulk of the fevers. The hectic fevers were almost all of
children. The fatal cases of fever were fourteen, the fatal cases in all
diseases for the year having been forty-four. What these putrid, nervous
and remittent fevers were, will now appear from some of Lettsom’s
descriptions. Fevers with symptoms of putrescency were marked by nausea,
bitter taste, and frequent vomiting, by laboured breathing and deep
sighing, offensive breath, sweats offensive and sometimes tinged with
blood, almost constant delirium, the tongue dry, the tongue, teeth and
lips covered with black or brown tenacious foulness, thrush and ulceration
in the mouth and throat, the urine with a dark sediment, the stools
excessively nauseous and foetid, and blackish or bloody, the eyes horny or
glassy, with the whites often tinged of a deep blood colour, spots on the
skin like fleabites, or larger haemorrhagic vibices, bleeding from the
gums, nose or old ulcers, hiccup near death, often a cough through the
fever. Lettsom’s treatment consisted in good liquors, Peruvian bark, and
above all fresh, or “cold” air: “When it is considered that putrid fevers
originate in close unventilated places, the introduction of fresh air
seems so natural a remedy that I have often admired its aid should have
been so long neglected[243].” Accordingly he persuaded the poor people to
open their windows, and dragged the sick out of doors as soon as it was
safe to do so; the effects, he says, were wonderful. His fifty-one cases
are most valuable illustrations of the perennial fever in the crowded
parts of London:

    Case 1 is of a man aged forty who had occasion to visit a miserable
    crowded workhouse in Spitalfields. He was instantly seized with such a
    nausea and debility as induced him to keep his room as soon as he got
    home. At the end of a week Lettsom found him in “the true jail-fever,
    or, what is the same, a true workhouse-fever.” He had involuntary
    stools and leaping of the tendons, and took more wine in a week than
    he had done for many years.

    Cases 2 to 12 were of several families in one house in a court in Long
    Lane, Aldersgate Street, who had been infected by a discharged
    prisoner from Newgate. Other cases follow, where the infection was
    caught from visiting the sick. In Case 17, Lettsom applied blisters
    “owing to the importunity of the friends,” but without advantage. Case
    30, on 26th October, 1773, was of a family of six persons near Christ
    Church, Lambeth, father, mother, boy of seventeen, child of two
    (slight attack) and two maids. Other localities were courts off
    Whitecross Street, Jewin Street, Little Moorfields, Chiswell Street,
    and St Martin’s-le-Grand. Case 43 was of a woman, aged thirty, in
    Bunhill Row; she attended a relation who died of a putrid fever, and
    was herself attacked; her eyes were bloodshot, her skin marbled and
    interspersed with a general deep-coloured eruption, her cheeks and
    nose mortified. Cases 44-47 were of people in a “very helpless
    situation” in Gloucester Court, Whitecross Street.

The year 1773, to which these experiences in a small part of London
relate, was one of high febrile mortality, according to the Bills. Two
years after, Dr William Grant was moved to write an ‘Essay on the
Pestilential Fever of Sydenham, commonly called Gaol, Hospital, Ship and
Camp Fever[244],’ which, as he said in his preface, “I often see in this
city: and though so common and fatal, appears not at present to be
generally understood.” It was, he says, “an indigenous plant, frequent in
this city, being produced by close confinement; but it often passes
unnoticed, because unknown.” The deaths by “fever” in the London Bills
were as follows until the end of the century:

_Deaths from Fever and from all causes in London._

          Fever      All
  Year    deaths    deaths

  1771     2273     21780
  1772     3207     26053
  1773     3608     21656
  1774     2607     20884
  1775     2244     20514
  1776     1893     19048
  1777     2760     23334
  1778     2647     20399
  1779     2336     20420
  1780     2316     20517
  1781     2249     20719
  1782     2552     17918
  1783     2313     19029
  1784     1973     17828
  1785     2310     18919
  1786     2981     20454
  1787     2887     19349
  1788     2769     19697
  1789     2380     20749
  1790     2185     18038
  1791     2013     18760
  1792     2236     20213
  1793     2426     21749
  1794     1935     19241
  1795     1947     21179
  1796     1547     19288
  1797     1526     17014
  1798     1754     18155
  1799     1784     18134
  1800     2712     23068

There were higher figures in the years immediately before 1771, the years
to which the generalities of Fordyce and Armstrong relate. There is a
decline in the fever-mortality towards the end of the century; but it is
just from the years 1799-1800 that we have an account by Willan of the
prevalence and conditions of London typhus, than which nothing can well be
imagined worse. The intermediate glimpses we get of typhus in London in
the writings of Dr Hunter, physician, and of Dr James Sims, show that the
disease was perennial.

    “In the month of February, 1779,” says Hunter[245], “I met with two
    examples of fever in the lodgings of some poor people whom I visited
    that resembled in their symptoms the distemper which is called the
    jail or hospital fever. It appeared singular that this disease should
    show itself after three months of cold weather. Being therefore
    desirous of learning the circumstances upon which this depended I
    neglected no opportunity of attending to similar cases. I soon found a
    sufficient number of them for the purpose of further information. It
    appeared that the fever began in all in the same way and originated
    from the same causes. A poor family, consisting of the husband, the
    wife, and one or more children, were lodged in a small apartment not
    exceeding twelve or fourteen feet in length, and as much in breadth.
    The support of them depended on the industry and daily labour of the
    husband, who with difficulty could earn enough to purchase food
    necessary for their existence, without being able to provide
    sufficient clothing or fuel against the inclemencies of the season. In
    order therefore to defend themselves against the cold of the winter,
    their small apartment was closely shut up, and the air excluded by
    every possible means. They did not remain long in this situation
    before the air became so vitiated as to affect their health and
    produce a fever in some one of the miserable family. The fever was not
    violent at first, but generally crept on gradually ... soon after the
    first a second was seized with the fever, and in a few days more the
    whole family perhaps were attacked, one after another, with the same
    distemper. I have oftener than once seen four of a family ill at one
    time and sometimes all lying on the same bed. The fever appeared
    sooner or later as the winter was more or less inclement, as the
    family was greater or smaller, as they were worse or better provided
    with clothes for their persons and beds, and with fuel, and as their
    apartment was more or less confined. The slow approach of the fever,
    the great loss of strength, the quickness of the pulse with little
    hardness or fulness, the tremors of the hands, and the petechiae or
    brown spots upon the skin, to which may be added the infectious nature
    of the distemper, left no doubt of its being the same with what is
    usually called the jail or hospital-fever.”

Dr James Sims, who had seen much of Irish typhus in Tyrone in his earlier
years, and had removed to London, wrote of typhus among the poor there in
1786, ten years before the more systematic and more circumstantial
descriptions by Willan[246].

This fever was exceedingly mortal, several medical men, he had reason to
believe, falling sacrifices to it. Sims never saw the cases till the 7th
or 8th day, when they were desipient, insensible, with pulse scarcely to
be felt and not to be counted, all having petechiae. None had scarlet rash
or sore-throat. They sank and died quietly; the strongest cordials did not
produce the smallest effect, and blisters in many did not even raise the
skin[247].

It is in the year 1796 that we begin to have the full and accurate records
by Willan of the prevailing diseases of London month by month as he saw
them at the Carey Street Dispensary, situated in the crowded quarter
between Holborn and the Strand[248]. His first reference to typhus is as
follows:

    “In September, also, fevers usually appear which from their
    commencement exhibit symptoms of malignancy; being attended with a
    brown dry tongue, violent pain of the head, delirium, or coma,
    deep-seated pains of the limbs, petechial spots and haemorrhagy. These
    fevers become highly contagious, especially when they occur in close,
    confined situations, and in houses where little attention is paid to
    ventilation or cleanliness. The disease is extended by infection
    during the months of October and November, but its progress is
    generally stopped by the frosts of December.”

Willan says little more of fever in London until September, 1798, when
these contagious malignant fevers became more numerous, both in the city
and adjacent villages, than had been known for many years before; also the
fever was more fatal than usual, one in five or six dying, whereas one in
seven was formerly a very unfavourable death-rate, and one in twenty not
unknown. Haemorrhages, aphthae, diarrhoea, starting of the tendons,
picking the bedclothes, violent delirium, ending in deafness, stupor,
hiccough and involuntary evacuations, were the usual accompaniments of
this fever. In the corresponding months of 1799 he recurs to the symptoms
of this “malignant contagious fever,” and depicts typhus as clearly as may
be. In September, 1799, it was “attended with a dull pain of the head,
great debility or sense of lassitude and pains referred to the bones,
tremblings, restlessness with slight delirium, a querulous tone of voice,
a small and frequent pulse, heat of the skin, thirst and a fur upon the
tongue, first of a dirty white colour, but turning in the latter stage of
the disease to a yellowish brown. In this form the fever continued
thirteen days without any dangerous symptoms, and then suddenly
disappeared, leaving the patient, for some time after, languid and
dispirited. All the individuals of a family were successively affected
with the same train of symptoms; many of them so slightly as not to be
much confined to their beds.” In October and November he describes the
symptoms of the disease in a more dangerous form. By this fever, he was
informed, some houses of the poor had been almost depopulated, the
infection having extended to every inmate. “The rumour of a plague was
totally devoid of foundation.”

He then describes the state of the dwellings where such fevers
occurred--the unwashed bed-linen, the numbers in one bed, the rooms
encumbered with furniture or utensils of trade, the want of light and air
in the cellars and garrets and in the passages thereto, the excremental
effluvia from the vault at the bottom of the staircase. It cannot be
wondered at, he concludes, that contagious diseases should be thereby
formed, and attain their highest degree of virulence; and he estimates
that “hundreds, perhaps thousands” of labourers in and near London, heads
of families and in the prime of life, perished annually from such fevers.
He denies that his account is exaggerated, and appeals for the truth of it
to medical practitioners whose “situation or humanity has led them to be
acquainted with” the localities[249].


Typhus in Liverpool, Newcastle and Chester in the last quarter of the 18th
century.

Liverpool, in the last quarter of the 18th century, came next in size to
London, having a population (in 1790) of 56,000 to the capital’s estimated
800,000. According to a medical author, whose experiences lay among the
middle classes, it was everything that could be wished in the way of
healthfulness and prosperity; but it had a dark side as well. About 7,000
of the people lived in cellars underground, and nearly 9,000 in back
houses, in small confined courts with a narrow passage to the street.
“Among the inhabitants of the cellars,” says Currie[250], “and of these
back houses, the typhus is constantly present; and the number of persons
under this disease that apply for medical assistance to the charitable
institutions, the public will be astonished to hear, exceeds three
thousand annually.... In sixteen years’ practice I have found the
contagious fever of Liverpool remarkably uniform among the poor. Seldom
extending itself in any considerable degree among the other classes of the
community, it has been supposed that Liverpool was little subject to
fever; but this will be shewn from authentic documents to be a great and
pernicious error.” At the Dispensary in the year 1780 the cases of typhus
averaged 160 per month, the numbers being as remarkably steady from month
to month as from year to year. In the ten years from 1 January, 1787, to
31 December, 1796, 31,243 cases of fever were entered on the books of the
Dispensary, an average of 3124 per annum[251].

Of 213,305 cases of all diseases at the Dispensary in seventeen years,
1780 to 1796, 48,367, nearly one-fourth, were labouring under typhus.
Supposing that these were all the cases of typhus in Liverpool, and that 1
in 15 died, we should have some 150 deaths from typhus in a year.
Supposing also that typhus was relatively as common at that time in
London, it will follow that nearly all the deaths under “fever” in the
bills of mortality might well have been from typhus fever; for London in
its several densely populated out-parishes was the fever-quarter of
Liverpool a dozen times over[252].

The Newcastle Dispensary was opened in October, 1777, by the exertions of
Dr John Clark, who was in correspondence with Lettsom in London[253]. Dr
Clark had been in the East India Company’s service, and had seen much of
ship-fever and of the fevers of the East. During a visit to his home in
Roxburghshire in the summer of 1770, between his voyages, he attended
several persons in continued fever. When he settled at Newcastle he saw
the worst kinds of contagious fever, in workhouses and “in the sordid and
crowded habitations of the indigent.” Putrid fever, or typhus, was by far
the most common disease attended from the new dispensary, although less
than at Liverpool, the operations of the charity being on a much smaller
scale. It was seldom out of Newcastle a whole year; and in some years, as
1778, 1779, 1783, 1786 and 1787 it was unusually rife in particular
districts, often attacking whole families. Scarlet fever was epidemic and
very fatal in 1778 and 1779, while dysentery attacked great numbers of the
poor in the autumns of 1783 and 1785. The following Table shows the
principal diseases attended from the Dispensary during the first
twenty-three months of its working, 1 Oct. 1777, to 1 Sept. 1779:

_Newcastle Dispensary 1777-79._

                          Cases          Too far
                         visited  Cured  advanced  Dead

  Putrid fever             391     357       9      16
  Ulcerated sore-throat    146     125      11       9
  Dysentery                 72      55       5       4
  Smallpox                  45      29       5       6

From 1 Oct. 1777, to 1 Sept. 1789, the cases of typhus visited were 1920,
of which 121 were fatal. During the winter of 1790 and the spring and
summer of 1791 it was prevalent amongst the poor, and was frequently
introduced into genteel families and sometimes even into those of the
first distinction. That outbreak was supposed to have been generated in
the Gateshead poorhouse. For some time its ravages were confined chiefly
to the low, ill-aired, narrow street called Pipewell Gate. In September
it made its appearance in Newcastle; at first the contagion was easily
traced from Pipewell Gate, and afterwards from one house to another. In
that outbreak, 188 poor persons were visited from the Newcastle
Dispensary, the Gateshead poor having been attended by the parochial
surgeon. Clark’s ten cases recorded of the epidemic were all of people in
good circumstances. The Dispensary Tables show cases of typhus every year
down to 1850, the largest totals being in 1793 (374, 18 deaths), 1801
(435, 20 deaths), and 1819 (368, 14 deaths); and these, we may take it,
were but a small fraction of all the cases in Newcastle.

Perhaps the most unexpected revelation of typhus is at Chester, from the
time when Haygarth began to write upon its public health in 1772. Chester
was then one of the most desirable places of residence in England. Boswell
wrote to Johnson, “Chester pleases me more than any town I ever saw.” The
old city within the walls was occupied by a superior class of residents,
including the cathedral clergy, county families, retired officers and
Anglo-Indians, professional men, merchants and tradesmen. It had the best
theatre out of London. Squares, crescents and broad streets were replacing
most of the old buildings. The six parishes that lay entirely within the
walls had a population, in 1774, of 3502, and an annual average death-rate
(in the ten years 1764 to 1773) of 1 in 58 or 17·2 per 1000, the central
parish of St Peter having a rate of 1 in 62, and the cathedral parish 1 in
87. It passed as one of the healthiest cities in the kingdom, being far
before Shrewsbury and Nottingham, to say nothing of the large towns where
the burials exceeded the baptisms. But its moderate death-rate over all, 1
in 42 living, would have been much lower but for the four poor suburban
parishes, with a population of 11,211, which had a death-rate of 1 in 35.
Haygarth gives a deplorable account of them. The houses were small, close,
crowded and dirty, ill supplied with water, undrained, and built on ground
that received the sewage from within the walls. The people were ill-fed
and they seldom changed or washed their clothes; when they went abroad
they were noisome and offensive to the smell. Many of them worked on the
large farms around Chester, others at shipbuilding and shipping (Chester
had then a considerable foreign trade), others at the mills and markets,
others at a nail-factory, while others were employed by the tradesmen
within the walls. Fever seems to have been perennial among them, the
deaths from typhus having been 23 in 1772, 33 in 1773 and 35 in 1774. “In
these poor habitations,” says Haygarth, “when one person is seized with a
fever, others of the family are generally affected with the same fever in
a greater or less degree.” It became rifer than usual in August, 1773, and
attacked 285, proving fatal to 28, or to one in ten. It had the common
symptoms of malignant fevers produced by human effluvia, and particularly
affected the head with pain, giddiness and delirium. It attacked in
general the lowest, few of the middle rank, and none (or only one) of the
highest rank[254].

Chester had no manufactures. Its population had grown rapidly of late, as
that of Liverpool had grown, the poorer classes being the prolific part of
the community; but it had no share in the industrial revolution, it did
not employ its women and children in factories, and it was in some
respects better than Leeds, Warrington, Manchester, or Carlisle. It is a
good illustration of a town growing rapidly without manufactures, and of a
community divided by the old walls into two quite distinct sections, a
rich and a poor. Such had been the drift of things in England apart from
the industrial revolution; but it is the latter which furnishes the best
illustrations of a poor prolific populace, of a growing struggle, and of
the attendant typhus fever.


Fever in the Northern Manufacturing Towns, 1770-1800.

The prosperity of the first two-thirds of the 18th century had been
attended with a very small increase of population. From 1700 to 1750 the
numbers in England are estimated to have grown no more than from about six
millions to six millions and a half. The fecundity of many rural parishes
was swallowed up by emigration to the American and West Indian colonies,
by the army and navy, and by the great waste of life in London and some
other towns. The increase was nearly all north of the Trent, while the old
weaving towns of the south-west had actually declined. Gloucestershire,
Somerset and Wilts were the most crowded counties in 1700. During the next
fifty years, the greatest increase was as in the following rough
estimate[255]:

                                          Increase
                           1700    1750   per cent.

  Lancashire             166,200  297,400   78
  West Riding of Yorks.  236,700  361,500   52
  Warwickshire            96,600  140,000   45
  Durham                  95,500  135,000   41
  Staffordshire          117,200  160,000   36
  Gloucestershire        155,200  207,800   34

In the counties where population had increased most, much of the increase
was still rural or semi-rural. Defoe describes how the land near Halifax
was divided into lots of from two to six or seven acres, hardly a house
out of speaking distance from another, at every house a tenter, and on
almost every tenter a piece of cloth, or kersey or shalloon. Every
clothier kept one horse at least, to carry his manufactures to the market,
and nearly every one kept a cow, or two or more, for his family. The
houses were full of lusty fellows, some at the dye-vat, some at the looms,
others dressing the cloths, the women and children carding or spinning,
being all employed from the youngest to the oldest: not a beggar to be
seen, nor an idle person[256]. We have no accounts of the health of this
population, except Nettleton’s statistics of smallpox in and around
Halifax in 1721 and 1722, given elsewhere, and the “epidemic
constitutions” recorded by Wintringham at York during the same period, and
by Hillary at Ripon.

Before the earliest of the inventions of spinning by machinery, the
weavers were gathering to the towns of Yorkshire, Lancashire and other
counties north of the Trent. The spinning-jenny of Hargreaves was wrecked
by a Blackburn mob in 1768, and a mob wrecked the cotton-mill built by
Arkwright at Chorley eleven years later. This was decidedly a time of
movement from the country to the towns, a movement which preceded the
spinning ingenuity of the sixties and may have been stimulated by the
earlier use of the fly-shuttle in weaving.

Much of the country round Manchester, though it doubtless retained those
farm-houses, hedgerows, and field paths which come into the idyllic
opening of ‘Mary Barton’ more than half a century later, was “crowded with
houses and inhabitants,” as Percival says: so populous were the environs
of Manchester that every house in the township had been found by a late
survey to contain an average of six persons. The proportion of deaths was
less than in 1757; but that was chiefly due to the accession of new
settlers from the country, which raised the ratios of marriages and
births[257]. Manchester had increased from a population of about 8000 in
1717 to one of 19,839 (inclusive of Salford) in 1757. When the inhabitants
were next counted in 1773, they were found to be 22,481 in Manchester
(5317 families in 3402 houses) and 4765 in Salford (1099 families in 866
houses). According to Percival, who gives these figures, the death-rate in
1773 was 1 in 28·4, the births exceeding the deaths by forty in a year.
The poor, he says, were now better lodged, and some of the most dangerous
malignant distempers were less violent and less mortal. Manchester,
however, was still an unhealthy place compared with the country,
especially to young children. Thus, the thirty-one townships in the parish
of Manchester contained, exclusive of the city, 13,786 inhabitants (2525
families in 2371 houses), and of these only 1 in 56 died annually
(compared with 1 in 28 in the city)--the births being to the deaths as 401
to 246 in the year 1772.

Again, the bleak upland parish of Darwen with a population in the year
1774 of 1850 souls mostly occupied in the cotton manufacture, had, during
the seven years before, more than twice as many baptisms as burials (508
to 233), the birth-rate (1 in 25·5) being high and the death-rate (1 in
56) low.

Leeds had a population of some six or seven thousand at the time of the
Civil Wars, and lost 1325 in nine months of the year 1645 from plague, all
of them the poorer class. A generation or two later, in the time of
Thoresby’s ‘Diary,’ it was a centre of the cloth trade; and it appears to
have grown steadily throughout the 18th century. In 1775 it had a
population of 17,117. We hear from Lucas of an epidemic typhus in it
previous to 1779[258]. Eighty persons had died of that fever in one year,
and many who struggled through the disease died afterwards of lingering
complaints. In two courts or yards (such as might have been the Lantern
Yard which Silas Marner found pulled down when he revisited Leeds) forty
persons were affected with the fever; some families had received ten
shillings a week from the assessment for the poor. As early as 1779 Lucas
proposed a house of reception for contagious fever, a proposal which was
carried into effect in 1804, after a whole generation of typhus and at a
time when there was little fever in Leeds or elsewhere. The infectious
fevers, being chiefly confined to the poor, often prevailed, says this
writer, for a length of time without exciting much alarm, or without their
fatality being attended to; but, he adds about the year 1790, “should a
few of the higher rank receive the infection, then the disease is
described in most exaggerated terms.”

Carlisle was a good instance of the increase of urban population and the
breeding of typhus. In seventeen years, from 1763 to 1780, the inhabitants
had increased from 4158 to 6229, many of the immigrants being Scots and
Irish with their families. The chief industry was the making of calico, in
which the women and children were employed as well as the men. When Dr
Heysham surveyed the town and suburbs for his census of 1779, he had
“opportunity of seeing many scenes of poverty and filth and
nastiness[259]”; and in the bill of mortality for that year he confesses
himself astonished that there should be so little fever.

The great outburst of typhus at Carlisle began in the end of March, 1781,
with no very obvious special provocation[260]. Upwards of 600 had typhus
to February 7th, 1782, at which date 12 or 15 were still suffering from
it. The deaths were less than 1 in 10 of all attacked: viz. 2 in May, 4 in
June, 8 in July, 8 in August, 7 in September, 9 in October, 8 in November,
6 in December, and 3 in January, 1782, a total of 55. Of this total of
fatal cases, 3 were boys, 4 bachelors, and 15 husbands: 3 girls, 2 maids,
22 wives, and 6 widows. Two-thirds of all the deaths were of married
people; Heysham saw no case in a child under three years. It affected
about a tenth part of the inhabitants of Carlisle (6299), and raged most
among the lower class who lived in narrow, close, confined lanes and in
small crowded apartments, of which there were a great many in Carlisle,
generally going through all the inmates of a house where it had once
begun. On seeking to trace the origin of the epidemic, he found that it
began in the end of March, 1781, in a house in Richard-gate, which
contained about half-a-dozen very poor families. Every window that could
be spared was shut up, to save the window-tax. The surgeon who attended
some of these poor wretches told Dr Heysham that the smell was so
offensive that it was with difficulty he could stay in the house. One of
the typhus patients in this house was a weaver, who, on his recovery, went
to the large workshop where he worked, and there, it was supposed, gave
the infection (in his clothes) to his fellow workmen, by whom new centres
of infection were made in various other houses. In August, a young man
just recovered from the fever went to his mother’s in the small village of
Rockliffe, four or five miles from Carlisle, to get back his strength in
the country air; his mother soon took the fever and died, and a neighbour
woman who came to her in her sickness likewise caught it and died. These
were all the cases known in the village, and they show the enormously
greater fatality of typhus in those not inured to its atmosphere and
conditions.

The state of population and health at Warrington was peculiar, and is
given fully in another chapter. There could be no more striking instance
of the growth of what the foreign writers call the proletariat; an old
market-town, with a small sail-cloth industry from Elizabethan times, it
became a busy weaving town owing to the demand for sail-cloth during the
war with the American colonies. The whole population of some 9000 men,
women and children, were wage-earners; the women were all the while
unusually prolific, and the sacrifice of infant life was enormous,
especially by smallpox. We have no particular accounts of fevers; but in
the bill of mortality for 1773, the year of a disastrous smallpox
epidemic, there were 25 deaths from fever, of which 10 were of “worm
fever,” or the remittent of children[261].

By the year 1790, when Ferriar’s accounts of fever in Manchester begin,
the industrial revolution had been accomplished, mills were everywhere,
and the characteristic hardships and maladies of a prolific working class
in a time of slack trade were already much the same as we find them
pictured with fidelity and pathos in the pages of Mrs Gaskell half a
century after.

But, so as not to exaggerate the ill health of the working class in
Manchester at the end of the 18th century, let us compare the births with
the deaths according to the doubtless imperfect registers[262]:

_Manchester, Births and Deaths, 1770-91._

  Year   Births   Deaths

  1770    1050     988
  1771    1169     993
  1772    1127     904
  1773    1168     923
  1774    1245     958
  1775    1359     835
  1776    1241    1220
  1777    1513     864
  1778    1449     975
  1779    1464    1288
  1780    1566     993
  1781    1591    1370
  1782    1678     984
  1783    1615    1496
  1784    1958    1175
  1785    1942    1734
  1786    2319    1282
  1787    2256    1761
  1788    2391    1637
  1789    2487    1788
  1790    2756    1940
  1791    2960    2286

The mean lodging-houses in the outskirts of the town, says Ferriar, in
1790[263], were the principal nurseries of febrile contagion: some of
these were old houses with very small rooms, into each of which four or
more people were crowded to eat, sleep, and frequently to work. They
commonly bore marks of a long accumulation of filth, and some of them had
been scarcely free from infection for many years past. As soon as one poor
creature dies or is driven out of his cell he is replaced by another,
generally from the country, who soon feels in his turn the consequences of
breathing infected air. There was hardly any ventilation possible, many of
these old houses being in dark narrow courts or blind alleys. In other
parts of the town the lodging-houses were new, and not yet thoroughly
dirty; but in these there was a long garret under the tiles, in which
eight or ten people often lodged, the beds almost touching. Again, many
lived in cellars, sleeping on the damp floor with few or no bedclothes;
the cellars of Manchester, however, were better ventilated than those of
Edinburgh, and freer from fever. These cellar-tenants were subject to the
constant action of depressing passions of the mind. “I have seen
patients,” says Ferriar, “in agonies of despair on finding themselves
overwhelmed with filth and abandoned by everyone who could do them any
service, and after such emotions I have seldom found them recover.”
Addressing the Literary and Philosophical Society of Manchester previous
to 1792, he pointed out in an _argumentum ad hominem_ that “the situation
of the poor at present is extremely dangerous, and often destructive to
the middle and higher ranks of society[264].” And again, “the poor are
indeed the first sufferers, but the mischief does not always rest with
them. By secret avenues it reaches the most opulent, and severely revenges
their neglect or insensibility to the wretchedness surrounding them[265].”

In an address to the Committee of Police in Manchester, he instances the
following cases:

    A family of the name of Turner in a dark cellar behind Jackson’s Row:
    they have been almost constantly patients of the Infirmary for three
    years past on account of disorders owing to their miserable dwelling.
    There are other instances of the same kind in Bootle Street.

    In Blakely Street, under No. 4, is a range of cellars let out to
    lodgers, which threatens to become a nursery of disease. They consist
    of four rooms communicating with each other, of which the two centre
    rooms are completely dark; the fourth is very ill-lighted and chiefly
    ventilated through the others. They contain four or five beds in each,
    and are already extraordinarily dirty.

    In a nest of lodging-houses in Brook’s entry near the bottom of
    Longmill-gate, a very dangerous fever constantly subsists, and has
    subsisted for a considerable number of years. He had known nine
    patients confined in fevers at the same time in one of those houses
    and crammed into three small dirty rooms without the regular
    attendance of any friend or of a nurse. Four of these poor creatures
    died, absolutely from want of the common offices of humanity and from
    neglect in the administration of their medicines. Another set of
    lodging-houses constantly infected is known by the name of the Five
    Houses, in Newton Street[266].

The fever in Manchester was not always malignant typhus: sometimes it had
the symptoms and low rate of mortality that suggest relapsing fever. Thus,
in the winter epidemic of 1789-90, very prevalent in Manchester and
Salford, out of Ferriar’s first ninety patients only two died; in some the
skin had a remarkable, pungent heat, in others there were profuse watery
sweats; women were commonly affected with hysterical symptoms during
convalescence, which was often tedious[267]. A certain number of these
cases would run into “a formed typhus,” with petechiae and all the other
signs of malignity; and in some seasons, as in the distressful year 1794,
typhus was the usual form. Two fatal cases in children, examined after
death, had peritonitis; “in the one no marks of the disease were
discernible within the cavity of the [intestinal] tube;” in the other, the
patient was covered with petechiae[268]. These cases of localized
inflammation in typhus he compares with Pringle’s cases of spotted fever
complicated with abscess of the brain.

The years 1792 and 1793 passed, says Ferriar, without any extraordinary
increase of fever patients, although the noxious influences were always
present. But in the summer and autumn of 1794 “the usual epidemic fever”
became very prevalent among the poor in some quarters of the town,
particularly after a bilious colic had raged among all ranks of people.
This was a time when work was slack; many workmen enlisted and left their
families. In November and December 1794, as many as 156 sent applications
to the Infirmary in a week to be visited in fever at their homes.

This was a memorable time of scarcity and distress all over the country,
the beginning of a twenty-years’ period of so-called “war-prices,” when
farmers’ profits were so large that they could afford to double or treble
their rents to the landlords. The history of epidemics comes at this point
into close contact with the economic history, which I shall touch on in
the sequel, after giving a few more particulars of typhus in England and
Scotland generally, previous to the outbreak of the war with France in
1793.


Typhus in England and Scotland generally, in the end of the 18th century.

The introduction of machinery and the building of mills brought typhus
fever to places much less crowded than Leeds, or Manchester, or Carlisle.

Dr David Campbell of Lancaster saw much of typhus in that town, and in
mill villages near it, in the years 1782, 1783, and 1784. In Lancaster
town he saw about 500 cases, of which 168 were in men, with 20 deaths, 236
in women, with 11 deaths, and 94 in children under fourteen, with 3
deaths. At Backbarrow cotton mill, twenty miles from Lancaster, there were
180 cases, of which 38 were in men, with 5 deaths, 11 in women, with 2
deaths, and 131 in children under fourteen, with no deaths[269]. At this
mill there was an extremely offensive smell in the rooms, which came from
the privy; the doors of the latter, “for indispensable reasons in the
economy of these works, where so many children are employed, always
communicate with the workrooms.” Every care had been taken to keep the air
sweet, but without effect. The offensive smell was in all the cotton mills
from the same cause; and in the Radcliffe mill belonging to Mr Peel, the
typhus was ascribed to that source, the nuisance having been at length got
rid of. Both at Backbarrow and Radcliffe the houses of the workpeople were
new, airy and comfortable. In the same years typhus raged with uncommon
severity at Ulverston and in various parts of Lancashire, where
cotton-mills had been set up[270].

The typhus of Liverpool and Newcastle was reproduced in Whitehaven and
Cockermouth on a scale proportionate to their size. Whitehaven, the port
of the Cumberland coal-field, was the Newcastle of the west coast, and had
a large trade with Ireland. Many of the labourers lived in cellars.
Brownrigg’s experiences of typhus fever in it went back to near the middle
of the 18th century. The Whitehaven Dispensary was opened in 1783, the
occasion for it being thus explained:--

    “Previous to the establishment of dispensaries Whitehaven and
    Cockermouth were infested by nervous and putrid fever. Many of their
    respectable inhabitants became its victims; and among the lower class
    of people it prevailed with deplorable malignancy. The present period
    happily exhibits a different picture. Notwithstanding our connection
    with the metropolis of Ireland, and other commercial places, contagion
    rarely appears; or, when accidentally introduced, is readily
    suppressed[271].”

The following is the abstract of “contagious fever cases” from the records
of the Whitehaven Dispensary from 30 June, 1783, to 9 June, 1800[272]:

  Year  Cured  Dead  Total

  1783    75     1     76
  1784   401     9    410
  1785   350    20    370
  1786    91     6     97
  1787    21     1     22
  1788    53     7     60
  1789   103     2    105
  1790   288    21    309
  1791    74     6     79
  1792    17     2     19
  1793     7     3     10
  1794    13     1     14
  1795    28     2     30
  1796    48     1     49
  1797    35     2     37
  1798    12     1     13
  1799    11     1     12
          ----  ---   ----
  Total   1627   85   1712

The year 1790 is indicated as an unhealthy one, by the excess of burials
over christenings, also at Macclesfield, where there were 316 christenings
to 380 burials, the proportion being usually the other way[273].

Dr John Alderson of Hull wrote in 1788 an essay on the contagion of fever,
in which there are no authentic details for Hull: “The calamity itself is
the constant complaint of every neighbourhood, and almost every newspaper
presents us with an example of the direful consequences of infection”--the
reference being to gaols more particularly[274]. Whatever was the reason,
there was undoubtedly a great deal of typhus in England in the eighties of
the eighteenth century. Oxfordshire, Gloucestershire, Worcestershire,
Wiltshire and Buckinghamshire experienced much typhus from 1782 to 1785,
although we have few particulars. “The remembrance of its ravages at
Gloucester, Worcester and Marlborough,” says Dr Wall of Oxford, “is still
fresh in every mind, where its virulence proved so peculiarly fatal to the
medical world.” At Aylesbury, Dr Kennedy survived an attack of the
“contagious fever,” to write an account (1785) of the epidemic, which he
traced to the gaol (the date, be it observed, is subsequent to Howard’s
visitations)[275]. At Maidstone, also, in 1785, the gaol fever was the
subject of a special account[276].

At Worcester in 1783 the younger Dr Johnstone caught typhus while visiting
the gaol, which was thereafter rebuilt at great expense. A prisoner took
it to Droitwich where 14 died[277].

Dr Wall gives clinical details of fifteen cases of typhus treated by him
in private practice at Oxford in 1785; one of his patients was an
apothecary whose business had exposed him very much to the influence of
contagion, as he was much employed amongst the poor in the suburbs of the
town and neighbouring villages and in the House of Industry[278]. In the
year 1783-85, much of the epidemic fever was of the nature of ague, as
described in another chapter. It is not always easy to separate it from
typhus; but there is no doubt that both were prevalent together. Thus in
the parish of Painswick, Gloucestershire, in the spring of 1785 there
occurred both “a contagious fever” and an “epidemic ague,” the latter
having left a good many persons dropsical and cachectic[279]. This had
been part of an epidemical fever which had raged for some time in the
county of Gloucestershire, and is said to have lately carried off a great
number of poor. At Norton, within five miles of Gloucester, there lived in
two adjoining tenements two families: in one a man and his wife and three
children, in the other a man and his wife, of whom only one remained alive
on the 1st of March, 1785[280].

The extraordinary failure of the harvest in Scotland in 1782 produced much
distress, and with it fever, in the winter following. The Glasgow and
Edinburgh municipalities imported grain for the public benefit. Various
traces of the scarcity and fever appear in the Statistical Account written
a few years after. Thus, in Holywood parish, Dumfriesshire, some fevers
were wont to appear in February and March among people of low
circumstances living in a narrow valley; and the unusual mortality in the
dear year 1782 was owing to an infectious fever in the same cottages. In
the regular bills of mortality of Torthorwald parish, Dumfriesshire, the
deaths from “fever” fall in the dear years, 1782-3, 1785, &c. In Dunscore
parish, in the same county, the burials of 1782 rose to the most unusual
figure of 30 (the baptisms being 17), “owing to a malignant fever[281].”

But Scotland was now past the danger of actual famine from even a total
failure of the harvest. Some farmers were ruined, and many more were
unable to pay the year’s rent; but the very poorest were enabled to find
food, one source being “the importation of white pease from America.” From
Delting, in Shetland, one of the poorest parishes, the report is: “There
is reason to believe that none died from mere want; but there is no doubt
that many, from the unwholesome food, contracted diseases that brought
them to their graves.”

The following relating to the parishes of Keithhall and Kinkell,
Aberdeenshire, in the scarcity following the lost harvest of 1782, is a
curiously detailed glimpse of the time:

    “Several families who would not allow their poverty to be known lived
    on two diets of meal a day. One family wanted food from Friday night
    till Sunday at dinner. On the last Friday of December, 1782, the
    country people could get no meal in Aberdeen, as the citizens were
    afraid of a famine; and a poor man, in this district, could find none
    in the country the day after. But the distress of this family being
    discovered, they were supplied. Next day the [Kirk] session bought at
    a sale a considerable quantity of bere, which was made into meal. This
    served the poor people until the importation at Aberdeen became
    regular, and every man of humanity rejoiced that the danger of famine
    was removed[282].”

We hear most of fevers in the Highland parishes, with their subdivisions
of holdings and an excess of population. Thus of Gairloch, Ross-shire, it
is said: “Fevers are frequent, sometimes they are of a favourable kind, at
other times they continue long and carry off great numbers”--the poor in
this parish, upon the Kirk Session roll, numbering 84 in the year 1792,
and the aggregate money paid to the whole number averaging £6. 7_s._ in a
year, whereas the fertile parish of Ellon, Aberdeenshire, with 40 on the
poor’s roll, paid them £43 per annum.

Again, of the fishing village of Eyemouth, it is said: “The only
complaints that prove mortal in this place are different kinds of fevers
and consumptions; and these are mostly confined to the poorest class of
people, and ascribed to their scanty diet.” And of another fishing parish,
in Banffshire, Fordyce, including Portsoy, it is said: “The most prevalent
distemper is a fever, and that for the most part not universal, but
confined to particular districts. It is sometimes thought to arise from
infection and communication with other parts of the country; at other
times from local situations and circumstances of the people’s houses and
habits of living in particular districts[283].”

The beginning of the great French war was the occasion of a considerable
increase of fever; although no records make it appear so fatal a time as
the years 1783-86. The commercial distress and want of work which began in
the autumn of 1792, were intensified by the bad harvests of 1794 and 1795,
which followed two harvests also deficient. This was the period of
distress and of epidemic fever to which Wordsworth referred in the passage
in the first book of the ‘Excursion,’ where he is relating the story of
Margaret’s ruined cottage[284].

There is little medical writing upon the epidemic fever of 1794-95; and,
in the very district of Wordsworth’s story, the records of the Whitehaven
Dispensary bear no traces of a great concourse of patients. There is
reason to think that the fever, if slow and weakening, was seldom fatal,
that it was _typhus mitior_, and that it was sometimes, perhaps often,
relapsing. One glimpse we get of it in the family of the afterwards
celebrated Dr Edward Jenner of Berkeley, in the winter of 1794-95. He thus
writes to a friend about the visitation of “grim-visaged typhus:”

    “You shall hear the history of our calamities. First fell Henry’s [his
    nephew and assistant] wife and sister. From the early use of bark,
    they both appeared to recover; but the former, after going about her
    ordinary business for some days, had a dreadful relapse which nearly
    destroyed her. It was during my attendance on this case that the
    venomed arrow wounded me.... Like Mrs Jenner’s fever, at an early
    period there was a clear intermission for four days.... On the eighth
    day after the first seizure it again set in, in good earnest, and
    continued one-and-twenty days.... Dr Parry was with me from Bath five
    times, Dr Hicks and Dr Ludlow as many, and my friend George was never
    absent from my bedside.... But, to return to that mansion of
    melancholy, Henry’s. His infant girl has now the fever; a servant maid
    in the house is dying with it; and to complete this tragical
    narrative, about five days ago fell poor Henry himself. His symptoms
    at present are such as one might expect: violent pain in the head,
    vertigo, debility, transient shiverings.... His pulse this evening is
    sunk from 125 to 100. The stench from the poor girl is so great as to
    fill the house with putrid vapour; and I shall remove him this morning
    by means of a sedan-chair to a cottage near my own house[285].”

This is a tolerably clear picture of a short-period fever with relapses,
or of relapsing fever strictly so-called; the stench, also, of one patient
is characteristic. Barker, of Coleshill or Birmingham, has much to say
under the same year 1794, of a slow, tedious fever, marked by “sluggish
action and comatose symptoms,” and much subject to relapses; but he does
not give the duration of the first or subsequent paroxysms, as Jenner
does, or the usual length of the clear intervals, his most definite case
being of a young woman who died in twenty-four hours from a relapse which
came on about three weeks after the fever had left her[286].

It was the access of fever in 1794-5, and the alarm that it caused among
the richer classes, that led to the opening of the Manchester House of
Recovery in 1796. In certain streets in the neighbourhood chosen for the
hospital, Portland Street, Silver Street and others in the same block, the
cases of contagious fever for nearly three years before the hospital was
opened are given by Ferriar as follows:

  Sept. 1793 to Sept. 1794, cases of fever, 400
  Sept. 1794 to Sept. 1795,   "   "    "    389
  Sept. 1795 to May 1796,     "   "    "    267

The cases began to be sent to the hospital on the 27th May, 1796, and an
attempt was made to extinguish contagion in the houses, by white-washing,
disinfecting and the like; so that in the same group of streets there were
only 25 cases of fever from 13 July, 1794 to 13 March, 1797. Meanwhile the
admissions to the hospital were few until the dearth of 1799-1802. One of
the manufacturing towns which is known to have shared in the epidemic
fever of 1794-96 was Ashton-under-Lyne, where upwards of three hundred
cases (with few deaths) occurred in less than three months at the end of
1795. This epidemic must have been somewhat special to Ashton, for it
produced much alarm in neighbouring places and caused Ashton to be avoided
from fear of infection.

Shortly after 1796, Ferriar made an inquiry into an epidemic of fever at a
village within a mile of Manchester; the houses were many of them new,
built for the convenience of a large cotton mill; but even the new houses
were offensive, with cellars occupied by lodgers, and almost every house
overcrowded. This was the first fever in the village, and it was traced to
a family who had come from Manchester with infected clothes. Stockport
about the same time erected a House of Recovery, having “the same general
causes of fever which render the disease so common in Manchester”; and
Ferriar adds: “I believe there is not a town in the kingdom containing
four thousand inhabitants which would not be greatly benefited by similar
establishments.”

The bad harvest of 1794 raised the price of wheat to 55_s._ 7_d._ on 1
January, 1795, and the prospect of another short harvest to 77_s._ 2_d._
on 1 July. A famine being threatened, the Government caused neutral ships
bound to French ports with corn to be seized, and brought into English
ports, the owners receiving an ample profit. Agents were also sent to the
Baltic to buy corn. By these means the price of wheat, which had risen in
August to 108_s._ 4_d._, fell in October to 76_s._ 9_d._ Parliament met on
the 29th October, and various measures were taken[287]. In the spring of
1796, the climax of distress was reached, wheat being at 100_s._ per
quarter. The harvest of 1796 was abundant and wheat fell to 57_s._ 3_d._
The harvests of 1797 and 1798 were not equally good, but they were not
altogether bad, and the price of wheat kept about 50_s._ for nearly three
years, which were years of comparative comfort between the dearth of
1794-96 and the dearth of 1799-1802.


Fevers in the Dearth of 1799-1802.

Although Willan chooses the end of the year 1799 to enlarge upon the
London fever, he does not connect it with the dearth that was already
beginning to be felt (soup kitchens having been opened in various parts of
London). The price of wheat, which had been steadily about 50_s._ in 1797
and 1798, rose in May, 1799 to 61_s._ 8_d._, after a hard winter which had
probably injured the autumn-sown corn. The harvest turned out ill, and the
price of wheat rose in December, 1799, to 94_s._ 2_d._ Bounties were
offered on imported foreign grain, but in June, 1800, the price was
134_s._ 5_d._, falling in August to 96_s._ 2_d._ on the crops promising
well. The latter end of harvest proved wet, much of the grain being lost,
so that the price per quarter of wheat rose to 133_s._ in December. There
was much suffering, and some rioting. Parliament met on the 11th November,
1800, on account of the dearth, the opinions of the members being much
divided as to the causes of the high prices. In March, 1801, wheat was at
156_s._ 2_d._ per quarter, beef from 10_d._ to 10½_d._ per pound, mutton
11_d._ to 12_d._ per pound. It is to this year, when the quartern loaf was
at one-and-eightpence, that a comparison by Arthur Young belongs, showing
the great change in the purchasing power of wages[288]. By the end of
summer, 1801, wheat rose to 180_s._, and the quartern loaf was for four
weeks at 1_s._ 10½_d._

Whatever statistics were then kept of fever-cases, show a decided rise in
the years 1800 and 1801:

          Manchester   Glasgow                      London
          House of      Royal       Newcastle       Bills of
          Recovery    Infirmary    Dispensary      Mortality
  Year (fever-cases) (fever-cases) (fever-cases) (fever-deaths)

  1796       371          43            201           1547
  1797       339          83             65           1526
  1798       398          45             67           1754
  1799       364         128             --           1784
  1800       747         104             --           2712
  1801      1070          63            425           2908
  1802       601         104             --           2201
  1803       256          85            352           2326
  1804       184          97            255           1702
  1805       268          99             74           1307

The London Fever Hospital was not opened until February, 1802, a small
house in Gray’s Inn Lane containing sixteen beds. It came at the end of
the epidemic, and was in small request during the next fifteen years. The
same epidemic at Leeds was the occasion of opening a House of Recovery
there in 1804, twenty-five years after Lucas had first called for it. The
state of affairs in Leeds, which at length moved the richer classes to
that step, is thus described by Whitaker[289]:

    “In the years 1801 and 1802 an alarming epidemic fever spread in Leeds
    and the neighbourhood. The contagion extended so rapidly and proved so
    fatal that some hundreds were affected at the same time, and two
    medical gentlemen, with several nurses, fell victims to the
    disease.... In 1802 whole streets were infected house by house; in one
    court, of crowded population, typhus raged for four months
    successively.”

One of the Leeds physicians, Dr Thorp, seized the occasion to urge the
need of a fever hospital, in a pamphlet written in 1802, in which he said:

    “In a visit made a few days ago to those abodes of misery, I saw in
    one particular district upwards of twenty-five families ill in
    contagious fever. In some houses two, in others six or seven
    [families] were confined, many of whom appeared to be in extreme
    danger.” The superintendent of the sick poor stated to Dr Thorp “that
    sixty families in epidemic fever are under his care at this time. New
    applications are making daily. In some families three, in others six
    or seven, are in the disease. Forty persons in fever have applied to
    him for medical aid within the present week[290].”

The wonder is that, with the enormous prices of food, things were not
worse. At the time when provisions were dearest, work was slack in several
industries. A commercial report of 1 April, 1801, speaks of the trade of
Birmingham as very distressed, a large proportion of the men being out of
work; the ribbon trade of Coventry was deplorable, and the woollen trade
of Yorkshire still worse. Evidence of epidemic typhus in various parts of
England came out in connexion with the reports on influenza in 1803.
Holywell, in Flintshire, with a large cotton-making industry, had not been
free from a bad kind of typhus for two years previous to the influenza of
1803[291]. In Bristol there was a good deal of fever in 1802-3, which
found its way, through domestic servants, into good houses in Clifton,
“and proved fatal in some instances[292].” It is probable that these are
only samples, the writings on epidemics being singularly defective at this
period. The following, dated 10th April, 1802, by a surgeon at Earlsoham,
near Framlingham, Suffolk, gives us a glimpse of malignant contagious
fever in a farm-house:

    “The most prevailing epidemics for the last twelve months have been
    typhus maligna and mitior, scarlatina anginosa, measles, and mumps.
    Many of the former have proved alarmingly fatal in several of our
    villages, whilst those of the second class of typhoid fevers have put
    on the appearance of the low nervous kind attended with great
    prostration of strength, depression of spirits, loss of appetite,
    etc., which frequently continue many weeks before a compleat recovery
    ensues.” Five cases, of “the most malignant kind of typhus,” occurred
    in a farmer’s family: one of the sons, aged eighteen, died in a few
    days with delirium, and black sordes of the mouth, tongue and throat;
    then the father, two daughters, and another son, took the infection
    but all escaped with their lives. Of four persons who nursed them, one
    caught the fever, and died. Four persons in a neighbouring family, who
    visited them, took infection, of whom two died[293].

There was perhaps nothing very unusual in such instances of country fevers
at the beginning of the century. The incident is exactly in the manner of
one that figures prominently in a story of Scottish life and customs at
the same period, which long passed current as a faithful picture and as
enforcing a much-needed moral[294].


Comparative immunity from Fevers during the War and high prices of
1803-15.

From 1803 to 1816 there was comparatively little fever in this country.
This was notably the case in London, but it was also true of all the
larger towns where fever-hospitals had been established, and it was as
true of Ireland as of England. This was, indeed, a time of great
prosperity, which reached to all classes, the permanent rise of wages
having more than balanced the increased cost of the necessaries of life.
The following prices of wheat will show that a dear loaf did not
necessarily mean distress while the war-expenditure lasted:

Prices of wheat (from Tooke).

                _s._  _d._

  1802           57     1

  1803           52     3

  1804 Lady Day  49     6
       Dec.      86     2

  1805 Aug.      98     4
       Dec.      74     5

  1806           73     5

  1807 Nov.      66

  1808 May       73     6
       Dec.      92

  1809 March     95
       July      86     6
       Dec.     102     6

  1810 June     113     5
       Dec.      94     7

  1811 June      86    11
       Nov.     101     6

  1812 Aug.     155
       Nov.     113     6

  1813 Aug.     112
       Dec.      73     6

  1814 July      66     5

  1815 Dec.      53     7

  1816 May       74
       Dec.     103

  1817 June     111     6

  1817 Sept.     77     7

  1818 Dec.      78    10

  1819 Aug.      75

  1820           72

  1821 July      51
       Dec.      50

  1822           42

  1823 Feb.      40     8
       June      62     5
       Oct.      46     5
       Dec.      50     8

  1824           65

The only years in the period from 1803 to 1816 in which there was some
slight increase of fever were about 1811-12. There was undoubtedly some
distress in the manufacturing districts at that time, owing to the much
talked-of Orders in Council, which had the effect of closing American
markets to British manufactures[295].

The small amount of fever in London between the year 1803 and the
beginning of the epidemic of 1817-19 rests on the testimony of
Bateman[296], who in 1804 took up Willan’s task of keeping a systematic
record of the cases at the Carey Street Dispensary. He has only two
special entries relating to typhus: one in the autumn of 1811, when some
cases occurred in the uncleanly parts of Clerkenwell and St Luke’s (“but I
have not learned that it has existed in any other districts of London”);
the other in October and November 1813, when there was more typhus among
the Irish in some of the filthy courts of Saffron Hill, near Hatton
Garden, than for several years past, the infection having spread rapidly
and fatally in several houses. The best evidence of this lull in typhus in
London is the almost empty state of the new fever-hospital:

  Year   Admissions

  1802      164
  1803      176
  1804       80
  1805       66
  1806       93
  1807       63
  1808       69
  1809       29
  1810       52
  1811       43
  1812       61
  1813       85
  1814       59
  1815       80
  1816      118
  1817      760

Until it was removed to Pancras Road, in September, 1816, the London
fever-hospital had only sixteen beds. But Bateman says that no one was
refused admission, and that for several years the house was frequently
empty three or four weeks together. Also at the Dispensary, in Carey
Street, he had an opportunity during the period 1804-1816,

    “Of observing the entire freedom from fevers enjoyed by the
    inhabitants of the numerous crowded courts and alleys within the
    extensive district comprehended in our visits from that charity.” And
    again, writing in the winter of 1814-15, Bateman says: “To those who
    recollect the numerous cases of typhoid fevers [this term did not then
    mean enteric] which called for the relief of dispensaries twelve or
    fourteen years ago, and the contagion of which was often with great
    difficulty eradicated from the apartments where it raged, and even
    seized the same individuals again and again when they escaped its
    fatal influences, the great freedom from these fevers which now
    exists, even in the most close and filthy alleys in London, is the
    ground of some surprise.” And once more, in the summer of 1816, just
    as the new epidemic period was about to begin, he says: “The
    extraordinary disappearance of contagious fever from every part of
    this crowded metropolis during the long period comprehended by these
    Reports [since 1804], cannot fail to have attracted the attention of
    the reader.”

Bateman concluded, not without reason, that this immunity of London from
fever was due to the high degree of well-being among the poorer classes in
times of plenty; and although he made out that the poor of Dublin, Cork
and some Scotch towns did not profit by times of plenty so much as those
in London, yet his reason for the abeyance of fever from 1804 to 1816
applied to England, Ireland and Scotland at large, and was doubtless the
true reason.

The following figures from Manchester[297], Leeds[298] and Glasgow[299]
hospitals, as well as the Irish statistics elsewhere given, are closely
parallel with those of London:

_Manchester House of Recovery._

  Year         Cases   Deaths

  1796-7        371      40
  1797-8        339      16
  1798-9        398      27
  1799-1800     364      41
  1800-1        747      63
  1801-2       1070      84
  1802-3        601      53
  1803-4        256      33
  1804-5        184      34
  1805-6        268      29
  1806-7        311      33
  1807-8        208      15
  1808-9        260      21
  1809-10       278      30
  1810-11       172      15
  1811-12       140      18
  1812-13       126      13
  1813-14       226      17
  1814-15       379      29
  1815-16       185      14
  1816-17       172       6

_Leeds House of Recovery._

  Year         Cases    Deaths

  1804 (2 mo.)   10       0
  1805           66       6
  1806           75       2
  1807           35       1
  1808           80       3
  1809           93       8
  1810           75      14
  1811           92       4
  1812           80      12
  1813          137      11
  1814           79       4
  1815          146      15
  1816          121      13
  1817          178       8
  1818(10 mo.)  254      20

_Glasgow Royal Infirmary (Fever Wards)._

  Year         Cases

  1795           18
  1796           43
  1797           83
  1798           45
  1799          128
  1800          104
  1801           63
  1802          104
  1803           85
  1804           97
  1805           99
  1806           75
  1807           25
  1808           27
  1809           76
  1810           82
  1811           45
  1812           16
  1813           35
  1814           90
  1815          230
  1816          399
  1817          714
  1818         1371

Even such fever as there was in Britain from 1804 to 1817 was not all
certainly typhus. The high death-rates at the Manchester fever-hospital in
1804 and 1805 (1 death in 7·5 cases and 1 death in 5·25 cases) may mean a
certain proportion of enteric cases in those years. “From 1804 to 1805,”
says Ferriar, “many cases were admitted of a most lingering and dangerous
kind.... Many deaths took place from sudden changes in the state of the
fever, contrary to the usual course of the disease, and only imputable to
the peculiar character of the epidemic. Similar cases occurred at that
time in private practice.” Next year, 1806, there was an epidemic among
the troops at Deal, described under the name of “remittent fever,” which
Murchison claims to have been enteric[300]. In September, 1808, says
Bateman, several were admitted into the London House of Recovery, with
malignant symptoms; “and some severe and even fatal instances occurred in
individuals in respectable rank in life.” He still uses the name of
typhus; but he is aware that the cases of continued fever, especially in
the summer and autumn of 1810, had often symptoms pointing to a
bowel-fever rather than to a head-fever[301].

The years 1807 and 1808 appear to have been the most generally unwholesome
during this period of comparative immunity from fever; they were marked by
the occurrence of dysenteries, agues, and infantile remittents, as well as
of fevers of the “typhus” kind. The chief account comes from
Nottingham[302]. The cases of “typhus” there were very tedious, but not
violent, nor attended with any unfavourable symptoms, only one case having
petechiae, and all having diarrhoea. The following table of admissions
for various kinds of fever (as classified by Cullen) at the Nottingham
General Hospital, 25 March, 1807, to 25 March, 1808, shows the
preponderance of “synochus” and next to it, of infantile remittent:

_Admitted to the Nottingham General Hospital, 1807._

  Intermittent fever            7
  Synocha                      10
  Typhus                       27
  Febris nervosa               26
  Synochus                    155
  Febris infantum remittens    88
  Dysentery                     5

The state of war in the Peninsula was favourable to epidemic or spreading
diseases, and there is a good deal to show that such diseases did exist
among the British troops[303]. But there is only one good instance of
England getting a taste of that experience of war-typhus which the
Continent had to endure for many years. This was on the return of the
remnant of the army after the defeat at Corunna on 16 January, 1809. The
troops were crowded pell-mell on board transports, which had a very rough
passage home. Dysentery broke out among them, and was the most urgent
malady when they landed at Plymouth in a state of filth and rags. Typhus
fever followed, but in the first three weeks at Plymouth, to the 18th of
February, it was not of a malignant type, only 8 dying of it in the Old
Cumberland Square Hospital; in the next three weeks, 28 died of it there.
Up to the 27th of March, 1809, the sick at Plymouth from the Corunna army
numbered 2432, of whom 241 died. Of 4 medical officers, 3 took the
contagion, of 29 orderlies, 25 took it. The fever was in some cases
followed by a relapse, which was more often fatal than the original
attack[304]. This was a typical instance of typhus bred from dysentery or
other incidents of campaigning, a contagion more dangerous to others than
to those who had engendered it. “Within a few yards of the spot where I
now write,” says Dr James Johnson, of Spring Gardens, London, “the greater
part of a family fell sacrifices to the effects of fomites that lurked in
a blanket purchased from one of these soldiers after their return from
Corunna[305].” In August, 1813, an Irish regiment passing through
Leyburn, a small market-town of the West Riding of Yorkshire, in an airy
situation, was obliged to leave behind a soldier ill of typhus, who died
of the fever after a few days. The infection appeared soon after in the
cottages adjoining, and remained in that end of the town for several
months, choosing the clean and respectable houses. In a farmer’s family, a
son, aged twenty-nine, died of it, while another son and two daughters had
a narrow escape. The disease appeared also in the village of Wensby, a
mile distant, and in other villages. Few lives were lost[306].

These were, perhaps, not altogether solitary instances in Britain of
typhus spread abroad by the movements of troops during the great French
war. Let us multiply such instances by hundreds, and we shall vaguely
realize the meaning of the statement that the period of the Napoleonic
wars, and more particularly the period from the renewal of the war in 1803
until its close in 1815, was one of the worst times of epidemic typhus in
the history of modern Europe. It was precisely in those years that
England, Scotland and Ireland enjoyed a most remarkable degree of freedom
from contagious fever.


The Distress and Epidemic Fever (Relapsing) following the Peace of 1815
and the fall of wages.

The long period of comparative immunity from typhus near the beginning of
the 19th century was first broken, both in Great Britain and in Ireland,
by the very severe winter of 1814-15; but it was not until the great
depression of trade following the peace of 1815 (which made a difference
of forty millions sterling a year in the public expenditure) and the bad
harvest of 1816 that typhus fever and relapsing fever became truly
epidemic, chiefly in Ireland but also in Scotland and England. The lesson
of the history is unmistakable: with all the inducements to typhus from
neglect of sanitation in the midst of rapidly increasing numbers, there
was surprisingly little of the disease so long as trade was brisk and the
means of subsistence abundant. The reckoning came in the thirty years
following the Peace.

In London, says Bateman[307], the epidemic began in the autumn of 1816,
before the influence of scarcity was acutely felt, in the courts about
Saffron Hill, the same locality in which he mentioned fever in the winter
of 1813-14 among the poor Irish. But this means little more than that the
Irish, whether in Ireland or out of it, are the first to feel the effects
of scarcity in producing fever. At the very same time that it began among
them in Saffron Hill, it began among some young people at a silk factory
in Spitalfields. In March, 1817, there was a good deal more of it in
Saffron Hill, as well as among the silk-weavers in Essex Street,
Whitechapel, in Old Street, in Clerkenwell, and in Shadwell workhouse.
Many poor-houses, and especially those of Whitechapel, St Luke’s, St
Sepulchre’s and St George’s, Southwark, were getting crowded in 1817 with
half-starved persons, among whom fever was rife in the summer and autumn.
There was also much of it in the homes of working people in the eastern,
north-eastern and Southwark parishes, with more occasional infected
households in Shoe Lane, Clare Market, Somers Town and St Giles’s in the
Fields (“in the filthy streets between Dyot Street and the end of Oxford
Street”)[307]. The hospitals and dispensaries were fully occupied with
fever, and the new House of Recovery in Pancras Road, with accommodation
for seventy patients, was soon full. At the Guardian Asylum for young
women, more than half of the forty inmates were seized with the fever in
one week. The cases were on the whole milder than in ordinary years; of
678 admitted to the House of Recovery in 1817, fifty died or 1 in 13·5. In
two-thirds of these patients the fever lasted two weeks or to the
beginning of the third week; of the remaining third, a few lost the fever
on the 7th, 8th or 9th day, a larger number on the 12th to the 14th day,
while a considerable number kept it to the end of the third week or
beginning of the fourth. Of the whole 678, only 75 had a free
perspiration, and in only 19 of these was the perspiration critical so as
to end the fever abruptly. The fever relapsed in 54 of the 678, a
proportion of relapsing cases which seemed to Bateman to be “remarkably
great[308].” In most the symptoms continued without break throughout the
illness. Besides other febrile symptoms, there were pains in the limbs and
back, aching of the bones, and soreness of the flesh, as if the patients
had been beaten. There was a certain proportion of severe complicated
cases of typhus. Bateman held that the differences in type depended on the
differences of constitution, giving the following reason for and
illustration of his opinion:

    “Thus, in the instance of a man and his wife who were brought to the
    House of Recovery together, the former was affected with the mildest
    symptoms of fever, which scarcely confined him to bed, and terminated
    in a speedy convalescence; while his wife was lying in a state of
    stupor, covered with _petechiae_ and _vibices_; in a word, exhibiting
    the most formidable symptoms of the worst form of typhus. Yet these
    extreme degrees of the disease manifestly originated from the same
    cause; and it would be equally unphilosophical to account them
    different kinds of fever and give them distinct generic appellations
    as in the case of the benign and confluent smallpox, which are
    generated in like manner from one contagion.” Besides this woman, only
    eight others had petechiae.

The House of Commons Committee were unable to find out with numerical
precision how much more prevalent the fever was in 1817-18 than in the
years preceding[309]. To their surprise they found that in six of the
general hospitals of London, which admitted cases of fever, “no register
is kept in the hospital to distinguish the different varieties of
disease.” The apothecary of St Luke’s Workhouse told them that he
attended, on an average of common years, about 150 cases of fever; in the
last year [1817] the number rose to 600; and they were assured by several
besides Bateman, that the great decrease of the deaths from “fever” in the
London bills of mortality during a space of fourteen years at the
beginning of the century (1803-17), was not a mere apparent decrease, from
the growing inadequacy of the bills, but was a real decrease.

The epidemic which began in 1817 continued in London throughout the years
1818 and 1819, chiefly in the densely populated poorer quarters of the
town. Two instances of the London slums of the time came to light before
the House of Commons Committee on Mendicity and Vagrancy in 1815-16:
firstly, Calmel’s Buildings, a small court near Portman Square, consisting
of twenty-four houses, in which lived seven hundred Irish in distress and
profligacy, neglected by the parish and shunned by everyone from dread of
contagion; and, secondly, George Yard, Whitechapel, consisting of forty
houses, in which lived two thousand persons in a similar state of
wretchedness. The dwellings of the poorer classes in London at this
period, before the alleys and courts began to disappear, were described
thus generally by Dr Clutterbuck[310]:

    “The houses the poor occupy are often large, and every room has its
    family, from the cellar to the garret. Thirty or forty individuals are
    thus often collected under the same roof; the different apartments
    must be approached by a common stair, which is rarely washed or
    cleansed; there are often no windows or openings of any kind
    backwards; and the _privies_ are not unfrequently within the walls,
    and emit a loathsome stench that is diffused over the whole house. The
    houses are generally situated in long and narrow alleys, with lofty
    buildings on each side; or in a small and confined court, which has
    but a single opening, and that perhaps a low gateway: such a court is
    in fact little other than a well. These places are at the same time
    the receptacles of all kinds of filth, which is only removed by the
    scavenger at distant and uncertain intervals, and always so
    imperfectly as to leave the place highly offensive and disgusting.”

In England, generally, this epidemic of 1817-19 is somewhat casually
reported. One writes from Witney, Oxfordshire, “on the prevailing
epidemic,” which began there in July, 1818, among poor persons, in
crowded, filthy and ill-ventilated situations. At first it was like the
ordinary contagious fever of this country, “a disease familiar to common
observation”; but afterwards it showed choleraic and pneumonic
complications. Sometimes the parotid and submaxillary glands were
inflamed; petechiae were absent[311]. The type of fever at Ipswich in the
spring of 1817 was contagious (e.g. six cases in one family) and sthenic,
or of strong reaction, admitting of bloodletting, according to the
teaching which Armstrong, Clutterbuck and others had been reviving for
fevers[312]. Those instances, one from Oxfordshire the other from Suffolk,
must stand for many. Hancock says that the fever of 1817-19 “visited
almost every town and village of the United Kingdom[313].” Prichard says
that it began in Ireland, “where the distress was most urgent, and
afterwards prevailed through most parts of Britain,” some of the more
opulent also being involved in the calamity. As to its prevalence in the
manufacturing towns of Yorkshire we have ample testimony. The Leeds House
of Recovery, which had not been fully occupied at any time since its
opening in 1804, received 178 cases in 1817, and 254 in the first ten
months of 1818. Of the latter, 66 came from low lodging-houses, of whom
upwards of 50 were strangers. Of 50 admitted in January, 1818, 20 came
from four or five lodging-houses in March Lane, and from another locality
equally bad--Boot and Shoe Yard; while the rest of the 50 in that month
came from houses and streets in the same vicinity. March Lane was one of
the worst seats of the great Leeds plague in 1645. By the month of April,
1820, the epidemic had decreased a good deal in Leeds, the cases becoming
at the same time more anomalous[314].

The following is one of the Rochdale cases:

    June 2, 1818, Alice Eccles, a delicate young woman living in a crowded
    and filthy court from which fever had not been absent for nearly a
    year, was bled to ten ounces, purged, and recovered. On September 20th
    the same woman returned, desiring to be bled again. She was labouring
    under her former complaint; “since her last illness she had been
    repeatedly exposed to contagion, or rather, she had been living in an
    atmosphere thoroughly saturated with infectious effluvia, the house in
    which she resided, and generally the room in which she slept, having
    had one or more cases of fever in them,” and the windows kept
    closed[315].

At Halifax in the summer of 1818, typhus (or relapsing fever) had
increased so much that fever-wards were added to the Dispensary. It had
been alarmingly fatal in a high-lying village near Settle. It was
prevalent in Ripon, Huddersfield and Wakefield; and had been brought from
Leeds to Atley. A Bradford physician visited 27 cases of fever in one day
at a neighbouring village. Throughout Yorkshire, it was confined to the
lower orders, and was not very fatal[316]. At Carlisle it began about
July, 1817, and became somewhat frequent in the winter and spring
following; of 457 cases treated from the Dispensary 46 died, or 1 in
10[317]. At Newcastle, a mild typhus (typhus mitior) broke out in the
autumn of 1816, not in the poorer quarters, but mostly among the domestics
of good houses in elevated situations. There was much privation at
Newcastle, as elsewhere, at this time, among the poor. Murchison takes
this fever of the autumn of 1816 at Newcastle to have been enteric or
typhoid; but it is described as a simple continued fever, with vertigo,
headache, and bloodshot eyes, lasting from five or six days to four or
five weeks, ending usually without a marked crisis, and causing few
deaths[318]. The epidemic continued in Newcastle for three years, the
admissions to the Fever Hospital from 4 Sept. 1818, to 4 March, 1819,
having been 160, with 12 deaths. Dr McWhirter wrote, in April, 1819, that
he saw on his rounds as dispensary physician “too many of the obvious
causes of fever,” including the filth and wretchedness of the poor
inhabitants: “one rather wonders that so many escape it than that some are
its victims[319].”

Thus far there has been little besides Bateman’s essay to indicate the
nature or type of the fever in England. In Ireland it was to a large
extent relapsing fever, and, as we shall see, it was so also in Scotland.
Bateman found less than a tenth part of the cases at the London Fever
Hospital to have relapses, which was an unusually large proportion, in his
experience. Elsewhere in England the tendency to relapse was either
wanting or the relapses were described or accounted for in other ways; to
understand this it has to be kept in mind that the epidemic was the
occasion of a great revival of blood-letting, a practice which had fallen
into disuse in fevers since the last half of the 18th century, and was
something of a novelty in 1817. The fever of that year was undoubtedly
abrupt in its onset, strong, “inflammatory,” with full bounding pulse,
beating carotids, hot and dry skin, intense headache, suffused eyes, and
the like symptoms, which seemed to call for depletion. The common practice
was to bleed _ad deliquium_, which meant to ten, or fourteen, or twenty
ounces, at the outset of the fever. There was hardly one of the writers
upon the epidemic, unless it were Bateman, an advocate of the cordial and
supporting regimen, who did not consider the stages or duration of the
fever as artificially determined by the blood-letting, and not as
belonging to the natural history.

In order to show how much the treatment by blood-letting dominated the
view of the fever itself, of its type, its stages, or duration, I shall
take the Bristol essay of Prichard, who adopted phlebotomy, as he says, at
first tentatively and with some fear and trembling, but at length
practised it vigorously, having found it to answer well[320]. The epidemic
of fever in Bristol began about June, 1817, and lasted fully two years.
The first cases brought to St Peter’s Hospital, which was the general
workhouse of the city, were of wretched vagrants found ill by the wayside
or abandoned in hovels. About the same time forty-two felons in the
Bristol Newgate, “one of the most loathsome dungeons in Britain, perhaps I
might say in Europe,” were infected, of whom only one died, and he of a
relapse. From June, 1817, to the end of 1819, there were 591 cases in the
poor’s house, 647 in the General Infirmary, and 975 treated from the
Dispensary, making 2213 cases, of which a record was kept. But there were
also many cases in private practice among the domestics, children, and
others in good houses, such as those on Redcliff Hill. The cases in the
poor’s house were classified by Prichard as follows:

                                     1817  1818  1819

  Simple Fever                        22    45    40
    with cephalic symptoms            24    27    25
      "  pneumonic symptoms            7    10    16
      "  gastric symptoms              3    11     5
      "  enteric symptoms              3     4     5
      "  hepatic symptoms              5     3     3
         exhausted and moribund        1     6     4
         not characterised            30    44     2
                                     ---   ---    --
                                      95   150   105
                                     ---------------
        Of these there died           20    16    11

The “genuine form,” or ground-type, according to Prichard, was “simple
fever,” of which the cases with cephalic symptoms were merely the more
protracted or more serious. “The pneumonic, hepatic, gastric, enteric and
rheumatic forms may be regarded as varieties”--the gastric and hepatic
being cases mostly in summer with jaundice, the enteric in autumn and
winter with diarrhoea and dysentery. Nearly all these patients were bled
within four or five days from the commencement of the disease: “in a very
large proportion of the cases the fever was immediately cut short”; when
it did not end thus abruptly, its symptoms declined gradually, and the
attack was over within eight or ten days. After the blooding “sleep very
frequently followed, and a partial or sometimes a complete remission of
the symptoms.” Only one case of relapse is mentioned, No. 118, of the year
1818, and that was a relapse in a very prolonged case: the patient was
admitted on 6 October, had a relapse on 18 November, and was discharged on
23 December. Prichard has not one word in his text to suggest relapsing
fever; the bulk of his cases were simple continued fever, with or without
cephalic or other local symptoms, ending in four, six, eight or ten days,
while some were cases of _typhus gravior_. The fever was undoubtedly
contagious: it spread through whole families, and in St Peter’s Hospital
itself it attacked seventy of the ordinary pauper inmates, including a
good many lunatics.


The Epidemic of 1817-19 in Scotland: Relapsing Fever.

Let us now turn to the epidemic in Scotland, where the relapsing type was
as marked as in Ireland, if not more so. The destitution in the Scots
towns in the autumn of 1816, and following years, was fully as great as
anywhere in the kingdom, although the peasantry of Scotland were not
famine-stricken, as those of Ireland were. The state of the poorer classes
in Edinburgh was graphically set forth in an essay by Dr Yule, in
1818[321], and in an article in _Blackwood’s Magazine_ the year after.
Vigorous efforts to relieve the distress were made by the richer classes,
and a special fever-hospital was opened at Queensbery House, the
admissions to which, together with the fever-cases at the Royal Infirmary,
were as follows:[322]

  Year   Admitted   Died   Ratio of deaths

  1817     511       33     1 in 15-16/33
  1818    1572       75     1 in 21
  1819    1027       30     1 in 34
  (to 1 Dec.)

Of this epidemic several accounts were published at the time, including
one by Welsh, superintendent of the fever hospital, which is dominated,
like the Bristol account of Prichard, by the idea that blood-letting cut
short the fever[323]. Christison, who had experience of the relapsing
form in his own person[324], describes also two other forms mixed with the
cases of relapsing fever: a mild typhus, the _typhus mitior_ (_typhus
gravior_ being exceedingly rare in that epidemic), and a form which began
like the inflammatory relapsing _synocha_, and gradually after a week put
on the characters of mild typhus.

The admissions for fever to the Glasgow Infirmary, which was then the only
charity that received fever cases, had been at a somewhat low level since
the last epidemic in 1799-1801. They began to rise again with the distress
of 1816:--

_Admissions for Fever, Glasgow Infirmary._

  Year   Cases

  1814    90
  1815   230
  1816   399
  1817   714
  1818  1371
  1819   630
  1820   289
  1821   234
  1822   229
  1823   269

At the height of the epidemic in 1818 an additional fever hospital was
opened at Spring Gardens, to which 1929 cases were admitted in that and
the following year. Great efforts were made in Glasgow to “stamp out” the
contagion by disinfectants and removal to hospital[325]; but the course of
the epidemic seemed to follow the economic conditions more than anything
else.

The outbreak at Aberdeen was later than in the south of Scotland, having
begun in August, 1818. The infection was said to have been brought to the
city by a woman who found a lodging in Sinclair’s Close. A group of houses
in the close, covering an area of seventy by fifty feet and containing
one hundred and three inmates, became the first centre of the fever. The
scenes described are like those of the Irish epidemics: in one room, a
man, his wife, and five children were lying ill on the floor; in another,
a man, his wife and six children; in a third, a young girl, whose mother
had just died of fever, was left with three infant brothers or sisters.
More than three-fourths of the denizens of the close were “confined to bed
in fever, and all the others crawling about during the intervals of their
relapses.” The value of all the furniture and clothing belonging to 103
persons could little exceed £5. There was a horrible stench both within
and without the houses (relapsing fever being remarkable for its odour).
Yet this close was usually as healthy as any other part of the town. A
House of Recovery, with sixty beds, was opened in the Gallowgate, and
thirty beds were given up to fever-cases in the Infirmary of the city.
Besides those ninety hospital cases at the date of 17 December, 1818, it
was estimated that were three hundred more. Begging had been put down, so
that the contagion had not spread to the richer classes. Despite these
removals to hospital, the epidemic became more general about the New Year,
1819, and of a worse type; two physicians died of it, and some others had
a narrow escape. At the outset, the fever had been of the relapsing
kind--“subject to relapses for a third and fourth time, more especially
when they return too early to their usual labour[326].” At a later period
the epidemic seems to have become ordinary typhus, as it did also in
Ireland and elsewhere; and it was called typhus in the essay upon it by Dr
George Kerr[327].

The extent of this epidemic of 1818-19 over Scotland generally is not
known; but the following notice of it in a country parish of Forfarshire
was probably a sample of more that might have been given.

    Early in the summer of 1818 an epidemic of continued fever appeared in
    a manufacturing village seven miles from Lintrathen; it attacked at
    first young and plethoric subjects, and ran through whole families. In
    August it reached Lintrathen parish, in which one practitioner had
    forty cases, with no deaths. The fever was of an inflammatory nature;
    the bulk of the cases fell in October, and were nearly all of young
    women. They were bled to syncope, which then meant usually to 32
    ounces. There was a prejudice against blooding among the old people,
    who said “they had had many fevers, and in their time no such thing
    was ever allowed.” But, according to the doctor, this withholding of
    the lancet had the effect of protracting their illnesses: “they
    toasted sick for six weeks, and were often confined to bed for
    months[328].”

The epidemic of 1817-19 brought into prominence two questions, the one
theoretical, the other practical. The theoretical question (not debated at
the time) was touching the place or affinities of relapsing fever in the
nosology. Christison maintained that it was the inflammatory fever, or
_synocha_ of Cullen, showing a peculiar tendency to relapse. The fever of
the same epidemic period in England was also undoubtedly a fever of strong
or inflammatory reaction, corresponding to Cullen’s definition of
_synocha_, but it relapsed much less frequently than in Ireland and
Scotland in the same years. Even in Ireland and Scotland there were always
many cases of “relapsing fever” which did not relapse. The law of its
relapses was reduced to great simplicity by a physician learned in fevers,
Dr John O’Brien, in the Dublin epidemic of 1827. The bulk of that epidemic
was a fever of short periods--three, five, seven or nine days, most of the
attacks ending on the fifth or seventh night of the fever. The attack
being ended in a free perspiration, there might or might not happen, after
an interval, a relapse, and again a relapse after that, or even a third.
The five-days’ fever was more liable to relapse than the seven-days’
fever, the seven-days’ fever more liable than the nine-days’ fever, the
fevers of the longest periods not liable at all. In other words, the
sooner the patient “got the cool,” by a night’s sweating, the more liable
he was to have one or more relapses[329].

The logical position of relapsing fever was completed by Dr Seaton Reid,
of Belfast, when he proposed, in his account of the epidemic in 1846-7, to
call it Relapsing Synocha[330]. Other fevers have shown a tendency to
relapse in certain circumstances. Three fevers which have many points in
common, the sweating sickness, dengue and influenza, are all subject to
relapses. It was doubtless of the sweating sickness that Sir Thomas More
was thinking when he wrote: “Considering there is, as physicians say, and
as we also find, double the peril in the relapse that was in the first
sickness.” Plague, also, might relapse, or recur in an individual once,
twice, three times, or oftener in the same epidemic season. Enteric is an
instance of a long-period fever which has at times a tendency to
relapses[331]. None of these, however, can dispute the claim of relapsing
synocha to be relapsing fever _par excellence_. For whatever reason, the
short-period fever of times of distress and dearth or famine has shown a
peculiar tendency to relapse, and has shown that tendency more in the 19th
century than in the 18th, and more among the Irish and Scotch poor than
among the English.

The practical question that came to the front in the epidemic fever of
1817-19 was that of isolation hospitals for the sick. It was thus stated
by Dr Millar, of Glasgow, in a letter of advice to the authorities of
Aberdeen:

    “It is only by a universal, or nearly universal sweep of the sick into
    Fever Hospitals, joined to a universal or nearly universal
    purification of their dwellings, that anything is to be hoped for in
    the way of suppressing our epidemic. So far as this grand object is
    concerned, all the rest is folly: it is worse than folly[332].”

This was the well-meant but somewhat fanatical application of a trite and
commonplace notion. It was well understood by reflective persons at that
time, who were quite sound on the contagiousness of fever, that the whole
question of segregating the poor in fever hospitals was beset with
difficulties, not merely of expense but also of expediency. A Select
Committee of the House of Commons sat upon it in 1818, and published their
report, with the minutes of evidence, on the 20th May. So much had been
said in Parliament by Peel and others, and said so truly, of the spreading
of fever all over Ireland by whole families turned adrift in beggary, that
the Select Committee were full of ideas of contagion, and of the great
opportunity of suppressing fever by destroying its germs or seeds. But
they had soon occasion to learn that a fever may be potentially
contagious, yet not contagious in all circumstances, and that segregation
in fever hospitals had a rival in dispersion through general hospitals.
Half-a-dozen London physicians of position, answering respectively for
Guy’s, St Thomas’s, the London, St Bartholomew’s, St George’s, the
Westminster and the Middlesex Hospitals, declared that they mixed their
cases of contagious fever in the ordinary wards among the other patients;
and when asked by the astonished Committee whether the fever did not
spread, they answered one after another with singular unanimity, “Never,”
which under cross-examination, became in one or two instances, “hardly
ever,” as, for example, in the evidence for St Thomas’s Hospital, where a
sister and a nurse had caught fever and died. The point of this London
evidence was that the great safeguard against febrile contagion was free
dilution with air, and that the great provocation of a contagious
principle was to “concentrate” the cases of fever[333]. The Bristol
experience in the same epidemic, although it did not come before the
Select Committee, was wholly in agreement with medical opinion in London.
The fever-cases there were received either into St Peter’s Hospital, which
was the city poor-house, or into the General Infirmary. The former was an
old irregular building, badly ventilated, in which the contagion spread
freely to the ordinary inmates and became very virulent. Contrasting with
the apartments of the old poor’s house, the wards of the Bristol General
Infirmary were spacious, lofty, well-ventilated:

    “Here the patients labouring under fever were dispersed among invalids
    of almost every other description; so that, whatever effluvia emanated
    from infected bodies became immediately diluted in the mass of air
    free from such pollution. Here, accordingly, no instance occurred of
    the propagation of fever. None of the nurses were attacked, nor were
    patients lying in the adjacent beds in any instance infected, though
    cases of the worst description, some of them exhibiting all the
    symptoms of typhus gravior, were placed promiscuously among the other
    patients, scarcely two feet of space intervening between the
    beds[334].”

The same practice was kept up in the Edinburgh Infirmary until 1858 or
longer; Christison, who gives a diagram of an ordinary ward with four
fever-beds in it, declared in 1850 that there had been no spread of fever
for fifteen years before, except on one occasion, when the rules of the
house were neglected[335]. The bold policy of dispersing fever-patients
among the healthy was begun by Pringle and Donald Monro during the
campaigns of 1742-48 and 1761-63 in the Netherlands and North Germany.
They found that concentration raised the contagion to high degrees of
virulence and that dispersion weakened it to the point of non-existence,
Monro’s success at Paderborn in 1761 having been of the most signal
kind[336].

The Select Committee of 1818 were more influenced by what they were told
of the good effects of the earliest Houses of Recovery, at Waterford,
Manchester and other places in the end of the last century. For several
years after their opening they were little needed, the epidemic which gave
the immediate impulse to their establishment having subsided in due time
both in the towns provided with Houses of Recovery and in the innumerable
places where no such provision had been made. The recommendations of the
Committee do not appear to have been carried out; for the London Fever
Hospital, in Pancras Road, which had been enlarged to seventy beds when
the epidemic began in 1817, remained the only special fever hospital in
London until the establishment of the hospitals of the Metropolitan
Asylums Board in 1870[337].

       *       *       *       *       *

The confusion of commerce, depression of trade and lack of employment
which followed the Peace of Paris, and gave occasion to the British and
Irish epidemic fevers of 1817-19, gradually righted themselves. The price
of wheat, which would have been still higher after the four-months drought
of 1818, but for large imports, gradually fell, and was about 50_s._ in
1821, and 40_s._ in the winter of 1822-23. After that, it rose somewhat
again, and the third decade of the century, in the middle of which
occurred the great speculative crash of 1825, was on the whole a hard time
for the working classes. The history of fever has few illustrations
between the epidemic of 1817-19 and that of 1826-27, excepting the great
famine-fever of Connemara and other parts of the West of Ireland in 1822,
elsewhere described, which coincided with a somewhat prosperous time in
England and called forth a princely charity[338].


The Relapsing Fever of 1827-28.

The epidemic of relapsing fever which was at a height in Dublin in 1826,
did not culminate in Edinburgh, Glasgow, and other towns of Scotland until
1828. It was a somewhat close repetition of the epidemic of 1817-19,
except that it was chiefly an affair of the towns, owing to depression of
trade and want of work following the great crash of commercial credit in
1825-26. In Glasgow, the admissions for fever to the Royal Infirmary began
to rise in 1825[339]:

_Glasgow: Admissions for Fever._

  Year

  1824    523
  1825    897
  1826    926
  1827   1084[340]
  1828   1511[340]
  1829    865
  1830    729

At Edinburgh the cases of fever treated in hospital were fewer in ordinary
years than at Glasgow, but they rose to a higher point in the epidemic
years[341]:

_Edinburgh: Admissions for Fever._

  Year

  1824                   177
  1825                   341
  1826 (nine months)     456
  1827                  1875
  1828                  2013
  1829                   771
  1830                   346

Christison gives the following account of the epidemic in Edinburgh in
1827-28:

    “Like that of 1817-19, it arose in Edinburgh during a protracted
    period of want of work and low wages among the labouring classes and
    tradespeople; it prevailed only among the working classes and
    unemployed poor--in the Fountainbridge and West Port districts, the
    Grassmarket ‘closes,’ the Cowgate and the narrow ‘wynds’ descending on
    either side of the long sloping back of the High Street and
    Canongate.” The fever had the same three types as in 1817-19--many
    cases of inflammatory, or relapsing, or synocha, a few of low fever
    (typhus), and some between the two--militant or inflammatory for a
    week, then becoming low, and running the continuous course of
    typhus.... “The inflammatory fever presented the same extreme violence
    of reaction as in the former epidemic--the same tendency to abrupt
    cessation, with profuse sweating--the same liability to return
    abruptly a few days afterwards--and the same disposition to depart
    finally in a few days more, and again abruptly with free perspiration.
    The cases of typhus were more frequently severe than in 1818-19.
    Icteric synocha occurred also oftener, although far from
    frequently[342].”

The epidemic of relapsing fever in 1826-28, which made a great impression
in the towns of Ireland and Scotland, has left few traces in specially
English records. But it is clear that there was some increase of fever
about the same time in London; and it becomes a matter of interest, as
well as of no little difficulty, to ascertain the type or types of the
same. It was just after this quasi-epidemic in London that Dr Burne
published his essay on fevers, the preface bearing the date of 28th
February, 1828[343]. The materials of this essay came from Guy’s Hospital,
and they were both clinical and anatomical. The author seeks to find a
common name for all varieties of continued fever, the name that he chooses
being “Adynamic Fever.” “By far the greater number of cases,” he says,
“are of the first or second degree only of severity, and not dangerous.”
These were cases of “simple continued fever,” or fever of short duration,
with flushed face, suffused eyes and other signs of the “inflammatory”
type, or of synocha. Although Burne does not give the exact proportion of
cases with relapse, as Bateman had done for the London epidemic of
1817-18, yet he makes it clear that relapses did occur, and he discusses
the phenomenon in a manner which makes his testimony interesting:
“Convalescents are more liable to a relapse after the adynamic fever than
after any other disease; and this may be accounted for by the very
enfeebled and exhausted state in which the powers of the system are
left.” His relapses were obviously a return of the original fever,
beginning again suddenly in the midst of convalescence with flushing of
the face, headache, dry tongue, and scanty urine, and with a great access
of febrile heat in the night, a disturbance of the system which generally
continued for several days, while in some it went off sooner with a
diarrhoea. He assigned three principal causes for the relapse--overloading
the enfeebled but craving stomach, walking out in the open air too soon,
and giving way to emotion[344].

The references to relapse apply almost certainly to fevers of the shorter
periods (synocha or “inflammatory” fever), and not to those cases of
enteric fever which did undoubtedly occur in the practice of Guy’s
Hospital in the same seasons.


Typhoid or Enteric Fever in London, 1826.

The identification of enteric fever and relapsing fever respectively, or
the separation of each from typhus, became actual in Britain at one and
the same time. I have already said all that seems necessary as to the
earlier appearances of relapsing fever on the stage of epidemiological
history. This will be the fitting point in the chronology, the third
decade of the 19th century, to bring in the question of enteric or typhoid
fever. As to its identification, or recognition as a distinct species,
that was not really completed, to the satisfaction of everyone, until the
elaborate analysis of the symptoms respectively of typhus and enteric
fevers by Sir William Jenner in 1849-51[345]. But, for ten years before
that, the co-existence with maculated typhus of a different long-period
fever, having abdominal symptoms and abdominal lesion, had been
recognised, and the characteristic ulceration or sloughing of the
lymph-follicles of the ileum, with sphacelation of the mesenteric
lymph-glands, had been clearly described by several London physicians and
depicted in coloured plates, in the years 1826 and 1827, during an unusual
prevalence of such cases in London. The authentic history of enteric fever
in Britain really begins with these writings by physicians of St George’s
and Guy’s Hospitals. But, as it is improbable that the type of fever was
absolutely new in the years 1825 and 1826, it may be asked whether the
enteric type cannot be discovered in the old accounts of British fevers,
and if so, whether we may assume in the past as much enteric fever
relatively to spotted typhus, relapsing fever, or simple continued fever,
as in the period after 1850.

Having adverted to this point from time to time in the preceding history
as it arose, for example in connexion with Willis’s fever of 1661,
Strother’s fever of 1727-29, the Rouen fever of 1750, and other instances
both in children (remittent or convulsive or comatose fever of children)
and in adults, I shall not recapitulate farther back than the beginning of
the 19th century.

There was a certain amount of post-mortem observation in the 18th century,
especially in camp sicknesses, by Pringle and others; but there is no
trace of intestinal ulceration among their fatal fevers. It was found,
however, in the epidemic of 1806 among the troops at Deal, and it is
probable that Ferriar’s cases at Manchester about 1804, and Bateman’s
cases of continued fever in London from 1804 to 1816, were in some part
enteric, although the anatomical test is wanting. That was a period when
there was singularly little of the old London fever in the houses of the
poorer class. Then came the remarkable “constitution” of relapsing or
simple continued fever, from about 1816 to 1828, the relapsing character
of which was far more obvious in Ireland and Scotland, than in London,
Bristol, or elsewhere in England, but was not altogether unobserved in
London, whether in 1817-19 or in 1827-28. The relapsing type disappeared
after that for fifteen or twenty years, and was replaced by typhus more
maculated than had been seen for many years. But, before the relapsing or
simple continued fever disappeared for a time, enteric fever was seen in
London in company with it.

The chief season of enteric fever in London was the autumn of 1826,
following a long period of great drought and heat. The remarkable weather
of that season was the same in England, Ireland and Scotland, and is thus
described for the last by Christison:

    “The spring and summer seasons of that year were remarkable for the
    extraordinary drought and heat which prevailed for many continuous
    months. No such seasons could be recollected by anybody, and assuredly
    there has been nothing similar in this country since.... The fine
    weather set in with the beginning of March, and continued, with
    scarcely a check, well into the autumn.... The drought prevailed and
    the heat increased till the middle of June, when a thunderstorm with
    heavy rain cooled the air for a day or two. But the heat then became
    greater than ever, and there was continuous sunshine and no rain till
    after the middle of July, when again there was thunder and rain, after
    which sun, heat and drought ruled the season once more.” The shade
    temperature at Edinburgh was 84° Fahr., at 3 p.m. on three successive
    days of July[346]. The two summers preceding had also been
    exceptional, that of 1824 having been hot and moist, that of 1825 hot
    and dry, with dysentery in Dublin.

In August, 1826, Dr Cornwallis Hewett, of St George’s Hospital, published
ten fatal cases of enteric fever, four of which had occurred in his own
practice, six in the practice of his colleagues[347]. The first was
admitted on 23 April, 1825, the latest on 3 July, 1826. While his paper
was under hand, he had read in the _Medico-chirurgical Review_ for July,
1826, some extracts from Bretonneau’s paper on “Dothiénentérite” (enteric
fever), and he pronounced the London cases to be the same as those
recently observed at Tours. Several other cases occurred at St George’s
Hospital in the autumn of 1826, three of them reported by Dr
Chambers[348]. At the very same time, there was a run of enteric cases at
Guy’s Hospital. Dr Bright says: “Fever occurred with considerable
frequency among the patients who presented themselves for admission into
Guy’s Hospital, during the months of October, November and December, 1826.
On the whole, the disease was not severe.” The more comprehensive account
of these cases was given by Burne, early in 1828, from which it appears
that the bulk of them were fevers of the shorter period, that there were
relapsing cases among them, and that some were cases of enteric fever,
verified by post-mortem examination[349]. It was the enteric cases that
attracted the notice of Dr Bright, who says nothing of the relapsing
cases, or of cases of simple continued fever. The fact that the intestinal
mucous membrane may become diseased during fever was, he says, “long known
in particular cases, but never suspected to be so general till brought
into view by the French physicians, and which has lately been illustrated
in this country with great beauty [this does not mean in plates] by the
pens of my able and assiduous friends Dr Chambers and Dr Hewett.” He gives
ten fatal cases, with coloured plates of the intestinal or mesenteric
lesion in some of them, the earliest coloured plate having been made from
a case admitted on 13 October, 1825, and the most typical plate of the
sloughing Peyer’s follicles from a case admitted on 25 November, 1826. He
gives also eleven cases of recovery, to show the benefit of treating the
diarrhoea by calomel[350]. Nearly all the cases occurred in the end of the
year, either of 1825 or 1826; and Burne confirms this when he says that
the cases with enteric lesion were found at Guy’s Hospital only in autumn.
Some two years after, in 1830, Drs Tweedie and Southwood Smith, physicians
to the London Fever Hospital, described cases of fever with ulcerated
intestine and sphacelated mesenteric glands. After that, the interest
shifted to typhus, which reappeared in London of an unusually maculated
type; so that the years 1826-30 make a somewhat distinct period in which
the new fever, with enteric lesion, was an engrossing medical topic. It is
tolerably certain that it was the unusual seasons of 1825 and 1826 which
brought enteric fever into prominence; while, as soon as it became
frequent, it could hardly have escaped the systematic apparatus of
clinical case-taking and post-mortem examination, with preservation and
drawing of specimens, for which Guy’s Hospital was already noted under the
influence of Bright and his colleagues, and in which the staff of St
George’s Hospital would appear to have been not less competent. Although
Dr Hewett, in 1826, identified his cases with the _dothiénentérite_ of
Bretonneau, yet neither he nor Dr Bright took the abdominal ulcerations or
sloughs as distinctive of a new kind of fever. They regarded them rather
as a new complication of “idiopathic” typhus fever, a “complication” which
appealed to them more on the side of treatment than of systematic
nosology; hence the writings of both physicians are occupied mainly with
the benefit of calomel in relieving the congestion of the bowels and in
checking the diarrhoea.

It is undoubted that cases of enteric fever in 1826-27 were relatively
more numerous in London than in Dublin and Edinburgh, where the epidemic
fever was almost wholly of the relapsing type. In Edinburgh, at least, the
comparative infrequency of enteric fever for years after it had been
recognized in Paris, Tours and other French cities, and had been found in
London as a common autumnal type, can be proved beyond cavil. Writing long
after of the first epidemic of relapsing fever in Edinburgh, Christison
said:

    “Of enteric typhus (typhoid fever) we saw nothing then [1817-20], nor
    for many years afterwards. If it might have been overlooked during
    life, it could not have been missed after death. For our dissections
    were many, and, to meet the bias of the day for finding a local
    anatomical cause for all fevers [the doctrine of Broussais], every
    important organ in the body was habitually looked to. Nevertheless we
    were constantly met with the want of morbid appearances anywhere,
    unless slight signs of vascular congestion in various membranous
    textures be considered such[351].”

These vascular congestions were, indeed, scanned closely for traces of
ulceration, after Bright’s plates of 1828, and any little irregularity on
the surface of a congested Peyer’s patch was liberally construed in that
sense, as in Craigie’s reports subsequently. But in the Edinburgh epidemic
of 1827-29, the anatomical signs of enteric fever were wanting until the
end of it. Writing in 1827, Alison said that he had dissected 26 cases
dead of the epidemic fever, without finding intestinal ulceration in one
of them. Christison, however, says that a very few cases of enteric fever
were dissected in Edinburgh in 1829[352].

In Dublin, also, the anatomical mark of enteric fever was missed in
1826-27, in the few dissections that were made during the epidemic[353].
An opinion in a widely different sense was given on that point by Stokes
twelve years after the event, to which I refer in a note[354].


Return of Spotted Typhus after 1831: “Change of Type.” Distress of the
Working Class.

A fever with relapses, and a fever with sloughing of the follicles and
lymph glands of the intestine, were not the only novelties in the first
thirty or forty years of the 19th century. Relapsing fever and enteric or
typhoid fever were each clearly separated, at a later date, from typhus
fever. But what was the “typhus fever” from which they were at length
separated? It was a fever which came prominently into notice after the
“constitution” of 1826-29 was ended--a fever with a mottled, measly, or
rubeoloid rash, and with various other spots, on account of which it was
described by Dr Roupell in 1831, in a lecture before the College of
Physicians of London, as a “new fever[355].” It was a new fever only in
the sense in which each new febrile “constitution,” whether it were an
influenza, an epidemic ague, or a malignant typhus, was apt to be called
popularly “the new fever,” in the 16th and 17th centuries. There were, of
course, erudite men at the College of Physicians in 1831 who knew that a
fever with a mottled rash, with vibices and petechiae, and with all other
symptoms of typhus gravior, had often occurred in England, Scotland and
Ireland in former times. The “spotted fever” was perhaps the most familiar
name of typhus in the 17th century. The mottled rash, like that of
measles, was described for the fever of Cork by Rogers in the beginning of
the 18th century, and for various other English and Irish epidemics by
Huxham, O’Connell, Rutty and others. But undoubtedly the maculated typhus
was somewhat new to the generation who saw it about 1830 and following
years, the continued fevers which had prevailed in England, Scotland and
Ireland since 1816 having been for the most part the simple continued, or
synocha, with or without the relapsing character, and to some extent
enteric fever[356].

It was from 1830 to 1834 that a change in the reigning type of fever began
to be remarked in London, Dublin, Edinburgh and Glasgow, the new type
becoming more and more evident as fevers became more prevalent in the
‘thirties’ and ‘forties.’ Typhus at length became so much a spotted fever
that the question arose whether it should not be classed among the
exanthemata. In 1840, Dr Charles West, having observed “the alteration in
character which fever has undergone within the last few years,” went over
the history (but more the foreign than the English) with a view “to
illustrate the question whether typhus ought not to be classed among the
exanthematous fevers[357]:” of course he found many old descriptions of a
mottled rash or other spots, but saw no reason to make spotted typhus one
of the exanthemata. Dr Kilgour, of Aberdeen, who treated more than a
thousand cases in his fever-ward at the infirmary there from 1838 to 1840,
wrote in 1841, “I am perfectly satisfied that this fever, call it by what
name we will, is truly an exanthematous fever[358].” Previous to 1835, the
spots of fever-cases in the Glasgow Infirmary had hardly been remarked;
but after that date all cases were classed either as spotted or not, the
spotted cases being three-fourths of the whole. Besides being spotted, the
fever of the new constitution was insidious in its approach and low in its
reaction, very unlike the sthenic, militant, inflammatory synocha of the
generation before. The blood-letting which had been all but universally
used in the fever from 1816 to 1828, and had seemed to answer well, was
continued for a time in the fever of the ‘thirties.’ But it was soon found
to be injurious: the patients in the new fever were apt to faint when only
a few ounces of blood (four or six) had been drawn, whereas in the other
fever (whether relapsing or simple continued) they had often lost thirty
ounces before deliquium was reached. It was found, on the other hand, that
fever-cases in the ‘thirties’ needed wine and other cordial regimen. There
was nothing new in these revolutions, whether of the fevers themselves, or
of the opinions as to their treatment. Sydenham’s method of taking his cue
for treatment from the “constitution” of the season, which was the method
of Hippocrates, appeared to be once more the best suited to the
circumstances.

It is not easy to make out what were the circumstances of the time that
led to the supersession of simple continued fever (or relapsing fever in
Ireland and Scotland), by spotted fever or typhus gravior in all parts of
the kingdom. Sydenham would have looked, among other things, to the
weather and the character of seasons; but from 1830 onwards there was no
season so notable as the dry and hot summer of 1826, although the end of
the year 1836 was remarkably wet. The period of typhus gravior was a time
of much sickness of other kinds--the Asiatic cholera of 1831-32, the
influenza of 1831, 1833, and 1836-37, and the general unhealthiness of the
year 1837. This was also the decade when the “condition-of-England
question” was a common topic, a time of strikes and of much distress among
the working classes, as shown in the reports of the Poor Law Commission.

In Glasgow there was a considerable prevalence of fevers year after year
from the relapsing-fever epidemic of 1827-29, according to the following
table of admissions for fever to the Royal Infirmary and the special
fever-hospitals[359]:

_Admissions for Fever, Glasgow._

  Year   Fever cases

  1827    1084
  1828    1511
  1829     865
  1830     729
  1831    1657
  1832   {1589
         {1148[360]
  1833    1288
  1834    2003
  1835    1359
  1836    3125
  1837    5387[361]
  1838    2047
  1839    1529

The worst year of the series for fever was 1837, and the worst month of
that year was May, when the fever-deaths were 1 in 3·22 of the mortality
from all causes. That great access of fever in Glasgow followed
immediately upon the great strike of the cotton-spinners, on 8th April,
1837, by which eight thousand persons, mostly women, were thrown out of
work[362]. The death-rate in Glasgow was in those years as high as
anywhere in the kingdom, and was higher in the nine years from 1831 than
in the nine years preceding. The population of Glasgow, says Cowan, had
increased on the industrial side, out of proportion to its middle and
wealthiest class[363]; and to that he would attribute the higher
death-rates in the second period (right-hand side), of the following
table:

_Glasgow Death-rates._

              1822-1830         |              1831-1839
                                |
         Death-rate  Death-rate |       Death-rate  Death-rate
         over all.   under five.|       over all.   under five.
  Year    One in      One in    |  Year  One in      One in
  1822     44·4        101      |  1831   33·8         79
  1823     36·4         78      |  1832   21·67        63
  1824     37·0         81      |  1833   35·7         77
  1825     36·3         81      |  1834   36·3         81
  1826     40·6        105      |  1835   32·6         67
  1827     37·0         84      |  1836   28·9         62
  1828     33·0         79      |  1837   24·6         65
  1829     37·9        100      |  1838   37·9         83
  1830     41·5         97      |  1839   36·1         72

The high death-rates in some of the years in the second column were owing
to special causes--Asiatic cholera in 1832, smallpox of children in 1835
and 1836, and to influenza, as well as to typhus, in 1831, 1833 and 1837.
As to the fever which prevailed from 1831 to 1836, as it was not relapsing
in type, so it was not associated with scarcity.

    “The increase of fever in Glasgow,” says Cowan, “during the seven
    years prior to 1837, had taken place, not in years of famine or
    distress, but during a period of unexampled prosperity, when every
    individual able and willing to work was secure of steady and
    remunerating employment. From the close of 1836, one of those
    periodical depressions in trade, arising from the state of our
    monetary system, had visited this city, and deprived a large
    proportion of the population of the means of subsistence[364].”

It was then that the cases of typhus trebled in number.

The epidemic of fever reached its height in Dundee about the same time as
in Glasgow, and in both towns sooner than anywhere else in Scotland or
England. One reason of this was the labour-troubles culminating in
strikes. In the twelvemonth from 15 June, 1836, to 12 June, 1837, more
than three-fourths of all the admissions to the Dundee Infirmary on the
medical side were for fever (700 cases). After the wet autumn of 1836
there were a good many cases of dysentery, of which 22 were treated in the
infirmary, with two deaths[365].

At Edinburgh, as at Glasgow, there had been an unusual amount of fever in
1831 and 1832, and a steady prevalence of it thereafter. The epidemic of
1836-39 was for the most part typhus of the winter seasons, declining each
spring and disappearing each summer, except in the summer of 1836, when
many cases came in June, July and August from airy parts of the town[366].
The climax of the epidemic was in 1838, a year later than in Glasgow and
Dundee, according to the admissions to the fever-wards of the
infirmary[367]:

_Admissions for Fever, Edinburgh Infirmary._

  Year    Cases

  1831     758
  1832    1394
  1833     878
  1834     690
  1835     826
  1836     652
  1837    1224
  1838    2244
  1839    1235
  1840     782

At Aberdeen the epidemic appears to have been later even than at
Edinburgh, if the following admissions to one of the two fever-wards (Dr
Kilgour’s) may be taken as a fair measure of it[368]:


_Admissions for Fever, Aberdeen._

  Year                        Cases   Deaths

  1838 (March to December)     189      26
  1839                         286      29
  1840                         534      53

In all these large towns of Scotland, the fever was purely typhus. The
various observers all describe the fever as of the spotted kind, the
proportion of cases with spots varying somewhat.

    Thus, at Glasgow Infirmary, from 1835 to 1839, there were 4202 cases
    with eruption, 1270 without eruption, and 143 doubtful. And, that the
    cases without eruption were not cases of enteric or typhoid, is
    probable from the record kept of the fatalities in Dr Anderson’s
    fever-wards[369]:

        In 1885 cases with eruption,   275 deaths, or 14·58 per cent.
         "  324 cases without eruption, 11 deaths, or  3·33 per cent.
         "  143 cases doubtful,          7 deaths, or  4·89 per cent.

    At Aberdeen, Kilgour counted 59 cases spotted in a total of 189 in
    1838, 96 in a total of 286 in 1839, and 278 in a total of 534 in 1840,
    all the cases, whether spotted or not, being of the same fever, which
    he considered an exanthematous malady as a whole. Of 169 cases
    tabulated by Craigie at Edinburgh, from 28 June, 1836, to 12 February,
    1837, there were 79 with an eruption, which was usually the mottled or
    rubeoloid rash.

The fatalities were relatively more in Edinburgh than in Dundee, comparing
two periods which were not the same. Of 700 cases at Dundee, from June,
1836, to June, 1837, only 50 died, or 1 in 14, notwithstanding a good many
complications from chest complaints and bowel complaints[370]. At
Edinburgh during fifteen months of 1838-39, there died 276 in 2037 cases,
or 1 in 7·3; of those cases, 1075 were in females, with 116 deaths, or 1
in 9, and 962 males, with 160 deaths, or 1 in 6[371]. The most common age
for the fever at Dundee was from twenty to forty years (416 out of 700
cases, with 26 deaths, or 1 in 16), while the most fatal age, as usual,
was from forty to sixty years, at which one person died of three attacked.
At Aberdeen, in the last year of the epidemic, the years of life from ten
to twenty had more cases (233 in a total of 657) than any other decade of
life. The average stay of a patient in the Aberdeen fever-wards was 18·67
days. The great preponderance of deaths in adolescents or adults was
clearly shown in the Glasgow fever-statistics, 1835-39.


                                       Fever-deaths per cent.
  Deaths from      Under        Over     of deaths from
  typhus fever   ten years   ten years      all causes

     4788           752         4036          11·57

The corresponding epidemic of typhus in England had the fortune to be
recorded in great part under the new system of Registration, which came
into force on the 1st of July, 1837. At the beginning of registration of
the causes of death, and until a good many years after, no distinction was
made in the published tables between typhus fever and enteric fever. But
we happen to know that the epidemic of 1837-38 was in London almost
wholly typhus, just as it was in the large towns of Scotland. Of sixty
cases in 1837-38, of which notes were kept by West, under Latham at St
Bartholomew’s Hospital, none that died and were examined post-mortem had
ulcerations, although some had congestion, of Peyer’s patches, the cases
being all reckoned typhus exanthematicus[372]. Sir Thomas Watson, who was
then physician to the Middlesex Hospital, says of the ulceration of
Peyer’s patches in continued fever:

    “Since attention has been drawn to the subject, the patches of glands,
    and the whole tract of mucous membrane, from the stomach to the
    rectum, have been diligently explored, and the result seems to be
    that, at certain times and places (in other words, in certain
    epidemics), the ulceration of the inner surface of the intestine is
    far less common than at others. It was comparatively rare in an
    epidemic of which I witnessed some part in Edinburgh [1827-29]. Then I
    came to London; and for several years I never saw a body opened after
    death by continued fever without finding ulcers of the bowels. More
    recently, however, and especially during the present epidemic (1838),
    I have looked for them carefully, in many cases that have proved fatal
    in the Middlesex Hospital, and have discovered neither ulceration nor
    any other apparent change in the follicles of the intestines.” And
    elsewhere he confirms the purely typhus character of the epidemic of
    1838: “Our wards at the Middlesex are full of it, and scarcely a case
    presents itself without these spots. We speak of it familiarly as the
    _spotted_ fever; or, from the resemblance which the rash bears to that
    of measles, as the _rubeoloid_ fever[373].”

From which it would appear that not even the ordinary average number of
endemic cases of enteric fever, such as might have been expected at a
hospital in the west end of London, were forthcoming in the epidemic of
1837-38, so purely was the type of fever typhus.

The deaths from this epidemic in London, from the 1st of July, 1837, to
the 31st of December, 1838, were as follows[374]:

        1837                           1838
    3rd      4th          1st      2nd      3rd      4th
  Quarter  Quarter      Quarter  Quarter  Quarter  Quarter

    826     1107         1285     1176      829      788

--a total of 6011 deaths from fever, nearly all typhus, in eighteen
months. The worst London parishes were Whitechapel and St Pancras, in
which latter the fever-hospital was situated. The high mortality from
fever, which had begun before the 1st of July, 1837, continued into the
year 1839, when the deaths in London (probably including some enteric)
were 1819.

Over all England and Wales, including London, the last six months of 1837
produced 9047 deaths from “typhus,” and the twelve months of 1838, 18,775
deaths, the winter of 1837-38 having been the most fatal period. After
London, the large towns most affected by the epidemic in the latter half
of 1837 were as follows:

               Deaths from
                typhus in
               six months

  Liverpool      524
  Manchester }
  and Salford}   274
  Birmingham      75
  Bolton          75
  Sunderland      72
  Leeds           71
  Sheffield       68
  Bradford        65
  Stockport       63
  Dudley          54
  Abergavenny     53
  Wolverhampton   45
  Newcastle       44
  Wigan           43
  Chorley         41
  Swansea         36
  Halifax         33
  Macclesfield    33
  Norwich         27

In each of the next two years the number of deaths from typhus in the four
largest towns was as follows:

                  Typhus      Typhus
                  deaths      deaths
                 in 1838     in 1839

  Manchester}
  and Salford}     627         416
  Liverpool        573         358
  Leeds            245         150
  Birmingham       123         141

From nearly all the registration districts of England and Wales, deaths
from fever were returned in 1837-39, so that the contagion must have been
very widely spread in town and country[375]. In London the epidemic
declined greatly in 1839, but in many parts of England the deaths
registered as “typhus” were hardly less numerous than in 1838, and in some
country divisions they were more, as if the contagion had taken longer to
reach the villages[376]. One village epidemic in North Devon in the latter
half of the year 1839 had been observed by Dr W. Budd, afterwards of
Bristol:

    The first case in the village (North Tawton, 1100 to 1200 inhabitants)
    was of a young woman in a poor and crowded cottage, who sickened on 11
    July, 1839; her mother, brother, and sister sickened in succession,
    her father and a young infant escaping the infection. In another
    cottage, four out of six were ill of fever, in another, three persons
    had it, and so on, the whole number of cases treated by Dr Budd in the
    village until the beginning of November being about eighty. It was
    carried from North Tawton to neighbouring hamlets: thus, a sawyer who
    lodged next door to the first infected cottage sickened of the fever
    and, on 2 August, returned to his home in the hamlet of Morchard. As
    he lay there, he was visited by a friend, who assisted to raise him in
    bed: “While thus employed, the friend was quite overpowered by the
    smell from the sick man’s body,” and on the tenth day thereafter
    sickened of fever, which spread to two of his children and to a
    brother who came from a distance to see him. Another sawyer who lodged
    with the former left North Tawton ill a week after him (9 August) for
    his home, also at Morchard, where he died after a period not stated;
    ten days after his death his two children took the fever, his widow
    escaping it. In a third instance, a widow L---- left North Tawton on
    21 August to visit her brother, a farmer in the hamlet of Chaffcombe,
    seven miles distant. Two days after her arrival she fell ill of fever
    and recovered slowly. In the same farmhouse the mistress caught it a
    month or two later and died on 4 November; the farmer himself took to
    bed with the fever on the day his wife died, and came safe through the
    attack. Three weeks after, an apprentice on the farm sickened, then a
    lad (the fifth in order) in the end of December, then the farmer’s
    sister, then another apprentice, then a serving-man, then a
    maidservant, and lastly the daughter of the widow L---- from North
    Tawton, who had been the first case in the house months before. This
    farmhouse at Chaffcombe sent off two distinct offshoots of contagion.
    The lad, who was fifth in the above series, was sent home ill to his
    mother’s cottage, between Bow and North Tawton, in the end of
    December. His mother sickened on 24 January, 1840, and died on 2
    February. Next door to her lived a married daughter, whose whole
    household were attacked. Another married daughter, who came from a
    distance to visit the sick, took the infection on her return home, and
    so started a new focus. From the same farm at Chaffcombe, the maid,
    who was ninth in order in the above series, was sent home to her
    father’s cottage in the hamlet of Loosebeare, four miles away; her
    father caught the fever from her, and a farmer K----, who lived across
    the road, having visited this man several times in his illness, took
    the fever next, other cases following under farmer K’s. roof, and
    thereafter throughout the whole hamlet of Loosebeare[377].

This was doubtless the way the epidemic spread in all the country
districts of England, the unwholesome state of labourers’ cottages, as
revealed in the reports of the Poor Law Commission, favouring it. In the
chapter on the fevers of Ireland we shall find that the contagion of
typhus and relapsing fever was dispersed in the same way, but to a much
greater extent, owing to the amount of vagrancy.

In the manufacturing towns of the North of England the fever continued at
a somewhat steady epidemic level for several years. The pathetic scenes of
typhus among the poor of Manchester in Mrs Gaskell’s famous tale of _Mary
Barton_ belong to the early part of the year 1839; but they might have
been drawn from almost any months of the two or three years following,
according to the passage cited below from the same work[378]. In 1839 the
Lancashire deaths from typhus were 1343; in Wales, Monmouth and
Herefordshire they were 1548. There is, indeed, little improvement in the
statistical returns as late as 1842. The deaths from “typhus” were as
follows in all England and Wales:


         1838    1839    1840    1841    1842
        18,775  15,666  17,177  14,846  16,201

    The deaths from the epidemic maladies of infants and children during
    the same five years were also very high.

                       1838      1839     1840    1841     1842

        Smallpox      16,268     9,131   10,434   6,368    2,715
        Measles        6,514    10,937    9,326   6,894    8,742
        Hooping cough  9,107     8,165    6,132   8,099    8,091
        Scarlatina     5,802    10,325   19,816  14,161   12,807
        Croup          4,463     4,192    4,336   4,177    4,457
        Diarrhoea      2,482     2,562    3,469   3,240    5,241

    The epidemic of smallpox corresponded closely to the epidemic of
    fever, the former being fatal chiefly to infants and young children,
    the latter fatal chiefly to adults. Before the smallpox epidemic had
    subsided scarlet fever became unusually mortal, especially in 1840,
    and kept its higher level of deaths for a generation after. The
    epidemic of fever, although it affected the mortality of the young
    comparatively little, was indirectly a reason why many of them died of
    other diseases; for the prostration of the parents, the
    impoverishment, and all the other troubles associated with an epidemic
    of typhus, led to inevitable sufferings among the young, which
    weakened their power of resistance.

The registration returns were not tabulated (except for London) from the
end of 1842 to the beginning of 1847, but there is reason to think that
the epidemic fever was not active in the interval. It is undoubted that
the enormous construction of railroads in England during those years gave
employment and wages to multitudes, and ended the distress the sooner.
This effect of railroad-making in England was so obvious that Lord George
Bentinck desired to relieve the distress in Ireland in 1846-47 by the same
means.


Enteric Fever mixed with the prevailing Typhus, 1831-42.

While there is complete agreement among the hospital physicians of the
great towns that the fever of 1837-39 was maculated typhus, to the total
exclusion of cases with ulceration of the bowel, as in the experience of
Watson at the Middlesex Hospital and of West (under Latham) at St
Bartholomew’s, yet some allowance should be made, in interpreting the
figures of fever mortality in those years throughout England and Wales,
for admixture of enteric fever. Budd’s statement that the only case which
was dissected in the epidemic at North Tawton, Devonshire, in 1839, had
the bowel-lesion of enteric fever, if it is to count in the absence of the
usual details (place, date, objective description), would mean that at
least one case there was not of the prevailing type of contagious epidemic
typhus. The coincidence of some such cases is made the more probable by
the evidence from Anstruther, Fifeshire, reported by John Goodsir,
afterwards Professor of Anatomy at Edinburgh, who was assisting his father
in practice there from 1835 to 1839. During that period, which was the
time of the typhus epidemic in the larger towns of Scotland, he attended
about one hundred cases of fever annually in Anstruther and the
neighbourhood; the fever was usually mild, only some sixteen of the cases
having proved fatal; of those sixteen he examined ten after death, finding
“ulceration” of the Peyer’s patches in all, and perforation of the
intestine in four of them. These facts he gave orally to Dr John Reid,
pathologist to the Edinburgh Infirmary, whose experience of the morbid
anatomy of fever was altogether different. Goodsir, having kept the
specimens, made them the subject of a paper some years after (1842), in
which he described very minutely the stages and degrees of congestion,
ulceration, sloughing and perforation in the lymph-follicles of the
intestine in fever, placing congestions at one end of the scale and
sloughing at the other, as the French pathologists then did[379]. Reid
examined, at the Edinburgh Infirmary from October, 1838, to June, 1839,
forty-one bodies dead of fever, to see whether the intestinal lesion,
which Goodsir had told him of, occurred in them. The distinctness of the
Peyer’s patches varied a good deal (differences which are known to be in
part congenital and in part to depend on age), and in only two instances
were they elevated and seemingly “ulcerated.”

    One of these was the case of an Irishman, from Sligo, aged 25, who had
    been so constipated that he was purged with colocynth, etc.: “at the
    lower part of the ileum, the elliptical patches were irregular on the
    surface, and presented several superficial and ill-defined depressions
    (ulcerations).” The other was the case of a girl, aged 15, who had not
    suffered from diarrhoea, but had the intestinal patches elevated and
    superficially “ulcerated[380].” Neither of these cases would probably
    be reckoned typhoid or enteric fever at the present time on the
    anatomical evidence only. The early French observers, Chomel, Louis,
    Andral and others, included in a scale all the appearances of the
    Peyer’s patches in fever that they thought morbid, from mere
    prominence of the lymphatic tissue and distinctness of the follicular
    pits, up to extensive sloughing and ulceration of the same, as if they
    were all the signs of one and the same fever in its various stages of
    development. But simple prominence or congestion of Peyer’s patches
    may occur in typhus fever, or in relapsing fever; nor would a slight
    erosion, or “superficial ulceration” raise in all cases a suspicion of
    enteric fever.

The observations of Home, Reid’s predecessor as pathologist to the
Edinburgh Infirmary, from 1833 to 1837, were however conclusive that true
enteric fever had occurred now and again during the steady prevalence of
typhus fever from year to year. In that space he made 101 post-mortem
examinations in fever-cases; in 29 the Peyer’s patches were distinct, in 7
of those 29 there was “a greater or less degree of ulceration,” and in 2
of those 7 there was perforation[381]. Murchison examined the post-mortem
register of the Edinburgh Infirmary for the years 1833 to 1838, and found
only fifteen cases of fever with ulceration of the bowel. But in the eight
months from 1 November, 1846, to June, 1847, there were nineteen
dissections with the characteristic lesion of typhoid, the season having
been remarkable everywhere for that disease.

In the following series of years the fatal cases of fever in the Edinburgh
Infirmary with ulceration were few[382]:

  Year    Enteric deaths

  1854          5
  1855          2
  1856          1
  1857          8
  1858          1
  1859          2
  1860          1
  1861          6

It was thought remarkable that the form of continued fever which was most
usually found in the great continental cities, in Paris, Berlin, Prague
and Vienna, namely that with ulceration of the lymph-follicles of the
intestine, should be but occasionally mixed with the old typhus in
England, Ireland and Scotland in the very same years. But there was
nothing to discredit the British observations, anatomical and clinical;
and in 1836 Dr Lombard, of Geneva, having visited various cities in
England, Scotland and Ireland bore witness to the matter of fact, strange
as it was to him. Writing to Graves, of Dublin, on 16 June, 1836, he said:
“Before I leave Ireland, allow me to express to you my great astonishment
at what I have seen in this country respecting your continued fever;” and
in a second letter, of 18 July, after his return to Geneva, he added, that
in Liverpool, ulceration of the ileum in continued fever was “occasional,”
that in Manchester he had been told it occurred “by no means always,” that
in Birmingham the cases of fever were not many, but “always” with
intestinal ulceration, and that in London “not a fourth part” of the cases
of fever had the latter condition, and these mostly in autumn[383]. This
was before the great epidemic of typhus had begun in the English towns. To
the same non-epidemic period (1834) belongs the statement of Carrick, for
Bristol, that fever was often observed to be infrequent or altogether
absent in the most crowded and dirty parts of the city at times when there
were a good many cases “in institutions and dwellings where cleanliness
and free air are most carefully attended to,” and that ulceration of the
bowel was the most common post-mortem appearance[384].

The comparative rarity of enteric fever in the chief towns of Scotland and
Ireland continued for a good many years longer, indeed until after the
differences between typhus and typhoid were perceived and admitted by all.
Even at the London Fever Hospital, during twenty-four years (1848-71)
after Sir William Jenner’s diagnostic points were strictly looked to in
its wards, much the greater part of the admissions were of typhus; in only
two periods, 1850-55 and 1858-61, during both of which there was
comparatively little fever of any kind in London, did the admissions for
enteric fever slightly exceed those for typhus; on an annual average of
the twenty-four years ending 1871, the cases of the former were only about
a fifth part of the whole. The cases of enteric fever increased decidedly
after 1865. Murchison thought that the increase might be accounted for in
part by the enlargement of the Fever Hospital, and by the unusually high
temperature of certain years, the summers and autumns of 1865, 1866, 1868
and 1870 having been remarkable for their great heat and prolonged
drought; but, he adds, “it is not a little remarkable that this increased
prevalence of enteric fever in the metropolis has been contemporaneous
with the completion of the main drainage scheme[385].”

Still more recently, the relative proportions of typhus and enteric fever
have been reversed, so that there have been years with little or no typhus
but with a good deal of enteric fever. There are some persons,
unacquainted with the history, who cannot imagine that it was ever
otherwise than now, who think of the former times of medicine, not as
differing in social, economic, and various other respects from their own,
but only as being less clever at diagnosis. There are others who realize
clearly enough the historical matter of fact, but find it necessary to
explain the almost contemporaneous decline of typhus and rise of typhoid
by some hypothesis of the latter being “evolved” out of the former. This
evolutional doctrine makes the mistake of ascribing to the species of
disease the same comparative fixity of characters that belongs to the
species of animals and plants. Beside the latter, the species of disease
are the creatures of a day. In the nosological field, the origin of
species is not analogous to the evolution of a new species of animal or
plant out of an old, as in the hypothesis of Darwin, for the reason that
every species of disease is evolved directly and, as it were, _pro re
nata_, out of a few simple conditions of human life, variously mixed but
always there to give occasion to one infective malady or another, which
may have a shorter existence, like sweating sickness, or a longer, like
plague. Edinburgh experiences offer a ready criticism of the evolutional
doctrine. Typhus declined, and typhoid rose; but it was in the old
tenement houses of the Canongate, Cowgate, Grassmarket, and High Street
that typhus declined, and it was mostly in the new streets across the
valley, or in the New Town of Edinburgh, that enteric fever arose, having
sometimes no more mysterious an origin than the results of defective or
cheap plumber-work, for example, the leakage of a soil-pipe fermenting, a
foot deep, beneath the basement floor. But it was not until a good many
years after that these new experiences became common; and meanwhile
Edinburgh and other towns in Scotland saw much of typhus and relapsing
fever.


Relapsing Fever in Scotland, 1842-44.

The epidemic of 1836-39 had been typhus of a specially maculated kind. The
period or “constitution” of synocha, rising twice to epidemics of
relapsing fever, had lasted from near the beginning of the century until
1828 or 1829. Then came the new constitution of low, depressed, spotted
fever, which would not stand blood-letting. But in 1842-44 relapsing fever
reappeared in Scotland. This reappearance was a blow to two doctrines of
the time--first that Ireland was the original breeding-place of all such
fevers, and secondly, that a return of the “constitution” of relapsing
fever would warrant a return to the practice of blood-letting, which had
fallen into disuse during the epidemic of typhus. The epidemic of 1842-44
was at first purely a Scots affair, with some extension to England, but
none to Ireland. As to blood-letting, once it had been given over in
fevers it was not readily taken up again, notwithstanding the theory that
relapsing fever belonged to those sthenic or inflammatory types of
sickness in which the lancet was still thought admissible. Moreover,
Christison, who remembered the relapsing synocha of 1817-19 and of
1827-28, said of the third epidemic: “The synocha of 1843-44, though so
prevalent, by no means presented the same strong phlogistic or sthenic
character as in the earlier epidemics of 1817-20 and 1826-29. The pulse
was neither so frequent nor so strong; the heat was not so pungent; the
glow of the integuments was less lively and less general[386].”

I take conveniently from Murchison the following succinct account of the
Scots relapsing fever of 1842-44[387]:

    “The next epidemic of fever in 1843 differed from those that preceded
    it, inasmuch as it did not originate in or implicate Ireland, but was
    mainly confined to Scotland. There was no increase of fever in the
    Irish hospitals during this year, whereas the number of admissions
    into the Glasgow Infirmary rose from 1,194 to 3,467; in the Edinburgh
    Infirmary from 842 to 2,080; and in the Aberdeen Infirmary from 282 to
    1,280. These numbers, too, are far from representing the true extent
    of the epidemic, for thousands of sick were sent from the hospital
    doors. The fever was almost exclusively relapsing fever; typhus was
    comparatively rare. The first cases were observed on the east coast of
    Fife, in 1841-2 (by H. Goodsir), and not in the crowded localities of
    large towns. In Dundee, where the proportion of typhus cases was
    comparatively great, the fever appeared early in the summer of 1842,
    and raged to a considerable extent during the whole of the autumn,
    before it showed itself elsewhere. In Glasgow the first cases occurred
    in September, 1842; but the fever was not generally prevalent until
    December, from which month the cases rapidly increased until October,
    1843, when the epidemic began to decline. The number of cases in
    Glasgow was estimated at 33,000, or 11½ per cent. of the entire
    population. In Edinburgh relapsing fever was first observed in
    February, 1843. It rapidly spread until October, after which it
    gradually abated, until, by the following April, it had well nigh
    disappeared. In the month of October, 1843, the number of fever cases
    admitted into the Edinburgh Infirmary amounted to 638, and during
    several months, from thirty to fifty cases were daily refused
    admission. The total number of cases in Edinburgh was calculated by
    Alison at 9,000. In Aberdeen the epidemic commenced about the same
    time, and followed the same course as in Edinburgh. At Leith,
    curiously enough, it did not appear until September, 1843; it then
    spread rapidly for two months, after which it declined, and by the end
    of February, 1844, it had almost ceased; but during this brief period
    it attacked 1,800 persons, or one in every fourteen of the population.
    The disease was general over Scotland, and was not restricted to the
    large towns; it prevailed in Greenock, Paisley, Musselburgh, Tranent,
    Penicuick, Haddington, Dunbar, the Isle of Skye, etc. Although the
    epidemic was mostly confined to Scotland, the same fever was observed
    in some of the large towns of England. The number of admissions into
    the London Fever Hospital rose from 252 in the preceding year to 1,385
    in 1843: and the annual report for 1843 makes it evident that a large
    proportion of these cases were relapsing fever. The rate of mortality
    of the epidemic was small, not exceeding from two-and-a-half to four
    per cent. Although this was the same fever as prevailed in 1817-19,
    even local bleeding was rarely resorted to, and many of the cases were
    thought to demand stimulants. All accounts agree in stating that the
    epidemic supervened upon a period of great distress among the Scottish
    poor, and that it was restricted throughout to the poorest and most
    wretched of the population.”

This epidemic, which was the subject of an altogether unusual amount of
writing in Edinburgh[388], partly on the supposition that relapsing fever
was a “new disease,” proved once for all that one had not to go to Ireland
for the engendering or making of a famine-fever. The demonstration came
just in time; for the epidemic was hardly over in Scotland, when the
series of great potato-famines in Ireland began in 1845, soon to be
followed by the disastrous epidemics of dysentery, relapsing fever and
typhus from 1846 to 1848. Indeed, so near was the Scots epidemic to the
Irish, that in the North of Ireland the first of the relapsing fever, in
1846, was called “the Scotch Fever,” on the supposition that it had
reached them from its recent focus in the West of Scotland[389]. The Irish
and original part of the great epidemic of 1846-48 has been fully
described in another chapter; much of the mortality was due to dysentery,
and the most prevalent fever was relapsing fever, with a very low rate of
fatality among the poorer classes. But in Ireland itself there was also
much typhus, very mortal to the richer classes who came in contact with
the starving multitudes.


The “Irish Fever” of 1847 in England and Scotland.

The contagion that reached England and Scotland from the scene of famine
in Ireland was more apt to produce typhus than relapsing fever. That the
Irish contagion was the principal source of the great epidemics in England
and Scotland in 1847-48, seems to be proved by every fact in their
progress, direction and other circumstances. But it is not so clear that
England and Scotland would not have had an unusual amount of typhus in the
same years even if the Irish had been kept out by an ideally strict
quarantine. What touched Ireland most, touched Scotland and England in a
measure. The seasons were bad in all parts of the kingdom; many were out
of work in the manufacturing towns; but as soon as the price of provisions
fell in 1848, the epidemic in England came to a sudden end.

The epidemic of fever in England in 1847 was almost wholly typhus; in
Scotland, it was to some extent relapsing fever, but there also it was
mainly typhus. It was more severe, while it lasted, than the epidemic of
1837 and following years; but it was of shorter duration, ceasing almost
abruptly in 1848. The rise of the epidemic of 1847 in London is shown by
the following quarterly returns of the deaths from fever:

  1st Quarter  2nd Quarter  3rd Quarter  4th Quarter

      442         568           895         1279

In the last quarter of 1846, the deaths from fever in London had been
619. In all England, the last quarter of 1846 was also most unhealthy, its
deaths from all causes being 53,055 (only 43,850 in the first quarter of
the year). The summer of 1846 had been remarkable for heat and drought,
and the end of the year was, according to precedent, an unwholesome time.
It was just the season for enteric fever, as in the still more memorable
circumstances of 1826. There is evidence from various parts of England and
Scotland that much of the fever of the end of 1846 was enteric; and it was
doubtless the unusual prevalence of that disease, and of other maladies
that are favoured, like it, by extreme fluctuations of the ground-water,
that explains the very high mortality of the last quarter of 1846[390].
But it is equally certain that it was typhus which raised the fever deaths
in London in the last quarter of 1847 to 1,279, and the deaths from all
causes in all England to the enormous total of 57,925. In the whole of the
year 1847, typhus alone claimed 30,320 deaths in England and Wales, the
total in 1848 falling to 21,406. Lancashire and Cheshire had the largest
share of this epidemic, and Liverpool the largest share in Lancashire. In
that Registration Division (the North-western) the deaths from typhus in
1847 were 9,076, and in 1848 they were 3,380. Next in order (excluding
London and suburbs) came the West Midland Division, and next to that
Yorkshire. At Liverpool, and in other places of the north-west of England,
the fever was very clearly connected with the enormous Irish immigration,
and was in great part among the Irish. There were floating lazarettos on
the Mersey, filled with fever and dysentery, workhouses overflowing, and
sheds hastily built to hold each 300 patients. The following returns from
the several sub-divisions of Liverpool for the months of July, August and
September, 1847, show the proportions of dysentery and fever, as well as
the mortality from diarrhoea, which last was mostly an affair of the
infants and young children[391]:

_Liverpool deaths, July-Sept. 1847._

                     Fever   Dysentery   Diarrhoea
  St Martin’s         291       82          174
  Dale Street         250       20          111
  St Thomas      (301 deaths on the floating lazarettos)
  Mount Pleasant      324       18           73
  Islington           105       37           78
  Great Howard Street (the fever extending to the upper classes)

In his report for the quarter before (April, May and June, 1847) the
registrar of the Great Howard Street sub-district says: “Eight Roman
Catholic priests, and one clergyman of the Church of England, have fallen
victims to their indefatigable attentions to the poor of their
church[392].”

In Manchester there were causes of fever independently of the Irish
contagion. The registrar of the Deangate sub-district writes in the third
quarter of 1847: “In the calamitous season just passed, manufactures have
been almost at a stand-still; food has been unattainable by the poor, for
employment they had none; Famine made her dwelling in their homes &c.” The
hardships of the children caused an immense mortality from summer
diarrhoea. The same registrar gives an account of the epidemic fever in
his report for the second quarter of 1847, from which it appears that,
although nearly all the hospital cases were distinctly maculated, and the
fever was undoubtedly typhus in all other respects and in its conditions,
yet tympanitis, with abdominal tenderness and diarrhoea, were specially
noted[393].

Besides Liverpool and Manchester, many other towns in Lancashire had the
“Irish fever” in them; also Birmingham, Dudley, Wolverhampton, Shrewsbury,
Leeds, Hull, York and Sunderland. Except in London, the fever mortality
was not unusual in the southern half of England[394].

In Scotland the epidemic was a mixture of relapsing fever and typhus. The
following were the proportions of each admitted to the Glasgow Royal
Infirmary:

  Year   Relapsing Fever  Typhus

  1846         777          500
  1847       2,333        2,399
  1848         513          980
  1849         168          342

In the Barony Fever Hospital, Glasgow, open from 5 August 1847 to July
1848, the relapsing cases were double the typhus cases at the opening of
the hospital, at the end of 1847 they were nearly equal, and from February
1848 the typhus cases were double the relapsing. In Edinburgh, where the
epidemic was less severe, the same relations were observed--relapsing
fever most at the beginning, typhus fever (much more fatal) most at the
end[395]. Some relapsing fever occurred also in London, among destitute
Irish, which was often attended by a miliary eruption (Ormerod).


Subsequent Epidemics of Typhus and Relapsing Fevers.

By midsummer, 1848, there was a most marked improvement in the public
health, corresponding with the great fall in the prices of food, under the
influence of free trade, and with a good harvest and the commencement of
an era of steady employment for workers. The improvement is strikingly
shown in the following comparison of the deaths from all causes in
Lancashire and Cheshire in the third quarter of each of the years 1846,
1847 and 1848:

                                  1846    1847    1848

  Deaths in the 3rd Quarter      15,221  17,080  11,720

Since the epidemic of 1847, which was not unfairly called “the Irish
fever,” there has been no such extensive and fatal outbreak of typhus or
relapsing fever in England, Scotland or Ireland. The fever deaths rose
somewhat in Ireland and in Glasgow in 1851-53, the type of disease being
relapsing and typhus. In London there was a considerable increase of
typhus in 1856, at the end of the Crimean War. From 1861 to 1867 there was
a considerable epidemic of the same fever in England and Scotland (not
much of it in Ireland until 1864), the chief centres in England having
been the Lancashire towns, Preston, Manchester, Accrington, Chorley,
Salford and Blackburn, and the occasion of it the “cotton famine” of the
American Civil War[396]. Greenock was the chief seat of typhus in 1863-64
in Scotland; indeed, in the whole kingdom, its death-rate from that cause
was approached by that of Liverpool only. Fevers had been very mortal
there in the epidemic of 1847 (it is said 353 deaths); in the next
fever-period they rose as follows[397]:

  1860  1861  1862  1863  1864

  19     57    63    98    274

This epidemic was more easily dealt with than those of the same kind
before it. Very large sums were subscribed by the wealthy, of which,
indeed, a considerable balance remained undistributed. Rawlinson, as
engineer, and Villiers, as Minister, devised extensive relief works, in
the form of main drainage for the distressed Lancashire towns, the whole
cost being defrayed eventually by the municipalities themselves. The
following table, from Murchison, shows the admissions for typhus to the
fever hospitals of various towns, subsequently to the great epidemic of
1847-48. The first rise in London was in 1856; the next rise, which was
somewhat prolonged, coincided with the epidemic in Lancashire.

_Hospital Cases of Typhus, 1849-71._

       London  Edin.   Glasgow Glasgow Dundee  Aberdeen     Cork
        Fever  Royal   Royal   Fever   Royal   Royal        Fever
  Year  Hosp.  Infirm. Infirm. Hosp.   Infirm. Infirm.      Hosp.

  1849   155     --      342    --       --      --           --
  1850   130     --      382    --       --      --           --
  1851    68     --      919    --       --      --           --
  1852   204     --     1293    --       --      --           --
  1853   408     --     1551    --       --      --           --
  1854   337     --      760    --       --      --           --
  1855   342     --      385    --       --      --           --
  1856  1062     --      385    --       --      --           --
  1857   274     --      314    --       --      --           --
  1858    15     --      175    --       17      --           --
  1859    48     --      175    --      128      --           --
  1860    25     --      229    --       67      --           --
  1861    86     --      509    --      129      --           116
  1862  1827     14      780    --       54      --           272
  1863  1309     74     1286    --      236      379 (4 mos.) 692
  1864  2493    212     2150    --      264      811         1021
  1865  1950    447     2334   1154     891      422          791
  1866  1760    847     1055    384     706      167          247
  1867  1396    303      761    795     225       68          124
  1868  1964    280      620   1023     502       78          245
  1869  1259    259     1430   2023     402      170          136
  1870   631    287      947    702     232       61          165
  1871   411    101      418    511     257        3          397

During the unusual prevalence of fever in Scotland, 1863-65, it was made
clear by the diagnosis in hospitals, that the excess was caused by typhus,
and not by enteric.

    Of 440 cases of fever treated in the Royal Infirmary of Edinburgh, in
    1864, 212 were cases of pure typhus, 140 were enteric fevers, while 88
    were simple continued fever and febricula. In the Royal Infirmary of
    Glasgow in 1864, of 2,190 cases of fever, 2,150 were reported to be
    cases of typhus fever, while only 40 were cases of enteric fever. In
    the Aberdeen Royal Infirmary not a case of enteric fever was observed:
    of 396 cases in the year 1863, 387 were pure typhus, and 9 febricula;
    and in 1864, of 926 cases, 897 were pure typhus and 29 febricula. In
    the Royal Infirmary of Dundee, of 355 cases of fever treated in 1864,
    318 were typhus, 16 enteric fever, and 21 febricula. It was only at
    Perth, and there not exclusively in hospital practice, that an excess
    of typhoid fever was observed; from 1st August, 1863, to 30th April,
    1864 (months which included the special typhoid season), there were
    101 cases of gastro-enteric or typhoid fever, 46 cases of typhus, 19
    of relapsing fever, and 59 of simple continued fever[398].

The last considerable prevalence of contagious fever in England and
Scotland was in 1869 and 1870. It was relapsing fever, mixed with some
typhus, and it was restricted almost to a few large towns, including
London, Liverpool, Manchester, Leeds, Bradford, Glasgow, and
Edinburgh[399]. It was first seen in London in 1868 among Polish Jews. It
was heard of as late as 1872 at Newcastle. It was observed during this
epidemic in Liverpool, Bradford and Edinburgh that the subjects of the
relapsing fever were not suffering from want[400]. The same observation
has been made in some foreign countries. Still, on the great scale and in
a broad view, relapsing fever has been _typhus famelicus_ or famine-fever,
occurring in association with other maladies due to want, and especially
in the circumstances which have been discussed fully in the chapter on
fevers in Ireland.


Relative prevalence of Typhus and Enteric Fevers since 1869.

It was not until the year 1869, or about the time when typhus fever ceased
to be epidemic or common, that the deaths from typhus fever, simple
continued fever and enteric fever began to be tabulated separately in the
Registrar-General’s reports. The following tables show for England and
Wales and for London a steady decline of the deaths from typhus and simple
continued fever since the end of the epidemic period 1869-71, which was
the last epidemic of typhus and relapsing fever in this country hitherto.
The deaths from enteric fever, it will be seen, remained somewhat steady
(in a growing population) for about ten years after the separation, and
then began to decline.

_Continued-fever Deaths in England and Wales, 1869-91._

                  Simple or
  Year   Typhus  Ill-defined  Enteric

  1869    4281      5310       8659
  1870    3297      5254       8731
  1871    2754      4248       8461
  1872    1864      3352       8741
  1873    1638      3081       8793
  1874    1762      3089       8861
  1875    1499      2599       8913
  1876    1192      1974       7550
  1877    1104      1923       6879
  1878     906      1776       7652
  1879     533      1472       5860
  1880     530      1490       6710
  1881     552      1159       5529
  1882     940      1016       6036
  1883     877       963       6068
  1884     328       768       6380
  1885     318       662       4765
  1886     245       505       5061
  1887     211       502       5165
  1888     168       436       4848
  1889     140       413       4971
  1890     160       361       6146
  1891     148       325       5075

_Continued-fever Deaths in London, 1869-91._

                 Simple or
  Year   Typhus  Ill-defined   Enteric

  1869    716        615        1069
  1870    472        570         976
  1871    384        436         871
  1872    174        322         867
  1873    277        325         968
  1874    312        337         879
  1875    128        272         817
  1876    159        202         769
  1877    157        194         901
  1878    151        197        1033
  1879     71        160         849
  1880     74        134         702
  1881     92        134         971
  1882     53         95         975
  1883     55        102         963
  1884     32         75         925
  1885     28         78         597
  1886     13         73         618
  1887     19         44         612
  1888      9         35         694
  1889     16         42         538
  1890     10         35         604
  1891     11         44         557

Such being the proportions of typhus and enteric fever since 1869, when
the separation was made, it remains to ask what share each of them may
have had in the total of “typhus,” or of continued fever generally, in the
years before the two forms were distinguished in the annual registration
reports. Of course, they were distinguished by many of the profession long
before that; so that there are means of forming a judgment. At the London
Fever Hospital, enteric fever and typhus were distinguished after 1849. If
the admissions of each kind of fever to that hospital be assumed to have
been proportionate to the prevalence of each in London from year to year,
we should get in the following table a means of estimating which of the
two forms of continued fever furnished most of the deaths in all London,
as given in the first column:

                            Admissions to London
            Deaths in        Fever Hospital
           London from
  Year     both fevers      Typhus  Typhoid

  1838        4078            --      --
  1839        1819            --      --
  1840        1262            --      --
  1841        1151            --      --
  1842        1184            --      --
  1843        2094            --      --
  1844        1721            --      --
  1845        1324            --      --
  1846        1838            --      --
  1847        3297            --      --
  1848        3685            --      --
  1849        2564           155     138
  1850        2032           130     137
  1851        2374            68     234
  1852        2183           204     140
  1853        2617           408     212
  1854        2816           337     228
  1855        2410           342     217
  1856        2717          1062     149
  1857        2195           274     214
  1858        1919            15     180
  1859        1840            48     176
  1860        1476            25      95
  1861        1848            86     161
  1862        3673          1827     220
  1863        2871          1309     174
  1864        3782          2493     253
  1865        3217          1950     523
  1866        2688          1760     582
  1867        2184          1396     380
  1868        2468          1964     459

From this it will appear that every great annual rise in the London deaths
from “fever,” since the last great typhus epidemic of 1847-48, has
corresponded to a greatly increased admission, not of enteric cases, but
of typhus cases into the London Fever Hospital. On the other hand, enteric
fever has been at a somewhat steady or endemic level for a good many
years. Even at that level it would have had a small share of the whole
fever-mortality in the old London; in modern London, especially in its
residential quarters, its rate has probably been higher than in former
times; while in recent years, owing to the absolute decline of typhus, it
has been by far the most common continued fever. If the conditions were
the same in London as in Edinburgh, it was the very creation of
residential streets and new quarters of the town that called forth typhoid
fever; while the more the town was remodelled, the more were the _fomites_
of typhus destroyed. Thus it seems probable that the same progress in
well-being among all classes, which has gradually brought typhus down
almost to extinction (or apparently so for the present), has been attended
with an increase of typhoid, an increase which has happily fallen within
the last few years from its highest point.

The disappearance, during the last twenty years, of typhus and relapsing
fevers from the observation of all but a few medical practitioners in
England, Scotland and Ireland, is one of the most certain and most
striking facts in our epidemiology. Most of the recent English cases have
occurred in Lancashire, especially in Liverpool, and in Sunderland,
Gateshead, Newcastle and other shipping places of the north. In the
decennial period 1871-80 the death-rate from typhus, per 1000 living, was
0·58 in Liverpool and 0·33 in Sunderland, rates which were about the same
as those from enteric fevers. The rates in 1881-83 were also high in the
same group of towns. As to other industrial centres, including the
coal-districts of Cumberland, Wales and Scotland, it is probable that a
good deal of typhus passes under the name of “typhoid,” the change in
medical fashion having outrun somewhat the real change in the relative
prevalence of each fever[401]. In Scotland the disease is still heard of
from time to time in Glasgow, Edinburgh, Leith, Dundee, Aberdeen,
Inverness and Thurso. In London the recent immunity from it is remarkable,
but intelligible. First, the populace is better housed: we have got rid of
the window-tax, rebuilt the houses in regular streets opening upon wide
thoroughfares, pulled down most of the back-to-back houses, dispersed the
working population over square miles of suburbs easily accessible from the
heart of the town by tramways and railways, perfected the sewerage and the
water-supply. These great structural changes are so far an earnest that
typhus cannot come back in the old way. Secondly, food has been for a long
time cheap and wages good. During the remarkable lull in typhus from 1803
to 1816, Bateman pointed out that the unwholesome state of the dwellings
of the working class remained the same as before, but that money was
flowing freely among all classes (thanks to the special war-expenditure).
Under free trade, the same abundance of the necessaries of life has been
secured in another way. Typhus, it need hardly be said, is an indigenous
or autochthonous infection; the conditions of its engendering are never
very far off. In a small and remote island off the coast of Skye, which I
happened to know in its pleasing aspects from having landed upon it during
a summer vacation, typhus fever was reported by the newspapers a few
months after to have broken out in the hamlet of twenty or thirty
families, the winter storms having prevented the fishers from leaving
their cottages or any stranger from approaching the island. In a sparsely
populated parish of the east coast of Scotland, two cases of genuine
typhus (one of them fatal), and two only, have occurred, to medical
knowledge, within the last ten years, each in a very poor cottage in a
different part of the parish and in a different season. So long as our
cheap supplies of food, fuel and clothing are uninterrupted, there is
small chance of typhus or relapsing fever. But the population of England
being now twice as great as the home-grown corn can feed, a return of
those fevers on the great scale is not out of the question in the event of
the foreign food-supply being interfered with, or the necessaries of life
becoming permanently dearer from any other cause.

The following Table of the fever-deaths in Scotland since the beginning of
Registration does not distinguish enteric from typhus, relapsing and
simple continued during the first ten years of the period; but it is
probable, from all that is known non-statistically or by hospital figures
only, as to the history of enteric fever in Scotland, that it made the
smaller part of the generic total of fever-deaths so long as typhus and
relapsing fevers were common.

_Scotland--Deaths from the Continued Fevers since the beginning of
Registration._

  Year

  1855  2419     }
  1856  2363     }
  1857  3087     }
  1858  2790     }
  1859  2436     } Inclusive of typhus, relapsing, enteric
  1860  2344     } and other continued fevers.
  1861  2579     }
  1862  3021     }
  1863  3441     }
  1864  4804[402]}

                                 Simple   Infantile  Cerebro-Spinal
       Typhus Enteric Relapsing continued Remittent

  1865  3272    1048     62       839        164        --
  1866  2172    1404     34       249        159        --
  1867  1745    1378     40       105        119        --
  1868  1561    1404     45       100        132        --
  1869  2059    1335     29       121        157        --
  1870  1460    1207    205       151        141        --
  1871  1129    1234    411       108        124        --
  1872   795    1223    115       103        118        --
  1873   628    1495     31       192        117        --
  1874   726    1455     27       104         80        --
  1875   615    1625     17        98         85        --
  1876   471    1448     18        65         88        --
  1877   265    1427      5       164         --        --
  1878   263    1477      2       147         --        --
  1879   210    1013      5       133         --        --
  1880   170    1338      4       155         --        --
  1881   229    1004      0       115         --        --
  1882   180    1204      2        90         --        --
  1883   152     998      1        71         --         7
  1884   138    1050      2        63         --         9
  1885   111     889      1        58         --         8
  1886    80     755      2        62         --        10
  1887   126     835      7        65         --         4
  1888   102     665      6        58         --         6
  1889    69     795      1        45         --         2
  1890    77     777     --        30         --         3
  1891   107     799      4        23         --         6


Circumstances of Enteric Fever.

The circumstances of typhus and relapsing fevers need no general stating
after what has been said of particular epidemics in England and Scotland,
or remains to be said, for the most distinctive instances of all, in the
chapter on fevers in Ireland. There has been so little typhus in the
country at large since the disease began to be registered apart in the
mortality returns, in 1869, that hardly anything can be inferred except
the fact of its disappearance. It is significant, however, that
Sunderland, one of the two great towns which have kept typhus longest and
in largest measure (Liverpool being the other) is distinguished for the
overcrowding of its dwelling-houses (7·24 persons to a house in the Census
of 1881, 7·00 in the Census of 1891).

But the circumstances of enteric fever are not only not so obvious as
those of typhus in the historical way; they are also more complex and
disputable. One fact in the natural history of enteric fever has been made
clear in the chronology, namely, its greater frequency after a severe
drought. It was in the autumn of 1826, after the driest and hottest summer
of the century, that cases of fever with ulceration of the bowel were
first described and figured in London. It was in the autumn of 1846, after
the next very dry and hot summer, that cases of the same fever again
became unusually common in many parts of England and Scotland. The same
sequence has been remarked on more recent occasions and in various
countries. It is explained by taking into account some other facts in the
natural history of enteric fever. In nearly all countries in our
latitudes, autumn is its principal season, and autumn is the season when
the level of the water in the soil, or in the wells, is lowest. Virchow
states the law of enteric fever in the following simple and concrete way:
“We [in Berlin] have a certain number of cases of typhoid at all times.
The number increases when the sub-soil water falls, and decreases when it
rises. Every year, at the time of the lowest level of the sub-soil water,
we have a small epidemic.” A sharp rise above the mean level of the year,
from the first week of September to the end of October, has been well
shown for London from the admissions to the hospitals of the Metropolitan
Asylums Board, 1875-1884. The curve has an equally sharp descent, passing
below the mean line of the year in the second week of December[403]. There
are indications that it is the partial filling of the pores of the
sub-soil with water, after they have long been occupied with air only,
that makes the virus of typhoid active, or, in other words, that the
rains of late summer and autumn are the occasion of the seasonal increase
of the infection.

Yet it is not the changes in the ground-water by themselves, just as it is
not rainfall and temperature by themselves, that make enteric fever to
prevail. The soil in which those vicissitudes of drought and saturation
are potent for evil must be one that is befouled with animal organic
matters, more especially with excremental matters. For that and other
reasons (such as the geological formation), enteric fever shows, in its
more steady or endemic prevalence from year to year or from decade to
decade, certain marked preferences of locality. Since 1869, when the
deaths from it began to be registered apart, it has been much more common,
per head of the population, in the quick-growing manufacturing and mining
towns than in any other parts of England and Wales, the districts with
highest enteric death-rates being the mining region of the East Coast from
the mouth of the Tees to somewhat north of the Tyne, the mining region of
Glamorgan, certain manufacturing towns of Lancashire and the West Riding
of Yorkshire, and some districts in the valley of the Trent in
Staffordshire and Nottinghamshire. The following Table shows, by
comparison with all England and Wales and with London, the excessive
death-rates from enteric fever in the registration divisions which head
the list:

_Highest mortalities from Enteric Fever in Registration Divisions of
England and Wales_[404].

  ------------------------------------------------------------------
                           Decennium                     | Decennium
                            1871-80                      |  1881-90
  -------------------------------------------------------|----------
                         |  Annual   |  Annual   |       |
                         |death-rate,|death-rate,|Enteric| Deaths,
                         |all causes,| Enteric,  |Deaths | Enteric,
                         | per 1000  | per 1000  | in 10 |  in 10
                         |  living   |  living   | years |  years
  -----------------------|-----------|-----------|-------|----------
  England and Wales      |   21·27   |    0·32   | 78421 |   53509
    London               |   22·37   |    0·24   |  8536 |    7497
  -----------------------|-----------|-----------|-------|----------
    Durham co.           |   23·77   |    0·56   |  4525 |    2590
    South Wales          |   21·09   |    0·45   |  3715 |    2550
    W. Riding, Yorks.    |   23·24   |    0·45   |  9166 |    5170
    N. Riding, Yorks.    |   19·68   |    0·44   |  1259 |     896
    Nottinghamshire      |   21·23   |    0·43   |  1707 |    1263
    Lancashire           |   25·17   |    0·39   | 12388 |    9874

_Durham Mining Districts._

  Stockton incl. part of |           |           |       |
    Middlesborough       |           |           |       |
    (4¾ years)           |   26·64   |    1·09   |   561 |      --
                         |           |           |       |
  Stockton (5¼ years)    |   22·49   |    0·62   |   208 |     258
                         |           |           | (5¼   |
                         |           |           | years)|
  Guisborough, incl. part|           |           |       |
    of Middlesborough    |           |           |       |
    (4¾ years)           |   24·80   |    1·17   |   251 |      --
                         |           |           |       |
  Guisborough            |           |           |       |
    (5¼ years)           |   20·45   |    0·38   |    71 |     106
                         |           |           |       |
  Middlesborough[405]    |           |           |       |
    (5¼ years)           |   19·93   |    0·63   |   272 |     460
                         |           |           | (5¼   |
                         |           |           | years)|
                         |           |           |       |
  Auckland               |   24·52   |    0·71   |   541 |     318

_South Wales Mining Districts._

  Pontypridd[406]        |   23·16   |    0·71   |   515 |     541
  Merthyr Tydvil         |   24·23   |    0·62   |   639 |     249
  Swansea                |   22·38   |    0·63   |   505 |     387
  Llanelly               |   20·93   |    0·8    |   330 |     165

In the second decennium of the Table, 1881-90, the total deaths from
enteric fever (the death-rates are still unpublished) are much below those
of 1871-80. All the counties of England and Wales have shared in that
notable decline, including Durham and Glamorgan. But these two great
districts of the coal and iron mining are, by the latest returns, still
keeping the lead; and it is probable that we shall find in them, or in
particular towns within them, the conditions that have been most
favourable to enteric fever in the earlier decennia of this century and
are still favourable to it. First it is to be observed that one of the
most noted of the old typhoid centres in Glamorgan, namely Merthyr Tydvil,
has ceased to be in that class; its enormous rate of growth has been
checked (to 18·9 per cent. from 1881 to 1891) and it has at the same time
become a more uniform and better-ordered municipality.

On the other hand, on the same river Taff, and in the tributary valley of
the Rhondda, there is an immense population of miners, among whom the
enteric fever death-rate will probably be found to have been higher in
1881-90 than in any other registration district. The most populous part of
the district is the town of Ystradyfodwg, which had 44,046 inhabitants in
1881 and 68,720 in 1891, an increase of over fifty per cent., the highest
urban rate of increase in the country. On the mean of the last three
years, 1891-93, its enteric fever death-rate has been ·62 per 1000. There
are several populous towns or townships in the mining districts of the
north-east which have in like manner kept their high rate of typhoid
mortality--Auckland, Easington, Bellington (Morpeth) and Middlesborough.
It is held by many that enteric fever has been most characteristically a
product of the modern system of closet-pipes and sewers. It is, of course,
the defects of the system that are, in this hypothesis, to blame,
including its partial adoption, the transition-state from the older
system, the tardy extension to new streets, as well as cheap and faulty
construction. All those things, together with the inherent difficulty of
connecting with a main sewerage the irregular squattings of a mining
community, are probably to be found in highest degree in those districts
of Durham and South Wales that are most subject to enteric fever. While
enteric fever is in some places steady or endemic from year to year, in
others its force is felt mostly in great and sudden explosions.

    One such happened in the city and district of Bangor in the summer of
    1882. The registration district had only 95 deaths from enteric fever
    in the ten years 1871-80, but in the single year 1882 it had 87 deaths
    registered under that name. Of 548 attacks (with 42 deaths) which were
    known from 22 May to 12 September, 407 fell in August and the first
    twelve days of September[407]. In the following year and throughout
    the rest of the decennium the district had its usual low average of
    enteric-fever deaths. One thing relevant to the explosion was probably
    the excessive rainfall of June and July (9·5 inches, as compared with
    4·8 inches about London).

    Another explosion, probably unique in the history of enteric fever,
    took place at Worthing, on the Sussex coast, in the summer of 1893.
    The enteric death-rate of the town had been much below the average of
    England and Wales from 1871 to 1880, the rate being 0·15 per 1000 and
    the whole deaths in ten years 36. During the next ten years, 1881-90,
    the whole enteric deaths were 43 in the entire registration district
    (population in 1891, 32,394). In 1891 the typhoid deaths were two, in
    1892 they were six. In 1893 a severe outbreak of typhoid took place
    within the municipal borough (population 16,606): In the first quarter
    of the year Worthing was one of the places mentioned for typhoid,
    having had 5 deaths; in April there were no deaths, in May 25, in June
    19, in July 61, in August 64, in September 11, and in the last quarter
    of the year 8, making 193 deaths in the year. The highest weekly
    number of cases notified was 253 in the second week of July. The
    enormously wide dispersion of the poison, in a town little subject to
    enteric fever, caused suspicion to fall on the water-supply, the more
    reasonably that the district of West Worthing, which had a separate
    water-supply, was said not to have suffered from the outbreak. A new
    water-supply was at once undertaken. A relief fund of £7000 was raised
    for the sufferers.

    The towns of Middlesborough, Stockton and Darlington, in the lower
    valley of the Tees, were together the scene of two remarkable
    explosions of enteric fever, the first from 7 September to 18 October,
    1890, the second from 28 December, 1890, to 7 February, 1891. The
    phenomenal nature of these outbreaks in the autumn and winter of
    1890-91 will appear from the following table of deaths by enteric
    fever:

                         Darlington  Stockton  Middlesborough
        Ten years 1881-90   104        258        460
                  -----------------------------------
                   1890      21         66        130
                   1891      17         59         93

    In the first of the two explosions the three towns were almost equally
    attacked per head of their populations; in the second explosion, in
    mid-winter, Darlington had relatively only half as many cases as each
    of the other two, which had about the same number of cases as in the
    former six-weeks’ period. In both periods, of six weeks each, the
    three towns had together 1334 cases of typhoid, while the country
    districts near them had a mere sprinkling. A flooded state of the Tees
    appeared to be a relevant antecedent to each of the explosions. The
    Tees is a broad shallow river flowing rapidly, subject to frequent
    inundations, tortuous in its lower course, forming at its mouth, where
    Middlesborough stands, a wide estuary bordered by low flat grounds.
    The rainfall at Middlesborough was 6·3 inches in August, of which 2·2
    inches fell on the 12th of the month, the river being high in flood
    thereafter. There were again high floods in November, chiefly caused
    by the melting of snow in the upper basin (5 inches fell at Barnard
    Castle in November, 3·1 inches at Middlesborough, while the December
    fall was 1·2 inches at the former and 1·4 inches at the latter). To
    apply correctly the ground-water doctrine of enteric fever to these
    explosions, other particulars would have to be known, more especially
    the extent of the previous dryness of the subsoil (the rainfall at
    Middlesborough was 9·3 inches in the first half of 1890, 15·6 in the
    second half, and below average for the whole year). But the flooded
    state of the Tees valley in August and November must have changed
    abruptly the state of the ground-ferments within the areas of the
    respective towns and so afforded, according to the general law, the
    conditions for an abrupt increase of enteric fever in these its
    endemic or perennial soils[408].

While the more or less steady or endemic prevalence of typhoid fever is
due to the formation and reproduction in the soil of an infective
principle (probably of faecal origin) which affects more or less
sporadically the individuals living thereon, after the manner of a miasma
rising from the ground, there have been some hardly disputable instances
of the infection being conveyed to many at once from a single source in
the drinking water and by the medium of milk[409]. But such instances,
suggestive though they be and easy of apprehension by the laity, must not
be understood as giving the rule for the bulk of enteric fever. In like
manner, the escape or reflux of excremental gases from pipes or sewers, or
the leakage into basements or foundations from faulty plumber-work, are
causes, real no doubt, but of limited application, which do not conflict
with, as they do not supersede, the more comprehensive and cognate
explanation of enteric fever as an infection having its habitat in the
soil and an incidence upon individuals after the manner of other miasmatic
infections. Sex has little or nothing to do with the incidence of the
infective virus. As to age, enteric fever rarely befalls infants, and, in
the general belief of practitioners, is a less frequent cause of death
among children than among adolescents and adults.

    In the following Table from the Registrar-General’s Decennial Review,
    1871-80, enteric fever is not separated from other continued fevers.
    It is probable that a considerable ratio of the deaths from 0 to 5
    years are due to febrile disorders other than enteric.

    _Annual Mortality per million living at all ages and at eleven groups
    of ages, males and females, from fever (including Typhus, Enteric
    Fever and Different Forms of Continued Fever) 1871-80._

                All
               ages   0-   5-  10-  15-  20-  25-  35-  45-  55-  65-  75+

    Both sexes  484  651  518  439  543  509  411  379  402  458  553  498
    Males       494  644  483  390  513  579  436  395  437  503  629  593
    Females     477  658  550  487  573  445  387  362  369  418  488  425

The cases notified under the Act in 1891 and 1892 have been found to
average five or six for every death registered in the corresponding
districts, the rate of fatality ranging widely. It is matter of familiar
knowledge that many of the attacks and fatalities occur among the richer
classes. New comers to an endemic seat of the disease are most apt to take
it (this has been elaborately shown for Munich, and holds good for the
British troops in India). There are undoubtedly constitutional
proclivities to it among individuals, which may run strongly in families.
As in other miasmatic infective diseases, such as yellow fever, Asiatic
cholera, and (formerly) plague, there seem to be occasions in the varying
states of body and mind, as well as in the external circumstances, when
the infection of enteric fever is specially apt to find a lodgement and to
become effective. The old plague-books gave lists of the things that were
apt to invite venom or to stir venom (see former volume pp. 212, 674); and
it is probable that some of these hold good also for the incidence of
enteric fever.



CHAPTER II.

FEVER AND DYSENTERY IN IRELAND.


The history of the public health in Ireland has been so remarkable that it
may be useful to take a continuous view of it in a chapter apart, so far
as concerns flux, or dysentery, and typhus with relapsing fever.

Ireland is a country which would have given Hume, had he thought of it,
the best of all his illustrations of the difficult problem handled in the
essay “Of National Characters”--how far the habits, customs, temperaments
and, he might have added, morbid infections have been determined by
climate, and how far by laws and government, by revolutions in public
affairs, or by the situation of the nation with regard to its neighbours.
Not only is there something special and peculiar in the actual
epidemiology of Ireland, but its political and social history has been apt
to borrow the phrases of medicine in a figure. “First the physicians are
to take care,” says Burke, “that they do nothing to irritate this
epidemical distemper. It is a foolish thing to have the better of the
patient in a dispute. The complaint, or its cause, ought to be removed,
and wise and lenient arts ought to precede the measures of vigour[410].”
And this singular use of the imagery of disease in Irish history might be
illustrated from many other passages of the same orator and essayist, just
as it may be seen any day in the columns of newspapers in our own time.
Giraldus Cambrensis began it, within a few years of the first English
conquest of Irish territory by Henry II. Writing of that singular effect
upon the English settlers by contact with the native Irish, whereby they
became, in the words of another medieval author, _ipsis Hibernis
hiberniores_, he resorts to the medical figure of “contagion” as the best
way to account for it. So again, to overleap six centuries, Bishop
Berkeley in his query “whether idleness be the mother or daughter of
spleen[411],” is trying upon the Irish both Hume’s problem of national
character and the use of the medical figure. And, to take a modern
instance, Lord Beaconsfield used the same figure of the old humoral
pathology, and gave his adhesion to a theory of national characters
adverse to the sense of Hume, when he ascribed the habits and manners of
the Irish, and the course of their national history, to their propinquity
to a “melancholy” ocean.

As far back as we can go in the history, two diseases are conspicuous--the
flux or “the country disease,” and the sharp fever or “Irish ague.” When
Henry II. invaded Ireland in 1172, his army suffered from flux, which the
contemporary chronicler, Radulphus de Diceto, dean of St Paul’s, set down
to the unwonted eating of fresh meat (_recentium esus carnium_), the
drinking of water, and the want of bread[412]. Less than a generation
after, Giraldus of Wales wrote his “Topography of Ireland,” wherein he
remarks that hardly any stranger, on his first coming to the country,
escapes the flux by reason of the juicy food (_ob humida
nutrimenta_)[413]. At that time Ireland was almost wholly a pastoral
country, and a pastoral country it has remained to a far greater extent
than England or Scotland. It is to this comparative want of tillage, an
almost absolute want when Giraldus was there, that we shall probably have
to look in the last resort for an explanation of the two national maladies
that here concern us--the “country disease” and the “Irish ague.” The same
dietetic reason that the dean of St Paul’s gave in 1172 for the prevalence
of flux in the army of Henry II., the want of bread and the eating of
fresh meat, can be assigned for the country disease long after, and, in
some periods, on the explicit testimony of observers. As to the Irish
ague, or typhus fever, Giraldus mentions it in the medieval period; and
Higden, copying him exactly, says: “The inhabitants of Ireland are vexed
by no kind of fever except the acute, and that seldom”--the word _acuta_
being the original of “the ague,” or, as in another translation of the
passage, “the sharp axes[414].” In this pastoral country, according to
Giraldus, there was little sickness and little need of physicians; but
there is hardly an instance of military operations by the English
unattended with sickness among the troops, and famine with sickness among
the native Irish.

The generalities of Fynes Moryson, a traveller of the time of James I.,
who included Ireland among the many countries that he visited and
described, throw light upon the dietetic peculiarities of the Irish.
Having little agriculture, and at that time no general cultivation of the
potato (although they adopted it much sooner than the English and Scots),
they lived, says Moryson, mostly on milk (as Giraldus Cambrensis also
records in the twelfth century), and upon the flesh of unfed calves, which
they cooked and ate in a barbarous fashion. “The country disease” is also
noted. The experience in Ireland from time immemorial, that a bellyful was
a windfall, must have been the origin of a habit observed by Moryson:

    “I have known some of these Irish footemen serving in England to lay
    meate aside for many meales to devoure it all at one time.” And again:
    “The wilde Irish in time of greatest peace impute covetousnesse and
    base birth to him that hath any corne after Christmas, as if it were a
    point of nobility to consume all within these festivall dayes.” The
    Irish slovenliness or filthiness in their food, raiment and lodging
    was apt, he says, “to infect” the English who came to reside in their
    country[415].

About a generation after we come to the earliest medical account of the
sicknesses of Ireland, by Gerard Boate, compiled during the Cromwellian
occupation[416]. The following occurs under the head of The Looseness:

    The English have given it the name of the Country Disease. The
    subjects of it are often troubled a great while, but take no great
    harm. It is easily cured by good medicines: “But they that let the
    looseness take its course do commonly after some days get the bleeding
    with it; ... and last it useth to turn to the bloody flux, the which
    in some persons having lasted a great while, leaveth them of itself;
    but in far the greatest number is very dangerous, and killeth the most
    part of the sick, except they be carefully assisted with good
    remedies.”

The other reigning disease is the “Irish Ague,” a continued fever of the
nature of typhus:

    “As Ireland is subject to most diseases in common with other
    countries, so there are some whereunto it is peculiarly obnoxious,
    being at all times so rife there that they may justly be reputed for
    Ireland _endemii morbi_, or reigning diseases, as indeed they are
    generally reputed for such. Of this number is a certain sort of
    malignant feavers, vulgarly in Ireland called Irish agues, because
    that at all times they are so common in Ireland, as well among the
    inhabitants and the natives, as among those who are newly come thither
    from other countries. This feaver, commonly accompanied with a great
    pain in the head and in all the bones, great weakness, drought, loss
    of all manner of appetite, and want of sleep, and for the most part
    idleness or raving, and restlessness or tossings, but no very great
    nor constant heat, is hard to be cured.” If blood-letting be avoided
    and cordial remedies given, “very few persons do lose their lives,
    except when some extraordinary and pestilent malignity cometh to it,
    as it befalleth in some years.” Those who recover “are forced to keep
    their beds a long time in extreme weakness, being a great while before
    they can recover their perfect health and strength.”

The occasion of Boate’s writing was the subjugation of Ireland by
Cromwell, in the course of which we hear from time to time of sickness.
The greatest of the calamities was the utter destruction of the prosperity
of Galway by the frightful plague of 1649-50, and by the suppression of
the Catholics, who had brought the port of Connaught to be a place of
foreign commerce[417].

Cromwell’s troops in 1649 incurred dysentery through the hardships of
campaigning. On 17 September, 1649, the Lord General writes from Dublin to
Mr Speaker Lenthall after the storming of Tredah or Drogheda: “We keep the
field much; our tents sheltering us from the wet and cold. But yet the
country-sickness overtakes many: and therefore we desire recruits, and
some fresh regiments of foot, may be sent us.” And on 25 October, “Colonel
Horton is dead of the country-disease[418].”

Another general reference to the “country disease” of Ireland, by Borlase,
is very nearly the same as Boate’s. It is introduced early in the history,
on the occasion of the death in 1591 of Walter, Earl of Essex, earl
marshal of Ireland:

    “The dysentery, or flux, so fatal to this worthy person, is commonly
    termed the country disease; and well it may, for it reigns nowhere so
    epidemically as in Ireland; tainting strangers as well as natives. But
    whether it proceeds from the peculiar disposition of the air, errour
    in diet, the laxity and waterishness of the meat, or some occult
    cause, no venomous creature living there to suck that which may be
    thought (in other countries) well distributed amongst reptilious
    animals, I shall not determine, though each of these circumstances may
    well conduce to its strength and vigour. Certain it is that regular
    diet preserves most from the violence, and many from the infection of
    this disease; yet as that which is thought very soveraign--I must say
    that the stronger cordial liquors (viz. brandy, usquebeh, treacle and
    Mithridate waters) are very proper, or the electuaries themselves, and
    the like[419].”

From the Restoration to the Revolution little is known of epidemics in
Ireland. It is probable that Dublin and the other considerable towns fared
much the same as English towns. A Dublin physician writing to Robert Boyle
on 27 February, 1682, speaks of a petechial fever, marked by leaping of
the tendons, which had been fatal to very many in that city for these
twelve or fourteen months[420]. With the Revolution the troubles of the
country begin again, and enter on their peculiarly modern phase. For our
history, two characteristic incidents come at the very beginning of the
new period of disorder among the Irish--the sicknesses of the siege of
Londonderry and the unparalleled havoc of disease among the troops of
Schomberg in the camp of Dundalk. In both, the old “country disease,”
which had affected Cromwell’s troops, was the primary malady, occurring,
of course, in circumstances special enough to have bred it anywhere; in
both, the dysentery was attended or followed by typhus fever, the old
“Irish ague;” and although the epidemics of Londonderry and Dundalk in
1689 are properly examples of war sickness, yet the circumstances of each
may help to realize the connexion between dysentery and typhus in the
ordinary history of the Irish.


Dysentery and Fever at Londonderry and Dundalk, 1689.

The siege of Londonderry[421] by the Catholic Irish army of James II.
began in April and ended on 28 July, having lasted 105 days. On 19 April
the garrison numbered 7020 men, and the total of men, women and children
in the town was estimated at 30,000, a number which included refugees from
the neighbouring country and would have been more but for many Protestants
at the beginning of the siege leaving the city and taking “protection” at
the hands of the besiegers. On 21 May, a collection was made for the poor,
who began to be in want. Sickness is heard of on 5 June, when several that
were sick were killed in their beds by the enemy’s bombs. The dread of the
bombs in the houses caused the people to lie about the walls or in places
remote from the houses all night, so that many of them, especially the
women and children, caught cold, which along with the want of rest and
failing food, threw them into fluxes and fevers. The pinch of hunger began
to be felt before the middle of June, about which time and for six weeks
after the fluxes and fevers were rife. A great mortality spread through
the garrison as well as the inhabitants; fifteen captains and lieutenants
died in one day, and it was estimated that ten thousand died during the
siege, “besides those who died soon after.” The want, the dysentery, the
fever and the vast numbers of dead every day must have produced a horrible
state of things; when, on 2 July, five hundred useless persons were put
outside the walls, to disperse as they best could, the besiegers are said
to have recognized them when they met them “by the smell.”

About the middle of June large quantities of provisions were found in
cellars and places of concealment under ground; after that the garrison
had always bread, although the allowance was small. An ingenious man
discovered how to make pancakes of starch and tallow, of which articles
there was no lack; the pancakes not only proved nutritious, but are said
to have been an infallible cure of the flux, or preservative from it. At
length, on 28 July some of the victuallers and ships of war which had been
in Lough Foyle since the 15th of June, sailed up to the head of the Lough
on the evening flood tide, finding little resistance from the enemy’s
batteries and none from “what was left of” the tide-tossed boom of logs
across the mouth of the river. Provisions poured in, and the siege was
raised; but it is clear that the infection continued for some time after,
having been found among such of the released garrison as repaired to
Schomberg’s camp at Dundalk.

The Catholic army is said (by the Protestants) to have lost 8000 or 9000
before the walls of Londonderry, “most by the sword, the rest of fever and
flux, and the French pox, which was very remarkable on the bodies of
several of the dead officers and soldiers[422].”

Not far off, at Dundalk, there began, a few weeks after, an extraordinary
outbreak of war-sickness, which, unlike the pestilence in Londonderry, was
altogether inglorious in its circumstances. In many respects it resembled
the disaster to Cromwell’s troops at the first occupying of Jamaica in
1655-56[423]; but it was worse than that, and it is probably unexampled in
the military annals of Britain[424].

Supplies had been voted in Parliament for quelling the Catholic rebellion
in Ireland, and an expedition was got together under the illustrious
Marshal, Duke of Schomberg. The force consisted of some ten thousand foot,
most of them raw levies from the English peasantry, with one regiment of
seasoned Dutch troops (“the blue Dutch”), and cavalry. While the bulk of
the force was undisciplined, their clothes, food, tents and other
munitions of war were bad or insufficient through the fraud of
contractors. The expedition embarked at Hoylake on the Dee and landed on
the 15th of August, 1689, nearly three weeks after the relief of
Londonderry, at Bangor, on the south side of Belfast Lough. Schomberg took
Carrickfergus, and began to advance on Dublin; but finding the towns
burned and the country turned into a desert, he threw himself into an
entrenched camp around the head of Dundalk Bay, nearly a mile from the
town of Dundalk. His camp was on a low moist bottom at the foot of the
hills. The Irish Catholic army took up a position among the hills “on high
sound ground,” not more than two miles distant from the English lines,
and, being in superior force, in due time they offered battle, which was
declined. Schomberg, who had been joined by the Enniskillen regiments of
dragoons and by men from Londonderry, had under him some 2000 horse and
not less than 12,000 foot at the time when James II. offered battle. The
undisciplined state of his English troops and the suspected treachery of a
body of French Protestants were among the causes that held Schomberg back;
but he had to reckon also with sickness almost from the moment of sitting
down at Dundalk. At a muster on 25 September, several of the regiments
were grown thin “by reason of the distemper then beginning to seize our
men.” The distemper was dysentery and fever. The two maladies were mixed
up, as they usually are in war and famines, the flux commonly preceding
the fever, and perhaps affording the virulent matters in the soil and in
the air upon which the epidemic prevalence of the fever depends. It was
easy to account for the dysentery among the troops at Dundalk; but as to
the fever, there was an ambiguity at the outset which Story is careful to
note: “And yet I cannot but think that the feaver was partly brought to
our camp by some of those people that came from Derry; for it was
observable that after some of them were come amongst us, it was presently
spread over the whole army, yet I did not find many of themselves died of
it.” Where the cause of death is specially named, it is fever, as in the
cases of Sir Thomas Gower, Colonel Wharton and other officers on the 28th
and 29th October. The fever was a most malignant form of typhus, marked by
the worst of all symptoms, gangrene of the extremities, so that the toes
or a whole foot would fall off when the surgeon was applying a
dressing[425].

It seems probable that most of the enormous mortality was caused by
infection, and not by dysentery due to primary exciting causes.

The primary exciting causes were obvious, but seemingly irremovable.
Schomberg had a great military reputation, but he was now over eighty, and
it does not appear that he made himself personally felt in the camp,
although he issued incessantly orders to inspect and report. As the
mortality proceeded apace during the six or eight weeks of inactivity,
murmurings arose against the commander. He was unfortunate in his choice
of a camping ground, and in an unusually cold and wet season. The newly
raised English troops seem to have been lacking equally in intelligence
and in moral qualities. Their foul language and debauchery were the
occasion of a special proclamation; their laziness and inability to make
themselves comfortable called forth numerous orders, but all to no
purpose. The regiment of Dutch troops were so well hutted that not above
eleven of them died in the whole campaign; but the English would not be
troubled to gather fern or anything else to keep themselves dry and clean
withal: “many of them, when they were dead, were incredibly lousy.”

The camping ground not only received the drainage of the hills, but,
strange to say, the rain would be falling there all day while the camp of
the enemy, only a few miles farther inland, would not be getting a drop.
On 1 October the tents on the low ground were moved a little higher up. On
the same date there were distributed among the regiments casks of
brandy--Macaulay says it was of bad quality--which appears to have been
the trusted remedy against camp sickness, as in the Jamaica expedition of
1655. There were twenty-seven victuallers or other ships riding in Dundalk
Bay; but the stores were bad, and the regimental surgeons had come
unprovided with drugs that might have been useful in flux or fever. While
the weather continued cold and wet, there was also a scarcity of firing
and forage. On 14 October all the regimental surgeons were ordered to meet
at ten in the morning to consult with Dr Lawrence how to check the
sickness[426]. Several officers having died on the 16th and 17th, the camp
was shifted on the 20th to new ground, the huts being left full of the
sick. Gower’s regiment had sixty-seven men unable to march, besides a good
many dead before or sent away sick. Story, the chaplain, went every day
from the new camp to visit the sick of his regiment in the huts, and
always at his going found some dead. He found the survivors in a state of
brutal callousness, utterly indifferent to each other, but objecting to
part with their dead comrades as they wanted the bodies to sit or lie on,
or to keep off the cold wind. The ships at anchor had now received as many
sick as they could hold, and the deaths on board soon became as many as on
shore. On 25-27 October, the camp was again shifted, but the sickness
continued apace. At length on 3 November, the Catholic army having
dispersed to winter quarters, the sick were ordered to be removed to
Carlingford and Newry. “The poor men were brought down from all places
towards the Bridge End, and several of them died by the way. The rest were
put upon waggons, which was the most lamentable sight in the world, for
all the rodes from Dundalk to Newry and Carlingford were next day full of
nothing but dead men, who, even as the waggons joulted, some of them died
and were thrown off as fast.” Some sixteen or seventeen hundred had been
left dead at Dundalk. The ships were ordered to sail for Belfast with the
first wind, and the camp was broken up. There was snow on the hills and
rain in the valleys; on the march to Newry, men fell out of the ranks and
died at the road side. When the ships weighed anchor from Dundalk and
Carlingford, they had 1970 sick men on board, but not more than 1100 of
these came ashore in Belfast Lough, the rest having died at sea in coming
round the coast of County Down. Such was the violence of the infection on
board that several ships had all the men in them dead and nobody to look
after them whilst they lay in the bay at Carrickfergus. An infective
principle, once engendered in circumstances of aggravation such as these,
is not soon extinguished. Belfast was the winter quarters, and in the
great hospital there from 1 November, 1689, to 1 May, 1690, there died
3762, “as appears by the tallies given in by the men that buried them.”
These numbers together make fully six thousand deaths, which agrees with
the general statement that Schomberg lost one half of the men whom he had
embarked at Hoylake in August. The Irish Catholic army began to sicken in
their camp in the hills above Dundalk Bay just before they broke up, and
they are said to have lost heavily by sickness in their winter quarters.

The war ended with the Treaty of Limerick, in 1691. The Seven Ill Years
followed,--ill years to Scotland, in a measure to England, and almost
certainly to Ireland also; but it does not appear that the end of the 17th
century was a time of special sickness and famine to the Irish, and it may
be inferred from the fact of Scots migrating to Ireland during the ill
years that the distress was not so sharp there. The epidemiology of
Ireland is, indeed, a blank until we come to the writings of Dr Rogers, of
Cork, in some respects the best epidemiologist of his time, which cover
the period from 1708 to 1734. His account of the dysentery and typhus of
the chief city of Munster in the beginning of the 18th century will show
that the old dietetic errors of the Irish, noted in medieval times, had
hardly changed in the course of centuries.


A generation of Fevers in Cork.

Rogers is clear that typhus fever was never extinct, while the three
several times when it “made its appearance amongst us in a very signal
manner,” are the same as its seasons in England, namely 1708-10, 1718-21
and 1728-30[428]. His experience relates only to the city of Cork, and, so
far as his clinical histories go, only to the well-to-do classes therein;
and although those seasons were years of scarcity and distress all over
Ireland, yet Rogers does not seem to associate insufficient food with the
fever, and never mentions scarcity. The fevers were in the winter, for the
most part, and were usually accompanied by epidemic smallpox of a bad
type, which in 1708 “swept away multitudes.” Nothing is said of dysentery
for the earliest of the three fever-periods; but for 1718 and following
years we read that “dysentery of a very malignant sort, frequently
producing mortification in the bowels,” prevailed during the same space;
and that the winters of the third fever-period, namely, those of 1728,
1729 and 1730 were “infamous for bloody fluxes of the worst kind.” It is
clear that the fever spread to the richer classes in Cork, for his five
clinical histories are all from those classes. The following is his
general account of the symptoms:

    The patient is suddenly seized with slight horrors or rather
    chilliness, to which succeed a glowing warmth, a weight and fixed pain
    in the head, just over the eyebrows; soreness all over his flesh, as
    if bruised, the limbs heavy, the heart oppressed, the breathing
    laboured, the pulse not much altered, but in some slower; the urine
    mostly crude, pale and limpid, at first, or even throughout, the
    tongue moist and not very white at first, afterwards drier, but rarely
    black. An universal petechial effloresence not unlike the measles
    paints the whole surface of the body, limbs, and sometimes the very
    face; in some few appear interspersed eruptions exactly like the
    _pustulae miliares_, filled with a limpid serum. The earlier these
    petechiae appear, the fresher in colour, and the longer they continue
    out, the better (p. 5). The fixed pain in the head increasing, ends
    commonly in a coma or stupor, or in a delirium with some. Some few
    have had haemorrhage at the nose, a severe cough, and sore throat. In
    some he had observed a great tendency to sweats, even from the
    beginning: these are colliquative and symptomatic, not to be
    encouraged. In but few there have appeared purple and livid spots, as
    in haemorrhagic smallpox: some as large as a vetch, others not bigger
    than a middling pin’s head, thick set all over the breast, back and
    sometimes the limbs, the pulse in these cases being much below normal.
    The extremities cold from the 6th or 7th day, delirium constant,
    tongue dry and black, urine limpid and crude, oppression greater, and
    difficulty of breathing more. It is a slow nervous fever (p. 18).

Rogers believed that mere atmospheric changes could not be the cause of
these epidemics: “they may favour, encourage and propagate such diseases
when once begun; but for the productive cause of them we must have
recourse to such morbid effluvia as above described [particles of all
kinds detached from the animal, vegetable and mineral kingdoms]; or
resolve all into the θεῖον τί so often appealed to by Hippocrates[429].”

But, as regards Cork itself, special interest attaches to the following
“four concurring causes:”

    “1st, the great quantities of filth, ordure and animal offals that
    crowd our streets, and particularly the close confined alleys and
    lanes, at the very season that our endemial epidemics rage amongst
    us.

    2nd, the great number of slaughter-houses, both in the north and south
    suburbs, especially on the north ridge of hills, where are vast pits
    for containing the putrefying blood and ordure, which discharge by the
    declivities of those hills, upon great rains, their fetid contents
    into the river.

    3rd, the unwholesome, foul, I had almost said corrupted water that
    great numbers of the inhabitants are necessitated to use during the
    dry months of the summer.

    4th, the vast quantities of animal offals used by the meaner sort,
    during the slaughtering seasons: which occasion still more mischief by
    the quick and sudden transition from a diet of another kind.”

In farther explanation of the fourth concurring cause, he says that in no
part of the earth is a greater quantity of flesh meat consumed than in
Cork by all sorts of people during the slaughtering season--one of the
chief industries of the place being the export of barrelled beef for the
navy and mercantile marine. The meat, he says, is plentiful and cheap, and
tempts the poorer sort “to riot in this luxurious diet,” the sudden change
from a meagre diet, with the want of bread and of fermented liquors, being
injurious to them[430].


Famine and Fevers in Ireland in 1718 and 1728.

Thus far Rogers, for the city of Cork in the three epidemic periods,
1708-10, 1718-21, and 1728-30, two of which, if not all three, were
periods of dysentery as well as of typhus. But it was usual in Ireland for
the country districts and small towns to suffer equally with the cities.
The circumstances of the Irish peasantry in the very severe winter of
1708-9 are not particularly known; if there was famine with famine-fever,
it was not such as to have become historical. But for the next
fever-period, 1718-20, we have some particulars. Bishop Nicholson, of
Derry, writes: “Never did I behold even in Picardy, Westphalia or
Scotland, such dismal marks of hunger and want as appeared he
countenances of most of the poor creatures I met with on the road.” One of
the bishop’s carriage horses having been accidentally killed, it was at
once surrounded by fifty or sixty famished cottagers struggling
desperately to obtain a morsel of flesh for themselves and their
children[431].

This was a time when the population was increasing, but agriculture, so
far from increasing in proportion to the number of mouths to feed, was
positively declining, unless it were the culture of the potato. In a
pamphlet of about 1724, on promoting agriculture and employing the poor,
the complaint is of beef and mutton everywhere, and an insufficiency of
corn. “Such a want of policy,” says one, “is there, in Dublin especially,
on the most important affair of bread, without a plenty of which the poor
must starve.” Another, a Protestant, has the following threat for the
clergymen of the Established Church: “I’ll immediately stock one part of
my land with bullocks, and the other with potatoes--so farewell
tithes[432]!” From this it is to be inferred that potatoes were not made
tithable until a later period, pasture being exempted to the last. For
whatever reason, grazing, and not corn-growing, was then more general in
Ireland than in the generations immediately preceding, much land having
gone out of tillage. The culture of the potato was driven out of the
fertile lowlands to the hill-sides, so as to leave the ground clear for
ranges of pasture. Rack-renting was the rule, doubtless owing to the same
reason as afterwards, the competition for farms. While the Protestants
emigrated in thousands, the Catholics multiplied at home in beggary. A
pamphleteer of 1727 says: “Where the plough has no work, one family can do
the business of fifty, and you may send away the other forty-nine.” Thus
we find the pasturing of cattle preferred to agriculture long after the
barbaric or uncivilized period had passed, preferred indeed by English
landlords or farmers[433].

There were three bad harvests in succession, 1726, 1727 and 1728,
culminating in a famine in the latter year. Boulter, archbishop of Armagh,
who then ruled Ireland, was able to buy oats or oatmeal in the south and
west so as to sell it below the market price to the starving Protestants
of Ulster, an interference with the distribution of food which led to
serious rioting in Cork, Limerick, Clonmel and Waterford in the first
months of 1728[434]. No full accounts of the epidemic fever of that famine
remain. Rutty, of Dublin, says it was “mild and deceitful in its first
attack, attended with a depressed pulse, and frequently with
petechiae[435];” while, according to Rogers and O’Connell[436], the
epidemic fever of Munster was the same. Of the famine itself we have a
glimpse or two. Primate Boulter writes to the Duke of Newcastle on 7
March, 1727:

    “Last year the dearness of corn was such that thousands of families
    quitted their habitations to seek bread elsewhere, and many hundreds
    perished; this year the poor had consumed their potatoes, which is
    their winter subsistence, near two months sooner than ordinary, and
    are already, through the dearness of corn, in that want that in some
    places they begin already to quit their habitations[437].”

Quitting their habitations to beg was a regular thing at a later time of
the year. It was in the course of these bad years, in 1729, that Swift
wrote his ‘Modest Proposal for preventing the Children of Poor People in
Ireland from being a Burden to their Parents or Country.’ The scheme to
use the tender babes as delicate morsels of food for the rich, was a
somewhat extreme flight of irony, not so finished as in Swift’s other
satires, but the circumstances out of which the proposal grew were more
real than usual.

    “It is a melancholy object,” says the Dean of St Patrick’s, “to those
    who walk through this great town, or travel in the country, when they
    see the streets, the roads and cabin doors crowded with beggars of the
    female sex followed by three, four, or six children, all in rags, and
    importuning every passenger for an alms.” Having ventilated his
    project for the children, he proceeds to show that “their elders are
    every day dying and rotting by cold and famine, filth and vermin, as
    fast as can be reasonably expected.”

All the while there was a considerable export of corn from Ireland. In the
beginning of 1730, two ships laden with barley were stopped at Drogheda by
a fierce mob and were compelled to unload[438].

The interval between those years of epidemic typhus in Ireland and the
next, 1740-41, was filled, we may be sure, with at least an average amount
of the endemial fever. Rutty specially mentions it in Dublin in the autumn
and winter of 1734-35: “We had the low fever, called nervous (and
sometimes petechial from the spots that frequently attended, although
probably not essential).” He then adds: “It is no new thing with us for
this low kind of fever to prevail in the winter season;” and gives figures
from the Dublin Bills of Mortality for forty years. He mentions the
petechial fever as being frequent next in January and February, 1736,
corresponding to a bad time of it in Huxham’s Plymouth annals. In 1738 and
1739 the type of the Dublin fever was relapsing, in part at least, the
same type having been seen at Edinburgh shortly before.

       *       *       *       *       *

The economics of Ireland, at this time, gave occasion to Berkeley’s
_Querist_, a series of weekly essays written in 1737 and 1738, and
collected in 1740, on the eve of the next great famine and mortality[439].
A few of the bishop’s sarcasms, in the form of queries, will serve to show
how anomalous was the economic condition of the country, and how easily a
crisis of famine and pestilence could arise.

    “169. Whether it is possible the country should be well improved while
    our beef is exported, and our labourers live upon potatoes?

    “173. Whether the quantities of beef, butter, wool and leather,
    exported from this island, can be reckoned the superfluities of a
    country, where there are so many natives naked and famished?

    “174. Whether it would not be wise so to order our trade as to export
    manufactures rather than provisions, and of those such as employ most
    hands?

    “466. Whether our exports do not consist of such necessaries as other
    countries cannot well be without?

    “353. Whether hearty food and warm clothing would not enable and
    encourage the lower sort to labour?

    “354. Whether in such a soil as ours, if there was industry, there
    would be want?

    “418. Whether it be not a new spectacle under the sun, to behold in
    such a climate and such a soil, and under such a gentle government, so
    many roads untrodden, fields untilled, houses desolate, and hands
    unemployed?

    “514. Whether the wisdom of the State should not wrestle with this
    hereditary disposition of our Tartars, and with a high hand introduce
    agriculture?

    “534. Why we do not make tiles of our own, for flooring and roofing,
    rather than bring them from Holland?

    “539. Whether it be not wonderful that with such pastures, and so many
    black cattle, we do not find ourselves in cheese?”

In several of his queries (381, 383) Bishop Berkeley is driving at the
expediency of domestic slavery. It was two hundred years since the same
expedient had been tried by Protector Somerset in England, during the
intolerable state of vagabondage which followed the rage for pasture
farming under the first Tudors. In Scotland, it was hardly more than a
generation since the institution of domestic slavery had commended itself
to Fletcher of Saltoun, as the only expedient that could free that country
from the vagabondage of a tenth, or more, of the population. England had
surmounted the difficulty long ago, Scotland got over it easily and
speedily when she was admitted to the English and colonial markets for her
linen manufacture by the Treaty of Union[440]. But in Ireland in the year
1740, and until long after, disabilities of all kinds, not only economic,
but political and religious, were fastened upon the weaker nation by the
stronger, the unfortunate cause of their long continuance having been the
costly inheritance of loyalty to James II. and the Mass.


The Famine and Fever of 1740-41.

At the time when the bishop of Cloyne was issuing his economic queries
from week to week (not much to the satisfaction of Primate Boulter),
things were making up for the greatest crisis of famine and pestilence
that Ireland experienced in the 18th century. There had been relapsing
fever among the poor in Dublin in the autumn of 1738, and it appeared
among them again in the summer and autumn of 1739. Rutty’s account of it
is as follows:

    “It was attended with an intense pain in the head. It terminated
    sometimes in four, for the most part in five or six days, sometimes in
    nine, and commonly in a critical sweat. It was far from being mortal.
    I was assured of seventy of the poorer sort at the same time in this
    fever, abandoned to the use of whey and God’s good providence, who all
    recovered. The crisis, however, was very imperfect, for they were
    subject to relapses, even sometimes to the third time, nor did their
    urine come to a complete separation.”

In October 1739, there appeared some dysenteries in Dublin.

The winter of 1739 set in severely with cold and wet in November, and
about Christmas there began a frost of many weeks’ duration which was
more intense than anyone remembered. It is said to have made the ground
like iron to the depth of nine inches; the ice on all the rivers stopped
the corn mills, trees and shrubs were destroyed, and even the wool fell
out of the sheep’s backs. In January 1740 the destitution was such that
subscription-lists were opened in Dublin, Cork, Limerick, Waterford,
Clonmel, Wexford and other places. Bishop Berkeley distributed every
Monday morning twenty pounds sterling among the poor of Cloyne (near Cork)
besides what they got from his kitchen. One morning he came down without
powder on his wig, and all the domestics of the episcopal palace followed
suit[441]. The distress became more acute as the spring advanced. The
potato crop of 1739 had been ruined, not by disease as in 1845-46, but by
the long and intense frost. It was usual at that time to leave the tubers
in the ridges through most of the winter, with the earth heaped up around
them. The frost of December found them with only that slight covering, and
rotted them: “a dirissimo hoc et diuturno gelu penitus putrescebant,” says
Dr O’Connell. Besides putrid potatoes, the people ate the flesh of cattle
which had died from the rigours of the season. Owing to the want of sound
seed-potatoes, the crop of 1740 was almost a blank. The summer was
excessively dry and hot. In Dublin, the price of provisions had doubled or
trebled, and some of the poor had died of actual starvation. In July
dysenteries became common, and extended to the richer classes in the
capital. Smallpox was rife at the same time, and peculiarly fatal in Cork.
Dysentery continued in Dublin throughout the autumn and winter of 1740
(the latter being again frosty), and became the prevailing malady
elsewhere.

On 8 February, 1741, Berkeley writes that the bloody flux had appeared
lately in the town of Cloyne, having made great progress before that date
in other parts of the country. A week after he writes (15 Feb.), “Our
weather is grown fine and warm: but the bloody flux has increased in this
neighbourhood, and raged most violently in other parts of this and the
adjacent counties[442].” This prevalence of dysentery, and not of fever,
as the reigning malady of the winter of 1740-41 in Munster is confirmed
by Dr Maurice O’Connell, who says that the typhus of the previous summer
gave place to it. Dysentery in the winter and spring, preceding the fever
of summer, was also the experience in the famine of 1817. Berkeley treated
the subjects of dysentery, not with tar water, but with a spoonful of
powdered resin dissolved in oil by heat and mixed in a clyster of
broth[443].

As the year 1741 proceeded, with great drought in April and May, typhus
fever (which had appeared the autumn before) and dysentery were both
widely epidemic, so that it is impossible to say which form of disease
caused most deaths. In Dublin during the month of March, 1741, the deaths
from dysentery reached a maximum of twenty-one in a week, “though it was
less mortal than in the country, to which the better care taken of the
poor and of their food undoubtedly contributed.” Bishop Berkeley writes on
the 19th of May:

    “The distresses of the sick and poor are endless. The havoc of mankind
    in the counties of Cork, Limerick and some adjacent places, hath been
    incredible. The nation probably will not recover this loss in a
    century. The other day I heard one from county Limerick say that whole
    villages were entirely depeopled. About two months since I heard Sir
    Richard Cox say that five hundred were dead in the parish where he
    lives, though in a country I believe not very populous. It were to be
    wished that people of condition were at their seats in the country
    during these calamitous times, which might provide relief and
    employment for the poor[444].”

It was said that there were twenty-five cases of fever in the bishop’s own
household, which were cured by the panacea, tar-water, drunk copiously--a
large glass, milk-warm, every hour in bed, the same method being practised
by several of his poor neighbours with equal success[445]. In a “Letter
from a country gentleman in the Province of Munster to his Grace the Lord
Primate[446]” it is said:

    “By a moderate computation, very near one-third of the poor cottiers
    of Munster have perished by fevers, fluxes and downright want.... The
    charity of the landlords and farmers is almost quite exhausted.
    Multitudes have perished, and are daily perishing, under hedges and
    ditches, some by fevers, some by fluxes, and some through downright
    cruel want in the utmost agonies of despair. I have seen the labourer
    endeavouring to work at his spade, but fainting for want of food,”
    etc.

The loss of life must have been great also in Connaught. A letter of 8
July, 1741, from Galway, says: “The fever so rages here that the
physicians say it is more like a plague than a fever, and refuse to visit
patients for any fee whatever[447].” The Galway Assizes were held at
Tuam[448], the races also being transferred to the same neighbourhood, not
without their usual evening accompaniments of balls and plays.

Of this famine and sickness it might have been said, in the stock medieval
phrase, that the living were hardly able to bury the dead[449].

As in later Irish famines, there appear to have been, in 1740-41, three
main types of sickness--dysentery, relapsing fever and typhus fever. In
Dublin, as we know from the direct testimony of Rutty, there was relapsing
fever in 1739, before the distress had well begun, and again in the summer
of 1741, when the worst was over. So much is said of dysentery that we may
well set down to it, and to its attendant dropsy, a great part of the
deaths, as in the famine of 1846-47. But it is probable that true typhus
fever, sometimes of a malignant type, as at Galway, was the chief
infection in 1741, which was the year of its great prevalence in England.
It was characterized by a mild and deceitful onset, like a cold. Spots
were not invariable or essential; they were mostly of a dusky red,
sometimes purple, and sometimes intermixed with miliary pustules.
O’Connell mentions, for Munster, bleeding from the nose, a mottled rash as
in measles, and pains like those of lumbago. One of the worst features of
the Irish epidemic of 1740-41 was the prevalence of fever in the gaols. At
Tralee above a hundred were tried, most of them for stealing the means of
subsistence; the gaol was so full that there was no room to lie down, and
fifty prisoners died in six weeks. Limerick gaol had dysentery and fever
among its inmates, and the judge who held the Munster Circuit died of
fever on his return to Dublin[450].

Rutty says that the fever fell most upon strong middle-aged men, less upon
women, and least of all upon children. The number of orphans was so great
after the famine that Boulter, the Anglican primate, seized the
opportunity to start the afterwards notorious Charter Schools for the
education of the rising generation according to the Protestant creed. In
all the subsequent Irish famines it was the enormous swarms of people
begging at a distance from their own parishes that spread the infection of
fever; and there seems to have been as much of beggary in 1741, when
Ireland was underpeopled with two millions, as in 1817-18, when it was
overpeopled with six millions. A few years after the famine, Berkeley
wrote in 1749:

    “In every road the ragged ensigns of poverty are displayed; you often
    meet caravans of poor, whole families in a drove, without clothes to
    cover, or bread to feed them, both which might be easily procured by
    moderate labour. They are encouraged in their vagabond life by the
    miserable hospitality they meet with in every cottage, whose
    inhabitants expect the same kind reception in their turn when they
    become beggars themselves.”

The estimates of the Irish mortality in 1741 varied greatly, as they have
done in the Irish famines of more recent times. One guessed a third of the
cottiers of Munster, another said one-fifth; and it is known that, whereas
in Kerry the hearth-money was paid in 1733 by 14,346, it was paid in 1744
by only 9372[451]. The largest estimates are 200,000 deaths or even
400,000 deaths in all Ireland in a population of less than two millions.
But Dr Maurice O’Connell, who practised in Cork, and saw in Munster the
mortality at its worst, estimated the deaths in all Ireland, in the two
years 1740 and 1741, from fevers, fluxes and absolute want, at 80,000.
Those who saw the famine, fever and dysentery of 1817-18 in a population
increased by three times were inclined to doubt whether even the smallest
estimate of 80,000 for 1740-41 was not too large; but it is clear that the
famished and fever-stricken in the 18th century were in many places
allowed to perish owing to the indifference of the ruling class or the
exhaustion of their means, so that a much higher rate of fatality may be
assumed for that epidemic than for the first of the 19th century Irish
famines.

       *       *       *       *       *

The distress came to an end before the winter of 1741, when food was so
cheap in Dublin that a shilling bought twenty-one pounds of bread. The
subsequent prevalence of typhus fever and dysentery in Ireland, whether
epidemic or endemic, is very imperfectly known to the end of the century.
It may be inferred that there was in that period no epidemic so great as
that of 1740-41; but it is clear from the records kept by Rutty in Dublin
down to 1764, and by Sims in Tyrone to 1772, that the indigenous fevers
and fluxes of the country were never long absent, being more common in
some years than in others[452].

The year 1744 was remarkable for a destructive throat distemper among
children, described elsewhere, and the year 1745 for smallpox dispersed by
swarms of beggars. In 1746 and 1748, the Dublin fever was relapsing in
part, “terminating,” says Rutty, “the fifth, sixth, seventh or eighth day
with a critical sweat. A relapse commonly attended, which however was
commonly carried off by a second critical sweat.” In 1748, though the
season was sickly, the diseases were not mortal, several of the fevers
being “happily terminated by a sweat the fifth or sixth day.” But there
were also fevers of the low kind, sometimes with petechiae, sometimes with
miliary pustules, though not essentially with either. In the autumn of
1754 Rutty begins to adopt the language of the time concerning a “putrid”
constitution, identifying the fever with the dangerous remittents which
Fothergill was then writing about in London; “it is probable that ours was
akin to them and owing to the same general causes.” In February, 1755, the
fevers were fatal to many, raising the deaths to double the usual number;
they attacked all ages, were of the low, depressed kind, and commonly
attended with miliary pustules. He again identifies them with the low,
putrid fever in London. From that time on to 1758, Rutty has frequent
references to the same fever, under the names of low, putrid, petechial
and miliary. It was at its worst in 1757, and was marked by the remarkable
tremors described by Johnstone at Kidderminster, as well as by miliary
eruptions and by a gangrenous tendency at the spots where blisters had
been applied. In November, 1757, it was fatal to not a few of the young
and strong in Dublin, “and we received accounts of a like malignity
attending this fever in the country[453].” It was still prevalent in the
North and West of Ireland in the spring of 1758. He describes also an
unusual amount of fever in the end of 1762. Sims, of Tyrone, an
epidemiologist in the same manner as Rutty, does not begin his full annals
until 1765; but he sums up the years from 1751 to 1760 as unhealthy by
agues in spring, dysenteries and cholera morbus in autumn, and “low,
putrid or nervous fevers throughout the year[454].” He adds:

    “To the unhealthiness of these years the bad state and dearth of
    provisions might not a little contribute; the poor, being incapable to
    procure sufficient sustenance, were often obliged to be contented with
    things at which nature almost revolted; and even the wealthy could not
    by all their art and power render wholesome those fruits of the earth
    which had been damaged by an untoward season.”

Much of the distress, however, was owing to the continual spread of
pasture-farming, which made the labour of villagers unnecessary[455].

The nearest approach to a great Irish epidemic in the second half of the
18th century was in 1771, as described by Sims, the type of fever being
clearly the same low, putrid or nervous fever, with offensive sweats and
muscular tremors, that was commonly observed in England also in the middle
third of the 18th century. Early in the summer of 1771 a fever began to
appear which, as autumn advanced, raged with the greatest violence; nor
was it overcome by a severe winter. It claimed the prerogative of the
plague, almost all others vanishing from before its presence. It began
twelve months sooner in the eastern parts of the kingdom, pursuing a
regular course from East to West. Some symptoms suggest cerebro-spinal
fever.

    The symptoms were languor, precordial oppression, want of appetite,
    slight nausea, pains in the head, back and loins, a thin bluish film
    on the tongue, turbid urine, eyes lifeless and dejected. After the
    fourth day, constant watchfulness, the eyes wild, melancholy,
    sometimes with bloody water in them, constant involuntary sighing, the
    tendons of the wrists tremulous, the pulse quick and weak, most
    profuse sweats, small dun petechiae principally at the bend of the arm
    and about the neck. At the height of the fever, on the ninth or tenth
    day, the tremulousness of the wrists spread to all the members,
    “insomuch that I have seen the bed-curtains dancing for three or four
    days to the no small terror of the superstitious attendants, who on
    first perceiving it, thought some evil spirits shook the bed. This
    agitation was so constant a concomitant of the fever as to be almost a
    distinguishing symptom.” The patients lay grinding their teeth; when
    awake, they would often convulsively bite off the edges of the vessel
    in which drink was given them. They knew no one, their delirium being
    incessant, low, muttering, their fingers picking the bed covering. The
    face was pale and sunk, the eyes hollow, the tongue and lips black and
    parched. Profuse clammy sweats flowed from them; the urine was as if
    mixed with blood: the stools were involuntary. Petechiae almost black
    came out, having an outer circle with an inner dark speck; sometimes
    there were the larger vibices. Bleedings at the nose were frequent.
    Those who were put to bed and sweated almost all died. Death took
    place about the 13th day.

Curiously enough this disease showed itself even among the middle ranks of
the people, especially those who lived an irregular life, used flesh diet
and drank much. Among the poorer sort, who used vegetable food, the fever
was more protracted and less malignant, but in the winter and spring it
made much greater havoc among them. “Bleeding, that first and grand
auxiliary of the physician in treating inflammatory disorders, seemed here
to lose much of its influence.” It was, indeed, the long prevalence of
this low or nervous type of fever in Britain and Ireland in the middle of
the 18th century that drove blood-letting in fevers out of fashion until
the return of a more inflammatory type (often relapsing fever) in the
epidemic of 1817. In 1770, while such fevers more or less nervous, putrid,
miliary, were beginning to be prevalent among the adults, there was a good
deal of “worm fever” among children. They suffered from heat, thirst,
quick, full pulse, vomiting, coma, and sometimes slight convulsions,
universal soreness to the touch, and a troublesome phlegmy cough. When not
comatose they were peevish. The fever was remitting, the cheeks being
highly flushed at its acme, pale in its remission. It lasted several days,
but seldom over a week, nor was it often fatal. In children under five or
six years, it could hardly be distinguished from hydrocephalus
internus[456]. The same association of the worm fever or remittent fever
of children with the putrid or nervous fever of adults had been noticed at
Edinburgh in 1735. Neither the fever of the adults nor that of the
children will be found, on close scrutiny, to have had much in common with
our modern enteric fever.


The Epidemic Fevers of 1799-1801.

Sims left Tyrone to practise as a physician in London, and with his
departure what seems to have been the only contemporary record of
epidemics in Ireland ceased. The last quarter of the 18th century in
Ireland had probably as much epidemic fever as in England; but it is not
until the years 1797-1801 that we again hear of fever and dysentery, on
the testimony of the records of the Army Medical Board, of the Dublin
House of Industry, and of the Waterford Fever Hospital. At the end of the
year 1796 the health of the regiments in Ireland was everywhere good; but
in December of that year, and in January 1797, the poor in the towns began
to suffer more than usual from fever, and in the course of the year 1797
fever appeared in several cantonments of troops--at Armagh as early as
February or March, at Limerick, at Waterford and in Dublin[457]. The
summer and autumn were unusually wet, so that the peasantry of the
southern and western counties were unable to lay in their usual supply of
turf for fuel. In the course of the winter 1797-98 a considerable increase
of fever and dysentery was remarked among them, and these two maladies
appeared in various regiments in the early months of 1798. This was the
year of the rebellion in the south-east of Ireland, pending the efforts
for the union with England. The British troops were much engaged with the
insurgents throughout the summer, and got rid in great part of the
maladies of their quarters while they were campaigning. But in the end of
the year fever began to spread, both among the inhabitants and among the
troops. It was nothing new for English and Scots regiments to suffer from
fever or dysentery during the greater part of their first year in Ireland;
but the epidemics in the end of 1798 were more than ordinary. The
Buckinghamshire Militia quartered in the Palatine Square of the Royal
barracks, Dublin, lost by “malignant contagious fever” 13 men in October,
13 in November, and 15 in December. From November to January, the Warwick
regiment suffered greatly in the same barrack. The Herefordshire regiment,
833 strong, lost 47 men at Fermoy, mostly from fever contracted in bad
barracks; the Coldstream Guards at Limerick, the 92nd regiment at Athlone,
and the Northamptonshire Fencibles at Carrick-on-Shannon, also lost men by
fever. In July, 1799, not a single regiment in Ireland was sickly; but a
wet and very cold autumn made a bad harvest, aggravating the distresses of
the poor and causing much sickness, which the troops shared. The county of
Wexford, the principal scene of the rebellion, suffered most, and next to
it the adjacent county of Waterford. The fever-hospital of the latter
town, the earliest in Ireland[458], was projected in 1799; the statement
made in the report of a plan for the new charity, that fifteen hundred
dependent persons suffered from contagious fever every year there, showed
that the need for it was nothing new, although hardly a tenth part of the
number sought admission to the hospital when it was at work. Next year,
1800, the managers of the newly-opened hospital gave some particulars of
the causes of fever in Waterford--want of food, causing weakness of body
and depression of mind, but above all the excessive pawning of clothes and
bedding, whereby they suffered from cold and slept for warmth several in a
bed. In the winter and spring of 1799-1800 the poor of Waterford had
epidemic among them fever and dysentery, as well as smallpox. In
Donagh-a-gow’s Lane nine persons died of dysentery between October 1799
and March 1800. The harvest of 1800 was again a failure, from cold and
wet, bread and potatoes being dear and of bad quality. In the autumn and
winter the distress, with the attendant fever and dysentery, became worse.
At that time in Dublin all fever cases among the poor were received into
the House of Industry (the Cork Street and Hardwick Hospitals were soon
after built for fever-cases), at which the deaths for four years were as
follows:

          Died in the Dublin
  Year    House of Industry

  1799         627
  1800        1315
  1801        1352
  1802         384

The enormous rise of the deaths in 1800 and 1801 shows how severe the
epidemic of fever must have been. Compared with the epidemic of 1817-18,
it has few records, perhaps because the political changes of the union
engrossed all attention. But the significant fact remains that the deaths
in the Dublin House of Industry in 1800 and 1801 were nearly as many as in
all the special fever-hospitals of Dublin during the two years, 1 Sept.
1817 to 1 Sept. 1819. At Cork, in 1800, there were 4000 cases of fever
treated from the Dispensary; at Limerick the state of matters is said to
have been as bad as in the great famine of 1817-18; and there is some
reason to think that the same might have been said of other places. All
the relief in 1800-1801 came from private sources, the example of Dublin
in opening soup-kitchens having been followed by other towns. The troops
shared in the reigning diseases, especially at Belfast and Dublin; in the
latter city, the spotted fever was severe both among the military and all
ranks of the civil population in August, 1801. The harvest of 1801 was
abundant, and the fever quickly declined. It had been often of the
relapsing type[459]. Dysentery appeared in the end of September, and
became severe in many places in October and November, being attributed to
the rains after a long tract of dry, hot weather. Ophthalmias and
scarlatinal malignant sore-throats were common at the same time.


The Growth of Population in Ireland.

When the history of the great famine and epidemic sicknesses of 1817-18
was written, it was found that this calamity had fallen upon a population
that had grown imperceptibly until it had reached the enormous figure of
over six millions, the census of 1821 showing the inhabitants of Ireland
to be 6,801,827. The increase from an estimated one million and
thirty-four thousand in 1695 was, according to Malthus, probably without
parallel in Europe. According to Petty, the inhabitants in 1672 numbered
about one million one hundred thousand, living in two hundred thousand
houses, of which 160,000 were “wretched, nasty cabins without chimney,
window or door-shut, and wholly unfit for making merchantable butter,
cheese, or the manufacture of woollen, linen or leather.” In 1695, the war
on behalf of James II. having intervened, the population as estimated by
South was 1,034,000. When the people were next counted in 1731, by a not
incorrect method in the hands of the magistracy and Protestant clergy,
they were found to have almost doubled, the total being 2,010,221. This
increase, the exactness of which depends naturally upon the accuracy of
Petty’s and South’s 17th century estimates, had been made notwithstanding
the famines and epidemics of 1718 and 1728, and an excessive emigration,
mostly of Protestants, to the West Indian and American colonies, which was
itself attended by a great loss of life through disease. For the rest of
the 18th century, the estimates of population are based upon the number of
houses that paid the hearth-tax. In the following figures six persons are
reckoned to each taxed hearth:

  Year    Persons

  1754   2,372,634
  1767   2,544,276
  1777   2,690,556
  1785   2,845,932

The hearth-money was not altogether a safe basis of reckoning, for the
reason that many were excused it on account of their poverty by
certificate from the magistrates, and that hamlets in the hills, perhaps
those which held their lands in rungale or joint-lease, often compounded
with the collectors for a fixed sum; so that cabins might multiply and no
more hearth-tax be paid[460]. It is probable that a considerable increase
had taken place which was not represented in the books of the
tax-collectors; for in 1788, only three years from the last date given,
the number of hearths suddenly leapt up to the round figure of 650,000
(from 474,322), giving a population of 3,900,000, at the rate of six
persons to a cabin or house. But it is undoubted that a new impulse was
given to population in the last twenty years of the 18th century, firstly
by the bounties on Irish corn exported, dating from 1780, which caused
much grazing land to be brought under the plough, and secondly by the
gradual removal, after 1791, of various penalties and disabilities which
had rested on the Roman Catholics since the reign of Anne, affecting their
tenure of land, and serving in various ways to repress the multiplication
of families. Accordingly we find the hearths rated in 1791 at the number
of 701,102, equal to a population of 4,206,612. The estimates or
enumerations from 1788, to the census of 1831, show an increase as
follows:

  Year    Persons

  1788   3,900,000
  1791   4,206,612
  1805   5,395,456
  1812   5,937,856
  1821   6,801,827
  1831   7,784,539

The secret of this enormous increase was the habit that the Irish
peasantry had begun to learn early in the 17th century of living upon
potatoes. From that dietetic peculiarity, it is well known, much of the
economic and political history of Ireland depends. At the time when it was
losing its tribal organization (rather late in the day, although not so
late as in the Highlands of Scotland), the country was in a fair way to
pass from the pastoral state to the agricultural and industrial. It is
conceivable that, if Ireland had peacefully become an agricultural
country, wheaten bread would have become the staple food of the people, as
in England in early times and again in later times; or that the standard
might have been oatmeal in the northern province, as in Scotland: in which
case one may be sure that the population would not have increased as it
did. “Since the culture of the potatoes was known,” says a topographer of
Kerry in 1756, “which was not before the beginning of the last century,
the herdsmen find out small dry spots to plant a sufficient quantity of
those roots in for their sustenance, whereby considerable tracts of these
mountains are grazed and inhabited, which could not be done if the
herdsmen had only corn to subsist on[461].” Twenty years later Arthur
Young found an enormous extension of potato culture, the pigs being fed on
the surplus crop[462]. The motive, on the part of the landlord or the
farmer, was to have the peat bogs on the hill-sides reclaimed by the
spade; the surface of peat having been removed, a poor subsoil was
exposed, which might be made something of after it had grown several crops
of potatoes, but hardly in any other way. Another motive was political;
namely, the multiplication by landlords of forty-shilling freeholder
dependent votes among the Catholics as soon as they became free to
exercise the franchise[463].

Malthus relied so much upon statistics, that he found the case of Ireland,
notable though it was, little suited to his method, and dismissed it in a
few sentences. But he indicated correctly the grand cause of
over-population:

    “I shall only observe, therefore, that the extended use of potatoes
    has allowed of a very rapid increase of population during the last
    century (18th). But the cheapness of this nourishing root, and the
    small piece of ground which, under this kind of cultivation, will in
    average years produce the food for a family, joined to the ignorance
    and depressed state of the people, which have prompted them to follow
    their inclinations with no other prospect than an immediate bare
    subsistence, have encouraged marriage to such a degree that the
    population is pushed much beyond the industry and present resources of
    the country; and the consequence naturally is, that the lower classes
    of people are in the most impoverished and miserable state.”

In another section he showed that the cheapness of the staple food of
Ireland tended to keep down the rate of wages:

    “The Irish labourer paid in potatoes has earned perhaps the means of
    subsistence for double the number of persons that could be supported
    by an English labourer paid in wheat.... The great quantity of food
    which land will bear when planted with potatoes, and the consequent
    cheapness of the labour supported by them, tends rather to raise than
    to lower the rents of land, and as far as rent goes, to keep up the
    price of the materials of manufacture and all other sorts of raw
    produce except potatoes. The indolence and want of skill which usually
    accompany such a state of things tend further to render all wrought
    commodities comparatively dear.... The value of the food which the
    Irish labourer earns above what he and his family consume will go but
    a very little way in the purchase of clothing, lodging and other
    conveniences.... In Ireland the money price of labour is not much more
    than the half of what it is in England.”

Lastly, in a passage quoted in the sequel, he showed how disastrous a
failure of the crop must needs be when the staple was potatoes; the people
then had nothing between them and starvation but the garbage of the
fields[464].

What the growth of population could come to on these terms was carefully
shown for the district of Strabane, on the borders of Tyrone and Donegal,
by Dr Francis Rogan, a writer on the famine and epidemic fever of
1817-18[465]. Strabane stood at the meeting of the rivers Mourne and Fin
to form the Foyle; and in the three valleys the land was fertile. All
round was an amphitheatre of hills, in the glens of which and among the
peat bogs on their sides was an immense population. The farms were small,
from ten to thirty acres, a farm of fifty acres being reckoned a large
holding. The tendency had been to minute subdivisions of the land, the
sons dividing a farm among them on the death of the father:

    “The Munterloney mountains,” says Rogan, “lie to the south and east of
    the Strabane Dispensary district. They extend nearly twenty miles, and
    contain in the numerous glens by which they are intersected so great a
    population that, except in the most favourable years, the produce of
    their farms is unequal to their support. In seasons of dearth they
    procure a considerable part of their food from the more cultivated
    districts around them; and this, as well as the payment of their
    rents, is accomplished by the sale of butter, black cattle, and sheep,
    and by the manufacture of linen cloth and yarn, which they carry on to
    a considerable extent.”

These small farmers dwelt in thatched cottages of three or four rooms, in
which they brought up large families[466]. Besides the farmers, there were
the cottiers, who lived in cabins of the poorest construction, sometimes
built against the sides of a peat-cutting in the bog. The following table
shows the proportion of cottiers to small farmers on certain manors of the
Marquis of Abercorn, near Strabane, at the date of the famine in 1817-18
(Rogan, p. 96):

                   Number of Families
     Manor         Farmers    Cottiers

  Derrygoon          368        335
  Donelong           243        322
  Magevelin and
  Lismulmughray      319        668
  Strabane           302        415
  Cloughognal        328        279

The cottiers rented their cabins and potato gardens from the farmers,
paying their rent, on terms not advantageous to themselves, by labour on
the farm. For a time about the beginning of the century the practice by
farmers of taking land on speculation to sublet to cottiers was so common
that a class of “middlemen” arose. One pamphleteer during the distress of
1822 speaks of the class of middlemen as an advantage to the cottiers, and
regrets that they should have been personally so disreputable as to have
become extinct. It is not easy to understand how they served the interests
of the cottiers: for the latter were answerable to the landlord for the
middleman’s rent, and were themselves over-rented and underpaid for their
labour. The system of middlemen did not in matter of fact answer; they
hoped to make a profit from the tenants under them, and neglected to work
on their own farms; it appears that they were a drunken class, and that
they were at length swallowed up in bankruptcy. After the first quarter of
the century the cottiers and the landlords (with the agents and the tithe
proctors) stood face to face; but at the date of the famine of 1817 there
was subletting going on, of which Rogan gives an instructive instance in
his district of Ulster[467].

Under this system of subdividing farms and subletting potato gardens with
cabins to cottiers, the following enormous populations had sprung up in
four parishes within the Dispensary district of Strabane and in four
manors of the Marquis of Abercorn adjoining them, but not included in the
Dispensary District:

  Town of Strabane                        3896
  Parish of Camus                         2384
     "   "  Leck                          5092
     "   "  Urney                         4886
  Manor of Magevelin and Lismulmughray    5548
  Manor of Donelong                       3126
     "  "  Derrygoon                      2568
     "  "  Part of Strabane               2796

In the language of the end of the 19th century, this would have been
called a “congested district” of Ireland; but all Ireland was then
congested to within a million and a half of the utmost limit, so that the
famine, which we shall now proceed to follow in this part of Ulster, has
to be imagined as equally severe in Connaught, in Munster, and even in
parts of Leinster.


The Famine and Fevers of 1817-18.

The winter of 1815-16 had been unusually prolonged, so that the sowing and
planting of 1816 were late. They were hardly over when a rainy summer
began, which led to a ruined harvest. The oats never filled, and were
given as green fodder to the cattle; in wheat-growing districts, the grain
sprouted in the sheaf; the potatoes were a poor yield and watery; such of
them as came to the starch-manufacturers were found to contain much less
starch than usual. The peat bogs were so wet that the usual quantity of
turf for fuel was not secured[468]. This failure of the harvest came at a
critical time. The Peace of Paris in 1815 had depressed prices and wages
and thrown commerce into confusion. During the booming period of
war-prices, from 1803 to 1815, farms and small holdings had doubled or
even trebled in rent, and had withal yielded a handsome profit to the
farmers and steady work to the labourers. When the extraordinary war
expenditure stopped, this factitious prosperity came to a sudden end. The
sons of Irish cottiers were not wanted for the war, and the daughters were
no longer profitable as flax-spinners to the small farmers. Weavers could
hardly earn more than threepence a day, and labourers who could find
employment at all had to be content with fourpence or sixpence, without
their food. A stone of small watery potatoes cost tenpence; but the value
of cattle fell to one-third, and butter brought little. By Christmas the
produce of the peasants’ harvest of 1816 was mostly consumed. “Many
hundred families holding small farms in the mountains of Tyrone,” says
Rogan, “had been obliged to abandon their dwellings in the spring of 1817
and betake themselves to begging, as the only resource left to preserve
their lives[469].” At Galway, in January, a mob gathered to stop the
sailing of a vessel laden with oatmeal. At Ballyshannon the peasants took
to the shore to gather cockles, mussels, limpets and the remains of fish.
In some parts the seed potatoes were taken up and consumed. The people
wandered about in search of nettles, wild mustard, cabbage-stalks and the
like garbage, to stay their stomachs. It was painful, says Carleton, to
see a number of people collected at one of the larger dairy farms waiting
for the cattle to be blooded (according to custom), so that they might
take home some of the blood to eat mixed with a little oatmeal. The want
of fuel caused the pot to be set aside, windows and crevices to be
stopped, washing of clothes and persons to cease, and the inmates of a
cabin to huddle together for warmth. This was far from being the normal
state of the cottages or even of the cabins, but cold and hunger made
their inmates apathetic. Admitted later to the hospitals for fever, they
were found bronzed with dirt, their hair full of vermin, their ragged
clothes so foul and rotten that it was more economical to destroy them and
replace them than to clean them.

Some months passed before this state of things produced fever. The first
effect of the bad food through the winter, such as watery potatoes eaten
half-cooked for want of fuel, had been dysentery, which became common in
February, and was aggravated by the cold in and out of doors. It was
confined to the very poorest, and was not contagious, attacking perhaps
one or two only in a large family. Comparatively few of those who were
attacked by it in the country places came to the Strabane Dispensary; but
the dropsy which often attended or followed it brought in a larger number.
The following table of cases at the Dispensary shows clearly enough that
dysentery and dropsy preceded the fever, which became at length the chief
epidemic malady[470]:

_Cases at Strabane Dispensary._

    1817       Dropsy   Dysentery   Typhus

  June            23        2         10
  July           107       31         60
  August          40       22        206
  September        9       23        287

At a few of the larger towns in each of the provinces typhus had risen in
the autumn of 1816 somewhat above the ordinary low level which
characterized the years from 1803 to 1816 in Ireland as well as in
Britain. At that time there was steadily from year to year a certain
amount of typhus in the poorest parts of the towns and here or there among
the cabins of the cottiers. Statistically this may be shown by the table
of regular admissions to the fever hospitals of some of the chief towns
from the date of their opening.

_Admissions to Irish Fever Hospitals, 1799-1818._

           Dublin,   Dublin    Cork      Waterford  Limerick   Kilkenny
          Cork St.  House of   Fever       Fever     Fever      Fever
  Year    Hospital  Industry  Hospitals  Hospital   Hospital   Hospital

  1799       --        --       --          146        --         --
  1800       --        --       --          409        --         --
  1801       --        --       --          875        --         --
  1802       --        --       --          419       446         --
  1803       --        --      254          188        86         73
  1804      415        82      190          223        95         80
  1805     1024       709      200          297        90         69
  1806     1264      1276      441          165        86         56
  1807     1100      1289      191          166        84         81
  1808     1071      1473      232          157       100         96
  1809     1051      1176      278          222       109        116
  1810     1774      1474      432          410       120        135
  1811     1471      1316      646          331       196        153
  1812     2265      2006      617          323       146        156
  1813     2627      1870      550          252       227        183
  1814     2392      2398      845          175       221        236
  1815     3780      2451      717          403       394        249
  1816     2763      1669     1026          307       659        162
  1817     3682      2860     4866          390      2586       1100
  1818     7608     17894    10408         2729      4829       1924

In 1812 the first step was taken towards the adoption of the Poor Law,
namely the division of the country into Dispensary Districts, which
remained the units of charitable relief until 1839, when the old English
system of a poor-rate and parochial Unions was applied to Ireland. During
that intermediate period much was left to the medical profession, which
contained many well-educated and humane men, to the priests and clergy,
and to charitable persons among the laity. There was fever in many places
where there were no fever hospitals. A physician at Tralee reported that
the back lanes of the town, crowded with cabins, were seldom free from
typhus. Rogan gives two instances from the Strabane district in the summer
and winter of 1815, at a time when the district was remarkably healthy. A
beggar boy was given a night’s lodging by a cottier at Artigarvan, three
miles from Strabane. Next morning he was too ill to leave; he lay three
weeks in typhus, and gave the disease to twenty-seven persons in the eight
cabins which formed the hamlet. A few months after, about a mile from
Strabane, a mother fell into typhus and was visited many times by her two
married daughters and by others of her children at service in the
neighbourhood. Nineteen cases were traced to this focus; “but the actual
number attacked was probably more than three times this, as the disease,
when once introduced into the town, spread so widely among the lower
orders as to create general alarm, and led to the establishment of the
small fever ward attached to the Dispensary.” It was in April, 1816, that
this was done, two rooms, each with four beds, having been provided at
Strabane for fever cases; but at no time until the summer of 1817 were
they all occupied at once.

The epidemic really began there in May, 1817, in a large house which had
been occupied during the winter by a number of families from the
mountains; they had brought no furniture with them, nor bedding except
their blankets, and lay so close together as to cover the floors. Each
room was rented at a shilling a week, the tenant of a room making up his
rent by taking in beggars at a penny a night. The floors and stairs were
covered with the gathered filth of a whole winter; the straw bedding,
never renewed, was thrown into a corner during the day to be spread again
at night. Every crevice was stopped to keep out the cold; the rain came in
through the roof, the floors were damp, and the cellars of the house full
of stagnant water turned putrid. Meanwhile more than a fourth part of the
families resident in Strabane, to the number of 1026 persons, were being
fed from a soup-house opened early in the spring of 1817, while there were
others equally destitute but too proud to ask relief. The rumour of this
charity soon brought crowds of people from the surrounding country, with
gaunt cheeks, says Carleton, hollow eyes, tottering gait and a look of
“painful abstraction” from the unsatisfied craving for food. In the crowd
round the soup-shop, the timid girl, the modest mother, the decent farmer
scrambled “with as much turbulent solicitation and outcry as if they had
been trained, since their very infancy, to all the forms of impudent cant
and imposture.” These soup-shops were opened in all the Irish towns. At
Strabane some of the richer class lent money to procure supplies, for sale
at cost price, of oatmeal, rice and rye-flour, the last being in much
request in the form of loaves of black bread.

The fever, having begun among the houseful of vagrants above mentioned,
made slow progress until June, when it spread through the town, and in the
autumn became a serious epidemic. Meantime the soup-kitchen was closed,
the supplies having ceased, and the country people returned to their
cabins carrying the infection of typhus everywhere with them. By the
middle of October, 1817, the epidemic was general in the country round
Strabane.

The following table shows the rise and decline of the epidemic of typhus
in the town itself.

_Cases of Fever attended from Strabane Dispensary_[471].

         1817  1818

  Jan.     9    83
  Feb.    13    46
  March    6    60
  April   13    48
  May      3    39
  June    10    71
  July    60   106
  Aug.   206    90
  Sept.  287    57
  Oct.   233    49
  Nov.   193    40
  Dec.   140    38

The exact particulars from the Dispensary district of Strabane show
clearly how famine in Ireland is related to fever. The epidemic of typhus
was an indirect result of the famine, and was due most of all to the
vagrancy which a famine was bound to produce in Ireland, in the absence of
a Poor Law. In the spring of 1817, said a gentleman near Tralee, “the
whole country appeared to be in motion.” “It was lamentable,” said Peel,
in the Commons debate, on 22 April, 1818, “at least it was affecting, that
this contagion should have arisen from the open character and feelings of
hospitality for which the Irish character was so peculiarly remarkable.”
They gathered also at funerals, and, as Graves said of a later epidemic,
they were “scrupulous in the performance of wakes.” The concourse of
people at the daily distributions of soup was another cause of spreading
infection, many of them having come out of infected houses[472]. Of such
houses, the lodging-houses of the towns, we have several particular
instances. At Strabane, there were four such, which sent ninety-six
patients to the fever hospital in eighteen months. At Dublin, a house in
Cathedral-lane sent fifty cases to the fever hospitals in a twelvemonth;
the house No. 4, Patrick’s close sent thirty cases in eight months; No.
52½ Kevin-street sent from five rooms nineteen persons in six weeks.

The spread of the disease was much aided by the ordinary annual migration
of harvest labourers. It was the custom every year for cottiers in
Connaught to shut up their cabins after the potatoes were planted, and to
travel to the country round Dublin in search of work at the hay and corn
harvests, leaving their families to beg; in the same way there was an
annual migration from Clare to Kilkenny, from Cavan, Longford and Leitrim
into Meath, and from Derry into Antrim, Down and Armagh[473]. In the
summer of 1817 some parishes of Derry were left with only four or five
families. The keeper of the bridge at Toome, over the Bann, counted more
than a hundred vagrants every day passing into Antrim, from the middle of
May to the beginning of July; and the same might have been seen at the
other bridge over the Bann at Portglenone.

As the spread of contagion came to be realized, the ordinary hospitality
to vagrants ceased. Rogan was struck with the apathy which at length arose
towards sick or dead relatives; even parents became callous at the death
of their children (of whom many died from smallpox). “For some time,” he
says, “it has been as difficult for a pauper bearing the symptoms of
ill-health to procure shelter for the night, as it was formerly rare to be
refused it.” In Strabane they extemporised a poor’s fund by voluntary
contributions of £30 a month, by means of which eighty poor families were
kept from begging in the streets. In Dublin there was so much alarm of
infection from the number of beggars entering the shops that trade was
checked. The following, relating to a town in the centre of Ireland, is an
extreme instance of the panic which the idea of contagion at length
caused:

    “In Tullamore, when measures were proposed for arresting the progress
    of fever, by the establishment of a fever hospital, so little was the
    alarm that the design was regarded by most of the inhabitants as a
    well-intentioned project, uncalled for by the circumstances of the
    community. But when the death of some persons of note excited a sense
    of danger, alarm commenced, which ended in general dismay: military
    guards were posted in every avenue leading to this place, for the
    purpose of intercepting sickly itinerants. The town, from the shops of
    which the neighbouring country is supplied with articles of all kinds,
    was thus in a state of blockade. It was apprehended that woollen and
    cotton goods might be the vehicles of infection, and all intercourse
    between the shops and purchasers was suspended. Passengers who
    inadvertently entered the town considered themselves already victims
    of fever. No person would stop at the public inns, nor hire a carriage
    for travelling; in a word all communication between the town and the
    adjacent country was completely interrupted. Apprehension did not
    proceed in most other places to the same extent as in Tullamore[474].”

Several isolated places escaped the epidemic of typhus, either for a time
or altogether. The island of Rathlin, seven miles to the west of Antrim,
which was as famished as the mainland, had no typhus at the time when it
was epidemic along the nearest shore; the island of Cape Clear, at the
southernmost point of Ireland, had a similar experience. The whole county
of Wexford, where the soil was dry and the harvest of 1816 had been fair,
kept free from typhus until 1818, partly because it was out of the way of
vagrants. The town of Dingle, at the head of a bay in Kerry, with old
Spanish traditions, was totally free from typhus at a time when its near
neighbour, Tralee, was full of it, the immunity being set down to the
well-being of the population from their industry at the linen manufacture
(and fisheries) and their thrifty habits. But the counties of Wexford and
Waterford, and other places more or less exempted in 1817, had a full
share of the epidemic in 1818, which was the season of its greatest
prevalence in most parts of Ireland except Ulster. The harvest of 1817 had
been little better than that of the year before, although the potato crop
was hardly a failure. The fine summer of 1818 brought out crowds of
vagrants who slept in the open, and, when they took the infection, were
placed in “fever-huts” erected near the roads[475]. The harvest of that
year was abundant, and by the end of 1818 the epidemic had declined
everywhere except in Waterford.

The most carefully kept statistics of the sickness and mortality were
those by Rogan for the Strabane Dispensary district, and the adjoining
manors of the Marquis of Abercorn, for each of which a private dispensary
was established under the care of a physician.

    Abstract of Returns of the Dispensary district of Strabane, shewing
    the numbers ill of fever from the commencement of the epidemic in the
    summer of 1817, till the end of September, 1818, the numbers labouring
    under the fever at that date, and the mortality caused by the disease
    (Rogan, p. 72).

                        Population   Ill of Fever   Dead   Remaining ill

        Town of Strabane    3896         639         59          13
        Parish of Camus     2384         685         61          37
          "    "  Leek      5092        1462         96          57
          "    "  Urney     4886        1381         86          42
                          ---------------------------------------------
                          16,258        4167        302         149

    Similar return for those parts of the Marquis of Abercorn’s estates
    not within the Dispensary district:

                                        Ill of fever
           Manors         Population   (to Oct. 1818)   Dead

        Magevelin and}
        Lismulmughray}       5548           1666         101
        Donelong             3126           1217          71
        Derrygoon            2568           1215          90
        Part of Strabane     2796            990          75
                           -----------------------------------
        Totals             14,038           5088         337

The proportion of attacks in these tables for a part of Tyrone, one-third
to one-fourth of the whole population, is believed to have been a fair
average for the whole of Ireland. Each attack, with the weakness that it
left behind, lasted about six weeks; cases would occur in a family one
after another for several months; in some cottages, says Rogan, only the
grandmother escaped.

One hundred thousand cases were known to have passed through the
hospitals. Harty thought that seven times as many were sick in their
cabins or houses, making 800,000 cases in all Ireland in two years; Barker
and Cheyne estimated the whole number of cases at a million and a half
(1,500,000). The mortality was comparatively small. It comes out greater
in the tables for the Strabane district than anywhere else in Ireland
except the hospital at Mallow. The following table, compiled by Harty,
shows how widely the fatality ranged (if the figures can be trusted), from
place to place and from season to season:

    Proportions of fatal cases of typhus in the chief hospitals of Ireland
    1817, 1818 and 1819 (Harty)[476].

                   1817    1818    1819   Average
                  One in  One in  One in  One in

        Dublin     14½     24      18¼     20
        Kilkenny   16½     14⅚     12⅔     14¼
        Dundalk    20-6/7  54      25      30
        Belfast    19⅕     15⅘     19      17⅓
        Newry      21-1/9  34½     13½     26
        Cork       29      35      35      33⅕
        Limerick   13½     15⅔     30⅔     16½
        Waterford  27⅓     25      23⅓     24⅗
        Clonmel    27      18      18¼     19⅓
        Mallow     22½      9⅗             12
        Killarney  74      67      33      62
        Tralee     20¾     69      43      39

What this meant to particular places will appear from some instances. In
the parish of Ardstraw, Tyrone, with a population of about twenty
thousand, 504 coffins are stated by the parish minister to have been given
to paupers in eighteen months. The burials were about twice as many as in
ordinary years, according to the register of the Cathedral churchyard of
Armagh:

        1815                  247 burials
        1816                  312   "
        1817                  571   "
        1 May-25 Dec. 1818    463   "

    Of the 463 burials in eight months of 1818, there were 165 from fever,
    180 from smallpox, and 118 from other causes.

Barker and Cheyne make the whole mortality of the two years from fever and
dysentery to have been 65,000; Harty makes it 44,300. But not more than a
sixth part of the latter total were registered deaths, and the estimate of
the whole may be wide of the mark. In the county of Kerry, ten Catholic
priests died of it. Many medical men took it, as well as apothecaries and
nurses, and several physicians died, of whom Dr Gillichan, of Dundalk, a
young man of good fortune, made a notable sacrifice of his life. Everyone
bore willing testimony to the devotion of the Roman Catholic clergy. Some
harrowing incidents were reported, such as those from Kanturk, in county
Cork:

    Dr O’Leary visited a low hut in which lay a father and three children:
    “There were also two grown-up daughters who were obliged to remain for
    several nights in the open air, not having room in the hut till the
    father died, when the stronger of the two girls forced herself into
    his place. On the road leading to Cork, within a mile of this town, I
    visited a woman of the name of Vaughan, labouring under typhus; on her
    left lay a child very ill, at the foot of the bed another child just
    able to crawl about, and on her right the corpse of a third child, who
    had died two days previously, and which the unhappy mother could not
    get removed. When the grant arrived from Government, I visited a man
    of the name of Brahill near the chapel gate, who with his wife and six
    children occupied a very small house, all of them ill of fever with
    the exception of one boy, who was so far convalescent as to creep to
    the door to receive charity from the passengers.”

    Infants rarely took the fever. Dr Osborne, of Cork, stated that in one
    instance a physician in attendance on the poor had to separate two
    children from the bed of their dead brother, the father and mother
    being already in a fever hospital; in another instance, he had to
    remove an infant from the corpse of its mother who had just expired in
    a hovel[477].

Nosologically the epidemic of 1817-18 presented several features of
interest. It began with dysentery, and ended with the same in autumn,
1818. It was in great part typhus, but towards the end of the epidemic,
in Dublin, at Strabane, and doubtless elsewhere, it changed to relapsing
fever, that is to say, the sick person “got the cool” about the fifth or
seventh day instead of the tenth or twelfth, but was apt to have one or
more relapses or recurrences of the fever. The relapsing type was milder
in its symptoms and was more rarely fatal. The average fatality of typhus
was much less than in ordinary years, while a good many of the fatal cases
came from the richer classes, to whom the contagion reached, the
proportion of fatalities among them being noted everywhere as very high,
up to one death in three or four cases[478]. The fatalities were most
common, as usual, at ages from forty to sixty. A full share of the women
and children took the fever, perhaps an excess of women, allowing for
their excess in the population. The following were the numbers at each
period of life among 18,891 cases treated in the hospitals of Dublin and
Waterford:

  Years of age  1-10  10-20  20-30  30-40  40-50  50 and over

  Cases         2426  6116    5230   2476   1415    1228

The action of the English Government was thought by some to have been
apathetic. Nothing was done to check the export of corn from Irish ports.
Peel, who held the office of Irish Secretary in 1817, was probably
actuated in this by the same constitutional and economic considerations
which led him, as Prime Minister in 1845, to refuse O’Connell’s demand for
a proclamation against the export of corn.

Carleton says that there were scattered over the country “vast numbers of
strong farmers with bursting granaries and immense haggards,” and that
long lines of provision carts on their way to the ports met or
intermingled with the funerals on the roads, the sight of which
exasperated the famishing people. Several carts were attacked and
pillaged, some “strong farmers” were visited, and here or there a “miser”
or meal-monger was obliged to be charitable with a bad grace; but on the
whole there was little lawlessness, less indeed than in England in 1756
and 1766, or in Edinburgh in 1741. In September, 1817, Peel commissioned
four Dublin physicians to visit the respective provinces and report on the
causes and extent of the epidemic fever. On 22 April, 1818, Sir John
Newport, member for Waterford, for whom Dr Harty had been collecting
information, raised a debate on the epidemic in the House of Commons, and
moved for a Select Committee. The debate, after the opening speech and a
sensible brief reply by Peel, degenerated at once into irrelevant talk on
the inadequacy of the fever hospital of London. The Select Committee was
named, and quickly reported on the 8th of May.

A Bill embodying the recommendations of the Committee received the royal
assent on 30th May. The Act provided for the extension of fever hospitals,
the exemption of lodging-houses, under certain regulations, from the
hearth-tax and the window-tax, and the formation of Boards of Health with
powers to abate and remove nuisances. The Boards of Health were found
unworkable, partly by reason of expense, partly of excessive powers. The
epidemic having visited Waterford somewhat late in its progress, Sir John
Newport again called attention to it on 6th April, 1819, and moved for the
revival of last year’s Committee. Mr Charles Grant, afterwards Lord
Glenelg, who was now Irish Secretary, gave much satisfaction to the
patriotic members both by his sympathetic speech on the occasion and by
his previous action at the Irish Office in the way of pecuniary help to
the fever hospitals or Dispensary district officers. The Second Report of
the Committee remarked that the rich absentee landlords had given nothing.
Another Act, of June, 1819 (59 Geo. III. cap 41), defined the duties of
officers of health, and contained an important clause (ix.) relating to
the spread of contagion by vagrants. By that time the epidemic was over;
nor can it be said that the action of the Government from first to last
had made much difference to its progress.

Vagrancy was the principal direct cause; and behind the vagrancy were
usages and traditions, with interests centuries old, which made the
landlords resolute not to pay poor-rates on their rentals. It was not
until twenty years after that the English Poor Law was applied to Ireland
(in 1839), whereby the pauper class were dealt with as far as possible in
their respective parishes. How far that measure was effective in checking
the spread of contagion will appear when we come to the great famine and
epidemic of dysentery and fever in 1846-49.

It will not be necessary to follow with equal minuteness the successive
famines and epidemics of typhus, relapsing fever and dysentery in Ireland,
to the great famine of 1846-49. After 1817 distress became chronic among
the cottiers and small farmers. Leases had been entered into at high rents
during the years of war prices, and in the struggle for holdings tenants
at will offered the highest rate. When peace came and prices fell, rents
were found to be excessive, not to say impossible. But in Ireland with a
rapidly increasing population it was easier to put the rents up than to
bring them down. Other things helped to embarrass the poor cottager: he
paid twice over for his religion, tithes to the parson, dues to the
priest; and he paid all the more of the tithe in that the graziers, who
were mostly of the established Church and the occupiers of the fertile
plains, had taken care to make potato land titheable (at what date this
innovation arose is not stated) but had used their power in the Irish
Parliament to resist the tithe on arable pastures. Again the cottiers or
cottagers paid, in effect, the whole of the poor rate in the form of alms;
for the dogs of the gentry kept all beggars from their gates.


Famine and Fever in the West of Ireland, 1821-22.

The next famine in 1821-22 is remarkable for two things besides its purely
medical interest. Owing to the number of desperate evicted tenants, it
gave occasion to an increased activity of the secret associations,
especially the Whiteboys of Tipperary and Cork[479]; and it called forth
the first great dole of English charity in the form of princely
subscriptions to a Famine Fund. The English charity in 1822 was prompt and
large-hearted, contrasting with the tardy help from the exchequer in the
much more serious famine of 1817-18. The true explanation of it is,
doubtless, that England on the second occasion had more money to spare.
The trouble in 1821-22 came from the total loss of the potato crop in
Mayo, Galway, Clare and Kerry, and from a partial loss of it in some other
counties of the south and west. There was no corn famine, and no general
dearth. Accordingly it affected the poorest class only, and the most
remote districts chiefly. The planting season of 1821 had not been
favourable, and the yield of potatoes had been poor. But the autumn was so
wet in the west that the floods in some places washed away the soil with
the potatoes in it, and in other places drowned the potatoes after they
had been pitted. The flooded state of the basin of the Shannon was a
natural calamity on the great scale that touched the imagination and
loosened the purse-strings. A Committee was formed at the London Tavern,
which sat through the spring of 1822, and quickly raised an immense sum.
The great mercantile firms of the City and of Liverpool gave each a
thousand pounds; a ball at the Opera House under the patronage of the king
(George IV.) brought six thousand, and from all sources the Committee
found themselves with three hundred thousand pounds at their disposal
(forty-four thousand of it from Ireland), while a fund at the Dublin
Mansion House amounted to thirty thousand more. Much of this was sent to
Galway, Mayo, Clare and Kerry, in time to save many thousands of families
from starvation[480]; it was, no doubt, wastefully given away, and there
was a balance of sixty thousand pounds sterling unused. More tardily in
June, 1822, Parliament voted one hundred thousand “for the employment of
the poor in Ireland,” and in July two hundred thousand to meet
contingencies of the famine. It was generally admitted that the Government
grants were jobbed and misappropriated to a scandalous extent. The towns
had to be made the centres of relief and the depôts of provisions; and yet
the towns were not suffering from famine or fever but only from penury.
The fever hospital at Ennis, the county town of Clare, was constantly
filled by strangers, the townspeople remaining healthy. Kerry was one of
the most afflicted counties, but Tralee and Killarney had no unusual
sickness. Limerick town had hardly more fever than in an ordinary year. In
Dublin the admissions for fever in 1822 were a good deal below the usual
number. On the other hand, Sligo town had much fever, and Galway town had
an altogether unique experience, the history of which, as related by Dr
Graves, will be the best possible view of the peculiar circumstances of
1821-22[481].

In Connemara, where the distress was acute, there were no roads over which
the provisions from England could be carted to the famished districts.
Accordingly a great store was made in Galway, to which crowds flocked from
the country in boats and on foot. Many died a few days after they arrived,
from exhaustion or from the surfeit of food after long hunger. Galway, a
crowded place at best, with narrow streets and lanes, contained thousands
of strangers, who slept about the quays and the fish-market, or in the
lanes and entries, or in crowded lodging-houses four or five in a bed. The
fever began in May, and quickly spread so much that the priests were kept
fully employed by calls to the dying. In June and July the sixty beds of
the fever hospital were filled, principally with the fugitives from
Connemara. Sixty more beds were added, and these by the middle of
September were insufficient. The infection had now spread to many good
houses. When Dr Graves and three other Dublin physicians arrived, on 26
September, they found ropes stretched across the streets to stop the wheel
traffic. The shops of tradesmen were avoided. The town was like a place in
the plague; people passing along the streets put their handkerchiefs to
their noses when they came to a house with fever in it. Yet the number of
cases was not remarkable; on 3 October, there were 404 sick in a
population of 30,000, of whom 130 were in the fever hospital and 274 at
their homes, the new cases occurring at the rate of 29 per diem. At length
it was found practicable to set up depôts of provisions in country places,
and the crowd of strangers left Galway. The fever was mild but tedious
among the poor, more violent and fatal among the well-to-do. In many
country places dysentery and choleraic diarrhœa were prevalent, as well as
fever. In Erris, county Mayo, dysentery and dropsy were more common than
fever, many of the cottiers having subsisted on weeds, shell-fish, or new
potatoes dug six weeks after the seed was planted. In this famine the
people ate the flesh of black cattle dead of disease. Excepting in
Connemara the county of Galway was not so soon affected as some other
parts of Ireland; but, as in 1818, the contagion of fever was spread
abroad by vagrants. After Mayo, Galway, Clare and Kerry, the counties most
affected were Roscommon and Sligo, and next to these Leitrim, Tipperary
and Cork.


Dysentery and Relapsing Fever, 1826-27.

Fever and dysentery decreased to an ordinary level in 1823, but rose
somewhat again in 1824, the summer of which was hot and moist. But it was
in the hot and dry summers of 1825 and 1826 that dysentery became notably
common in Ireland generally and in Dublin in particular. It began in the
capital in June--among the richer class of people. About the middle of
August admissions for dysentery were perceptibly raising the number of
patients in the Cork Street Fever Hospital, and continued to do so
throughout the autumn. At one dispensary three out of four applicants had
dysentery. All those admitted to hospital were over twenty years of age;
of thirty-five cases under Dr O’Brien, nine died, all of which had
ulceration of the great intestine, in one case gangrenous. The mortality
was not nearly so great among the richer classes, in which respect
dysentery reversed the rule of typhus fever. O’Brien had one obvious case
illustrating the curious connexion between dysentery and rheumatic fever,
originally remarked by English observers in the 18th century. A hospital
porter was admitted with “fever of a mixed catarrhal and rheumatic type.”
Having been blooded and subjected to free evacuations, his fever left him
on the fourth day, but he was at once seized with dysentery, which ran its
course[482].

It is to be noted that this epidemic of dysentery began in Dublin in the
hot June weather of 1825 among the richer classes, and that there was no
notable increase of fever while it lasted. It appears to have declined in
Dublin in the early part of 1826. After a cold and dry spring there began
one of the hottest and driest summers on record. The first rain for four
months fell on the 15th of July, 1826, the thermometer rose as high as
86°, and was on a mean several degrees above summer temperature in Dublin.
In the spring labour had become slack, and before long it was estimated
that 20,000 artizans in the Liberties (weavers and others) were out of
work. Early in May there began a most extraordinary epidemic of relapsing
fever, with which some typhus was mixed. By the 9th of May, the 220 beds
of the Cork Street Hospital were full, and applicants were sent away
daily. On 4 August, a temporary hospital of 240 beds was opened in the
garden of the Meath Hospital; on the 18th, the Wellesley Hospital, in
North King Street, was opened with 113 beds; on the 15th, tents to hold
180 patients were erected on the lawn of the Cork Street Hospital, raising
its accommodation to 400; a warehouse in Kevin Street was furnished with
beds for 230 patients, and some increase was made to the beds in Sir
Patrick Dun’s and Stevens’s Hospitals. The whole number of fever-beds in
Dublin hospitals at length reached 1400; but not half the number of cases
was provided for. At a meeting in the Mansion House on 26 October, it was
stated that there were at that date 3200 persons sick of the fever at
their homes, besides the 1400 in the hospitals. Funds were subscribed,
soup-kitchens and dispensaries opened in various districts of Dublin, and
kept open most of the winter, “but they made little impression on the
epidemic, which continued with unabated violence.” In March, 1827, it
began suddenly to decline, and fell rapidly until it was nearly extinct in
May; and that, too, although “the complaints of distress and want are to
the full as loud as at the commencement of the epidemic, and provisions
are dearer[483].” The corresponding sicknesses in Edinburgh and Glasgow
were later--the fever chiefly in 1828, the dysentery in 1827 and 1828.

This great epidemic was mainly one of relapsing fever. The patient “got
the cool,” or passed the crisis of the fever, usually on the evening of
the fifth or seventh day, sometimes on the ninth, the evening
exacerbation, which was to prove critical, being ushered in generally with
a rigor, and passing off in profuse perspiration throughout the night. The
five-day fever was more certain to relapse than that of seven days, the
seven-day fever was more likely to relapse than that of nine days. The
relapses might be one or two or three or more, prolonging the illness for
weeks. The clear interval varied from twenty-four hours to fourteen days.
There were some cases with jaundice which led Stokes and Graves to speak
loosely of “yellow fever[484].” O’Brien saw only four cases with exquisite
icterus in fifteen hundred cases of relapsing fever. There was a small
proportion of cases of ordinary typhus of a severe kind, marked by
unusual delirium or phrensy and the absence of sordes on the teeth or
petechiae on the skin; the typhus cases became more numerous in the winter
season, or, in other words, the original attack lasted to nine, eleven, or
thirteen days, with little or no tendency to relapse. Gangrene was not
uncommon in one part of the body or another, and in four cases the feet
became gangrenous[485].

Even with the admixture of pure typhus cases, and with dysenteric
complications in the autumn and winter, the mortality of the whole
epidemic was small--not more than it would have been among a third part
the number of fever cases in an ordinary year. At the Cork Street Hospital
alone (including the tents) there were 8453 admissions from 4th August,
1826, to 4th April, 1827, with 332 deaths, or four deaths in a hundred
cases. The proportion of recoveries was quite as remarkable in known
instances in the squalid homes of the poor, where two or three would be
found ill of fever on one pallet, or a father and six children in one
room, shunned by the neighbours.

The strangest thing in this epidemic was the sequel of it. In the spring
of 1827, intermittent fever, which had not made its appearance for several
years in Dublin, began to prevail pretty generally; whilst the ordinary
continued fever showed a strong tendency to assume the intermittent and
remittent forms. It is not surprising, therefore, that Dr O’Brien, who had
these varied experiences of epidemic dysentery in 1825, of epidemic
relapsing fever and typhus in 1826, and of intermittent fever in 1827,
should adopt Sydenham’s language of epidemic constitutions, and revert to
the old Sydenhamian doctrine of causes. While the sequence of epidemic
diseases in Dublin was some dysentery in the autumn and winter of 1825 and
relapsing fever on a vast scale during the excessively dry spring and
summer of 1826, in country districts of Ireland, such as Skibbereen,
dysentery became epidemic after the great drought and heat of 1826, while
“fever disappeared altogether,” and indeed all other prevalent forms of
sickness gave way before it, so general was it. Such is the report from
Skibbereen, county Cork, a district that became early notorious, in the
great famine of 1846-47, and was perhaps a kind of barometer of Irish
distress twenty years earlier. The epidemic dysentery of 1826 attacked all
classes there, but chiefly the poorest; it was apt to begin insidiously,
and, as it was often neglected, so it often became obstinate and hard to
cure. Dr McCarthy attributed it to the drought of 1826, the commercial
distress of 1825, the lack of employment for labourers, the overgrowth of
population, and the alarming rise in the prices of food[486]. He uses the
same economic illustrations as O’Connell and Smith O’Brien in the Great
Famine twenty years after, which were, indeed, as old as the time of
Bishop Berkeley[487].

Although little is heard of the fever of 1826-27 except in Dublin, it is
probable that the same causes which produced it there were operative in
other large towns. The admissions to the Limerick Fever Hospital rose
rapidly in the end of 1826. Geary, who was appointed one of its physicians
that year, estimates that about one in twelve of the population of
Limerick (63,310) were treated for fever in 1827 at public institutions,
besides those treated in private practice. It was relapsing fever, as in
Dublin[488].


Perennial Distress and Fever.

According to all the figures of Irish fever-hospitals, and the
generalities of their physicians, fever was now constantly present in the
towns. After the relapsing epidemic of 1826-27 had subsided, there was no
rise above the steady level until the years 1831 and 1832, when a
considerable increase appears in the admissions to the hospitals of
Dublin, Limerick and Belfast. But the fever of 1831-32 was totally
eclipsed by the cholera, and little is heard of typhus in Irish writings
until 1835-36, when an epidemic arose, purely of typhus fever, which is
said to have been as severe upon some districts as that of 1817-18 had
been. This outbreak fell at the time of the Commission presided over by
the Earl of Devon, the report of which is authoritative for the state of
the Irish lower class and the causes of the same. The country cottiers and
the poor of the towns were always on the verge of starvation. Dr Geary, of
Limerick, in 1836 estimated as follows the proportion of poor to the whole
population, “the poor” being taken to mean “those who would require aid if
a Poor Law existed[489]:”

_Proportion of “Poor” in the several Parishes of Limerick, 1836._

                 St Nicholas   St John and
                 and St Mary   St Laurence   St Munchin   St Michael

  Population       14,629        15,667        4,071        16,226
  Number of Poor    7,000         6,400          930         2,500

Most of the poor lived in the old town of Limerick in lofty and
closely-built houses which the better classes had abandoned. These
dilapidated barracks were the abodes of misery and filth, two and often
three families occupying a single room: “It is here, as in the decayed
Liberties of Dublin[490], that the indigent room-keeper, the ruined
artisan, the unemployed labourer, and the ejected country cottier, with
their famishing families retreat.” Their degradation, Dr Geary thought,
was owing to the delay of Parliament in giving Ireland the Poor Law. The
sanitary state of the old town was disgraceful. Heaps of manure were
carefully kept in back yards, to be sold to farmers in the spring--“a very
principal source of livelihood” for those who collected it. Certain houses
near these depôts had always fever in them, dysentery was frequent, and
Exchange-lane never free from it[491]. An extensive glue-mill in the Abbey
poisoned the air with the effluvia of putrid animal matters. The following
table shows the number of fever-cases admitted to the Hospital or attended
from the Dispensary in 1827 and in four ordinary years thereafter:

_Limerick:--Table of Hospital Cases of Fever and Cases at their Homes
attended from the Dispensary._

        Hospital Cases                      Dispensary Cases
                      Average                        Average
                     mortality.                      mortality.
  Year Admitted Died  One in          Attended Died   One in     Total

  1827   2781    137    20             2800     80     35         5581
  1828    854     37    23              960     22     39         1714
  1829    506     23    22              640     18     35         1146
  1830    806     34    23½             910     25     36         1716
  1831   1015     65    15½             920     31     29         1935
                 -----------------------------------------------------
  Totals 5962    296    20             6130    176     34        12092

From 1831 to 1836 the admissions to hospitals were as follows:

  Year Admitted Died

  1832   1028    57
  1833    824    42
  1834    906    55
  1835   1484   121
  1836   3227   235

The last lines show the epidemic increase, which began in the autumn of
1835. It will appear from the following (by Geary) that it was largely an
epidemic of young people, and that the fatality was by far the greatest
among the comparatively small number of persons attacked at the higher
ages--a well-known law of typhus of which this Limerick demonstration was
perhaps the first numerically precise:

_Table of the Numbers admitted to Limerick Fever Hospital at stated ages
of five years, with the deaths, from 6 Jan. 1836 to 6 Jan. 1837._

                         Average
  Ages in               mortality
   Years  Admitted Died per cent.

     1-5    81       2     2¼
     5-10  489      13     2½
    10-15  762      18     2¼
    15-20  701      37     5¼
    20-25  362      22     6
    25-30  304      27     8¾
    30-35  100      12    12
    35-40  203      45    23¼
    40-45   70      13    18½
    45-50   82      22    27
    50-55   23       5    21½
    55-60   36      12    33¼
    60-65    2       1    50
    65-70   10       5    50
  Over 70    2       1    50
  ------------------------------
  Total   3227     235     7¼

One-sixth of these Limerick hospital cases, to the number of 567, came
from the county, chiefly from the damp, boggy districts five to sixteen
miles from the city. The whole admissions were rather more than the same
hospital received in the famine year, 1817. But, although 1836 was not a
year of special scarcity, there must have been some cause at work to
raise the perennial typhus to the height of an epidemic, not only in
Limerick, but in Dublin, Cork, Waterford, Ennis, Belfast, and other towns.
In the country, an epidemic outburst during the months of March, April and
May, 1836, in the parish of Donoughmore, Donegal, is perhaps only a sample
of others unrecorded: it was remarkable in that nine-tenths of the cases
of fever had as a sequel large boils on various parts of the body, but
principally on the limbs[492].

In Dublin, the influenza of the first months of 1837 seemed to check the
prevalence of typhus for a time; but the latter increased greatly when the
influenza was over, so that the admissions to the Cork Street Hospital
until the end of 1838 nearly equalled those of the worst epidemics since
the hospital was opened in 1804[493]. Females in typhus were admitted
greatly in excess of males; a large proportion (1847 in two years) were
under fifteen years of age; the fever rarely relapsed, so that it was
mostly typhus, as in England and Scotland at the same time. In twelve
months of the same period (Oct. 1837 to Sept. 1838) there were 1786
admissions for fever at Cork, 1840 at Limerick, and 1706 at Belfast[494].

In Dublin, as in London, Edinburgh and Glasgow, the continued fevers of
the “thirties” were distinctively spotted typhus, which was a new
constitution. Graves, lecturing at Dublin in November, 1836, said: “We are
now at a point of time possessing no common interest for the reflection of
medical observers. It is now nearly two years since my attention was first
arrested by the appearance of maculated fever, of which the first examples
were observed in some hospital cases from the neighbourhood of Kingstown.
This form of fever has lasted ever since, prevailing universally, as if it
had banished all other forms of fever, and being almost the only type
noticed in our wards[495].”

This increase of fever in Ireland, as well as the change in its type,
corresponded closely to the great epidemic outburst in Scotland and
England. The census of Ireland, taken in June, 1841, for the ten years
preceding, gave a somewhat loose return of the causes of death in each
year of the decennial period[496].

The worst years for fever were 1837 and 1840, the best year 1841. The
deaths from fever in ten years were 112,072, being 1 in 10·59 of the
deaths from all causes. The counties with highest fever mortality were
Cavan, Mayo, Galway and Clare; the worst towns were Belfast, Kilkenny,
Dublin, Limerick and Carrickfergus. Of these deaths from typhus-like
fevers, 14,501 occurred in 86 fever-hospitals, which were open, or which
kept records, for more or less of the decennial period. The following
table shows the proportions of rural, urban and hospital fever-deaths in
each of the four provinces:

_Deaths from fever in ten years, 1831-41._

                         Leinster      Munster       Ulster    Connaught

  Rural fever-deaths       16,159       23,718       21,616     19,319
  Urban                     4,626        4,878        3,183      1,262
  Hospital                  9,030        5,465        2,439        386
                          -----------------------------------------------
                           29,815       34,061       27,238       20,958

  Rural population }
  in 1841          }    1,531,106    2,009,220    2,160,698    1,338,635

  Ratio of do. per }
  sq. mile         }          247          332          406          386

The following detailed table for the province of Leinster shows the
enormous preponderance of fever-deaths in the cottages or cabins[497].
Only Dublin and Kilkenny have most of the deaths in their fever hospitals
or public institutions; it was not until near the end of this decennial
period, the year 1839, that workhouses, with their infirmaries, began to
be provided for all the poor-law unions:

_Fever Mortality in Leinster, 1831-41._

                       Deaths from Fever      Deaths
                       in Hospitals and     from Fever
    Localities        Public Institutions     at home        Total

  Carlow County                 202            891            1093
  Drogheda Town                   1            238             239
  Dublin County                 111           1248            1359
  Dublin City                  6393           2369            8762
  Kildare County                276           1068            1284
  Kilkenny County               114           2378            2492
  Kilkenny City                 487            204             691
  King’s County                 126           1754            1880
  Longford County                 3           1265            1268
  Louth County                    1           1201            1202
  Meath County                  294           2151            2445
  Queen’s County                 84           1763            1847
  Westmeath County               54           1550            1604
  Wexford County                637           1736            2373
  Wicklow County                280           1002            1282
                             --------------------------------------
                               9063         20,758          29,821


The Great Famine and Epidemic Sicknesses of 1846-49.

The great epidemic of relapsing fever, typhus, dysentery, anasarca and
purpura, which arose in Ireland in the end of 1846 or spring of 1847 and
lasted until the beginning of 1849, had for its direct antecedents the
more or less complete loss of the potato-crop through blight in two
successive autumns, 1845 and 1846, while the state of distress and
sickness was prolonged by the potato disease in 1847 and 1848[498]. The
potato-blight, which caused so much alarm in Ireland for the first time in
September, 1845, had been seen in Germany several years before, in Belgium
in 1842, in Canada in 1844, and in England about the 19th of August, 1845.
Shortly after the last date, it attacked the Irish potato-fields, first in
Wexford, and before the end of the year it was estimated that one-third to
one-half of the yield, which was a fifth larger than usual from the
greater breadth planted and the abundant crop, was lost by absolute
rottenness or unfitness for food, the process of decay being of a kind to
make great progress after the tubers were pitted. The loss to Ireland was
estimated at about one pound sterling per head of the population. Sir
Robert Peel was keenly alive to the magnitude of the calamity which
threatened the Irish peasantry. His first step was to summon to his aid a
botanist, Dr Lindley, and a chemist, Dr Playfair; the latter went down to
Drayton Manor, and joined the prime minister in examining samples of the
diseased potatoes. The question was whether some chemical process could
not be found to arrest the decay of the tubers. Sir Robert Peel, in a much
talked-of address at the opening of the Tamworth Reading-Room in the
winter of 1840, had hailed the rising sun of science and useful knowledge.
It was only in reference to morals and religion that Peel’s deliverance
called forth criticism, more particularly the memorable series of letters
to the _Times_ by John Henry Newman. But one of Newman’s gibes was in a
manner prophetic of Peel’s attitude in approaching the material distress
of Ireland: “Let us, in consistency, take chemists for our cooks, and
mineralogists for our masons.” The two professors proceeded to Ireland,
but could only confirm the fact, already known, that one-third, or
one-half, of the potato-crop would be lost.

Botany and chemistry being powerless to stay the effects of the
potato-blight, the appeal was next to economics. Ireland produced not only
potatoes but also corn. But for the most part the cottiers and cottagers
tasted little of the oats or wheat which they grew; as soon as the harvest
was gathered, the corn was sold to pay the November rents, and was
exported. Ireland was still in the paradoxical condition which Bishop
Berkeley puzzled over a hundred years before: “whether our exports do not
consist of such necessaries as other countries cannot well be without?”
The industry and trade of Irish ports was largely that of corn-milling and
shipping of oatmeal, flour and other produce; thus Skibbereen in the
extreme south-west, where the horrors of famine were felt first, had
several flour-mills and a considerable export trade in corn, meal, flour
and provisions. The Irish corn harvest of 1845 had been abundant:
O’Connell cited the _Mark Lane Express_ for the fact that 16,000 quarters
of oats from Ireland had arrived in the Thames in a single week of
October; on the 23rd of the same month the parish priest of Kells saw
fifty dray-loads of oatmeal on the road to Drogheda for shipment. Ireland
paid its rent to absentee landlords in corn and butter, just as a century
before it had paid it largely in barrelled beef, keeping little for its
own use besides potatoes and milk. In the face of the potato famine, the
measure approved by the Irish leaders of all parties, O’Connell and Smith
O’Brien as well as ducal proprietors, was to keep some of the oatmeal at
home. A committee which sat at the Dublin Mansion House were of opinion,
on 19 November, 1845, that the quantity of oats already exported of that
harvest would have sufficed to feed the entire population of Ireland.
O’Connell’s plan was to raise a million and a half on the annual revenue
of the Irish woods and forests (£74,000), and to impose a tax on
landlords, both absentee and resident, and with the moneys so obtained to
buy up what remained of the Irish corn harvest for use at home. In the
ensuing session of Parliament, both he and Smith O’Brien protested that
Ireland had no need of English doles, having resources of her own if the
landlords were compelled to do their duty.

About the same time Lord John Russell, leader of the Opposition, was led
by the danger of famine in Ireland to pronounce for the repeal of the Corn
Laws of 1815; and at the meetings of the Cabinet in December, Peel urged
the same policy upon his colleagues for the same reason. The political
history does not concern us beyond the fact that the threatened Irish
distress caused by the first partial potato-blight of 1845 was the
occasion of the Corn and Customs Act of June, 1846, by which the Corn Laws
were repealed, and that an Irish Coercion Bill, brought in on account of
outrages following an unusual number of evictions, was made the occasion
of turning out Peel’s ministry at the moment of its Free Trade victory, by
a combination of Tory protectionists, Whigs and Irish patriots.

The direct effects of the potato-blight of 1845 were not so serious as had
been expected. The Government quietly bought Indian meal (maize flour) in
America without disturbing the market, and had it distributed from twenty
principal food-depots in Ireland, to the amount of 11,503 tons, along with
528 tons of oatmeal. This governmental action ceased on the 15th of
August, 1846, by which time £733,372 had been spent, £368,000 being loans
and the rest grants. The people were set to road-making, so as to pay by
labour for their food, the number employed reaching a maximum of 97,000 in
August. The Government, having been led by physicians in Dublin to expect
an epidemic of fever, passed a Fever Act in March, 1846, by which a Board
of Health was constituted. But no notable increase of sickness took place,
and the Board was dissolved. There was a small outbreak of dysentery and
diarrhoea at Kilkenny (and possibly elsewhere) in the spring of 1846,
which the physician to the workhouse set down to the use of the Indian
meal “and other substitutes for potatoes[499].”

It was the total loss of the potato crop in the summer and autumn
following, 1846, together with a failure of the harvest in England and in
other countries of Northern Europe, that brought the real Irish distress.
A large breadth of potatoes had been planted as usual, but doubtless with
a good deal of the seed tainted. An ordinary crop would have been worth,
according to one estimate, sixteen millions sterling, according to
another, twice as much. The crop was a total loss. The fields looked well
in the summer, but those who dug the early potatoes found them unusually
small. About the beginning of August the blight began suddenly and spread
swiftly. A letter of the celebrated Father Mathew, the temperance
reformer, brings this out:

    “On the 29th of last month (July) I passed from Cork to Dublin, and
    this doomed plant bloomed in all the luxuriance of an abundant
    harvest. Returning on the 3rd instant (August) I beheld with sorrow
    one wide waste of putrefying vegetation. In many places the wretched
    people were seated on the fences of the decaying gardens wringing
    their hands and wailing bitterly the destruction that had left them
    foodless[500].”

The relief-works and distribution of Indian meal, which had been estimated
by the Government to last only to August, 1846, at a cost of £476,000
(one-half of it being a free grant), were resumed under the pressure of
public opinion, in the winter of 1846 and spring of 1847, a cost of
£4,850,000, one-half of the sum being again a free grant. Before the
distress was over, other free grants and advances were made; so that, on
15 February, 1850, Lord John Russell summed up the famine-indebtedness of
Ireland to the Consolidated Fund at £3,350,000, (which was to be repaid
out of the rates in forty years from that date). Allowing an equal sum
freely gifted from the national exchequer, the whole public cost of the
famine would have been about seven millions sterling.

The short crops in Britain in 1846 were an excuse for not interfering with
the export of oats from Ireland. The imports of Indian meal were left to
the ordinary course of the market, and the distribution to retail traders.
The corn merchants of Cork, Limerick and other ports made fortunes out of
the American cargoes, and the dealers throughout the country made large
profits.

To encourage the influx of foreign food-supplies, and to lower freights,
the Navigation Laws were suspended for a few months, so that corn could be
carried in other than British bottoms. When Parliament met in January,
1847, the distress in Ireland occupied the greater part of the Queen’s
Speech.

Lord George Bentinck proposed that sixteen millions should be advanced for
the construction of railroads, so as to give employment and wages to the
starving multitudes. The Government, however, objected that such relief
would operate at too great a distance, in most cases, from the homes of
the people; and it was urged by independent critics that a State loan for
railways would really be for the relief of the landlords more than of the
peasantry. The large sums actually voted were spent in road-making and in
procuring food and medical relief. A Board of Works directed the
relief-works. A Commissariat, with two thousand Relief Committees under
it, directed the distribution of food. A Board of Health provided
temporary fever-hospitals and additional physicians. It was not to be
expected that this machinery would work well, and, in fact, the public
relief was costly in its administration and often misdirected in its
objects. Private charities, especially that of the Society of Friends,
gave invaluable help, money being subscribed by all classes at home and
sent from distant countries, including a thousand pounds from the Sultan
of Turkey. On one day, the third of July, 1847, nearly three millions in
Ireland received food gratuitously from the hands of the relieving
officers. In March, 1847, the public works were employing 734,000. The
number relieved out of the poor rates at one time reached 800,000.
Workhouses were enlarged, and temporary fever-hospitals were built to the
number of 207, which in the two years 1847 and 1848, received 279,723
patients.

Emigration to the United States and Canada, which had averaged 61,242
persons per annum from the last half of 1841 to the end of 1845, rose
steadily all through the famine until it reached a total of 214,425 in the
year 1849, the passage money to the amount of millions sterling having
come largely from the savings of the Irish already settled in the New
World.

The grand effect of the famine upon the population of Ireland was revealed
by the census of 1851. The people in 1841 had numbered 8,175,124; in 1851
they numbered 6,515,794. The decrease was 28·6 per cent. in Connaught,
23·5 per cent. in Munster, 16 per cent. in Ulster, and 15·5 per cent. in
Leinster. In many remote parishes the number of inhabitants, and of
cabins, fell to nearly a half. The depopulation was wholly rural, so much
so that there was a positive increase of inhabitants not only in the large
county towns, but even in small towns such as Skull and Kanturk, situated
in Poor Law unions where the famine and epidemics had made the greatest
clearances all over[501]. Our business here is with the epidemical
maladies, which contributed to this depopulation; but a few words remain
to be said on the subject at large.

Malthus had been prophetic about this crisis in the history of Ireland.
Criticizing Arthur Young’s project to encourage the use of potatoes and
milk as the staple food of the English labourer instead of wheat, so as to
escape the troubles of scarcity and high prices of corn, Malthus says:

    “When, from the increasing population, and diminishing sources of
    subsistence, the average growth of potatoes was not more than the
    average consumption, a scarcity of potatoes would be, in every
    respect, as probable as a scarcity of wheat at present; and when it
    did arrive it would be beyond all comparison more dreadful. When the
    common people of a country live principally upon the dearest grain, as
    they do in England on wheat, they have great resources in scarcity;
    and barley, oats, rice, cheap soups and potatoes, all present
    themselves as less expensive, yet at the same time wholesome means of
    nourishment; but when their habitual food is the lowest in this scale,
    they appear to be absolutely without resource, except in the bark of
    trees, like the poor Swedes; and a great portion of them must
    necessarily be starved[502].”

The forecast of Malthus was repeated in his own way by Cobbett, although
neither of them foresaw the potato-blight as the means.

    “The dirty weed,” said Cobbett in a conversation in 1834, “will be the
    curse of Ireland. The potato will not last twenty years more. It will
    work itself out; and then you will see to what a state Ireland will be
    reduced.... You must return to the grain crops; and then Ireland,
    instead of being the most degraded, will become one of the finest
    countries in the world. You may live to see my words prove true; but I
    never shall[503].”

This is what has come to pass in a measure, and will come to pass more and
more. Only in some remote parts do the Irish cottiers now live upon
potatoes and milk. It has come to be quite common for them to grow an
Irish half acre of wheat, and, what is more to the purpose, to consume
what they thus produce instead of selling it to pay the rent. Doubtless
the enormous imports of American, Australian and Black Sea wheat have made
it easier for the Irish to have wheaten bread. But, whatever the reason,
they have at length adopted the ancient English staff of life, a staple or
standard which they were in a fair way to have achieved long ago, had not
their addiction to “lost causes and impossible loyalties” given an
unfavourable turn to the natural progress of the nation[504].

We come at length to the purely medical side of the great famine of
1846-47[505]. The distress in the latter part of the year 1846 was felt
first in the west and south-west--in the districts to which the famine of
1822 had been almost confined. It happened that the state of matters
around Skibbereen, the extreme south-western point of Ireland, was brought
most under public notice; but it is believed that there were parts of the
western sea-board counties of Mayo, Galway, Clare and Kerry from which
equally terrible scenes might have been reported at an equally early
period. It was in Clare that relief at the national charges was longest
needed.

Dr Popham, one of the visiting physicians to the Cork Workhouse, wrote as
follows:

    “The pressure from without upon the city began to be felt in October
    [1846], and in November and December the influx of paupers from all
    parts of this vast county was so overwhelming that, to prevent them
    from dying in the streets, the doors of the workhouse were thrown
    open, and in one week 500 persons were admitted, without any
    provision, either of space or clothing, to meet so fearful an
    emergency. All these were suffering from famine, and most of them from
    malignant dysentery or fever. The fever was in the first instance
    undoubtedly confined to persons badly fed or crowded into unwholesome
    habitations; and as it originated with the vast migratory hordes of
    labourers and their families congregated upon the public roads, it was
    commonly termed ‘the road fever’[506].”

It was the same in the smaller towns of the county, such as Skibbereen; in
the month of December, 1846, there were one hundred and forty deaths in
the workhouse; on one day there were fifteen funerals waiting their turn
for the religious offices. Still farther afield, in the country parishes,
the state of matters was the same. The sea-board parish of Skull was a
typical poor district, populous with cabins along the numerous bays of the
Atlantic, but with few residential seats of the gentry. On the 2nd of
February, 1847, the parish clergyman, the Rev. Traill Hall (himself at
length a victim to the contagion), wrote as follows:

    “Frightful and fearful is the havock around me. Our medical friend, Dr
    Sweetman, a gentleman of unimpeachable veracity, informed me yesterday
    that if he stated the mortality of my parish at an average of
    thirty-five daily, he would be within the truth. The children in
    particular, he remarked, were disappearing with awful rapidity. And to
    this I may add the aged, who, with the young--neglected, perhaps,
    amidst the widespread destitution--are almost without exception
    swollen and ripening for the grave[507].”

They were “swollen” by the anasarca or general dropsy, which was reported
from nearly all parts of Ireland as being, along with dysentery and
diarrhoea, the prevalent kind of sickness before the epidemic fever became
general in the spring of 1847. The same had been remarked as the precursor
of the fever of 1817-18. In the end of March, Dr Jones Lamprey, sent by
the Board of Health, found the parish of Skull “in a frightful state of
famine, dysentery and fever.” Dysentery had been by far more prevalent
than fever in this district, as in many others. “It was easily known,”
says Dr Lamprey, “if any of the inmates in the cabins of the poor were
suffering from this disease, as the ground in such places was usually
found marked with clots of blood.” The malady was most inveterate and
often fatal. It must have had a contagious property, for the physician
himself went through an attack of it[508].

In the Skibbereen district the dead were sometimes buried near their
cabins; at the town itself many were carried out in a shell and laid
without coffins in a large pit[509]. Along the coast of Connemara for
thirty miles there was no town, but only small villages and hundreds of
detached cabins; this district is said to have been almost
depopulated[510].

Besides the dysentery and dropsy, which caused most of the mortality in
the winter of 1846-47, another early effect of the famine was scurvy, a
disease rarely seen in Ireland and unknown to most of the medical men. It
was by no means general, but undoubtedly true scurvy did occur in some
parts: thus in the Ballinrobe district, county Mayo[511], it was very
prevalent in 1846 for some months before the epidemic fever appeared,
being “evidenced by the purple hue of the gums, with ulceration along
their upper thin margin, bleeding on the slightest touch, and deep
sloughing ulcers of the inside of the fauces, with intolerable
foetor”--affecting men, women, and children. In some places, as at
Kilkenny early in 1846, there was much purpura[512]. These earlier effects
of the famine (dysentery and diarrhoea, dropsy, scurvy and purpura), were
seen in varying degrees before the end of 1846 in most parts of Ireland.
The counties least touched by them were in Leinster and Ulster, such as
Down, Derry, Tyrone, Fermanagh and some others, where the peasantry lived
upon oatmeal as well as on potatoes. But even these were invaded by the
ensuing epidemic of fever, the only place in all Ireland which is reported
to have escaped both the primary and the secondary effects of the famine
having been Rostrevor, on the coast of Down, a watering-place with a rich
population, which was also one of the very small number of localities that
escaped in 1817-18.

According to the following samples of admissions to the Fever Hospital of
Ennis in the several months, the summers were the season of greatest
sickness, a fact which was noted also in the epidemic of 1817-18:

  Year   Month    Patients

  1846  November      93
   "    December     224
  1847  June         757
  1848  February     210
   "    May          705
   "    November     400

The almost uniform report of medical men was that the epidemic of fever
began in 1847, in the spring months in most places, in the summer in
others. Relapsing fever was the common type. It was usually called the
famine fever for the reason that it was constantly seen to arise in
persons “recovering from famine,” on receiving food from the Relief
Committees[513]. It was a mild or “short” fever, apt to leave weakness,
but rarely fatal. Dr Dillon, of Castlebar, reports that he would be told
by the head of a family: “We have been _three times down_ in the fever,
and have all, thank God, got through it.” Dr Starkey, of Newry, “knew many
families, living in wretched poverty on the mountains near the town, who
were attacked with fever, and who without any medical attendance, and but
little attendance of any kind, passed through the fever without a single
death.” The doctor of Bryansford and Castlewellan, county Down, (where
there was no famine), declared that the recoveries of the poor in their
own cottages destitute of almost every comfort, were astonishing. In the
Skibbereen district, Dr Lamprey was “often struck with the rarity of the
ordinary types of fever among the thousands suffering from starvation.” In
some of the most famine-stricken places, such as the islands off the
coast of Mayo and Galway, and in Gweedore, Donegal, not more than one in
a hundred cases of relapsing fever proved fatal. In Limerick the mortality
was “very small.” In many places it is given at three in the hundred
cases, in some places as high as six in the hundred. When deaths occurred,
they were often sudden and unexpected,--more probable in the relapse than
in the first onset. At Clonmel it was remarked that a certain blueness of
the nose presaged death; in Fermanagh it was called the Black Fever, from
the duskiness of the face. The report from Ballinrobe, Mayo, says that it
was attended by rheumatic pains, which caused the patients to cry out when
they stirred in bed[514]. It was mostly a fever of the first half of life,
and more of the female sex than of the male. One says that it was
commonest from five to fifteen years of age, another from ten to thirty
years.

Relapsing fever was the most common fever of the famine years, in the
cabins, workhouses and fever hospitals, in the country districts as well
as the towns and cities. Dr Henry Kennedy says of Dublin: “Cases of
genuine typhus were through the whole epidemic very rare, I mean
comparatively speaking.” But everywhere there was a certain admixture of
typhus, and in some not unusual circumstances the typhus was peculiarly
malignant or fatal--many times more fatal than the relapsing fever. The
poor themselves do not appear to have suffered much from the more
malignant typhus, unless in the gaols and workhouses. When the doors of
the Cork workhouse were thrown open in December, 1846, five hundred were
admitted pell mell in one week; the deaths in that workhouse were 757 in
the month of March, 1847, and 3329 in the whole year. In the Ballinrobe
workhouse, county Mayo, “men, women and children were huddled together in
the same rooms (the probationary wards), eating, drinking, cooking, and
sleeping in the same apartment in their clothes, without even straw to lie
on or a blanket to cover them.” Typhus at length appeared in that
workhouse, said to have been brought in by a strolling beggar, and the
physician, the master and the clerk died of it. Wherever the better-off
classes caught fever, it was not relapsing but typhus, and a very fatal
typhus. At Skibbereen the relapsing fever “was not propagated by
contagion; but in persons so affected, when brought in contact with the
more wealthy and better fed individuals, was capable of imparting fevers
of different types[515].” There were many opportunities for such
contact-in serving out food at the depôts, in superintending the gangs
working on the roads, in attending the sessions, in visiting the sick. The
crowds suffering from starvation, famine-fever or dysentery exhaled the
most offensive smells, the smell of the relapsing fever and the anasarca
being peculiar or distinguishable[516]. There appeared to be a scale of
malignity in the fevers in an inverted order of the degree of misery. The
most wretched had the mildest fever, the artizan class or cottagers had
typhus fatal in the usual proportion, the classes living in comfort had
typhus of a very fatal kind. This experience, however strange it may seem,
was reported by medical observers everywhere with remarkable unanimity.
One says that six or seven of the rich died in every ten attacks, others
say one in three. Forty-eight medical men died in 1847 in Munster, most of
them from fever; in Cavan county, seven medical men died of fever in
twelve months, and three more had a narrow escape of death: two of the
three physicians sent by the Board of Health to the coast of Connemara
died of fever[517]. Many Catholic priests died as well as some of the
Established Church clergy; and there were numerous fatalities in the
families of the resident gentry, and among others who administered the
relief. Yet a case of fever in a good house did not become a focus of
contagion; the contagion came from direct contact with the crowds of
starving poor, their clothes ragged and filthy, their bodies unwashed, and
many of them suffering from dysentery. The greater fatality of fever among
the richer classes had been a commonplace in Ireland since the epidemic of
1799-1801, and is remarked by the best writers[518]. At Loughrea, in
Galway, Dr Lynch observed that “in the year 1840 the type of fever was
very bad indeed, and very many of the gentry were cut off by it.” He
reckoned that ordinarily one in six cases of fever among the richer class
proved fatal, one in fifteen among the poor[519]. But in the great famine,
six years after, the fever of the poor assumed the still milder type of
relapsing, fatal perhaps to one in a hundred cases, or three in a hundred,
while the fever which contact with them gave to those at the other extreme
of well-being became a peculiarly malignant typhus, fatal to six or seven
in ten cases, as Dr Pemberton of Ballinrobe found, or to three or four in
ten cases, as many others found. Of course it was the peasantry who made
up by far the greater part of the mortality in the years of famine; but
they were cut off by various maladies, nondescript or definite, while the
richer classes died, in connexion with the famine, of contagious typhus
and here or there of contagious dysentery.

Even in the crowded workhouses and gaols, more deaths occurred from
dysentery than from fever. But in some of the gaols great epidemics arose
which cut off many of the poor by malignant infection. That was an old
experience of the gaols, studied best in England in the 18th century; the
worst fevers, or those most rapidly fatal, were caught by the prisoners
newly brought to mix with others long habituated to their miserable
condition. The gaols in Ireland during the famine were crowded to excess,
not so much because the people gave way to lawlessness--their patience and
obedience were matters of common complimentary remark--but because they
committed petty thefts, broke windows, or the like, in order to obtain the
shelter and rations of prisoners. The mortality in the gaols rose and fell
as follows[520]:

  Year    Deaths in gaol

  1846         130
  1847        1320
  1848        1292
  1849        1406
  1850         692
  1851         197

Most of the deaths in these larger totals came from two or three great
prison epidemics in each of the series of years--at Tralee,
Carrick-on-Shannon, Castlebar and Cork in 1847, at Galway in 1848, at
Clonmel, Limerick, Cork and Galway in 1849, the highest mortality being
485 deaths in Galway county gaol in 1848. Descriptions remain of the state
of the gaols at Tralee and Castlebar in 1847, from which it appears that
they were frightfully overcrowded and filthy. Dr Dillon, of Castlebar,
says that the county gaol there in March, 1847, had twice as many
prisoners as it was built for, “those committed being in a state of
nudity, filth and starvation.” He expected an outbreak of typhus, and
applied to the magistrates to increase the accommodation, which they
declined to do. In due time, very bad maculated typhus broke out, of which
the chaplain, matron and others of the staff died. This contagious fever
is said to have proved fatal to forty per cent. of those attacked by it.
The deaths for the year are returned at 83 in Castlebar gaol, those in
Tralee gaol at 101, and in the gaol of Carrick-on-Shannon at 100.

No exact statistical details of the mortality in the great Irish famine of
1846-49 were kept. Ireland had then no systematic registration of deaths
and of the causes of death, such as had existed in England since 1837.
Information as to the mortality was got retrospectively once in ten years
by means of the census, heads of families being required to fill in all
the deaths, with causes, ages, years, seasons, &c., of the same, that had
occurred in their families within the previous decennial period. This was,
of course, a very untrustworthy method, more especially so for the famine
years, when many thousands of families emigrated, leaving hardly a trace
behind, many hamlets were wholly abandoned, and many parishes stripped of
nearly half their inhabited houses. When a certain day in the year 1851
came round for the census papers to be filled up, a fourth part of the
people were gone, and that fourth could have told more about the famine
and the deaths than an equal number of those that remained. However, the
Census Commissioners did their best with the defective, loose or erroneous
data at their service. Much of the interest of the Irish Census of 1851
centered, indeed, in the Great Famine; and the two volumes of specially
medical information compiled by Sir William Wilde, making Part V. of the
Census Report, are a store of facts, statistical and historical, of which
only a few can be given here[521].

_Table of Workhouses and Auxiliary Workhouses in Ireland during the
Famine._

          No. of      Numbers    Numbers   Ratio of deaths
  Year  Workhouses   relieved   that died     One in

  1846     129       250,822    14,662       17·11
  1847     130       332,140    66,890        6·92
  1848     131       610,463    45,482       13·4
  1849     131       932,284    64,440       14·47
  1850     163       805,702    46,721       17·74

During the ten years from 6 June, 1841, to 30 March, 1851, the deaths from
the principal infective or “zymotic” diseases in the workhouses were as
follows:

  Dysentery      50,019
  Diarrhoea      20,507
  Fevers         34,644
  Measles         8,943
  Cholera         6,716
  Smallpox        5,016

Besides the workhouses, there were during the famine 227 temporary fever
hospitals, which received 450,807 persons from the beginning of 1847 to
the end of 1850, of whom 47,302 died.

According to the Census returns, the deaths from the several causes
connected with the famine were as follows in the respective years:

                       Dysentery
  Year     Fever    (with Diarrhoea)  Starvation

  1845     7,249       ------           -----
  1846    17,145        5,492           2,041
  1847    57,095       25,757           6,058
  1848    45,948       25,694[522]    }
  1849    39,316       29,446[523]    } 9,395
  1850    23,545       19,224           -----

According to this table, fever caused more deaths than dysentery. But
there are reasons for thinking that the deaths from dysentery, anasarca
and other slow effects of famine and bad food really made up more of the
extra mortality of the famine-years than the sharp fever itself. In the
returns from the workhouses, dysentery is actually credited with about
one-half more deaths than fever. It is known that most of the mortality at
the beginning of the famine, the winter of 1846-47, was from dysentery and
allied chronic forms of sickness. Dysentery also followed the decline of
the relapsing-fever epidemic of 1847-48. Dillon, of Castlebar, says that
many, who had gone through the fever in the autumn of 1847, fell into
dysentery in 1848, during which year it was very prevalent. Mayne says
that dysentery often attacked those recovering from fever, and proved
fatal to them[524]. In the General Hospital of Belfast the fatality of
fever-cases was 1 in 8, “but this included dysentery.” Probably the same
explanation should be given of the high rates of fatality in the Fever
Hospital of Ennis, the chief centre of relief for the greatly distressed
county of Clare: 1846, 1 in 12½; 1847, 1 in 5¾; 1848, 1 in 5½.

It will be noticed that some thousands of deaths were put down to
starvation in the Census returns. Perhaps a more technical nosological
term might have been found for a good many of these, such as anasarca or
general dropsy. But even if physicians had made the returns, instead of
the priests or relatives, they would have put many into a nondescript
class, for which starvation was a sufficiently correct generic name.
Scurvy was another disease of malnutrition which was far from rare during
the famine; the deaths actually set down to that cause were some hundreds
over the whole period.

The deaths from all causes in the decennial period covered by the Census
of 1851 were 985,366. But these returns were made, as we have seen, on a
population which had been reduced by a fourth part in the course of ten
years, so that they fall considerably short of the reality. If the
population of Ireland had multiplied at the same rate as that of England
and Wales from 1841 to 1851, namely, 1·0036 per cent. per annum, it should
have been 9,018,799 in the year 1851; but it was only 6,552,385.
Emigration beyond the United Kingdom had averaged 61,242 persons per annum
from the 30th of June, 1841, to the 31st December, 1845; next year, 1846,
it rose to 105,955, in 1847 it was “more than doubled,” in 1848 it was
178,159, in 1849, 214,425, in 1850 it was 209,054, and in 1851 it touched
the maximum, 249,721. Nearly a million emigrated in the six years
preceding the date of the Census, and there was besides a considerable
migration to Liverpool, Glasgow, London and other towns of England and
Scotland. It is probable that emigration accounts for two-thirds of the
decrease of inhabitants revealed by the Census of 1851; but the extra
mortality of the famine years, or the deaths over and above the ordinary
deaths in Ireland during a decennial period, can hardly be estimated below
half a million.


Decrease of Typhus and Dysentery after 1849.

The potato famines of 1845-48 were a turning-point in the history of
Ireland. From that time the population has steadily declined and the
well-being of the people steadily improved. By the Census of 1871 the
population was 5,386,708, by that of 1881 it was 5,144,983, by that of
1891 it was 4,704,750. Registration of births and deaths, which began in
1864, shows the following samples:

  Year    Births    Deaths

  1867   144,318    98,911
  1871   151,665    88,720
  1880   128,010   102,955
  1888   109,557    85,892

The enormous amount of pauperism which followed the great famine was at
length brought within limits: from 1866 to the present time it has been
marked by a steady increase of out-door relief, and by some increase in
the numbers within the Union Workhouses; the out-door paupers have
increased from 10,163 on 1 Jan., 1866, to 53,638 on 1 Jan., 1881, the
absolute number of indoor paupers having remained, on an average of good
and bad years, somewhat steady in a declining population.

The public health has been undisturbed by great epidemics since the potato
famine, although the effects of that calamity did not wholly cease until
some years after. It is best estimated by the mean annual average of
deaths among a thousand inhabitants, a ratio which has been low for the
provinces of Connaught and Munster, and not excessive for the provinces of
Ulster and Leinster. The following tables are of the death rates in two
sample years, 1880 and 1889 respectively[525]:

              1880   1889

  Connaught   15·3   12·4
  Munster     19·5   15·1
  Ulster      20·0   16·8
  Leinster    23·3   18·3

_Four healthiest counties_:

       1880         |       1889
  Mayo       14·5   |  Galway    11·8
  Sligo      15·3   |  Kerry     12·1
  Galway     15·6   |  Leitrim   12·1
  Roscommon  15·8   |  Cavan     12·2

_Four unhealthiest counties_:

        1880           |        1889
  Dublin co.     31·7  |  Dublin co.  24·5
  Waterford co.  24·9  |  Antrim      21·2
  Louth          22·6  |  Down        18·6
  Antrim         21·9  |  Armagh      17·0

The higher death rates of some counties are chiefly owing to their greater
urban populations. The health of the cottier districts is remarkably good,
and is rarely if ever disturbed by any _morbus miseriae_. The cabins,
except in a few remote parts, are more comfortable than they used to be,
the diet is better, the clothing is better, the education of the children
is better. The present happier lot of the Irish peasantry can be measured
not unfairly by the statistics showing the decrease in the number of
cabins of the lowest class, and the increase of dwellings in the higher
classes.

The history of fever and dysentery in Ireland subsequently to the great
epidemics of 1846-49 has few salient points. Dysentery, the old “country
disease,” has steadily declined to about a hundred deaths in the year,
while the considerable mortality from diarrhoea, nearly two thousand
deaths in a year, is nearly all from the cholera infantum or summer
diarrhoea of children in the large towns. The history of the continued
fevers is made complex by the modern identification of typhoid or enteric
fever. According to the testimonies of several, it played but a small part
in the epidemics of 1846-49, even in Dublin itself[526], and it can hardly
be doubted that its recent increase in that city is not apparent but real.
The following table from the year 1880 to the present time will show how
the deaths from continued fever are now divided in the registration
returns:

                  Simple
  Year  Typhus  continued  Enteric

  1880   934       1073     1087
  1881   859        774      813
  1882   744        657      844
  1883   810        593      853
  1884   628        572      693
  1885   505        443      716
  1886   394        380      772
  1887   405        385      740
  1888   362        330      741
  1889   359        250      968
  1890   391        231      855
  1891   266        183      859
  1892   268        210      714

This decline of typhus in a country where for many generations it seemed
to be a national malady is a remarkable testimony to the influence of the
changed conditions which have made typhus rare everywhere.

There are some interesting points in connexion with Irish typhus since
1849. After the subsidence of the great epidemic of relapsing and typhus
fevers (1847-49), says Dr Dennis O’Connor, of Cork, “intermittent fever
made its appearance, and, as long as it lasted, scarcely a case of
continued fever was seen. As soon as the last cases of intermittent
disappeared, the present epidemic broke out (1864-65), and still rages
with much severity. This alternation of continued and intermittent fever
is remarkable. Indeed it might have been observed that the fever of 1847
passed first into a remittent form, and gradually into the intermittent
which prevailed more or less for ten years subsequently[527].” The same
succession of relapsing fever by intermittent fever was observed after the
epidemic of 1826 by Dr John O’Brien, of Dublin[528]. The epidemic of fever
which Dr O’Connor describes for Cork in 1864-65, appeared in Dublin about
the same time--the latter half of 1864. It was of the nature of typhus in
both cities, cerebro-spinal in part, but probably not typhoid[529]. At
Cork it had some peculiarities--a croupous-like exudation on the tongue,
resembling thrush in the mouth, and a dark mottled rash (rubeola nigra),
or fiery red spots on a dark red ill-defined base. “The true typhoid rash
has been seen but seldom, and the petechiae of genuine typhus, so frequent
in former epidemics, have been equally rare. The latter I attribute to the
improved condition of our poor in good clothing and the ventilation of
their dwellings.” The intellect was little disturbed in this fever, there
was usually a crisis about the fourteenth day, and there were no relapses.
The sequelae were peculiar--“great nervous debility, leading to a
semi-paralysed state of the limbs,” congestion of the lungs, sometimes
solidification, or gangrene or suppuration of them. It occurred at a time
“when the food of the people is most abundant and of the best quality.”
There had been three bad harvests in succession from 1860, but it may be
inferred from a Dublin article of August, 1863, that no epidemic of typhus
had arisen in Ireland down to that date, although there was much typhus in
England, especially in Lancashire owing to the “cotton famine.” When the
epidemic did arise in Dublin, Cork, and doubtless elsewhere in Ireland, in
the latter part of 1864, to continue throughout 1865, it was not connected
with scarcity or distress among the common people. On the other hand, Dr
Grimshaw, of Dublin, found that it was subject to influences of the
weather, as if the infective principle had been a soil poison like that of
plague, yellow fever, cholera, or enteric fever. Taking the Cork Street
Fever Hospital for his study, he made out that there was a very close
correspondence, from the 29th of May to the 31st of December, 1864,
between the fluctuating pressure upon its accommodation and the periodic
rises in the atmospheric moisture and heat, the crowd of patients being
always greater when a high temperature coincided with a large
rainfall[530]. One would not have been surprised to find some such law as
that in enteric or typhoid fever, although a correspondence from day to
day is subject to many sources of fallacy; but, by all accounts, the
disease was typhus, the last of the considerable outbreaks of it in
Ireland hitherto, and an outbreak that seemed to require, both at Cork and
Dublin, the language of Sydenham’s epidemic constitutions for its adequate
description. For a good many years, the continued fever of Dublin has been
chiefly enteric or typhoid. As late as 1862 a physician to the Fever
Hospital, unconvinced by the method of Sir William Jenner, believed that
he observed a transition from the old typhus into the new enteric: “The
change at first seemed to be to the gastric type; to which was shortly
added diarrhoea in nearly every instance; and this latter, again,
occurring in a large number of cases which presented all the characters of
typhus, including a dense crop of petechiae[531].” Assuming that there had
been a mixture of cases of enteric and typhus fevers, the latter must have
had diarrhoea among the symptoms, as they often had in special
circumstances (as well as tympanitis). Since that time the species of
typhus has greatly declined, and the species of typhoid has considerably
increased. The remodelling which Dublin has undergone, like all other old
cities, explains the one fact. The notorious Liberties have been in great
part rebuilt, and the conditions of typhus, as well as its actual fomites,
to that extent removed. On the other hand, something has happened to
encourage the soil poison of enteric fever. It is not easy to say what are
the conditions that have favoured the enteric poison in modern towns; but
there can be little doubt about the fact in general, or that Dublin and
Belfast are among the best fields for the study of the problem[532].



CHAPTER III.

INFLUENZAS AND EPIDEMIC AGUES.


Epidemic agues are joined in the same chapter with influenzas for the
reason that they can hardly be separated in the earlier part of the
history. Until 1743 the name influenza was not used at all in this
country. The thing itself can be identified clearly enough in certain
instances from the earliest times. But there are periods, such as 1657-59,
1678-79, and 1727-29 when short waves of epidemic catarrhs or catarrhal
fevers came in the midst of longer waves of epidemic agues, “hot agues,”
or intermittents, the whole being called by the people “the new disease,”
or “the new ague,” while by physicians, such as Willis and Sydenham, they
were taken to be the distinguishable constituent parts of one and the same
epidemic constitution. The last period in which epidemic agues were so
recognised and named in England was from 1780 to 1785; and in the midst of
that also there occurred an epidemic catarrh--the “influenza” of the year
1782. It is possible that our own recent experience of a succession of
influenzas, or strange fevers, from 1889 to 1893, in some respects the
most remarkable in the whole history, would have seemed an equally
composite group if they had fallen in the 17th century and had been
described in the terminology of the time and according to the then
doctrines or nosological methods. Without prejudice to the distinctness
and unity of the influenza-type in all periods of the history, I am
unable, after trying the matter in various ways, to do otherwise than take
the epidemics of ague in chronological order along with the influenzas. As
the history will require the frequent use of the name “ague,” and, in due
course, that of the name “influenza,” it will be useful to examine at the
outset their respective etymologies and the meanings that usage has given
to them.

Originally the English name ague did not mean a paroxysmal or intermittent
fever, or a fever with a long cold fit followed by a hot fit, or the
malarial cachexia with sallowness, dropsy and enlarged spleen, or any
other state of health arising from the endemic conditions which are known
as malarial over so large a part of the globe in the tropical and
sub-tropical zones. It meant simply _acuta_, the adjective of _febris
acuta_ made into a substantive. Thus Higden’s reference in the
_Polychronicon_ (which is exactly in the words of Giraldus Cambrensis a
century and a half before) to the _febris acuta_ of Ireland is translated
by Trevisa (14th cent.): “Men of that lond haue no feuere, but onliche the
feuere agu, and that wel silde whanne”; and by an anonymous translator:
“The dwellers of hit be not vexede with the axes excepte the scharpe axes,
and that is but selde[533].” Again in the MS. English translation of the
Latin essay on plague by the bishop of Aarhus, the acute fever which is
described as the attendant or variant of bubo-plague proper (well known
long after as the pestilential fever, a malignant form of typhus), is thus
rendered:

    “As we see a sege or prevy next to a chambre, or of any other
    particuler thyng which corrupteth the ayer in his substance and
    qualitee: whiche is a thing maye happe every daye. And therof cometh
    the ague of pestilence. And aboute the same many physicions be
    deceyved, not supposing this axes to be a pestilence.... And suche
    infirmite sometime is an axes, sometime a postume or a swellyng--and
    that ys in many thinges.”

The same use of ague is continued in the first native English book on
fevers, Dr John Jones’s ‘Dyall of Agues,’ which has chapters on plague as
well as on pestilential fever and on all other fevers including
intermittents. In Ireland the name of ague was applied until a
comparatively late period to the indigenous typhus of the country, as if
in literal translation of the _febris acuta_ first spoken of by Giraldus
in the 12th century. Ague in early English meant any sharp fever, and most
commonly a continued fever. The special limitation to intermittents
appears to have followed the revival of the study of the Graeco-Roman
writers on medicine, Galen above all, in the sixteenth century. But Jones,
who was freer than the more academical physicians of his time from
classical influences, is shrewd enough to see that it was a mistake to
transfer the experiences of Greece verbatim to England and to make them
our standard of authority: he is speaking, however, not of intermittents
but of the simple ephemeral fever, or inflammatory fever of one day:

    “Such as have the fever of heat or burning of the sun, sayeth Galen,
    theyr skin is drye and hot as that which is perched with the sun; of
    the which, in this orizon and countrye of oures, we have no great nede
    to entreate of, leaving it to the phisitions and inhabitantes that
    dwell nerer to the meridionall line and hoter regions, as Hispaine and
    Africke[534].”

At a later date, when the Hippocratic tradition had displaced the Galenic,
Rogers of Cork, perhaps the earliest writer on fevers whose observations
are essentially modern, has occasion thus to reflect upon the extreme
deference of Sydenham to his Greek model: “Again we learn from Hippocrates
that fevers in the warmer climates of Greece, at Naxos, Thasos or Paros,
ran their course in certain periods of time, which no ways answers in
regions removed at a farther distance from the sun,”--Rogers himself
having had no experience of intermittents among all the fevers and
dysenteries that he saw from 1708 to 1734, although Cork was surrounded by
marshes[535].

At the time of the Latin translations of Greek medical writings by Linacre
and Caius in the Tudor period, there were in this country actual
experiences of strange fevers, which were interpreted according to the
Greek teaching of quotidians, tertians and quartans, with their several
bastard or hybrid or larval forms. These, as I have said, were certainly
not the endemic fevers of malarious districts; they were, on the contrary,
widely prevalent all over the country during one or more seasons in
succession and more occasional for a few years longer; then there would be
a clear interval of years, and again an universal epidemic of “the new
fever,” “the new acquaintance,” “the new ague” or the like.

Sydenham, for example, has much to say of agues or intermittents prevalent
in town and country for a series of years, and then disappearing for as
long a period as thirteen years at a stretch. But he does not count these
as the agues of the marsh; his single reference to the latter is in his
essay on Hysteria, where he interpolates a remark that, if one spends two
or three days in a locality of marshes and lakes, the blood is in the
first instance impressed with a certain spirituous miasma, which produces
quartan ague, and that in turn is apt to be followed, especially in the
more aged, by a permanent cachectic state[536]. If Sydenham had intended
to bring all the intermittents of his experience into that class, he would
not have left the paludal origin of them to a casual interpolated remark.
On the other hand, he refers the epidemic agues, which occupy his pen so
much, to emanations from the bowels of the earth, according to a theory of
his friend Robert Boyle, applied by the latter to epidemical infections in
general and to epidemic colds or influenzas in particular. Sydenham and
his learned colleagues were not ignorant of the endemic agues of marshy
localities, but they made little account of them in comparison with the
aguish or intermittent fevers that came in epidemics all over England.

In admitting the reality of such agues, we must be careful not to ascribe
them to such conditions as Talbor, the ague-curer, found in one village in
Essex. We must be careful not to do so, because there are plausible
reasons for doing so. The ground is much better drained now than formerly;
there is less standing water, fewer marshes, a much smaller extent of
water-logged soil. But the malarious parts of England have been tolerably
well defined at all times; and at all times the greater part of the
country was as little malarious as it is now. It is the frequent reference
to agues in old medical writings that has led some modern authors to
construct a picture of a marshy or water-logged England, for which there
is no warrant. Cromwell died of a tertian ague which he caught at Hampton
Court; therefore “the country round London in Cromwell’s time” must needs
have been “as marshy as the fens of Lincolnshire are now.” The country
round London was much the same then as now, or as in John Stow’s time, or
as in the medieval monk Fitzstephen’s time, or as it has ever been since
the last geological change. The ague of which Cromwell died in the autumn
of 1658 was one of those which raged all over England from 1657 to
1659--so extensively that Morton, who was himself ill of the same for
three months, says the country was “one vast hospital.” Whatever was the
cause of that great epidemic of “agues,” and of others like it, we have no
warrant to assume that “the country round London,” or wherever else the
epidemic malady prevailed, was then as marshy as the fens of
Lincolnshire[537].

The other name in the title of this chapter, influenza, appeared
comparatively late in the history. It is an Italian name, which is usually
taken to mean the influence of the stars. It may have got that sense by
popular usage, but the original etymology was probably different. As early
as the year 1554 the Venetian ambassador in London called the sweating
sickness of 1551 an _influsso_, which is the Italian form of _influxio_.
The latter is the correct classical term for a humour, catarrh, or
defluxion, the Latin _defluxio_ itself having a more special limited
meaning. It was not astrology, but humoral pathology, that brought in the
words _influxio_ and _influsso_; and I suspect that influenza grew out of
the latter, but not out of the notion of an influence rained down by the
heavenly bodies.

It was in 1743 that the Italian name of “influenza” first came to
England[538], the rumour of a great epidemic, so called, at Rome and
elsewhere in Italy having reached London a month or two before the disease
itself. The epidemic of 1743 was soon over and the Italian name forgotten;
so that when the same malady became common in 1762, some one with a good
memory or a turn for history remarked that it resembled “the disease
called influenza” nearly twenty years before. After the epidemic of 1782,
the Italian name came into more general use, and from the beginning of the
present century it became at once popular and vague. The great epidemics
of it in 1833 and 1847 fixed its associations so closely with catarrh that
an “influenza cold” became an admitted synonym for coryza or any common
cold attended with sharp fever. Lastly, the series of epidemics from 1889
to 1893 effectually broke the association with coryza or catarrh.

Before influenza became adopted as the common English name towards the end
of last century, what were the names popularly given to the malady in this
country? The earliest references to it are in the medieval Latin
chronicles under the name of _tussis_ or cough, or in some periphrasis. In
the fifteenth century the English name was “mure” or “murre,” which
appears to be the same root as in murrain. Thus the St Albans Chronicle,
under the year 1427, enters a certain “infirmitas rheumigata,” which in
English was called “mure”; and the obituary of the monks of Canterbury
abbey has two deaths from “empemata, id est, tussis et le murra[539].” In
the Tudor period there is no single distinctive name, unless it be “hot
ague”: in 1558 the name is “the new burning ague,” in 1562 “the new
acquaintance,” in 1580 “the gentle correction,” and at various times in
the 17th century “the new disease,” “the new ague,” “the strange fever,”
“the new delight,” “the jolly rant.” Robert Boyle called one sudden
outbreak “a great cold.” Molyneux, of Dublin, mentions “a universal cold”
in one year (1688), and “a universal transient fever” in another (1693).
The earlier 18th century writers mostly use the word catarrh or catarrhal
fever, either in Latin or in English, the popular names probably
continuing fanciful as before, as for example Horace Walpole’s “blue
plagues.” That which stands out most clearly in the English naming from
the earliest times is the idea of something new or strange; but the
newness or strangeness pertained quite as much to the agues as to the
catarrhs. The notion of ague may be said to be uppermost in the 16th and
17th centuries, that of catarrh in the 18th and 19th; while our very
latest experiences have once more brought a suggestion of ague to the
front.


Retrospect of Influenzas and Epidemic Agues in the 16th and 17th
centuries.

In the former volume of this history I have dealt with the various
epidemics of “hot ague,” “new disease” or the like down to the epidemic of
1657-59. It will be convenient to go over some of that ground again, with
a view to distinguish, if possible, the catarrhal types from the aguish,
and to illustrate the use of the word ague as applied to a universal
epidemic. Two of the epidemic seasons in the 16th century, 1510 and 1539,
are too vaguely recorded for our purpose; but I shall review briefly the
seasons from 1557-58 onwards.

    It is known from the general historians that there were two seasons of
    fever all over England in 1557 and 1558, of which the latter was the
    more deadly, the type according to Stow, being “quartan agues.” In
    letters of the time the epidemic of 1557 is variously named: thus
    Margaret, Countess of Bedford, writes on 9 August from London to Sir
    W. Cecil that she “trusts the sickness that reigns here will not come
    to the camp [near St Quentin, where Francis, Earl of Bedford was]....
    As for the ague, I fear not my son.” On the 18th of the same month,
    Sir Nicholas Bacon writes from Bedford to Cecil: “Your god-daughter,
    thanks be to God, is somewhat amended, her fits being more easy, but
    not delivered of any. It is a double tertian that holds her, and her
    nurse had a single, but it is gone clearly;” to which letter Lady
    Bacon adds a postscript about “little Nan, trusting for all this
    shrewd fever, to see her.” On 21 September, it appears that the
    sickness had reached the English camp near St Quentin, for the Earl of
    Bedford writes: “Our general is sick of an ague, our pay very slack,
    and people grudge for want.” As late as the 25th October the Countess
    of Bedford writes from London to Cecil that she “would not have him
    come yet without great occasions, as there reigns such sickness at
    London[540].”

    Next year, 1558, the epidemic sickness returned in the summer and
    autumn, in a worse form than before. Stow calls it “quartan agues,”
    which destroyed many old people and especially priests, so that a
    great number of parishes were unserved. Harrison, a canon of Windsor,
    says that a third part of the people did taste the general sickness.
    On the 6th September, sickness affected more than half the people in
    Southampton, Portsmouth, and the Isle of Wight. From the 20th October
    to the end of the year, no fewer than seven of the London aldermen
    died, a number hardly equalled in the first sweating sickness of 1485,
    and the queen (Mary) died of the lingering effects of an ague, which
    was doubtless the reigning sickness. On 17th October, the English
    commissioners being at Dunkirk to negotiate the surrender of Calais,
    one of them, Sir William Pickering, fell “very sore sick of this new
    burning ague: he has had four sore fits, and is brought very low, and
    in danger of his life if they continue as they have done.” That year
    Dr Owen published _A Meet Diet for the New Ague_, and himself died of
    it in London on the 18th of October[541].

    Fuller quaintly describes the ague of 1558 as “a dainty-mouthed
    disease, which, passing by poor people, fed generally on principal
    persons of greatest wealth and estate[542].” Roger Ascham wrote in
    1562 to John Sturmius that, for four years past, or since 1558, “he
    was afflicted with continual agues, that no sooner had one left him
    but another presently followed; and that the state of his health was
    so impaired and broke by them that an hectic fever seized his whole
    body; and the physicians promised him some ease, but no solid
    remedy[543].” Thoresby, the Leeds antiquary of the end of the 17th
    century, found in the register of the parish of Rodwell, next to
    Leeds, a remarkable proof of the fatality of these agues, which fully
    bears out the general statements of Stow and Harrison. In 1557 the
    deaths in the register rose from 20 to 76, and in 1558, which the
    historians elsewhere say was the most fatal year, they rose to
    124[544]. This was as severe as the sweating sickness of 1551, for
    example in the adjoining parish of Swillington, or in the parish of
    Ulverston, in Lancashire[545].

The English names of the epidemic sickness in the summers and autumns of
1557 and 1558 are all in the class of agues--“this new burning ague,” “a
strange fever,” “divers strange and new sicknesses taking men and women in
their heads, as strange agues and fevers,” “quartan agues.” One medical
writer, Dr John Jones, says in a certain place that “quartans were
reigning everywhere,” and in another place, still referring to 1558, that
he himself had the sickness near Southampton, that it was attended by a
great sweat, and that it was the same disease as the sweating sickness of
1551. There were certainly two seasons of these agues, 1557 and 1558, the
latter being the worst; and it is probable from Short’s abstracts of a few
parish registers in town and country that there was a third season of them
in 1559. The year 1557 has been made an influenza year, perhaps because
the Italian writers have emphasized catarrhal symptoms here or there in
the epidemic of that year; while both the years 1557 and 1558 have been
received into the chronology of epidemic or pandemic agues or malarial
fevers[546]. There are perhaps a dozen English references in letters and
chronicles to the sicknesses of those years, either to particular cases or
to a general prevalence, but they do not enable us to distinguish a
catarrhal type in 1557 from the aguish type which they assert for both
1557 and 1558.

Four years after, another very characteristic influenza was prevalent in
Edinburgh.

    Randolph writes from Edinburgh to Cecil in the end of November, 1562:
    “Maye it please your Honer, immediately upon the Quene’s (Mary’s)
    arivall here, she fell acquainted with a new disease that is common in
    this towne, called here the newe acqayntance, which passed also
    throughe her whole courte, neither sparinge lordes, ladies nor
    damoysells, not so much as ether Frenche or English. It ys a plague in
    their heades that have yt, and a sorenes in their stomackes, with a
    great coughe, that remayneth with some longer, with others shorter
    tyme, as yt findeth apte bodies for the nature of the disease. The
    queen kept her bed six days. There was no appearance of danger, nor
    manie that die of the disease, excepte some olde folkes. My lord of
    Murraye is now presently in it, the lord of Lidingeton hathe had it,
    and I am ashamed to say that I have byne free of it, seinge it seketh
    acquayntance at all men’s handes[547].”

It is not improbable that the interval between 1558 and 1562 may have been
occupied with milder revivals of the original great epidemic, the one at
Edinburgh counting in the series.

It appears from a Brabant almanack for the year 1561 that a sudden
catarrhal epidemic was quite on the cards in those years: the astronomer
foretells for the month of September, 1561: “Coughs innumerable, which
shall show such power of contagion as to leave few persons unaffected,
especially towards the end of the month[548].” There is an actual record
from more than one country (Italy, Barcelona, as well as Edinburgh) of
such universal catarrhs and coughs a year later than the one foretold. The
Italian writers assign the universal catarrhs and coughs to the autumn of
1562, the Barcelona writer to the winter solstice of that year, and the
letter from Edinburgh to “the laste of November.”

The next undoubted influenza, that of 1580, was compared abroad to the
English sweat:

    “In some places,” says Boekel, “the sick fell into sweats, flowing
    more copiously in some than in others, so that a suspicion arose in
    the minds of some physicians of that English sweat which laid waste
    the human race so horribly in 1529;” and again, “the bodies were
    wonderfully attenuated in a short time as if by a malignant sudden
    colliquation, which made an end of the more solid parts, and took away
    all strength[549].” The season of it was the summer.

    The outbreak attracted much attention from its universality, and was
    described by many abroad.

    Boekel says that it was of such fierceness “that in the space of six
    weeks it afflicted almost all the nations of Europe, of whom hardly
    the twentieth person was free of the disease, and anyone who was so
    became an object of wonder to others in the place.... Its sudden
    ending after a month, as if it had been prohibited, was as marvellous
    as its sudden onset.” It came up, he says, from Hungary and Pannonia
    and extended to Britain. The principal English account of this
    epidemic comes from Ireland[550]. In the month of August, 1580, during
    the war against the Desmonds, an English force had advanced some way
    through Kerry for the seizing of Tralee and Dingle; “but suddenlie
    such a sicknes came among the soldiers, which tooke them in the head,
    that at one instant there were above three hundred of them sicke. And
    for three daies they laie as dead stockes, looking still when they
    should die; but yet such was the good will of God that few died; for
    they all recovered. This sicknesse not long after came into England
    and was called the gentle correction.”

    This outbreak among the troops in Ireland is said to have been in
    August, before the sickness came to England. But it can be shown to
    have been at its height in London in the month of July. The year 1580
    was almost free from plague in London; the weekly deaths are at a
    uniform low level (a good deal below the births) from January to
    December, except for the abrupt rise shown in the following
    table,--the kind of rise which we shall see from many other instances
    to be the infallible criterion of an influenza[551]:

    _Weekly Deaths in London._

    1580.

                        Deaths by     Dead of
        Week ending     all causes    plague      Baptised

        June  23           55           2           59
         "    30           47           4           57
        July   7           77           4           65
         "    14          133           4           66
         "    21          146           3           61
         "    28           96           5           64
        Aug.   4           78           5           73
         "    11           51           4           53
         "    18           49           1           72

    As in 1557-58, the English references are to agues, both before and
    after the Gentle Correction of July-August, 1580. Cogan says that for
    a year or two after the Oxford gaol fever (1577) “the same kind of
    ague raged in a manner all over England and took away many of the
    strongest sort in their lustiest age, etc.” And he seems to have the
    name “gentle correction” in mind when he says: “This kind of sickness
    is one of those rods, and the most common rod, wherewith it pleaseth
    God to brake his people for sin.” Cogan’s dates are indefinite. But
    there is a letter of the Earl of Arundel to Lord Burghley, 19th
    October, 1582, which shows that “hot ague” was epidemic as late as the
    second autumn after the influenza proper: “The air of my house in
    Sussex is so corrupt, even at this time of the year, as when I came
    away I left twenty-four sick of hot agues.”

Two such epidemics in England as those of 1557-8 and 1580-82, of hot agues
or strange fevers, taking the forms of simple tertian or double tertian or
quartan or other of the classical types, would have made ague a familiar
disease, and its name a household word. For not only were there two or
more aguish seasons (usually the summer and autumn) in succession, but to
judge by later experience there would have been desultory cases in the
years following, and in many of the seizures acquired during the height of
the epidemic, relapses or recurrences would have happened from time to
time or lingering effects would have remained. Hence it is unnecessary to
assume that the agues that we hear casual mention of had been acquired by
residence in a malarious locality. They may have been, and most probably
were, the agues of some epidemic prevalent in all parts of the country.
These epidemics were the great opportunities of the ague-curers, as we
shall see more fully in the sequel. It is to the bargaining of such an
empiric with a patient that Clowes refers in 1579: “He did compound for
fifteen pound to rid him within three fits of his ague, and to make him as
whole as a fish of all diseases.”

There were more sicknesses of that kind, perhaps not without a sweating
character, in the last ten years of the 16th century[552]. But they are
indefinitely given as compared with earlier and later epidemics, and I
shall pass to the next authentic instance.

    The autumn of 1612 was undoubtedly a season of epidemic ague or “new
    disease” in England[553]. When Prince Henry, eldest son of James I.,
    fell ill in November, in London, during the gaieties attending the
    betrothal of his sister the Princess Elizabeth to the Count Palatine
    of the Rhine, a letter-writer of the time said of his illness: “It is
    verily thought that the disease was no other than the ordinary ague
    that hath reigned and raged almost all over England since the latter
    end of summer[554].” The attack began in the end of October. The
    spirited and popular prince had been leading the gaieties in place of
    his father, who could not stand the fatigue, and was “seized by a
    fever that came upon him at first with a looseness, but hath continued
    a quotidian ever since Wednesday last [before the 4th of November],
    and with more violence than it began, so that on Saturday he was let
    blood by advice of most physicians, though Butler, of Cambridge, was
    loth to consent. The blood proved foul: and that afternoon he grew
    very sick.... I cannot learn that he had either speech or perfect
    memory after Wednesday night, but lay, as it were, drawing on till
    Friday between eight and nine of the evening that he departed. The
    greatest fault is laid on Turquet, who was so forward to give him a
    purge the day after he sickened, and so dispersed the disease, as
    Butler says, into all parts; whereas if he had tarried till three or
    four fits had been passed, they might the better have judged of the
    nature of it; or if, instead of purging, he had let him blood before
    it was so much corrupted, there had been more probability.” At the
    dissection, the spleen was found “very black, the head full of clear
    water and all the veins of the head full of clotted blood. Butler had
    the advantage, who maintained that his head would be found full of
    water, and Turquet that his brains would be found overflown and as it
    were drowned in blood[555].” Butler, it appears, was “a drunken sot.”
    When King James asked him what he thought of the prince’s case, he
    replied “in his dudgeon manner” with a tag of verse from Virgil ending
    with “et plurima mortis imago.” The Princess Elizabeth could not be
    admitted to see her brother “because his disease was doubted to be
    contagious[556].” It was at least epidemic, for in the same week
    alderman Sir Harry Row and Sir George Carey, master of the wards, died
    “of this new disease[557].” The earliest reference to it that I find
    is the death, previous to 11 September, of Sir Michael Hicks at his
    house Rackholt in Essex, “of a burning ague,” which came, as was
    thought, by his often going into the water this last summer, he being
    a man of years[558]; but much more probably was a case of “the
    ordinary ague that hath reigned and raged almost all over England
    since the latter end of summer.” The next year was still more
    unhealthy, to judge by samples of parish registers; agues are
    mentioned also in letters; thus, one going on 25 March, 1613, to visit
    Sir Henry Savile, found him “in a fit, an ague having caught hold of
    him[559].”

    The winter of 1613-14 was marked by most disastrous floods in Romney
    Marsh, in Lincolnshire, in the Isle of Ely, and about Wisbech, and
    most of all in Norfolk[560]; but the malarious conditions so brought
    about, being subsequent to, were not conceivably the cause of, the
    epidemics of ague in the autumn of 1612 and 1613, which made so great
    an excess of burials over christenings in the parish registers.

    A curious record remains of an aguish sickness in a child, which had
    begun about January, 1614. On 18 March, of that year, the dowager
    Countess of Arundel wrote from Sutton, near Guildford, to her son Earl
    Thomas, who was making the grand tour to Rome and elsewhere with his
    wife, and had left the children to the care of their grandmother:
    “Your two elder boys be very well and merry, but my swett Willm.
    continueth his tersion agu still. This day we expect his twelfth fitt.
    I assur myselfe teeth be the chefe cause. I look for so spedy ending
    of it, he is so well and merry on his good days, and so strong as I
    never saw old nor yonge bear it so well. I thank Jesu he hath not any
    touch of the infirmity of the head, but onely his choler and flushe
    apareth, but he is as lively as can be but in the time of his fits
    onely, which continueth some eight hours[561].”

    The epidemic of ague or “new disease,” which began to rage all over
    England in the end of the summer, 1612, had probably recurred in the
    years following, down to 1616. There is not a trace of plague during
    those years in any known record; and yet they are among the most
    unhealthy years in Short’s abstracts of town and country parish
    registers[562].

The first half of the 17th century is a period which is almost a blank in
the conventional annals of “influenza” in Europe. But that period, which
was the period of the Thirty Years’ War, had many widespread sicknesses. I
do not wish to claim these as influenzas, or to contend that they were
infections equivalent thereto in diffusiveness. We may, however, find a
place for them in this context; for they were certainly as mysterious as
any epidemics admitted into the canon of influenzas. So far as concerns
Britain, the first was the epidemic ague, or “new disease,” of 1612 and
1613, probably recurring until 1616. The second was the universal spotted
fever of 1623 and 1624, of which I have given an account in the chapter on
typhus. That was followed by the plague of 1625, and that again by a
harvest ague in the country in the end of the same year. The next epidemic
ague or “general sickness, called the new disease,” fell mostly in England
upon the two years 1638 and 1639. It was in part a harvest ague, “a
malignant fever raging so fiercely about harvest that there appeared
scarce hands enough to take in the corn[563]”; but it was also a winter
disease. I pass over the war-typhus of 1643, to which the name of “new
disease” was also given, and the widespread fever of the year following.
In 1651 we hear again of a strange ague, which “first broke out by the
seaside in Cheshire, Lancashire and North Wales,” eighty or a hundred
being sick of it at once in small villages. Whitmore, who saw this
epidemic in Cheshire, identified it with the Protean disease which he
described in 1657-58, and hazarded the theory that the former was a
diluted or “more remiss” infection carried by the wind from Ireland, where
the plague was then raging, in Dublin, Galway, Limerick and other places,
after their sieges or occupations by the army of the Commonwealth.

Thus in the first half of the 17th century we have more or less full
evidence of epidemics of “new disease” in 1612-13, 1623-24, 1625, 1638-9,
1643-4 and 1651, not one of which was an influenza as we understand the
term[564].

We come at length to the years 1657-59, in the course of which one
catarrhal epidemic, or perhaps two, did prevail for a few weeks. The hot
agues or “new disease” had been raging all over the country from the
summer of 1657; then in April, 1658, there came suddenly universal coughs
and catarrhs, “as if a blast from the stars”; they ceased, and the hot
agues dragged on through the summer and autumn. A letter from London, 26
October, 1658, says: “A world of sickness in all countries round about
London: London is now held to be the wholesomest place,” and adds that
“there is a great death of coach-horses almost in every place, and it is
come into our fields[565].” It was after this, in the spring of 1659, if
Whitmore has made no mistake in his dates, that coughs and catarrhs
“universally infested London, scarce leaving a family where any store
were, without some being ill of this distemper.” The details have been
given fully in the former volume[566]. I wish merely to remark here that
the two catarrhal epidemics, or influenzas proper, in two successive
springs, were sharply defined episodes in the midst of a period of
epidemic agues, and that the “new disease” as a whole, during the two or
three years that it lasted, had such an effect in the way of ill health
and mortality that it was afterwards viewed as a “little plague” worthy of
being set in comparison with the Great Plague of 1665.

Willis does not say that the epidemic agues lasted after 1658, perhaps
because his essay was printed early in 1659; but Whitmore, whose preface
is dated November, 1659, says, without distinguishing the hot ague from
the catarrhal fever but speaking of them both as one Protean malady: “it
now begins again, seizing on all sorts of people of different nature,
which shows that it is epidemic.” Sydenham does not appear upon the scene
until 1661; but when his epidemic constitutions do begin, it is with
intermittents or agues, which lasted, according to him, until 1664.
Perhaps if Sydenham’s experience had extended back to 1657 he would have
made his aguish constitution to begin with that year, and to go on
continuously until 1664. At all events it does not appear that the year
1660 was a clear interval between Willis’s and Whitmore’s period of
1657-59, Sydenham’s period of 1661-64; for it so happens that John Evelyn
has left the following note of his own illness:

    “From 17 February to 5 April [1660] I was detained in bed with a kind
    of double tertian, the cruell effects of the spleene and other
    distempers, in that extremity that my physicians, Drs Wetherburn,
    Needham and Claude were in great doubts of my recovery.” Towards the
    decline of his sickness he had a relapse, but on the 14th April “I was
    able to go into the country, which I did to my sweete and native aire
    at Wooton.” On the 9th of May he was still so weak as to be unable to
    accompany Lord Berkeley to Breda with the address inviting Charles II.
    to assume the crown.

Sydenham makes the “constitution” which began for him in 1661 to decline
gradually, and to end definitely in 1664, after which he finds
intermittents wholly absent for thirteen years, or until 1677. This clear
interval will make a convenient break in the chronology, whereat we may
bring in the popular and professional notions of ague then current, and
the popular practice in that disease by empirics.


The Ague-Curers of the 17th Century.

It is to be observed that all the respectable writers of the profession
speak of agues or intermittents as epidemic over the country for a
definite period, and as disappearing thereafter for years together. At the
same time they say little or nothing of the endemic malarious fevers of
marshy localities. Further, it appears that the professed ague-curers,
although they would wish to represent ague as a perennial disease, are
really basing upon the same experiences of occasional epidemics which
Willis, Whitmore and Sydenham recorded as occasional. The best instance of
this is the ‘Pyretologia’ by Drage of Hitchin. It was published for
practice in 1665, being designed to show forth the author’s skill as an
ague-curer[567]. When we examine its generalities closely, we find that
they all come from the sickly season of 1657, the first of those described
by Willis.

    The great autumnal epidemic of that year (and the following), which we
    know from other sources to have been reckoned a “little plague,” he
    describes as “a malignant sickness,” which was followed in the winter
    by quartans. He himself escaped the autumnal fever but he incurred the
    quartan later in the year. In his own case, while the original
    paroxysm of this ague was still going on, a new one arose towards
    evening, and again, on the following day, a new paroxysm gathered
    vigour and supplanted the old, becoming the substantive paroxysm. Many
    of those who died of the quartan in 1657 had either the paroxysms
    duplicated, or a total want of them, or, in another passage, “the
    quartan which followed the autumnal disease of heterogeneous quality
    in 1657, cut off divers old people, the fever being erratic,
    duplicated or triplicated.” It was a bad sign when the quartan became
    doubled or trebled; regularity of the paroxysm was a sign of a good
    recovery. The symptoms of a quartan are various; but it is not easy to
    pronounce that these all are the symptoms of an intermittent fever, or
    the prodromal signs thereof, unless intermittent fevers be epidemic at
    the time. He gives the case of a civil and pious priest who had a
    tedious quartan from being struck with lightning; he was confined to
    bed for two years, with loss of hearing, but, strangely enough,
    retaining the use of his eyes; sometimes he was vexed with
    convulsions, sometimes with quartan fever. The “plebs medicorum” say
    that a quartan fever comes of melancholy, a tertian of choler, a
    quotidian of putrefied pituitous matter. The “plebs plebis” think that
    the cause is wind or flatus, and that they get rid of the ague by
    belching. In his own case he observed that if he drank more cold ale
    than usual, he was seized with distension in the loins and with
    palpitation, and belched up “flatus and crass vapours infected with
    the quality of a quartan.” He knew a man who, in the fourth or fifth
    month of a quartan, drank wine too freely, so that the paroxysms came
    every day, and that violently; after a week he had an especially
    severe paroxysm, and then no more for three weeks, when the fever
    returned under the type of an exquisite quartan. One case, which he
    mentions twice, led him to doubt whether quartans were not catching:
    a certain girl suffering from a quartan asked her father, who was
    skilled in the art, to open a vein; her parent declared that during
    the blooding the morbid smell of the flowing blood reached his
    nostrils, so that he was seized of his daughter’s fever at the proper
    time of her paroxysms, having three or four ague fits in due order;
    meanwhile the girl was free from the paroxysms for a whole week, but
    no longer. The singular nature of quartans is further brought out in
    the fact that papules, pustules and exanthems breaking out on the skin
    were quite common in the quartan fever which followed the malignant
    epidemic of the autumn of 1657. “In the fevers hardly any heat is
    perceived; and so the unskilled vulgar say ‘This is an ague’ (Hoc est
    anglicè _Ague_), and ‘This is fever and ague’ (Et hoc est febris et
    anglicè _Ague_) when cold and heat are mixed equally or combined
    regularly.” Peruvian bark does not evacuate the morbific matter unless
    by chance it provokes vomiting; cases treated by it often relapse, and
    are not well in the intervals. Bark does not occur in his own
    prescriptions; but he had cured many with “pentaphyllum.” He knew
    several physicians in the epidemic of quartans in 1657 who trusted to
    narcotics entirely.

Drage must have had a real experience of aguish distempers of one kind or
another during the sickly seasons of 1657-59. But it is clear from the
essays or advertisements of empirics that agues were discovered in many
forms of sickness that were neither intermittent fevers nor fevers of any
distinctive type. One of these practitioners in the time of Charles I.
claims to be “the king’s majesty’s servant in ordinary[568]”; which is not
incredible, as Sir Robert Talbor, whom Charles II. deigned to honour, was
an ague-curer of the same class.

    “An ague, which hitherto amongst all sorts hath been accounted the
    physitian’s shame, both for definition and cure (thus farre hath
    ignorance prevailed), but that the contrary is manifest appeareth
    sufficiently by this following definition: and shall be cured whether
    tertian, quartern or quotidian, by me Aaron Streater, physitian of
    Arts in Oxford, approved by Authority, the King’s Majesties servant in
    ordinary, and dwelling against the Temple, three houses up in
    Chancerie Lane, next house to the Golden Anchor.” An ague, he goes on,
    “is either interpolate (intermittent) or continual; it is either
    engendered of a melancholic humour or it is a splenetic effect; the
    liver is obstructed by abundance of choler proceeding from a salt
    rheum that cometh from the brain” etc. Agues are to be dreaded most
    for their remote effects: “Say not therefore, ‘It is but an ague, but
    a feaver; I shall wear it out.’ Dally not with this disease;” and he
    adds a case to show what people may come to if they neglect an ague at
    the beginning: “Being carried downe from London to South-hampton by
    Master Thomas Mason,--September 1640, word was brought me of a Mayd
    dead, 16 years of age: and being requested to see what disease she
    dyed of, I took my chirurgion with me and went. And after section or
    search, I found as followeth: a gallon and a half of green water in
    the belly, that stunk worse than carrion; under the lyver an impostume
    as bigg as my fist, full of green black corrupted matter, and the
    lyver black and rot. The spleen and kidneys wholly decayed, and the
    place as black as soot; the bowels they were fretted, ulcerated and
    rotten. In the chesse was two great handfuls of black burnt blood in
    dust or powder; the heart was all sound, but not a drop of blood in
    it; nor one spoonfull in the whole body.

    Here was an Annatomy indeed, skinne and bone; and I verily beleeve
    that there was no braine left, but that she lived while that was
    moyst: the sent was so ill, and I not well, that I forbore to search
    it.

    God that knowes the secrets of all hearts knowes this is a truth, and
    nothing else here written. Arthur Fauset, chirurgion at Southampton,
    was the man I employed to cut her up, as many there can witness that
    were present.

    And what of all this, may some say? Why this. An eight weeks’ ague in
    the neglect of it breeds all these diseases, and finally death.”

Let us take next the advertisement of an apothecary a generation after,
who professed to cure Kentish agues,--“the description and cure of Kentish
and all other agues ... and humbly showing (in a measure) the author’s
judgment why so many are not cured, with advice in relation thereunto,
whether it be Quotidian, Tertian or Quartan, simple, double or
triple[569].” Before the Fire of London he had practised in Mark Lane, but
after his house was destroyed he removed to Kent, attending Maidstone
market every Thursday, and residing at Rochester, a city which, “besides
being subject to diseases in common with others, hath two diseases more
epidemical, namely, the Scurvey for one but the Ague in special.” The
symptoms of scurvy, as he gives them, cover perhaps the one moiety of
disease, and those of ague the other.

    Agues are of two sorts, curable and incurable; the curable are those
    that come in a common way of Providence, the incurable those that are
    sent more immediately from God in the way of special judgment, as
    instances adduced from Scripture show. What is an ague? Some think it
    is a strange thing, they know not what; the more ignorant think it is
    an evil spirit, but coming they know not whence. Agues have their seat
    in the humours either within the vessels or without them; those
    residing within are continual quotidians, continual tertians,
    continual quartans; those without are intermittent ditto. (This
    distinction of within and without the vessels is traditional, and is
    found in Jones’s _Dyall of Agues_ as well as in Dutch medical books a
    century later.) The paroxysms of the intermittents are really the
    uprising of the Archaeus [of van Helmont], or spirit, to oppose the
    rottenness of the humours. A quartan is harder to cure than any other
    ague; part of its cure is an old 14th-century rule of letting blood in
    the plague; “let blood in the left hand in the vein between the ring
    finger and the little finger, which said thing to my knowledge was
    done about sixteen years ago [to say nothing of three hundred years
    ago] by the empiric Parker in this country, with very good success and
    to his great honour and worldly advancement.” This ague-curer says
    little of Peruvian bark; his specific is the powder of Riverius, “the
    preparation of which, as well as some of the powder itself is lately
    and providentially come to my hands.” Three doses cost not above five
    shillings, “and I never yet gave more in the most inveterate of these
    diseases.... My opinion is that he that will not freely part with a
    crown out of his pocket to be eased of such a disease in his body
    deserves to keep it.”

The most celebrated ague-curer of the Restoration period was Sir Robert
Talbor, who thus describes the high motives that made him a
specialist[570]:

    “When I first began the study and practice of Physick, amongst other
    distempers incident to humane bodies I met with a quartan ague, a
    disease that seemed to me the _ne plus ultra_ of physic, being
    commonly called Ludibrium et Opprobrium Medicorum, folly and derision
    of my profession, did so exasperate my spirit that I was resolved to
    do what study or industry could perform to find out a certain method
    for the cure of this unruly distemper.... I considered there was no
    other way to satisfy my desire but by that good old way, observation
    and experiment. To this purpose I planted myself in Essex near to the
    seaside, in a place where agues are the epidemical diseases, where you
    will find but few persons but either are, or have been afflicted with
    a tedious quartan. In this place I lived some years, making the best
    use of my time I could for the improving my knowledge.”

Talbor’s first chapter is a fluent account of how agues are produced by
“obstructions” of the spleen. This was a matter of theoretical pathology
which an empiric could make a show with as well as another. But the
empiric betrays himself as soon as he comes to practice. The enlarged
spleen of repeated agues, or of the malarial cachexia, is commonly known
as the ague-cake. There is no doubt that much of the unhappiness of the
aguish habit resides in the ague-cake, and that one of the best pieces of
treatment is to apply counter-irritants or the actual cautery to the left
side, against which the enlarged spleen presses as a cake-like mass.
Talbor, however, desired to free the patient from his “ague-cake”
altogether:

    “I have observed these in four patients: two were cast out the stomach
    by nature, and the other two by emetic medicines. One of them was like
    a clotted piece of phlegm, about the bigness of a walnut, pliable like
    glue or wax, weighing about half an ounce; another about the bigness
    of the yolk of a pullet’s egg, and like it in colour, but stiffer,
    weighing about five drachms; the other two of a dark colour, more
    tough, about the like bigness, and heavier. It is a general
    observation amongst them that their ague comes away when they see
    those ague-cakes[571].”

Having followed this “good old way of observation and experiment” for
several years among the residents of the Essex marshes, Talbor came to
London, and set up his sign next door to Gray’s Inn Gate in Holborn. In
1672 (14th July) he issued a small work with a Greek title--the quacks
were fond of the Greek character on their title-pages--“Πυρετολογια, a
rational account of the cause and cure of agues, with their signs:
whereunto is added a short account of the cause and cure of feavers.” He
made a bid also for practice in “scurvy,” a disease of landsmen in those
times which was more a bogey than ague itself--“a strange monster acting
its part upon the stage of this little world in various shapes,
counterfeiting the guise of most other diseases ... sometimes it is
couchant, other times rampant, so alternately chronic and acute.”

Most of the agues which Talbor professed to have met with in London in
those years must have been equally factitious: for Sydenham, who makes
more of “intermittents” than other writers of repute, was of opinion that,
for thirteen years from 1664 to 1677, fevers of that type had not been
seen in London, except some sporadic cases or cases in which the attack
had begun in the country. But the air was then full of talk and
controversy about Peruvian bark, or Jesuits’ powder (_pulvis patrum_), or
“the cortex,” which was cried up as a specific in agues by some, and cried
down by others. Talbor had seized upon this specific, and claimed to have
an original way of administering it, whereby its success was assured. We
get a glimpse of his practice from Dr Philip Guide, a Frenchman who came
to London and practised for many years as a member of the College of
Physicians[572]. Talbor had cured the daughter of Lady Mordaunt of an
ague, and the cure had reached the ears of Charles II. One of the French
princesses having been long afflicted with a quartan ague,

    “The king commanded Mr Talbor to take a turn at Paris, and as a mark
    of distinction he honoured him with the title of knight. He succeeded
    wonderfully. But he could not cure Lady Mordaunt’s daughter a second
    time, whom he had cured once before at London, by whom he gained most
    of his reputation.” He tried for two months, but did not relieve the
    symptoms. Dr Guide was called in, and being asked to give his opinion
    of the ague that the young lady was afflicted with, “after some
    inquiry I found her distemper was complicated and quite different from
    the ague, which made me lay the thought of the ague aside, and apply
    myself wholly to the complicated disease, which I effectually cured in
    twelve days, together with her ague, without having any further need
    of the infallible specific of Sir Robert Talbor.”


The Peruvian Bark Controversy.

It can hardly be doubted that the conflicting opinions as to the benefit
of Peruvian bark in ague, which have been often cited in disparagement of
medicine and as an example of its intolerance, arose from the
indiscriminate use of it in “agues” diagnosed as such by quacks and
pushing practitioners. The bark had been brought first to Spain in 1632
and had been tried medicinally in 1639[573]. It was under the powerful
patronage of the Jesuits, especially of Cardinal de Lugo, and most of it
at that time found its way to Rome, the centre of a malarious district. In
1652 it failed to cure a “double quartan” in an Austrian archduke, and
thereafter fell into some disrepute. A violent controversy on its specific
use in agues arose in the Netherlands; it had failed in every case at
Brussels, it had not failed in a single case at Delft. Meanwhile it
remained, very dear, sixty florins having been paid at Brussels in 1658
for as much as would make twenty doses, to be sent to Paris. The London
‘Mercurius Politicus’ of the week 9-16 December, 1658, contained an
advertisement[574] that a supply of it had been brought over by James
Thompson, merchant of Antwerp, and was to be had either at his own
lodgings at the Black Spotted Eagle in the Old Bailey or at Mr John
Crook’s, bookseller, at the sign of the Ship in St Paul’s Churchyard. The
London physicians such as Prujean and Brady countenanced it, and Willis,
in reprinting his essay on Fevers in 1660, spoke of it as coming into
daily use. Sydenham, whose publisher was the same Crook at the sign of the
Ship, made a brief reference to it in the first edition (1666) of his
_Observationes Medicae_, in the section upon the epidemic constitution of
intermittents during the years 1661-64. He admits that the bark could keep
down fermentation for the time being; but the _materies_ which the
fermentation would have dissipated if it had been allowed its way, will
remain in the system and quickly renew its power. He had known a quartan
continue for several years under the use of bark. It had even killed some
patients when given immediately before the paroxysm. Prudently and
cautiously given, in the decline of such fevers, it had been sometimes
useful and had stopped the paroxysms altogether, especially if the aguish
fits were occurring at a season when the malady was less epidemical. But
it is clear that Sydenham in 1666 inclined strongly to non-interference
with the natural depuratory action of the fever upon the _materies_ of the
disease. His teaching that the cortex, while it kept down the fermentation
of the blood for a time, left the dregs of the fever behind, was thus
popularly stated some years after by Roger North in relating the fatal
illness of his brother the Lord Keeper Guilford in the summer of
1685[575].

    The fever of Lord Guilford was not an intermittent at all, but a
    “burning acute fever without any notable remissions and no
    intermissions,” a case of the epidemic typhus of that and the
    succeeding year, elsewhere described. The treatment was first in the
    hands of Dr Masters, pupil and successor of Dr Willis, whose cardinal
    doctrine of fevers was that they were a natural fermentation of the
    blood. He ordered phlebotomy. Next Dr Short, of another school, was
    sent for: “So to work with his cortex to take it off: and it was so
    done; but his lordship continued to have his headache and want of
    sleep. He gave him quieting potions, as they called them, which were
    opiates to make him sleep; but he ranted and renounced them as his
    greatest tormentors, saying ‘that they thought all was well if he did
    not kick off the clothes and his servant had his natural rest; but all
    that while he had axes and hammers and fireworks in his head, which he
    could not bear.’ All these were very bad signs; but yet he seemed to
    mend considerably; and no wonder, his fever being taken off by the
    cortex. And it is now found that, without there be an intermission of
    the fever, the cortex doth but ingraft the venom to shoot out again
    more perniciously.” The Lord Keeper’s illness dragged on, and at
    length the physicians “found he had a lent fever which was growing up
    out of the dregs which the cortex had left; and if it were not taken
    off, they knew he would soon perish. So they plied him with new doses
    of the same under the name of cordial powders, whereof the quantity he
    took is scarce credible; but they would not touch his fever any more
    than so much powder of port. And still he grew worse and worse. At
    length the doctors threw up[576].”

Sydenham having indicated in his edition of 1666 that bark was dangerous
when given immediately before a paroxysm, but that it was sometimes useful
in the decline of the fever, and that its benefits were greatest in those
desultory agues which appeared at, or continued into, a season when agues
had become less epidemical, he proceeded in his third edition of 1675 to
enlarge these indications for giving bark in ague. He begins, as Talbor
had begun in his essay of 1672, and as the empiric Streater had in his
advertisement of 1641, by calling quartans the _opprobrium medicorum_, and
he then lays down precisely how bark was to be given in those obstinate
fevers, as well as in tertians of the aged or feeble: namely, after the
fever had exhausted itself _suo Marte_, in the intervals between two
paroxysms, an ounce of bark (in two ounces of syrup of roses) to be taken
in the course of the two free days, a fourth part at a time morning and
evening. The dosage may have been borrowed from Talbor, as Sir George
Baker alleges[577]; it matters little for anyone’s fame. Sydenham,
however, in a letter of October, 1677, thus claimed to have been
independent of Talbor so far as concerned the directions for giving bark
which he inserted in his edition of 1675:

    “I have had but few trials, but I am sure that an ounce of bark, given
    between the two fits, cures; which the physicians in London not being
    pleased to take notice of in my book, or not believing me, have given
    an opportunity to a fellow that was but an apothecary’s man, to go
    away with all the practice on agues, by which he has gotten an estate
    in two months, and brought great reproach on the faculty[578].”

Talbor was patronised by Charles II., who caused him to be made one of his
physicians. On 2 May, 1678, a few months after the date of Sydenham’s
letter, Lord Arlington wrote to the president of the College of
Physicians[579]: “His Majesty, having received great satisfaction in the
abilities and success of Dr Talbor for the cure of agues, has caused him
to be admitted and sworn one of his physicians.” Next year, 1679, the king
had an attack of the reigning ague, and a recurrence of it in 1680. It is
probably to the occasion of one or other of these attacks that an undated
letter belongs from the Marquis of Worcester to the marchioness: “The
physicians came to the Council to acquaint them that they intend to give
the king the Jesuit’s powder five or six times before he goes to
Newmarket, which they agreed to. He looks well, eats two meals of meat a
day, as he used to do[580].” Evelyn has preserved a story told him by the
Marquis of Normanby, which probably relates to the same aguish attack of
Charles II.[581]:

    “The physicians would not give the _quinquina_ to the king, at a time
    when, in a dangerous ague, it was the only thing that could cure him
    (out of envy, because it had been brought into vogue by Mr Tudor
    [Talbor] an apothecary), till Dr Short, to whom the king sent to know
    his opinion of it privately, sent word to the king that it was the
    only thing which could save his life, and then the king enjoined his
    physicians to give it to him, which they did, and he recovered. Being
    asked by this lord [Normanby] why they would not prescribe it, Dr
    Lower said it would spoil their practice, or some such expression.”

What Dr Lower was most likely to have said was, that it went against his
principles to give bark in fevers. He was a physiologist, in the sense of
an anatomist, the pupil of Willis at Oxford and his successor in practice
in London. It was the teaching of Willis that blood was like the juice of
vegetables, particularly the juice of the grape, in respect of fermenting,
just as it was like milk in respect of curdling. Fever was a sudden access
of fermentation, apt to arise in spring and autumn, from internal or
constitutional occasions, as well as to come at any time by infection; by
this febrile ferment, ebullition or commotion, the blood was purged of
certain impurities, comparable to the lees of wine, which were removed
from the body in the sweat, the urine or other critical evacuation.
Jesuit’s bark was believed to check fermentation, or, in the later phrase
of Pringle and others, it was antiseptic; and it was probably because he
thought it would check the natural defaecating action of the blood in an
ague that Lower refused to prescribe it. Sydenham was more tentative,
pliant, empirical. He cavilled at Willis’s doctrine of the ebullition or
fermentation of the blood without actually rejecting it; for he held
practically the same view of the salutary or depuratory nature of fever,
which was indeed the Hippocratic view of it. Accordingly in his first
reference to bark, in 1666, he sustains the objection to it, that it
interfered with a natural depuratory action; and it was only in following
the lead of Talbor, a more empirical person than himself, that Sydenham
overcame his doctrinal scruples. Dr Short, to whom Charles II. sent
privately for advice, was of Sydenham’s party; soon after that occasion,
the latter dedicated to Short his ‘Tractate on Gout and Dropsy’ (1683). It
was Short who “went to work with his cortex” upon the Lord Keeper in 1685,
after Dr Masters, of the school of Willis, had tried his hand with
phlebotomy. The king’s experiences, a few months before the Lord Keeper’s
death, had been just the same, and with the same result: the deathbed of
Charles II., it is well known, was the scene of ecclesiastical rivalries;
but the physicians at the bedside of the king had their rivalries too.

On Monday the 2nd of February, at eight in the morning, the king had a
seizure of some kind in his bed-chamber, which was currently said to have
been an “apoplectic fit[582],” although there is nothing said of
paralysis. A letter of the 3rd February[583] says the king “was seized in
his chair and bed-chamber with a surprising convulsion fit which lasted
three hours.” Dr King, an expert operator who had assisted Lower in the
delicate operation before the Royal Society on 23 November, 1667, of
transfusing blood from one body to another, happened to be at hand, and,
at once drawing his lancet, bled the king. His promptitude in action,
which probably left him little time for diagnosis, was much applauded, and
the Privy Council voted him a reward of a thousand pounds, which Burnet
says he never received.

    “This rescued his Majesty for the instant,” says Evelyn, (who came up
    from Wooton on hearing the news, and is probably correct in his
    narrative), “but it was only a short reprieve. He still complained,
    and was relapsing, often fainting, with sometimes epileptic symptoms,
    till Wednesday, for which he was cupp’d, let blood in both jugulars,
    had both vomit and purges, which so reliev’d him that on Thursday
    hopes of recovery were signified in the public Gazette; but that day,
    about noone, the physitians thought him feverish. This they seem’d
    glad of, as being more easily allay’d and methodically dealt with than
    his former fits; so as they prescribed the famous Jesuit’s powder: but
    it made him worse, and some very able doctors who were present did not
    think it a fever, but the effect of his frequent bleeding and other
    sharp operations us’d by them about his head, so that probably the
    powder might stop the circulation, and renew his former fits, which
    now made him very weake. Thus he pass’d Thursday night with greate
    difficulty, when, complaining of a paine in his side, they drew 12
    ounces more of blood from him; this was by 6 in the morning on Friday,
    and it gave him reliefe; but it did not continue, for being now in
    much paine, and struggling for breath, he lay dozing, and after some
    conflicts, the physitians despairing of him, he gave up the ghost at
    halfe an houre after eleven in the morning, being 6 Feb. 1685, in the
    36th yeare of his reigne, and 54th of his age.... Thus died King
    Charles II. of a vigorous and robust constitution, and in all
    appearance promising a long life[584].”

Whether the bark would have saved him if the aguish nature of the
paroxysms (such as he had in 1679 and again in 1680) had been clear from
the first, may be doubted. But his chances of recovery were certainly made
worse by the halting and stumbling diagnosis, (according to Evelyn)--now
apoplexy, now epilepsy, now fever[585].

The true value of cinchona bark in medicine was not seen until much that
was vague in the use of the term “ague” had been swept away. In the last
great epidemic period of agues in this country, as we shall see, from 1780
to 1786, bark was found, for some reason, to be ineffective. It is not in
the treatment of epidemic agues, but of agues in malarious countries, that
the benefits of Jesuits’ bark have been from first to last most obvious.

The practice in so-called agues was long in the hands of empirics, who,
like their class in general, made business out of ignorant or lax
diagnosis. I shall add here what remains to be said of specialist
ague-curers in later times. They are heard of in London in the Queen Anne
period, and as late as 1745.

    Swift writes in his Journal to Stella, 25 December, 1710, from Bury
    Street, St James’s: “I tell you a good pun: a fellow hard by pretends
    to cure agues, and has set out a sign, and spells it _egoes_; a
    gentleman and I observing it, he said, ‘How does that fellow pretend
    to cure agues?’ I said, I did not know, but I was sure it was not by a
    _spell_. That is admirable.” In 1745, Simon Mason, of Cambridge,
    published by subscription and dedicated to Dr Mead an essay, _The
    Nature of an Intermitting Fever and Ague considered_ (Lond. 1745), in
    which he has the following on “charm-doctors”:--“When one of these
    poor wretches apply to a doctor of this stamp, he enquires how many
    fits they have had; he then chalks so many strokes upon a heater as
    they tell him they have had fits, and useth some other delusions to
    strengthen the conceit of the patient” (p. 167). Francis Fisher, who
    had been upper hostler in a livery stable in Crutched Friars near
    forty years, “told me he seldom missed a week without several ague
    patients applying to him, and he cured great numbers by a charm they
    wore in their bosoms” (p. 239). Another, who kept a public-house near
    St George’s Fields, Southwark, sold “febrifuge ale” at a shilling a
    pint. It was a small ale brewed without hops, but with bark,
    serpentery, rhubarb and cochineal mixed in the brewing. The receipt
    was given him by an old doctor who was a prisoner in the King’s Bench.
    His customers came in the morning fasting, and drank their shilling’s
    worth after the publican had given them faith by a cordial grip of the
    hand. “By this means,” he told Mason, “I got a good trade to my house,
    and a comfortable maintenance too.”

We may now return to the actual history of the epidemic fevers upon which
the Peruvian bark was first tried on a large scale in England. The
“intermittent” constitution which began in 1677 and lasted year after year
until 1781 or even longer was a very remarkable one. It was called at the
time the new fever, or the new ague, and it had at least one short
interlude of influenza or epidemic catarrhal fever in the winter of 1679,
just as the last epidemic of the kind, in 1657-59, had at least one, and
probably two, short and swift epidemic catarrhs in spring. But before we
come to that epidemic of 1678-81, there falls to be noticed an epidemic in
the month of November, 1675, which has always been counted among the
influenzas proper. After giving the particulars of it from Sydenham and
from the London bills of mortality, I shall show from Sydenham and the
bills of mortality that there was an exactly similar epidemic in the month
of November, 1679, which has not been admitted into the conventional list
of influenzas. Thereafter I shall proceed to the epidemic constitution of
1678-81 as a whole, which has been reckoned among the epidemic agues or
malarious epidemics.


The Influenza of 1675.

The first that we hear of the universal cold of 1675 is an entry which
Evelyn makes in his diary under 15 October: “I got an extreme cold, such
as was afterwards so epidemical as not only to afflict us in this island,
but was rife over all Europe, like a plague. It was after an exceeding dry
summer and autumn.” It was not until November that the epidemic cold made
an impression upon the death-rate in London; the deaths mounted up from
275 in the week ending 2 November, to 420 and 625 in the two weeks
following, and thereafter gradually declined to an ordinary level. Part of
the excess, but by no means the greater part of it, was set down under
fevers, as the following section from the weekly bills of the year will
show:

1675

                                Griping in
  Week Ending  Fever  Smallpox  the Guts    All causes

      Nov. 2    42        9        29          275
           9    60       12        42          420
          16   130       13        43          625
          23    99        2        28          413
          30    61        6        29          349
      Dec. 7    54        7        25          308
          14    43        5        12          266

This shows the characteristic rise and fall of an epidemic catarrh both
in the article of fever deaths and in the column of deaths from all
causes. The other excessive articles besides fever in the two worst weeks
are also characteristic of influenza mortality:

              Week ending   Week ending
               9 Nov.        16 Nov.

  Consumption    68            99
  Aged           40            67
  Tissick        10            35

Sydenham’s account bears out the figures[586]. At the end of October, he
says, the mild, warm weather turned to cold, while catarrhs and coughs
became more frequent than at any time within his memory. They lasted until
the end of November, when they ceased suddenly. Afterwards he gives a
special chapter to the “Epidemic Coughs of the year 1675, with Pleurisies
and Pneumonias supervening.” The epidemic spared, he says, hardly anyone
of whatever age or temperament; it went through whole families at once. A
fever which he calls _febris comatosa_ had been raging far and wide since
the beginning of July, with which in the autumn dysenteric and diarrhoeal
disorders were mingled (it was an exceedingly dry season). This
constitution held the mastery all the autumn, affecting now the head, now
the bowels, until the end of October, when catarrhs and coughs became
universal and continued for a month. Sydenham’s view of the sequence of
events was his usual one, namely, that one constitution, by change of
season, passed by transition into another. Whatever the constitution of
“comatose” fevers may have been, which prevailed “far and near,” it has
left no trace upon the bills of mortality in London, which are remarkably
low until the beginning of November. But as soon as the epidemic of coughs
begins, the weekly deaths mount up in an unmistakeable manner, so that for
two or three weeks in November, the mortality is nearly double that of the
weeks preceding or following.

The “severe cold and violent cough,” of 1675, says Thoresby of Leeds[587],
who was then a boy, “too young or unobservant to make such remarks as
might be of use,” was known in the north of England “profanely” by the
name of the “jolly rant.” Thoresby well remembered that it affected all
manner of persons, and that so universally that it was impossible, owing
to the coughing, to hear distinctly an entire sentence of a sermon. He
gives December as the month of it in Leeds, and says that it affected
York, Hull, and Halifax, as well as the counties of Westmoreland, Durham,
and Northumberland. In Scotland also we find a trace of a strange epidemic
sickness. It was the time of the persecution of the Covenanters, whose
preachers moved hither and thither among the farm-houses. One of them,
John Blackadder, was at the Cow-hill in the parish of Livingstown in
August, 1675. He came in one evening from the fields very melancholy, and
in reply to questions, he said he was afraid of a very dangerous
infectious mist to go through the land that night. He desired the family
to close doors and windows, and keep them closed as long as they might,
and to take notice where the mist stood thickest and longest, for there
they would see the effects saddest. “And it remained longest upon that
town called the Craigs, being within their sight, and only a few families;
and within four months thereafter, thirty corpses went out of that
place[588].” The prophecy was fulfilled within four months, which would
bring us to the date of the influenza, although the mortality for a small
place is somewhat excessive.


The Influenza of 1679.

For the sake of comparison, I pass at once to an epidemic of coughs and
colds in the month of November, 1679, which Sydenham has chronicled, but
no one except Cullen[589] has thought of including among the influenzas.
It produced the characteristic effect of influenza on the London weekly
bills, and it came in the midst of epidemic agues, just as the epidemic
catarrhs of 1658 and 1659 had done. The following rise and fall are just
as distinctive of an influenza as on the last occasion in 1675:

1679

                                      Griping of
  Week ending    Fever    Smallpox    the Guts   All causes

  Nov. 11          50        18           34        328
       18          89        27           39        541
       25         126        21           55        764
  Dec.  2          82        27           38        457
        9          63        12           38        388

Sydenham’s account[590] of this remarkable November outburst of sickness
in London, written within a few weeks of its occurrence, is almost exactly
a repetition of his language concerning the epidemic coughs of November,
1675. The prevailing intermittent fevers, he says, gave place to a new
epidemic depending upon a manifest crasis of the air. The new epidemic was
one of coughs, which were so much more general than at the same season in
other years that in nearly every family they affected nearly every person.
In some cases of the cough, the aid of a physician was hardly needed; but
in others the chest was so shaken by the violent convulsive cough as to
bring on vomiting, and the head was affected with vertigo. For the first
few days the cough was almost dry, and so purely paroxysmal as to remind
Sydenham of the whooping-cough of children. Everyone was surprised, he
says, at the frequency of these coughs in this season. His own suggestion
was that the rains of October[591] had filled the blood with crude and
watery particles, that the first access of cold had checked transpiration
through the skin, and that Nature had contrived to eliminate this serous
colluvies either by the branches of the “vena arteriosa” or (as some will
have it) by the glands of the trachea, and to explode it by the aid of a
cough. Phlebotomy and purging were the best cures; diaphoretics he
considered less safe, and he ascribed to their abuse the fever into which
some fell, and the pleurisies which were apt to attack patients with great
violence during the subsidence of the epidemic catarrh.


The Epidemic Agues of 1678-80.

The other English writer on the epidemic constitution of 1678-79 is Dr
Christopher Morley[592]. Like Sydenham, he is occupied almost exclusively
with the epidemic agues; but he also records the extraordinary rise of the
mortality in London for a few weeks in the last months of the year, and
the causes thereof, although it did not occur to him to count that as a
separate part of “the new disease,” still less as the principal part,
which it really was in London so far as concerned the death-rate. Dating
his preface from London, the 31st of December, 1679, he says in the text:
“Within the very days of my present writing, it happens that as many as
four hundred deaths more than usual have taken place in a fortnight,” the
excessive mortality having been due to “coryza, bronchitis, catarrh, cough
and fever,” which were the effects of “most pernicious destillations.”

I shall now go back to the beginning of the epidemic constitution in the
midst of which this November interlude occurred, and I shall follow it
season after season to the end, so as to set forth in historical
prominence that which was regarded at the time as “the new disease.” When
Sydenham returned to London in the autumn of 1677, after six months’ rest
from practice, he was told by his professional friends that intermittents
were being seen here and there (after a clear interval of thirteen years),
being more frequent in the country than in the city. In the letter of
October, 1677, cited above, he speaks of Talbor having made a fortune in
two months by his cures of agues with bark.

    The first particular notice of the “new fever” occurs in a London
    letter of 23 February, 1677/78: “Lady Katherin Brudenhall has been in
    great danger of death by the new feaver[593].” A severe aguish illness
    of Roger North, fully described in his ‘Autobiography,’ was probably
    another instance of the reigning malady; it came upon him in the hot
    weather of 1678, while he was residing with his brother, Lord
    Guilford, at Hammersmith[594]. In the autumn of 1678, the “new fever”
    came more into notice. On the 8th of September, a letter was brought
    to Evelyn in church, from Mr Godolphin (afterwards celebrated as the
    minister of William III.), to say that his wife was exceedingly ill
    and to ask Evelyn’s prayers and assistance. Evelyn and his wife took
    boat at once to Whitehall, and found the young and much-beloved Mrs
    Godolphin “attacqu’d with the new fever then reigning this excessive
    hot autumn, and which was so violent that it was not thought she could
    last many hours.” She died next day, in her twenty-ninth year; but, as
    she had been brought to bed of a son six days before, her fever may
    have been more from puerperal causes than from “the new fever then
    reigning.” Other known cases of ague the next season were those of Sir
    James Moore, his majesty’s engineer, who, in August, 1679, coming from
    Portsmouth “was seized with an ague, and had two or three violent
    fits, which carried him off[595];” and of the king, Charles II., who
    was congratulated on his recovery by the lord mayor and aldermen, on
    15 September, and had a recurrence of the aguish attack (“two or three
    fits”) on 15 May, 1680[596]. There are also references to the agues of
    1679 in the country, in the letters of Lady North[597].

Sydenham wrote his account of this epidemic of intermittents in compliance
with a request from Dr Brady, Master of Gonville and Caius College,
Cambridge, that he would continue the method of his ‘Observationes
Medicae’ into the years following, and in particular give an account of
his method of administering bark. He occupied most of his space with
treatment; but he gives here and there the following epidemiological
details. The agues were mostly tertians, or quotidians, or duplex forms of
these, whereas on a former occasion they had been mostly quartans; after
two or three intermissions they were apt to become continual fevers. The
agues, which had occurred in the spring of 1678, became more common in the
summer and autumn, when they raged so extensively that no other disease
deserved the name of epidemic so much. In winter smallpox took the lead;
but early in July, 1679, the agues began again, and so increased day by
day that in August they were raging excessively and destroying many. It
was in August that the king had his “great cold” at Windsor, which
afterwards changed to an ague. Sydenham then comes to the November
interlude of epidemic catarrhs, which was followed by “a fever without
cough” (_non penitus deleta, sed manente adhuc in sanguine, malae crasis
impressione_), lasting to the beginning of 1680. As that year wore on, the
intermittent fevers began again, and continued more or less until 1685,
becoming indeed less common in London, and less severe, than in the first
four years of the constitution, but in other places, now here, now there,
not less so than at first[598].

I have kept to the last the special account of this epidemic written by
Morley at the end of the second year of it, namely, in December, 1679. He
had been a witness of this fever, first at Leyden in the autumn of 1678,
and next in England in the autumn of 1679, and he made it the subject of a
treatise at the request of an eminent physician in London. It was not so
severe by half in England as in Holland, but the English made a great deal
more of it, calling it the New Disease, the New Ague, the New Fever, the
New Ague Fever, and, in Derbyshire sarcastically, the New Delight. In
Holland they called it neither new nor old, neither intermittent nor
continued, nor a conjunction of both, but simply _morbus epidemicus_, or
_febris epidemica_. His master at Leyden, Professor Lucas Schacht, taught
very decidedly that it was of a scorbutic nature, and as early as the
month of June, 1678, had prophesied the arrival of such an epidemic fever
because “tertians were becoming more and more scorbutic,” just as they had
done before the great epidemic of fever in Holland in 1669. Morley claims,
however, that the fever of 1678 was in some respects different from that
of 1669, as well as from that of the year immediately preceding, 1677,
when “an incredible multitude of people all over Belgium, and in every
city and town, fell sick.” The Dutch, it appears, called these occasional
outbreaks simply “the epidemic fever,” neither intermittent nor continued;
and certainly that of 1669, which is sometimes counted among the epidemic
agues, was a very remarkable “ague.” (See Chapter I. p. 19.)

The epidemic fever of 1678, wherever it may have been bred or engendered,
was prevalent in England at the same time as in Holland--in an exceedingly
hot and dry autumn. The most constant symptoms, says Morley (and he writes
both for Holland[599] in 1678 and for the country districts of England in
the autumn of the following year), were nausea, severe vomiting,
incredible tightness about the breast, weight in all the limbs, weariness,
giddiness, vigils, thirst, restless tossing, and languor remaining after
the disease was gone. Among the more remarkable symptoms were the
following: Many had aphthae of the mouth, some twice or thrice, some being
endangered by the severity and closeness of the patches of thrush. In some
there occurred bleeding from the nose, or from piles, stranguary, etc.
Round worms were observed, issuing both by the mouth and anus. In some few
there were spots on the skin, but hardly ever petechiae or tumours near
the ears. It affected all classes equally, all ages and both sexes. Some
said it was easier to children than to adults, but others denied this.
Some said it was more pernicious in the country than in the towns. In
Leyden, the deaths never exceeded 150 in the week, being about twenty in a
week above the ordinary level. More died from the coughs, anginas,
peripneumonies and pleurisies that followed, than from the disease itself.
Schacht says that the wind for nearly two years had been steadily from the
North, or veering to the East or West. The Leyden faculty, and the Dutch
generally, did not think the disease a malignant one; it was very freely
called so, however, in England, the chorus being led by empirics and
illiterate persons: “Ac indicio est,” says Morley, “libellus perexiguus
nostra lingua ab Empirico conscriptus de hoc morbo.” This seems to refer
to the tract by one Simpson, which I shall notice briefly[600].

    Simpson styles himself a Doctor of Physic, and denies that he is an
    empiric. One sign of his affinity to that order, however, is that he
    objects to the orthodox treatment--emetics, drenches, a too cooling
    regimen, and purges, while he thinks blood-letting of doubtful
    utility. The symptoms were chills at the outset, pains in the head and
    back (in some with shaking), then intense burning heat, thirst,
    profuse immoderate sweats and great debility, a general lassitude,
    dulness, and stupor which in many were followed by delirium and a
    comatose state. Sometimes the fever simulated a quotidian, sometimes a
    tertian. He calls it “this new fever so grassant in city and country”
    and says that in many it assumed “the guise of a morbus cholera, known
    by the much vomitings or often retchings to vomit; and in others under
    the livery of the gripes with looseness, or, in some, looseness
    without gripes.” This choleraic tendency concurring with other usual
    causes from the late season of fruit-eating etc., had swelled the
    bills of mortality. The morbus cholera and the gripes were to the new
    fever “like the circumjoviales that move in the same sphere with (but
    at some distance from) their master-planet.”

The meaning of all this is obvious on turning to the London weekly, bills
of mortality. In the months of August and September for three years in
succession, 1678-80, the deaths from “griping in the guts” and from
“convulsions” rose greatly. These were, indeed, three successive seasons
of fatal diarrhoea, mostly infantile, as I shall show in the chapter on
that disease.

The following extracts from the London weekly bills of mortality show how
“fevers,” as well as other diseases, contributed to the great rise in the
autumns of 1678, 1679, and 1680.

_Autumnal London Mortality in 1678._

1678

                                    Griping
  Week ending    Fever   Smallpox   in Guts   All causes

      Aug. 20     77       31         87        459
           27     79       37        130        510
      Sept. 3     82       37        121        530
           10    103       27        164        621
           17     82       23        178        580
           24     83       20        152        528
       Oct. 1     82       25        117        485
            8     77       27        106        456

_Summer and Autumnal London Mortality in 1679._

1679

                                    Griping
  Week ending    Fever   Smallpox   in Guts   All causes

      July 22     42       55        101        442
           29     60       50        134        565
      Aug.  5     78       63        143        531
           12     62       43        161        579
           19     55       64        149        545
           26     68       53        112        514
      Sept. 2     96       40         97        466
            9     92       47         75        471
           16     85       50         87        462

(For the Influenza weeks, see former Table.)

_Autumnal London Mortality in 1680._

1680

                                    Griping
  Week ending    Fever   Smallpox   in Guts   All causes

      Aug. 10     70       17        108        427
           17     90        6        132        494
           24     98       17        127        552
           31    140       18        228        816
      Sept. 7    101       14        215        671
           14     94       13        173        635
           21    106        9        175        628
           28    130        9        159        615
       Oct. 5    125       16        138        597
           12    121       10         94        530
           19    109       14         68        488
           26     93        5         58        407
       Nov. 2     77       10         53        396

The last of the three autumnal seasons, 1680, is one of the few in the
bills with high deaths from fever along with high deaths from choleraic
disease; and that excess of fever mortality may have been due in part to
the ague epidemic, then in its third season.

The following extracts from Short’s summation of parish registers show the
great excess of burials over baptisms in various parts of England during
the years of the aguish epidemic constitution.

_Country Parishes._

           Registers   Sickly    Baptisms   Burials
  Year     examined   parishes   in do.     in do.

  1678        136       17         312        527
  1679        137       44         800       1203
  1680        137       54        1093       1649
  1681        137       41         679       1156
  1682        140       30         632        975

_Market Towns._

           Registers   Sickly    Baptisms   Burials
  Year     examined   parishes   in do.     in do.

  1678         22        5         578        789
  1679         23        7         877       1371
  1680         24        7         946       1494
  1681         24        9         945       1333
  1682         25        9         795       1092
  1683         25        8        1109       1398
  1684         25        8         865       1243
  1685         25        4         741       1191


The Influenza of 1688.

The seasons continued, according to Sydenham, to produce epidemic agues
until 1685, when the constitution radically changed to one of pestilential
fevers, affecting many in all ranks of society and reaching a height in
1686. Sydenham records nothing beyond that date, having shortly after
fallen into ill health and ceased to write or even to practise. One would
wish to have known what he made of the “new distemper” in the summer of
1688, for it was a sudden universal fever, and yet not a catarrh or a
“great cold.” It is thus referred to in a letter of the month of June,
from Belvoir, Rutlandshire[601]: “The man that dos the picturs in inemaled
is gon up to London for a weke.... I wish the man dos not get this new
distemper and die before he comes agane.” On turning to the London weekly
bills of mortality we find in the first weeks of June the characteristic
rise of one of those sudden epidemic fevers or new diseases, of which the
earliest with recorded figures was the “gentle correction” of July, 1580.
The following are the weekly London figures corresponding to the “new
distemper” of 1688:

_Weekly London Mortalities._

1688

  Week ending   Fevers   All causes

  May 29          58        368
  June 5          76        518
      12         101        559
      19          65        435
      26          66        437

The contemporary London notice of this “influenza” comes from Dr Walter
Harris, who mentioned it in a book written the year after[602]:

    “From the middle of the month of May in the year 1688, for some weeks,
    a slight sort of fever became epidemical. It affected the joints of
    the patients with slight pains, and they complained of a pain in their
    heads, especially in the fore-part, and of a sort of giddiness. It was
    more rife than any that I ever observed before, from any cause
    whatsoever, or in any time of the year. A great many whole families
    were taken at once with this fever, so that hardly one out of a great
    number escaped this general storm. Now this so epidemical or febrile
    insult seemed plainly to me to depend upon the variety of the season
    of the year, the most intense heat of some days being suddenly changed
    to cold.... Never were so many people sick together: never did so few
    of them die. They recovered under almost any regimen,--almost everyone
    of them.”

It will be seen, however, that the bills rose very considerably for four
weeks, and that, too, in the healthiest season of the year.

A somewhat fuller account of its symptoms is given by Molyneux for
Dublin[603]. He had been informed by a learned physician from London that
it had been as general there as in Dublin, which we know to have been the
case from Harris’s account. Both Molyneux and Harris call it a slight
fever, without mentioning catarrhal symptoms. The spring months
immediately preceding had been remarkable for drought.

    At Dublin this “short sort of fever” was first observed about the
    beginning of July, or some six weeks later than in London. “It so
    universally seized all sorts of men whatever, that I then made an
    estimate not above one in fifteen escaped. It began, as generally
    fevers do, with a chilness and shivering all over, like that of an
    ague, but not so violent, which soon broke out into a dry burning
    heat, with great uneasiness that commonly confined them to their beds,
    where they passed the ensuing night very restless; they commonly
    complained likewise of giddiness, and a dull pain in their heads,
    chiefly about the eyes, with unsettled pains in their limbs, and about
    the small of their back, a soreness all over their flesh, a loss of
    appetite, with a nausea or aptness to vomit, an unusual ill taste in
    their mouths, yet little or no thirst. And though these symptoms were
    very violent for a time, yet they did not continue long: for after the
    second day of the distemper the patient, usually of himself, fell into
    a sweat (unless ’twas prevented by letting blood, which, however
    beneficial in other fevers, I found manifestly retarded the progress
    of this): and if the sweat was encouraged for five or six hours by
    laying on more cloaths, or taking some sudorifick medicine, most of
    the disorders before mentioned would entirely disappear or at least
    very much abate. The giddiness of their head and want of appetite
    would often continue some days afterwards, but with the use of the
    open fresh air they certainly in four or five days at farthest
    recovered these likewise and were perfectly well. So transient and
    favourable was this disease that it seldom required the help of a
    physician; and of a thousand that were seized with it, I believe
    scarce one dyed. By the middle of August following, it wholly
    disappeared, so that it had run its full course through all sorts of
    people in seven weeks time.... This fever spread itself all over
    England; whether it extended farther I did not learn.”

This short fever of men was preceded by a slight but universal
horse-cold[604].


The Influenza of 1693.

Molyneux considered the strange transient fever of the summer of 1688 to
have been the most universal fever that perhaps had ever appeared, and he
thought the universal catarrh of five years’ later date (1693) to have
been “the most universal cold.” We have thus a means of contrasting in the
descriptions of the same author a universal slight fever and a universal
catarrh, which happened within five years of each other, and were neither
of them called at the time by the name of influenza,--a name not known in
Britain until half a century later. Before coming to Molyneux’s
description, it should be said that the London bills of mortality bear no
decided trace of an influenza in the end of the year 1693, the following
being the highest weekly mortalities nearest to the date given for the
epidemic at Dublin[605]:

_London Weekly Mortalities._

1693

  Week ending   Fever    All causes

  October 10      43        353
          17      62        353
          24      53        384
          31      69        457
  November 7      68        455
          14      48        365

Molyneux’s account of the flying epidemic of 1693 is as follows[606]:

    “The coughs and colds that lately so universally prevailed gave us a
    most extraordinary instance how liable at certain times our bodies
    are, however differing in constitution, age and way of living, to be
    affected much in the same manner by a spreading evil.... ’Twas about
    the beginning of November last, 1693, after a constant course of
    moderately warm weather for the season, upon some snow falling in the
    mountains and country about the town [Dublin], that of a sudden it
    grew extremely cold, and soon after succeeded some few days of very
    hard frost, whereupon rheums of all kinds, such as violent coughs that
    chiefly affected in the night, great defluxion of thin rheum at the
    nose and eyes, immoderate discharge of the saliva by spitting,
    hoarseness in the voice, sore throats, with some trouble in
    swallowing, whesings, stuffings and soreness in the breast, a dull
    heaviness and stoppage in the head, with such like disorders, the
    usual effects of cold, seized great numbers of all sorts of people in
    Dublin.

    “Some were more violently affected, so as to be confined awhile to
    their beds; those complained of feverish symptoms, as shiverings and
    chilness all over them, that made several returns, pains in many parts
    of their body, severe head-aches, chiefly about their foreheads, so as
    any noise was very troublesome: great weakness in their eyes, that the
    least light was offensive; a perfect decay of all appetite; foul
    turbid urine, with a brick-coloured sediment at the bottom; great
    uneasiness and tossing in their beds at night. Yet these disorders,
    though they very much frightened both the sick and their friends,
    usually without help of remedy would abate of themselves, and
    terminate in universal sweats, that constantly relieved.... When the
    cold was moderate, it usually was over in eight or ten days; but with
    those in whom it rose to a greater height, it continued a fortnight,
    three weeks, and sometimes a month. One way or other it universally
    affected all kinds of men; those in the country as well as city; those
    that were much abroad in the open air, and those that stay’d much
    within doors, or even kept close in their chambers; those that were
    robust and hardy, as well as those that were weak and tender--men,
    women and children of all ranks and conditions.... Not one in thirty,
    I may safely say, escaped it. In the space of four or five weeks it
    had its rise, growth, and decay; and though from first to last it
    seized such incredible numbers of all sorts of men, I cannot learn
    that any one truly dyed of it, unless such whose strength was before
    spent by some tedious fit of sickness, or laboured under some heavier
    disease complicated with it.... It spread itself all over England in
    the same manner it did here, particularly it seized them at London and
    Oxford as universally and with the same symptoms as it seized us in
    Dublin; but with this observable difference that it appeared three or
    four weeks sooner in London, that is, about the beginning of
    October.... Nor was its progress, as I am credibly informed, bounded
    by these Islands for it spread still further and reached the
    Continent, where it infested the northern parts of France (as about
    Paris) Flanders, Holland, and the rest of the United Provinces with
    more violence and no less frequency than it did in these countries.”

Yet no other writer, English or foreign, appears to have mentioned it. Its
existence rests on the authority of Molyneux alone, according to the above
very circumstantial narrative.


The Influenza of 1712.

There were so many fevers from 1693 to the end of the century that it is
not easy to distinguish epidemic agues or catarrhs among them. If we
follow the continental writers, it is not until 1709 and 1712 that there
is any concurrence of testimony for such widespread maladies. Evelyn,
however, says that in the remarkably dry and fine months of February and
March, 1705, “agues and smallpox prevail much in every place” (21st
February). 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 all over Europe in
1709 are scanty and ambiguous. It is probably to this “universal cold”
that Molyneux refers under the year 1708[607]; but English writers have
not otherwise mentioned an epidemic in 1709.

The next, in 1712, was a “new ague” of the kind without catarrhal
symptoms, like that of 1688. One German writer called it the
“Galanterie-Krankheit,” another the “Mode-Krankheit,” and it was about the
same time that the French name “la grippe” came into use. These names all
mean “the disease _a la mode_” or the reigning fashion[608]; they remind
one of the earlier “trousse galante” and “coqueluche” (a kind of bonnet),
and of the “grande gorre” of 1494. It appears to have made little or no
impression on the mortality, and would hardly have been noticed but for
its wide prevalence. In England it was the subject of a brief essay by Dr
John Turner under the title of “Febris Britannica Anni 1712[609]”--a
certain epidemic fever, of the milder kind, fatal to none, but prevalent
far and wide and leaving very few families untouched. It was marked by
aching and heaviness of the head, burning or lancinating pains in the
back, pains in the joints like those of rheumatism, loss of appetite,
vomiting, pains of the stomach and intestines. The venom though not sharp,
acted quickly. Turner ascribed it to malign vapours from the interior of
the earth (_malignos terrae matris halitus_). Its season in England, as in
Germany, was probably the summer or autumn. Turner begins his discourse
with a reference to the plague in the East of Europe, which, he says, had
been kept out of England by quarantine, to the murrain which was then
raging in Italy (and appeared in England in 1714), and to fevers of a bad
type which had traversed all France during the past spring, invading noble
houses and even the royal palace. Having begun his discourse thus, he ends
it by remarking that the slight British fever did not, in his opinion,
forebode a plague to follow. It may have been a recurrence of this
epidemic next year that Mead speaks of under the name of the “Dunkirk
rant” (supposed to have been brought over from Dunkirk by returning troops
after the Peace of Utrecht) in September, 1713; it was, he says, a mild
fever, which began with pains in the head and went off easily in large
sweats after a day’s confinement[610]. The weekly bills of mortality in
London are no help to us to fix the date of the one or more slight fevers
or influenzas about 1712-13. The great fever-years of the period were 1710
and 1714; but the fever was typhus, probably mixed with relapsing fever,
according to the evidence in another chapter. Even compared with the
universal fever or influenza of 1688, that of 1712 must have been
unimportant; for the former sent up the London mortality considerably,
whereas there is no characteristic rise to be found in any month of 1712
or 1713.

Either to this period, or to the undoubted aguish years 1727-28, belongs a
curious statement as to “burning agues, fevers never before heard of to be
universal and mortal,” in Scotland, the same having been a “sad stroke and
great distress upon many families and persons.” The authority is Patrick
Walker, who traces these hitherto unheard of troubles to the Union of the
Crowns (1707)[611].

On other and perhaps better authority, it does appear that Scotland before
that period was reputed to be remarkably free from agues; and it is
probable that the universal and mortal burning agues some time between
1707 and 1728, had come in one of those strange epidemic visitations, just
as the agues of 1780-84 did. It would be erroneous to conclude from such
references to ague that Scotland had ever been a malarious country. Robert
Boyle refers in two places to the rarity of agues in Scotland in the time
of Charles II.; the Duke of York, he says[612], on his return out of
Scotland, 1680, mentioned that agues were very unfrequent in that country,
“which yet that year were very rife over almost all England”--to wit, the
epidemic of 1678-80. Again, agues, especially quartans, are rare in many
parts of Scotland, “insomuch that a learned physician answered me that in
divers years practice he met not with above three or four[613].” However,
Sir Robert Sibbald, while he admits the rarity of quartans, does allege
that quotidians, tertians and the anomalous forms occurred, that agues
might be epidemic in the spring, with different symptoms from year to
year, and that certain malignant fevers, not called agues, were wont to
rage in the autumn[614].


Epidemic Agues and Influenzas, 1727-29.

The contemporary annalist of epidemics in England is Wintringham, of York,
who enters remittents and intermittents almost every year from 1717 to the
end of his first series of annals in 1726; but none of his entries points
very clearly to an epidemic of ague[615]. It is not until the very
unwholesome years 1727-29 that we hear of intermittent fevers being
prevalent everywhere, with one or more true influenzas or epidemic
catarrhs interpolated among them. To show how unhealthy England was in
general, I give a table compiled from Short’s abstracts of the parish
registers, showing the proportion of parishes, urban and rural, with
excess of burials over christenings:

_Country Parishes._

                      Registers
         Registers   showing high   Births     Deaths
  Year   examined     death-rate    in ditto   in ditto

  1727     180           55           1091      1368
  1728     180           80           1536      2429
  1729     178           62           1442      2015
  1730     176           39           1022      1302

_Market Towns._

                      Registers
         Registers   showing high   Births     Deaths
  Year   examined     death-rate    in ditto   in ditto

  1727      33           19           2441      3606
  1728      34           23           2355      4972
  1729      36           27           3494      6673
  1730      36           16           2529      3445

It is clear from the accounts by Huxham, Wintringham, Hillary, and Warren,
of Bury St Edmunds[616], that much of the excessive sickness in 1727-29
was aguish, although much of it, and probably the most fatal part of it,
was the low putrid fever so often mentioned after the first quarter of the
18th century. At Norwich, where the burials for three years, 1727-29, were
nearly double the registered baptisms, many were carried off, says
Blomefield, “by fevers and agues, and the contagion was general.” In
Ireland also, a country rarely touched by true agues, Rutty enters
intermittent fever as very frequent in May, 1728; and again, in the spring
of 1729: “Intermittent fevers were epidemic in April; and some of the
petechial kind. Nor was this altogether peculiar to us; for at that same
time we were informed that intermittent and other fevers were frequent in
the neighbourhood of Gloucester and London; and very mortal in the country
places, but less in the cities.”

       *       *       *       *       *

In the midst of this epidemic constitution of agues and other fevers there
occurred one or more horse-colds, and one or more epidemic catarrhs of
mankind. The most definitely marked or best recorded of these was the
influenza of 1729.

The universal cold or catarrh of 1729 fell upon London in October and
November, and upon York, Plymouth and Dublin about the same time. It
prevailed in various parts of Europe until March, 1730, its incidence upon
Italy being entirely after the New Year. The rise in the London deaths was
characteristic: the level was high when the epidemic began, but the
epidemic nearly doubled the already high mortality during the worst week
and trebled the deaths from “fever.”

_London Weekly Mortalities._

1729

  Week ending    Fever   All causes

  October   21     88       564
            28    118       603
  November   4    213       908
            11    267       993
            18    166       783
            25    124       635

The high mortalities of the weeks following may be taken as due to the
sequelae of the epidemic (pneumonias, pleurisies, malignant fevers) and
are indeed so explained in one contemporary account:

  Week ending  Fever   All causes

  December 2     92       678
           9    132       779
          16    116       707
          23    123       710
          30    109       628

The influenza of October and November, 1729, was the occasion of a London
essay[617], which appears to treat solely of the epidemic catarrh and its
after-effects, and not of the two years’ previous sicknesses, which are
the subject of another essay, by Strother, written before the influenza
began. London, says this author, as well as Bath, and foreign parts, have
been on a sudden seized universally with the disorders named in his title
(fevers, coughs, asthmas, rheumatisms, defluxions etc.). These had come in
the course of an unusually warm and wet, or relaxing, winter; “we have for
some time past dwelt in fogs, our air has been hazy, our streets loaden
with rain, and our bodies surrounded with water.” So many different
symptoms attend the “New Disease” that a volume, he says, would not
suffice to describe them, but he thus summarizes them:

    Sudden pain in the head, heaviness or drowsiness, and anon their noses
    began to run; they coughed or wheezed, and grew hoarse; they felt an
    oppression and load on their breasts, and turned vapourish, either
    because they apprehended ill consequences, or because their spirits
    were oppressed with a load of humours. The victims of the epidemic, he
    says again, were very subject to vapours; they are, upon the least
    fatigue or emotion of mind, dispirited, and flag upon every emergency.
    Among other symptoms were, quick pulse, thirst, loss of appetite and
    vertigo: the mouth and jaws hot, rough and dry, the thrush raising
    blisters thereon; the throat hoarse; a fierce brutal cough, which
    weakens by bringing on profuse sweats; the urine, muddy and white, “if
    they who are seized have been old asthmaticks.”

He speaks of cases that had proved suddenly fatal and says that all who
died of “epidemical catarrhs” had been found to have polypuses in their
hearts. If reference be made to the Table, it will be seen that the high
mortality continued in London for at least a month after the epidemic had
passed through its ordinary course of rise, maximum and decline; and it is
probably to that post-epidemic mortality that the author refers in the
following passages:

    “Numbers, as appears by our late bills, are taken with malignant
    fevers, or malignant pleurisies or with pleuritic fevers....
    Whosoever, then, would prevent a defluxion from turning into a fever,
    or from anything yet worse, if worse can be, must keep warm and
    observe a diluting regimen so long as till their water subsides and
    the symptoms are vanquished.... I am convinced by experience that many
    poor creatures have perished under these late epidemical fevers, from
    the fatal mistake of never retiring from their usual employments till
    they have rivetted a fever upon them, and till they have neglected
    twelve or fourteen days of their precious time.” This was fully
    endorsed by Huxham for the influenza of 1733: “Morbus raro lethalis,
    quem tamen, multi, vel ob ipsam frequentiam, temeri spernentes, seras
    dedêre poenas stultitiae, asthmatici, hectici, tabidi.”

Hillary’s account for Ripon is very brief[618]:

    “The season continuing very wet, and the wind generally in the
    southern points, about the middle of November [1729] an epidemical
    cough seized almost everybody, few escaping it, for it was
    universally felt over the kingdom; they had it in London and Newcastle
    two or three weeks before we had it about Ripon.”

Wintringham, of York, says the epidemic in the early winter of 1729 was “a
febricula with slight rigors, lassitude, almost incessant cough, pain in
the head, hoarseness, difficulty in breathing, and attended with some
deaths among feeble persons, from pleuritic and pulmonary
affections[619].” There was a tradition at Exeter as late as 1775 that two
thousand were seized in one night in the epidemic of 1729. Huxham, of
Plymouth, says of the epidemic in November:

    “A cartarrhal febricula, with incessant cough, slight dyspepsia,
    anorexia, languor, and rheumatic pains, is raging everywhere. When it
    is more vehement than usual, it passes into bastard pleurisy or
    peripneumony; but for the most part it is easily got rid of by letting
    blood and by emetics.” In December, the coughs and catarrhal fever
    continued, while mania was more frequent than usual, and in January,
    1730, the cartarrhal fever still infested some persons.

Rutty, of Dublin, merely says: “In November raged an universal epidemic
catarrh, scarce sparing any one family. It visited London before us[620].”

These references to the unusual catarrhal febricula in November, 1729, are
all that occur in the epidemiographic records kept by some four British
writers who recorded the weather and prevalent diseases of those years.
The epidemic catarrh made a slight impression upon them beside some other
epidemics, and hardly a greater impression than another of the same kind,
which seems to have occurred in the beginning of 1728. Thus, Rutty says,
under November, 1727: “In Staffordshire and Shropshire their horses were
suddenly seized with a cough and weakness. In December, it was in Dublin
and remote parts of Ireland; some bled at the nose.” On December 25th, he
enters: “The horses growing better, a cough and sore throat seized mankind
in Dublin[621].” Huxham, for Devonshire, under Oct.-Nov. 1727 confirms
this: “a vehement cough in horses, which lasted to the end of December;
the greater number at length recovered from it.” He does not say in that
context that an epidemic cough followed among men, as Rutty does say for
Dublin; but in a subsequent note upon horse-colds, he says: “In 1728 and
1733 it [the precedence of the horse-cold] was most manifest; in which
years a most severe cough seized almost all the horses, one or two months
earlier than men.” From which it would appear that the influenza of
Nov.-Dec. 1729, was not the only one during the aguish years 1727-29.

In the weekly London bills the other series of mortalities that look most
like those of an influenza are in the month of February, 1728 (748, 889,
850 and 927 in four successive weeks, being more than double the average).


The Influenza of 1733.

The next influenza was three years after that of 1729--in January, 1733.
In London, it raised the weekly deaths for a couple of weeks to a far
greater height than the preceding had done. Also the purely catarrhal
symptoms of running from the eyes and nose are more prominent in the
accounts for 1733 than for the influenza of 1729. The first notice of it
comes from Edinburgh. The horses having been “attacked with running of the
nose and coughs towards the end of October and beginning of November,” the
same symptoms began suddenly among men on the 17th December, 1732[622]. By
the 25th the epidemic was general in Edinburgh, very few escaping, and it
continued in that city until the middle of January, 1733. In a great many
it began with a running of lymph at the eyes and nose, which continued for
a day. Generally the patients were inclined to sweat, and some had profuse
sweats. It was noted as remarkable that the prisoners in the gaol escaped;
also the boys in Heriot’s Hospital, as well as the inhabitants of houses
near to that charity. The Edinburgh deaths rose as in the following table;
the bulk of these extra burials are said to have been at the public
charges, the epidemic having swept away a great number of poor, old, and
consumptive people:

  Buried in November, 1732   89
    "    "  December, 1732  109
    "    "  January,  1733  214
    "    "  February, 1733  135

Hillary[623] fixes the date of its beginning at Leeds on 3 February, one
week later than at York, three weeks later than at Newcastle, or than in
London and the south of England generally. At Leeds in three days’ time
about one-third part of the people were seized with chills, catarrh,
violent cough, sneezing and coryza; the epidemic lasted five or six weeks
in the town and country near. Dr John Arbuthnot, who was then living in
Dover Street, is clear that the outbreak in London was later than in
Edinburgh, which indeed appears also from the paragraph in the
_Gentleman’s Magazine_, dated Wednesday the 11th January, and from a
comparison of the dates of highest mortalities in London (p. 349) and
Edinburgh. It was in Saxony from the 15th November to the 29th of that
month, and in Holland before it broke out in England. But it had begun in
New England in the middle of October, and had broken out soon after in
Barbados, Jamaica, Mexico and Peru. Its outbreak in Paris was at the
beginning of February, 1733, and at Naples in March. The symptoms, says
Arbuthnot, were uniform in every place--small rigors, pains in the back, a
thin defluxion occasioning sneezing, a cough with expectoration. In France
the fever ended after several days in miliary eruptions, in Holland often
in imposthumations of the throat. In some, the cough outlasted the fever
six weeks or two months. The horses were seized with the catarrh before
mankind[624].

    The account of the influenza of 1733 in London in the _Gentleman’s
    Magazine_ is under the date of 11 January: “About this time coughs and
    colds began to grow so rife that scarce a family escaped them, which
    carried off a good many, both old and young. The distemper discovered
    itself by a shivering in the limbs, a pain in the head, and a
    difficulty of breathing. The remedies prescribed were various, but
    especially bleeding, drinking cold water, small broths, and such thin
    liquids as dilute the blood[625].”

Huxham says that it was in Cornwall and the west of Devon in February,
1733, and that at Plymouth, on the 10th of that month, some were suddenly
seized: “the day after they fell down in multitudes, and on the 18th or
20th of March, scarce anyone had escaped it.”

    It began with slight shivering, followed by transient erratic heats,
    headache, violent sneezing, flying pains in the back and chest,
    violent cough, a running of thin sharp mucus from the nose and mouth.
    A slight fever followed, with the pulse quick, but not hard or tense.
    The urine was thick and whitish, the sediment yellowish-white, seldom
    red. Several had racking pain in the head, many had singing in the
    ears and pain in the meatus auditorius, where sometimes an abscess
    formed: exulcerations and swelling of the fauces were likewise very
    common. The sick were in general much given to sweating, which, when
    it broke out of its own accord and was very plentiful, continuing
    without striking in again, did often in the space of two or three days
    carry off the fever. The disorder in other cases terminated with a
    discharge of bilious matter by stool, and sometimes by the breaking
    forth of fiery pimples. It was rarely fatal, and then mostly to
    infants and old worn out people. Generally it went off about the
    fourth day, leaving a troublesome cough often of long duration, “and
    such dejection of strength as one would hardly have suspected from the
    shortness of the time.” The cough in all was very vehement, hardly to
    be subdued by anodynes: and it was so protracted in some as to throw
    them into consumption, which carried them off within a month or
    two[626].

Huxham is unusually full on the coughs and anginas of horses for several
months before the influenza of men. In August, 1732, coughs were troubling
some horses; in September, a coughing angina (called “the strangles”)
everywhere among horses which almost suffocates most of them; in October
the disease of horses is raging at its worst; and in December it is still
among them.


The Influenza of 1737.

After several years, unhealthy in other ways, the influenza came again in
the autumn of 1737. In Devonshire, according to Huxham, the horses began
to suffer from cough and angina, and some of them to die, as early as
January, 1737, the epizootic being mentioned again in February, but not
subsequently. The same observer says the influenza began at Plymouth in
November and lasted to the end of December, 1737, seizing almost everyone,
and proving much more severe than the epidemic catarrhal febricula of
1733[627]. In London it must have begun in the end of August, to judge by
the characteristic rise in the weekly bills, and in the item of “fevers”
more especially; and although the deaths kept high for a longer period
than in 1733, yet no single week of 1737 had much more than half the
highest weekly mortality of the preceding influenza season.

_London Weekly Mortalities._

1733

  Week ending  Fevers  All causes

  January  16    69      531
           23    83      783
           30   243     1588
  February  6   170     1166
           13   110      628
           20    66      591

1737

  Week ending  Fevers  All causes

  August   30   117      611
  September 6   161      720
           13   201      837
           20   229      861
           27   167      770
  October   4   143      687
           11   114      551

In Dublin the worst week’s mortality in 1737, in the month of October, was
144, whereas in the influenza of 1733 the highest weekly bill had been
only 98[628]. Hardly any particulars of the influenza of 1737 remain,
although it appears to have been widely diffused, being recorded for
Barbados and New England. The only source of English information is Huxham
of Plymouth, who mentions some symptoms which should serve to characterize
this outbreak, namely: violent swelling of the face, the parotids and
maxillary glands, followed by an immense discharge of an exceedingly acrid
pituita from the mouth and nose; toothache and, in some, hemicrania; “in
multitudes,” wandering rheumatic pains; in others violent sciatics; in
some griping of the bowels. Huxham makes one interesting statement: “This
catarrhal fever has prevailed more or less for several winters past;” or,
in other words, the interval between the severe influenza of 1733 and the
milder influenza of 1737 was not altogether clear of the disease. He adds
that it put on various forms, according to the different constitutions of
those it attacked.


The Influenza of 1743.

Six years after, in 1743, came another influenza, which presents some
interesting points. A writer in the _Gentleman’s Magazine_ for May, 1743,
says that the epidemic began in September last in Saxony, that it
progressed to Milan, Genoa, and Venice, and to Florence and Rome, where it
was called the Influenza; in February last (1743) no fewer than 80,000
were sick of it [? in Rome] and 500 buried in one day. At Messina it was
suspected to be the forerunner of a plague--which did, indeed, ensue. It
is now (May) in Spain, depopulating whole villages. The outbreak in Italy
is authenticated by many notices collected by Corradi, Brescia having had
the epidemic in October, 1742, Milan and Venice in November, Bologna in
December, Rome, Pisa, Leghorn, Florence and Genoa in January, 1743, Naples
and the Sicilian towns in February. The English troops, in cantonments
near Brussels, were little touched by it when it reached that capital
about the end of February, but, strangely enough, “many who in the
preceding autumn had been seized with intermittents then relapsed[629].”

In London the epidemic appears to have begun in the end of March, and had
trebled the deaths in the week ending 12th April; by the beginning of May
it was practically over.

_London Weekly Mortalities._

1743

  Week ending  Fevers  All causes

  March 29       94      579
  April  5      189     1013
        12      300     1448
        19      223     1026
        26      115      629
  May    3       82      537

The familiar view of the influenza in London is given in a letter by
Horace Walpole from Arlington Street, 25 March, 1743[630]:

    “We have had loads of sunshine all the winter: and within these ten
    days nothing but snows, north-east winds and _blue plagues_. The last
    ships have brought over all your epidemic distempers; not a family in
    London has scaped under five or six ill; many people have been forced
    to hire new labourers. Guernier, the apothecary, took two new
    apprentices, and yet could not drug all his patients. It is a cold and
    fever. I had one of the worst, and was blooded on Saturday and Sunday,
    but it is quite gone; my father was blooded last night; his is but
    slight. The physicians say there has been nothing like it since the
    year thirty-three, and then not so bad [the bill of mortality almost
    the same]; in short our army abroad would shudder to see what streams
    of blood have been let out! Nobody has died of it [as yet, but later
    some 1000 in a week above the usual bill] but old Mr Eyres of Chelsea,
    through obstinacy of not bleeding; and his ancient Grace of York;
    Wilcox of Rochester succeeds him, who is fit for nothing in the world
    but to die of this cold too.”

The account in the _Gentleman’s Magazine_ confirms the vast shedding of
blood: “In the last two months it visited almost every family in the city;
so that the surgeons and all the phlebotomists had full employment.
Bleeding, sweating and blistering were the remedies usually prescribed.
All over the island it cut off old people. At Greenwich upwards of twenty
hospital men and boys were buried in a night[631].” In Edinburgh, as in
London, the weekly burials were trebled. On Sunday, May 6th, fifty sick
persons were prayed for in the Edinburgh churches, and in the preceding
week there had been seventy burials in the Greyfriars, being three times
the usual number[632]. It reached Dublin in May, proving milder and less
fatal than in London (perhaps that is why the writer in the _Gentleman’s
Magazine_ says it did not visit Ireland at all); it visited, also, the
remote parts of Ulster and Munster, scarce sparing a family[633].

It had reached Plymouth in the end of April. Huxham, who is again the
chief witness to its symptoms, says that it was much less severe there
than in the south of Europe or even than in London.

    Innumerable persons were seized at once with a wandering kind of
    shiver and heaviness in the head; presently also came on a pain
    therein, as well as in the joints and back; several, however, were
    troubled with a universal lassitude. Immediately there ensued a very
    great and acrid defluxion from the eyes, nostrils and fauces, and very
    often falling upon the lungs, which occasioned almost perpetual
    sneezings, and commonly a violent cough. The tongue looked as if
    rubbed with cream. The eyes were slightly inflamed; and, being
    violently painful in the bottom of the orbit, shunned the light. The
    greater part of the sick had easy, equal and kindly sweats the second
    or third day, which, with the large spitting, gave relief. Great loss
    of strength, however, remained. Frequently towards the end of this
    “feveret,” several red angry pustules broke out: often, likewise, a
    sudden, nay a profuse, diarrhoea with violent griping. In many cases
    Huxham was astonished at the vast sediment (yellowish white), which
    the urine threw down, “than which there could not be a more favourable
    symptom[634].” One remarkable feature of the epidemic of 1743 was
    recalled by W. Watson in a letter to Huxham on the epidemic of 1762:
    “In the disorder of 1743 the skin was very frequently inflamed when
    the fever ran high; and it afterwards peeled off in most parts of the
    body[635].”


Some Localized Influenzas and Horse-colds.

For the space of nineteen years, from 1743 to 1762, there occurred no
universal cold common to all the countries of Europe; the convergence of
positive testimony, which is so remarkable on many occasions from the 16th
century onwards, is found on no occasion during that interval. And yet the
period is not wanting in instructive notices of epidemic catarrh, which I
shall take from English writings only. British troops occupied Minorca
during some of those years, and the epidemics of the island were carefully
noted by Cleghorn. Under the year 1748 he writes:

    “About the 20th April there appeared suddenly a catarrhal fever, which
    for three weeks raged so universally that almost everybody in the
    island was seized with it. This disease exactly resembled that which
    was so epidemical in the year 1733. For in most part of the sick the
    feverish symptoms went off with a plentiful sweat in two or three
    days; while the cough and expectoration continued sometime longer. In
    a few athletic persons, who were not blooded in time, it terminated in
    a fatal pleurisy or phrensy[636].”

Another English epidemiographist, Hillary, who had begun his records at
Ripon, was in those years resident in Barbados; and in that island, as in
Minorca, we hear of unmistakeable universal colds, although none of them
at the same time as the one recorded by Cleghorn. The Barbados annalist
records a general catarrhous fever in September, 1752[637], and a
recurrence of the same in the end of December, lasting until February 1753
(catarrh and coryza, cough, hoarseness, a great defluxion of rheum, some
having fever with it). As it ceased in February, 1753, a slow nervous
fever began, and continued epidemic for eighteen months, until September,
1784, when it totally disappeared, and was not seen again so long as
Hillary remained in the island (1758). In 1755 there was another epidemic
catarrhal fever, first in February and again in the end of the year. In
the earlier outbreak, few escaped having more or less of it, the symptoms
being cold ague for a few hours, followed by a hot fever with great pain
in the head, or pains in the back and all over the body, which lasted two
or three days, or longer, and then went off in some by a critical sweat.
In the October outbreak it affected children mostly. Once more, in 1757,
the same catarrhous fever returned, with almost the same
circumstances[638]. That year there was a universal catarrh in North
America.

Not less remarkable than the epidemic catarrhal fever in Minorca in 1748,
or those in Barbados in 1752-3, 1755 and 1757, was the epidemic of 1758 in
Scotland[639]. It was first noticed with east winds from the 16th to 20th
September, several children having taken fever like a cold. In the last
week of September thirty out of sixty boys at the Grammar School of
Dalkeith were seized with it in two or three days. In October it became
more general, among old and young, and increased till about the 24th, when
it began to abate. In Edinburgh not one in six or seven escaped. It was in
most parts of Scotland in October--Kirkaldy, St Andrews, Perthshire (where
many died of it), Ayrshire, Glasgow, Aberdeenshire, Rossshire (end of
October). A gentleman told Dr Whytt that in the Carse of Gowrie, in
September, “before this disease was perceived, the horses were observed to
be more than usually affected with a cold and a cough.”

The symptoms in Scotland were of the Protean kind of “influenza”: there
might be fever with no cold; or a coryzal attack with little or no fever;
or some had bleeding at the nose for several days, which might be profuse;
or the soreness and pains in the bones might be in all parts of the body,
or confined to the cheekbones, teeth and sides of the head. Others had a
fever without any distinctive concomitant, but a cough when the fever
subsided[640]. One of Whytt’s patients, a lady aged thirty, had been
feverish for four days, when a scarlet rash appeared, but did not come
fully out; the fall of the pulse and fever coincided with the beginning of
a troublesome tickling cough, “so that the cough might be said to have
been truly critical.” Those who exposed themselves too soon frequently
relapsed. Few died of the disease, except some old people. “In some parts
of the country, when the disease was not taken care of in the beginning,
as being attended with no alarming symptoms, it assumed the form of a slow
fever, which sometimes proved mortal.”

The year after the localised influenza of Scotland there was an epidemic
of the same kind in Peru and Bolivia, that year, 1759, being one in which
no universal fever or catarrh is reported from any other country. It
extended from south to north, along the coast as well as over the high
table-lands of Bolivia and the sierra region of Peru, invading, among
others, the populous towns of Chuquisaca, Potosi, La Paz, Cuzco and Lima.
In five or six days hardly one inhabitant of a place had escaped it,
although some had it very slightly. As it was swift in its attack, so it
was soon over, lasting about a month in each place. Its symptoms were
great dizziness and heaviness of the head (vertigo and gravedo),
feebleness of all the senses, deafness, strong pains over all the body,
moderate fever, weariness, great prostration, complete loss of appetite,
bleeding from the mouth and nostrils (this had been noted in Scotland the
year before), and a long convalescence. Dogs shared the disorder, and
might have been seen lying stretched out in the streets, unable to stand.
It will be observed that the symptoms given do not include catarrh[641].

Before we come to the next general influenza in Britain, that of 1762,
there are some facts to be mentioned as to agues and horse-colds in the
interval since 1743. In Rutty’s Dublin chronology, agues are entered as
prevalent in 1745. In 1750, about the middle or end of December, the most
epidemic and universally spreading disease among horses that anyone living
remembered made its appearance in Dublin, and in Ulster and Munster almost
as soon. It had been in England in November, and was like that which
preceded the universal catarrhs of mankind in 1737 and 1743. In 1751,
irregular agues were frequent in March, as were also tumours of the face,
jaws and throat. Agues also continued to be frequent in April, both in
Dublin and in several parts of the country. In December, 1751, and
January, 1752, there was another horse-cold, the same as a twelvemonth
before. In 1754 the spring agues were frequent in Kilkenny and Carlow,
though rare in Dublin. In 1757, “intermittent fevers, which had not
appeared since April, 1746,” came in the end of February. In 1760, a great
catarrh among horses became general in Dublin in April. Coughs and tumours
about the fauces and throat, with a slight fever, often occurred in March;
and regular intermittents, tertians or quotidians, were more frequent than
for some years past. These, according to Sims, of Tyrone, abated after
1762, so that he had not seen an intermittent since 1764 until the date of
his writing, 1773.

The horse-cold of 1760 was observed in London in January. The _Annual
Register_ says under date 27 Jan.: “A distemper which rages amongst horses
makes great havock in and about town. Near a hundred died in one week.” In
a letter a day later (28 Jan.) Horace Walpole writes: “All the horses in
town are laid up with sore throats and colds, and are so hoarse you cannot
hear them speak.... I have had a nervous fever these six or seven weeks
every night, and have taken bark enough to have made a rind for
Daphne[642].” This same horse-cold is reported from the Cleveland district
of Yorkshire: “In February, [1760] horses were invaded by the most
epidemic cold or catarrh that has ever happened in the remembrance of the
oldest men living[643].” The same authority for Cleveland says that
intermittents were frequent and obstinate in the spring of 1760.

Among these miscellanies of the history may be mentioned an outbreak of
“violent pleuritic fever or peripneumene” in the spring of 1747, which was
fatal to a comparatively large number in the parish of George Ham, North
Devon. Thirteen died of it from the 20th to the 31st March, four in April,
four in May, and one in June, “most of them in four or five days after the
first seizure.” The same family names recur in the list[644].


The Influenza of 1762.

The universal slight fever or catarrhal fever of 1762 was, in London, much
less mortal than those of 1733 and 1743.

_London Weekly Mortalities._

1762

  Week ending  Fevers  All causes

  May  4         72       467
      11        104       626
      18        159       750
      25        162       659
  June 1        121       516
       8         85       504

It began in London about the 4th of April, and by the 24th of that month
“pervaded the whole city far and wide, scarcely sparing anyone.” It was in
Edinburgh by the beginning of May, and in Dublin about the same time, but
did not reach some parts of Cumberland until the end of June. Short, who
was then living at Rotherham, says that it “continued most of the
summer[645].” It had the usual variety of symptoms in the individual
cases, of which only a few need be again particularized. Where the fever
was sharp, it usually remitted during the day, having its exacerbation in
the night. Sometimes it proved periodical, and of the tertian type: “it
usually returned every night with an aggravation of the feverish symptoms”
(Rutty). Perspiration was a constant symptom; the tongue was as if covered
with cream (Baker repeats this figure of Huxham’s in 1743). “Depression of
mind and failure of strength were in all cases much greater than was
proportionate to the amount of disease. A great number of those affected
were very slowly restored to health, languishing for months, and some even
for a whole year with cough and feverishness--relics of the disease which
it was difficult to shake off. Some, after struggling long with impaired
health, fell victims to pulmonary consumption. In some there were pains in
all the joints and in the head, with lassitude and vehement fever, but
with little signs of catarrh.” Rutty, of Dublin, says that in some a
measly efflorescence or a red rash was seen, attended by violent
itching[646]. Among labourers in the country, the pestilence was so
violent as to destroy many within four days, from complications of
pneumonia, pleurisy and angina. Sometimes it took the form of a slow
fever, “and approximated to that form of malady which the ancients
denominated ‘cardiac’[647].”

The mortality is said to have varied much. White, of Manchester, declared
that fewer died there than in ordinary while the epidemic lasted. On the
other hand Offley, of Norwich, said there were more victims there than by
the epidemic of 1733 “or by the more severe visitation called influenza in
1743”--the two visitations which were incomparably the worst in the whole
history, according to the London bills. Baker says that it infested cities
and the larger towns crowded with inhabitants earlier than the surrounding
villages, and is inclined to think that it was mostly brought by persons
coming from London[648].

The progress of this epidemic over Europe had been peculiar. It was seen
in the end of February, 1762, at Breslau, where the deaths rose from 30 or
40 in a week to 150. It was in Vienna at the end of March, and in North
Germany about the same time as in England--April and May. There were at
that time British troops in Bremen, among whom the epidemic appeared
shortly after the 10th April[649].

    “It looked at first as if they were going to have agues, but soon they
    were attacked with a cough and a difficulty of breathing and pain of
    the breast, with a headache, and pains all over the body, especially
    in the limbs. The first nights they commonly had profuse sweats. In
    several it had the appearance of a remitting fever for the two or
    three first days.” The cough in many was convulsive. The epidemic
    seized most of the people in the town of Bremen: very few of the
    British escaped, but none of them died, except one or two, from a
    complication of drunkenness and pneumonia.

It is said to have been nowhere in France except in Strasburg and the rest
of Alsace, in June. Baker says, “Whilst it raged everywhere else, it did
not reach Paris or its vicinity, a fact which I learned from trustworthy
persons.” On board British ships of war in the Mediterranean it occurred
in July. Its severity appears to have varied greatly in different cities
of the same country. Rutty, for Ireland, agrees with Baker, for England,
that it was more fatal in the country than in the towns.


The Influenza of 1767.

The next influenza, that of 1767, was so unimportant that its existence in
England would hardly have been known but for Dr Heberden’s paper, “The
Epidemical Cold in June and July 1767[650].” Those few who were affected
by a cold in London early in June observed that it differed from a common
cold, and resembled the epidemical cold of the year 1762, on account of
the great languor, feverishness, and loss of appetite. It became more
common, was at its height in the last week of June or beginning of July,
and before the end of July had entirely ceased. It was less epidemical and
far less dangerous than the cold of 1762, so much so that the London bills
of mortality hardly witness at all to its existence. The attack began with
several chills; then came a troublesome and almost unceasing cough, very
acute pains in the head, back, and abdomen under the left ribs,
occasioning want of sleep. Many of the symptoms hung upon several for at
least a week, and sometimes lasted a month. The fever might be great
enough to bring on deliriousness, yet had plain remissions and
intermissions. The same disorder was reported to be common about the same
time in many other parts of England, and more fatal than it was in London.
Heberden did not anticipate from it the lingering effects in the
individual, for months or years, which marked so many of the cases in
1762[651].


The Influenza of 1775.

Heberden invited physicians in the provinces to send in accounts of the
epidemic of June and July, 1767, but no one seems to have responded.
However, the next epidemic catarrh, of November and December, 1775, was
made the subject of many communications from all parts of Britain, in
response to a circular drawn up by Dr John Fothergill. This was a
distinctly catarrhal epidemic, running of the nose and eyes, cough and
(or) diarrhoea, being commonly noted.

At Northampton some had “a severe pain in one side of the face, affecting
the teeth and ears, and returning periodically at certain hours in the
evening, or about midnight, attended with vertigo, delirium and limpid
urine during the exacerbation. Some whose cases were complicated with the
above symptoms had a general rash, but without its proving critical....
Many of those who escaped the catarrh have been more or less sensible of
giddiness, or pains in the head or face,” with limpid urine, etc., as if
they had a full attack[652]. The epidemic began in London about the 20th
October, and made a slight impression upon the bills of mortality in some
weeks of November and December[653]. Grant says that it lasted nearly five
months in London, having been attended by the same “comatose” fever which
Sydenham associated with the epidemic catarrh of 1675. The fatalities in
Grant’s practice occurred late in the epidemic:

    “On the 23rd December [1775] I had lost one patient, and soon after
    two others; all died comatous, owing, as I then imagined, to the
    remains of the comatose fever of Sydenham, which had raged all the
    autumn, was complicated with the catarrhous fever, and continued by
    the wet, warm uncommon weather for the season of the year; and I still
    [1782] am of opinion that this complication is the reason why the
    epidemic catarrh of 1775 proved much more fatal than it did in 1782--a
    fact known to all of us[654].”

A Liverpool writer also says that the catarrh of 1782 “distinguished by
the same title,” was a much slighter complaint than the “influenza” of
1775. The latter, however, was a summer epidemic, and was naturally less
complicated with pneumonia and bronchitis, whatever the “comatose” fever
of 1775 may have been. Grant’s statement that the influenza of 1775 lasted
five months in London is borne out by the Foundling Hospital records: on
11 November, there were 16 in the Infirmary with “epidemic fever and
cough,” next week 22 with “fevers, coughs and colds,” and so on week by
week under the same names until the 9th of March, 1776[655]. At Dorchester
it was general after 10th November; about the same time it was in Exeter,
where within a week it seized all the inmates, but two children, in the
Devon and Exeter Hospital, to the number of 173 persons. The middle of
November is also the date of its decided outbreak at Birmingham, at
Worcester, and at Chester, where Howard found the prisoners suffering from
it. At York in the north, as at Blandford in the south, it is claimed to
have begun earlier than in London. At Lancaster it was not seen until
three weeks after the accounts of its prevalence in London began to come
in, but only three days after it was first heard of in Liverpool. At
Aberdeen it was fully a month later than in London. It did not visit
Fraserburgh, though there was a putrid fever there very fatal at that
time[656].

In many cases the disease assumed the type of an intermittent towards its
decline, but bark was not useful (Fothergill, Ash, while Baker says that
bark did good when the fever was spent). All the observers agree both as
to its slight fatality and its universality. At Chester it attacked 73 out
of 97 affluent persons, neighbours in the Abbey Square; at the Cross,
inhabited by people in trade, 109 had the disease out of 144; in the
House of Industry, not one escaped out of 175; it attacked people in the
country rather later than in the town, and less generally, but it was in
villages and even in solitary houses.

The unusual prevalence of catarrh among horses (and dogs) is asserted by
John Fothergill (“during this time”), Cuming (“after the middle of August
very generally in Yorkshire”), Glass (in September), Haygarth (in North
Wales, about August and September), Pulteney (“before we heard of it among
the human race”). The fullest statement is by Dr Anthony Fothergill, of
Northampton:

    “This distemper prevailed some time among horses before it attacked
    the human species. The cough harassed them severely and rendered them
    unfit for work, though few died. About the same time also it infested
    the canine species and with great fatality, especially hounds. An
    experienced huntsman informed me that it ran through whole packs in
    many parts of England and that several dogs died[657].”

The progress of influenza from other countries towards Britain was so much
a matter of rumour or vague statement in the earlier periods that it has
not seemed worth while to make a point of it under each epidemic. It
happens, however, that there is good evidence of the line of progress of
the epidemic of 1775. The afterwards celebrated Professor Gregory, of
Edinburgh, encountered it in Italy in the autumn, and followed it all the
way home to Scotland. He saw it successively in Genoa, in the south of
France, in the north of France, in London, and last of all in Edinburgh,
where he himself at length fell ill with it, several of his travelling
companions having taken it in Italy two or three months before. In his
lectures long after (as reported by Christison, who heard them about 1817)
he traced the influenza of 1775 from south to north: “It appears to have
broken out somewhere on the north and west coast of Africa, whence it
spread not only north into Europe, but likewise eastward to Arabia, Egypt,
Syria, Palestine, Asia Minor, Hindostan, China, and was ascertained to
have spread over the whole immense empire of the Chinese. From China it
returned westward by a northern route through the extensive dominions of
Russia and from that country it was sent again over Europe in 1782[658].”


The Influenza of 1782.

Seven years after, in the early summer of 1782, there came another swift
and brief wave of catarrhal fevers over England, Scotland and Ireland, in
the midst of a great “constitution” of epidemic agues which continued for
several years. This was the occasion when the Italian name of “influenza”
was formally adopted by the College of Physicians. Perhaps the first
appearance of the name in English was in an account of the epidemic in
Italy in 1729, given by a London periodical devoted to political news from
foreign countries, and called, “The Political State of Great
Britain[659].” In 1743 the news of the Italian epidemic under its native
name reached London before the infection itself, the Italian name being
frequently given to it while it lasted that season in England. When the
next epidemic came, in 1762, it was not called the influenza as a matter
of course, but was compared to the disease in 1743 “called the influenza.”
In the epidemic of 1775, “influenza” came more into use, and in 1782 it
was the name usually given to the epidemic malady. The adoption of this
name put an end at length to the ambiguity between epidemic agues and
influenzas, leaving the curious correspondences between them in time and
place, or the nosological affinities between them, as interesting as ever.

As late as the very fatal aguish years 1727-29, there was no clear
separation of the epidemic agues from the influenzas, of which latter
there were two or more, the one in the end of 1729 being easy to identify.
In the great aguish constitution of 1678-81, Sydenham distinguished the
epidemic coughs and catarrhs in Nov. 1679; but Morley made no such
distinction, describing the whole series of agues for two seasons (and he
might have done so for two seasons more) as the “new fever,” “new ague,”
or “new delight,” as in Derbyshire, without a suspicion that the universal
coughs, catarrhs and fevers in November, 1679, were something
nosologically distinct, which the future would identify as “influenza.” In
like manner Whitmore, in the great aguish period immediately preceding,
that of 1658-59, had described the “new disease” as one single Proteus. In
the still earlier epidemic seasons of 1557-58 and 1580-82, everything was
“ague,” although we now discover influenza mixed therewith. I do not say
that this inclusive naming was the better scientifically; nor do I uphold
Willis and Sydenham in their teaching that the intermittent constitution
passed into the catarrhal, in 1658 and 1679 respectively. But it is
necessary to bear in mind the matter of fact, namely, that those agues,
amidst which the “great colds” occurred, were epidemic agues, and not the
endemic fevers of malarious places; and I have now to show that the
“influenza” of 1782 was in like manner a brief episode in the midst of
several successive seasons of agues, which were as much “new” or “strange”
as any of those in the earlier history. Whether the epidemic agues of
1780-85 were the last of the kind in Britain had better be left an open
question until our most recent and most strange experiences in 1890-93 are
read in the light of history.

The influenza of 1782 was a very definite incident of a few weeks--_teres
atque rotundus_. It is easily discoverable in the weekly bills of
mortality in London to have fallen in the month of June:

_London Weekly Mortalities._

1782

  Week ending   Fevers   All causes

  May   21        45        336
        28        49        390
  June   4        57        385
        11       121        560
        18       110        473
        25        89        434
  July   2        49        296

The sudden rise and fall of the deaths and the height reached are much the
same as in other such epidemics in the summer--the “gentle correction” of
1580, the “transient slight fever” of 1688, and the epidemic catarrh of
1762. On the other hand the epidemics of autumn, winter or spring in 1729,
1733, 1737 and 1743 were far more severe, while the winter epidemics of
1675 and 1679 had figures almost the same as the summer epidemics.

The influenza of 1782 was not remarkable, whether in its fatality or in
its characters; but it received far more attention than any that had
preceded it. Two collective inquiries were held upon it, one by a Society
for promoting Medical Knowledge[660], the other by a committee of the
College of Physicians of London[661], many physicians all over England,
Scotland and Ireland contributing to one or other. There were also three
or more separate essays[662].

The epidemic appeared in 1782 at Newcastle in the end of April, and raged
there all May and part of June. In London it appeared between the 12th and
18th of May, in the Eastern Counties about the middle of May, in Surrey
and at Portsmouth, Oxford and Edinburgh, also about the third week of May,
but not in Musselburgh until the 9th or 10th of June. It was at Chester on
the 26th of May, at Plymouth on the 30th, at Ipswich, Yarmouth, York,
Liverpool and Glasgow in the first week of June. In Northumberland it was
raging in July, and did not cease until the third week of August. In
Scotland it was at a height in July, during the haymaking[663]. The most
curious fact in its incidence comes from North Devon; it was prevalent in
Barnstaple at the usual time, the month of June; but the neighbouring town
of Torrington was not then affected by it, having previously gone through
the epidemic, it is said, from a date as early as the 24th of March[664].
In all places it spread quickly, affecting from three-fourths to
four-fifths of the adult inhabitants, but children not so much. At
Christ’s Hospital, London, only fourteen out of seven hundred boys had it.
Wherever it attacked children, it did so mildly. It lasted under six weeks
in each place that it came to. There were some strange attacks of it in
London in September, “two months after the late epidemical catarrh had
entirely disappeared from England.” The king’s ships ‘Convert’ and
‘Lizard’ arrived in the Thames from the West Indies in September. Their
crews were perfectly healthy till they reached Gravesend, where they took
on board three custom-house officers; and in a very few hours after that
the influenza began to make its appearance. Hardly a man in either ship
escaped it; and many both of the officers and common seamen had it in a
severe degree[665]. Others who came to London from the West Indies in
merchantmen in the end of September were attacked by influenza in their
lodgings in the beginning of October[666]. To this epidemic belong also
the strange experiences of the Channel Fleet in its two divisions under
Howe and Kempenfelt; but I postpone for the present the whole question of
influenza at sea.

Gray thus sums up the great variety of symptoms as related by his numerous
correspondents:

    Chilliness and shivering, sometimes succeeded by a hot fit, the
    alternation continuing for some hours; languor and lassitude,
    sneezing, discharge from the nose and eyes, pain in the head
    (particularly between or over the eyes), cough, sometimes dry,
    sometimes accompanied with expectoration, inflammation in one or both
    eyes, oppression and tightness about the praecordia, difficulty of
    breathing, pain in the breast or side, pain in the loins, neck,
    shoulders or limbs, sense of heat or soreness in the throat and
    trachea, hoarseness, bleeding from the nose, spitting of blood and
    loss of smell and taste, nausea, flatulence. Also watery blisters
    about the upper parts of the body, and swellings in the face and other
    parts, attended with considerable soreness, apparently erysipelatous.
    In some the catarrhal symptoms were very slight, or entirely wanting,
    the disorder in those cases being like a common fever.

The committee of the College of Physicians said that “the universal and
almost pathognomonic symptom was a distressing pain and sense of
constriction in the forehead, temples, and sometimes in the whole face,
accompanied with a sense of soreness about the cheek-bones under the
muscles,” reminding one of the _fierro chuto_ or “iron cap” of the South
American epidemic in 1719. Sometimes no catarrhous affection followed
these strange head pains. The languor of body and depression of spirits
were thought to be more protracted than in 1762, but the fatalities at the
time were fewer than in the earlier epidemic, and there were fewer
consumptions following. Sweating, also, was said by some to be less
remarkable than in 1762; but Carmichael Smyth said: “The late influenza
[1782] might very properly have been named the sweating sickness, as
sweating was the natural and spontaneous solution of it[667].” One
distinctive thing in the epidemic of 1762 was missed by most in 1782,
namely, the peculiar constriction of the breast, with heat and soreness of
the trachea, as if excoriated; but Hamilton describes that very thing for
1782 in Bedfordshire[668]. As in other epidemics of the kind, especially
those which have been least catarrhal, there were hardly two cases quite
the same.


The Epidemic Agues of 1780-85.

Let us now take up the strange history of epidemic agues for two or three
years preceding and following the influenza of June, 1782. Sir George
Baker begins his account of them thus[669]: “The predominance of certain
diseases observable in some years, and the total or partial disappearance
of the same in other years, constitute a subject worthy of our
contemplation.”

    These agues were first noticed in London in the spring and autumn of
    1780, but they infested various parts of England a little earlier. In
    the more inland counties the agues were “often attended with
    peculiarities extraordinary and alarming. For the cold fit was
    accompanied by spasm and stiffness of the whole body, the jaws being
    fixed, the eyes staring and the pulse very small and weak.” When the
    hot fit came on the spasms abated, and ceased in the sweating stage;
    but sometimes the spasm was accompanied by delirium, both lasting to
    the very end of the paroxysm. Even in the intermissions a convulsive
    twitching of the extremities continued to such a degree that it was
    not possible to distinguish the motion of the artery at the wrist.
    “This fever had every kind of variety, and whether at its first
    accession it were a quotidian, a tertian or a quartan, it was very apt
    to change from one type to another. Sometimes it returned two days
    successively, and missed the third day; and sometimes it became
    continual. I am not informed that any died of this fever whilst it
    intermitted. It is, however, certain that many country people whose
    illness had at its beginning put on the appearance of intermission,
    becoming delirious, sank under it in four or five days.”

Reynolds, another London physician, in a letter to Sir George Baker
confirms all that the latter says of these singular epidemic agues: “No
two cases resembled each other except in very few circumstances[670]”--the
remark commonly made about the influenza itself. If these descriptions of
the epidemic ague had not been given by physicians living as late as 1782,
and altogether modern in their methods, we might have supposed that they
were confusing influenzas with agues, or using the latter term inexactly.
“The ague with a hundred names” is the striking phrase of Abraham Holland,
in his poem on the plague of 1625. Whitmore, describing the fatal epidemic
ague (with an episode of influenza) in 1658-59, does not say that it had a
hundred names, but that it assumed a hundred shapes, “which render it such
a hocus-pocus to the amazed and perplexed people, they being held after
most strange and diverse ways with it.... So prodigious in its alterations
that it seems to outvie even Proteus himself[671].”

As farther showing the anomalous character of these epidemic agues, or
their difference from the endemic, Baker adds:--

    “It is a remarkable fact, and well attested, that in many places,
    whilst the inhabitants of the high grounds were harassed by this
    fever, in its worst form, those of the subjacent valleys were not
    affected by it. The people of Boston and of the neighbouring villages
    in the midst of the Fens were in general healthy at a time when fever
    was epidemic in the more elevated situations of Lincolnshire.” Women
    were nearly exempt, but few male labourers in the fields escaped it.

Baker heard from all parts that the same constitution continued through
1781 and 1782; and that since that time, though it seemingly abated,
yet agues had been much more prevalent than usual, and had even been
frequent in places where before that period they were uncommon. They
were very noticeable in London from 1781 to 1785, not least so during
the very severe cold of the winter and spring of 1783-84. We hear
of great numbers attacked at Hampstead with common intermittents in
February and the following months of 1781, during which time even
the measles, in the greater number of cases, “ended in very troublesome
intermittents[672]”--just as they were apt to end often in troublesome
coughs.

The annals of Barker, of Coleshill, are full of references to agues, among
other fevers, from 1780 onwards. Under 1781 he writes:--

    “This spring that very peculiar, irregular, dangerous and obstinate
    disease, the burning, or as the people in Kent properly enough called
    it, the Plague-ague, made its appearance, became very epidemical in
    the eastern part of the kingdom, and raged in Leicestershire, the
    lower part of Northamptonshire, Bedfordshire, and in the fens
    throughout the year.... This strongly pestilential disease had such
    an effect upon them that the complexion of their faces continued for a
    time as white as paper, and they went abroad more like walking corpses
    than living subjects.”

As many as five persons in an evening were buried from it in some large
towns in Northamptonshire; and about Boston it was so general and grievous
that out of forty labourers hired for work in harvest, half of them, it
was said, would be laid up in three days[673]. In 1783 the “pestilential
agues” were as bad in Northamptonshire and eastern parts as the year
before. A Liverpool writer says:

    “In the autumn of 1782 the quartan ague was very prevalent on the
    opposite shore of the river in Cheshire: it was universal in the
    neighbourhood of Hoylake, where many died of it. Yet it was scarcely
    heard of in Liverpool, although from the uncommon wetness of the
    season it prevailed throughout the kingdom[674].”

On October 25, 1783, a correspondent of the _Gentleman’s Magazine_ offered
an explanation of the “present epidemic disorder, which has so long
ravaged this country, and that in the most healthy situations of it,”
namely, “the putrescent air caused by the number of enclosures, and the
many inland cuts made for navigation[675].” Next year, 1784, appears to
have been the principal season of epidemic agues on both sides of the
Severn valley, one practitioner at Bridgenorth making them the subject of
a special essay[676].

It was at this time that Fowler brought into use his solution of arsenic
as a substitute for bark in agues, the latter having notably failed in the
epidemics since 1780.

Baker says: “The distinguishing character of this fever was its obstinate
resistance to the Peruvian bark; nor, indeed, was the prevalence of the
disease more observable than the inefficacy of the remedy:” in that
respect the epidemic agues had belied the experience with bark in ordinary
agues. Again, it is singular that bark had failed most, and arsenic been
especially useful in those parts of England where ordinary malarious agues
were never seen. One practitioner in Dorset laid in a large stock of
arsenic, wherewith he “hardly ever failed to stop the fits soon[677].”
Another, at Painswick, in Gloucestershire, used it successfully in two
hundred cases of epidemic agues from 1784 onwards. He gives the following
account of these unusual agues at Painswick:

    “This town, which is situated on the side of a hill, and is remarkable
    for the purity of its air, is very populous. In the year 1784 the
    epidemic ague, that prevailed in many parts of the kingdom, made its
    appearance in this place, and has continued till the present time
    [Nov. 1787], although previously to that period the disease was hardly
    ever seen here, unless a stranger came with it for the recovery of his
    health, on account of the healthy situation of the place. It affected
    whole families, and appeared to be most violent in spring and autumn.
    In the summer of 1786 it was followed by a fever of the kind called
    typhus, or low nervous fever, which not unfrequently degenerated into
    a putrid fever and proved very fatal[678].” In May, 1785, at a general
    inoculation of smallpox, “many had been afflicted with intermittents
    of several months’ duration attended with anasarcous swellings[679].”

It will be seen from the following table of cases treated at the Newcastle
Dispensary, under the direction of Dr John Clark, during twelve years from
1 October, 1777, to 1 September, 1789, that influenza makes the smallest
show among them, being far surpassed by the intermittent fevers and
dysenteries, while all three together are greatly exceeded by the
perennial typhus fever:

                                       Cases treated

  Putrid fever                            1920
  Intermitting fever                       313
  Epidemic dysentery in 1783 and 1785      329
  Influenza of 1782                         53

In Scotland, also, agues became epidemic about the year 1780. There is no
reason to suppose that their prevalence in these years was less
exceptional there than in England and Ireland. It will be seen, indeed,
from the following table compiled from the books of the Kelso Dispensary
that the only years of their considerable prevalence were the same as the
years of epidemic ague in England.

_Kelso Dispensary_[680].

             All    Cases
  Year      Cases  of Ague

  1777       302      17
  1778       306      33
  1779       460      70
  1780       675     161
  1781       510     103
  1782       440      61
  1783       510      73
  1784       459      40
  1785       573      62
  1786       563      48
  1787       525      24
  1788       577      25
  1789       546      48
  1790       640      18
  1791       715      13
  1792       570      16
  1793       666      19
  1794       447       9
  1795       513      23
  1796       355      12
  1797       318       9
  1798       415       7
  1799       558       2
  1800       665       4
  1801       433       9
  1802       377       5
  1803       308       2
  1804       422       5
  1805       469       0
  1806       318       1

It was doubtless the recollection of these epidemic agues that led the
parish ministers who wrote in the ‘Statistical Account of Scotland’ from
1791 to 1799 to remark upon a supposed progressive decline of endemic
ague, which they set down to drainage of the land[681]. It is probable,
however, that each tradition of ague in Scotland dated from one of its
epidemic periods; it has been shown, indeed, in the foregoing that
Scotland in the end of the 17th century was reputed tolerably free from
ague, and that the severe agues previous to 1728, which belonged to the
epidemical kind, were thought to be something new.


The Influenza of 1788.

According to Barker, of Coleshill, who kept systematic notes of the
epidemic maladies from year to year, there were several recurrences of the
influenza of 1782[682]. But there is only one of these seasons, the
summer of 1788, that other English writers have singled out as a time of
influenza. It was undoubtedly of a very mild type, producing hardly any
effect upon the bills of mortality; but it attracted the notice of
several. Dr Simmons, the editor of the _London Medical Journal_, became
the recorder of it, collecting reports from various parts, as others had
done in 1782. He himself treated 160 cases at the Westminster General
Dispensary, and 65 more elsewhere. It was most prevalent in London from
the second to the fourth week of July, but the mortalities for those weeks
show no abrupt rise. It was at Chatham, Dover, Plymouth and Bath about the
same time, at Manchester in the beginning of August, in Cornwall in the
middle of August, and at Montrose about the end of August, or perhaps most
certainly in October. On 5 August, a physician at York wrote: “We have not
had the slightest appearance of a catarrh in our city or neighbourhood
during the year.” The epidemic was undoubtedly a partial one in Britain,
and so slight as to have made little impression where it did occur. It is
said to have been very general at Warsaw in April or May, at Vienna in
April (20,000 cases before the 20th), at Munich in June, at Paris in the
end of August and still continuing on the 24th October, at Geneva on the
10th October. Its most constant symptom in England was pain in the
fore-part of the head, with vertigo; next most constant was a pain at the
pit of the stomach and along the breast-bone; cough was wanting in perhaps
a third of the cases and was always slight, diarrhoea was somewhat
general, running from the eyes exceptional, sore-throat in perhaps
one-sixth of the cases[683]. At Plymouth where it was seen earliest and
clearest among the regiment of artillery and in the guardships, the
symptoms were pain in the head and limbs, soreness of the throat, pain in
the breast, a feeling of coldness all over the skin, and these followed by
cough, a great discharge from the nose and eyes, and slight nausea. It was
much less noticeable among the townspeople than among the troops and
sailors[684]. It occurred chiefly among soldiers or sailors also at Dover
and Chatham. At Bath it was marked by chills, headache, swelling of the
throat, difficult swallowing, quick pulse, hot, dry skin (but not pungent
as in malignant fever), ending in a sweat; no delirium, but broken sleep
or vigil; the eyes scarcely affected, cough in some, but not vehement; in
some, sublingual swellings which suppurated[685]. At Manchester it looked
as if it had been brought in by travellers who had acquired it in
London[686].

At Portsmouth a singular thing happened two or three months after the
epidemic had passed. The frigate ‘Rose’ arrived on 4 November from
Newfoundland; within a short time all the dogs on board were seized with
cough and catarrh, and soon after the whole ship’s company were affected
in the same way[687]. Simmons says of the epidemic of 1788 in general:
“During the progress of the influenza, a complaint which was evidently an
inflammatory affection of the mucous membrane of the fauces, etc. was
frequently observed among horses and other cattle, and was generally as
violent among them as it was mild among their rational neighbours”--many
dying after four or six days.

The very slight and partial influenza of July and August, 1788, happened
at a time when there was much fever of a more serious kind in the country.
The history of the latter belongs to another chapter; but there was in
Cornwall, in the same season as the influenza, an epidemic fever which
might in former times have been described as a part, and the most fatal
part, of the “new disease,” and may be taken in this context rather than
in the chapter on typhus. The same physician, Dr William May, of Truro,
gave an account of the influenza first[688] and of the other fever
afterwards[689].

    The latter began at Truro in the end of April, 1788, and was also at
    St Ives and other small towns in various parts of the county. A
    malignant fever had for near two years before been exceedingly rife
    among the poor (owing to distress from loss of pilchard fishing), and
    had carried off a great number of them; but this was something new.
    Yet it was “truly a fever of the typhus type,” one of its symptoms
    being constant wakefulness. It passed through whole families,
    affecting all ages and constitutions. It ended on the 17th day,
    whereas the influenza (says May in his other paper) ended with a sweat
    on the fourth or fifth day. In one small neighbourhood this epidemic
    fever affected chiefly the aged, who were blooded owing to dyspnoea:
    out of ten or eleven so affected, not one recovered, an experience
    that reminded May of what Willis said of the village elders being
    swept off by the “new fever” of 1658. Surgeons at St Austel, East Looe
    and Falmouth are cited as having seen much of the same fever. In like
    manner the Manchester chronicler of the influenza of 1788 says:
    “Fevers of different kinds, but chiefly of the type now distinguished
    by the appellation of typhus, were exceedingly prevalent after the
    epidemic catarrh had in great measure ceased to be general; but from
    which, by tracing the symptoms, the fever might usually be found to
    have originated[690].”

For a good many years after the period last dealt with, nothing is heard
in Britain either of epidemic agues or of influenza[691]. Writing in 1800,
Willan said that intermittents had not, to his knowledge, been epidemic in
London at any time within twenty years. He explains this by “the practice
of draining, and the improved modes of cultivating land in Essex, Kent,
and some other adjoining counties, from which either agues were formerly
imported, or the effluvia causing them were conveyed by particular
winds”--the latter being the doctrine of Lancisi for the country round
Rome. But he forgets that their appearance nearly twenty years before was
a strange phenomenon to the practitioners of that generation, and that
Sydenham, whom he cites to prove agues in London in former times, had also
remarked their absence, except in occasional cases, for as long a period
as thirteen years. Of such occasional agues acquired in London, Willan
and Bateman had each one or two examples in the autumn of 1794, and the
spring of 1805.

As in the case of epidemic agues, so also in the case of influenzas, there
was immunity in Britain for a good many years after 1788; and, as the
slight epidemic catarrh of 1788 was something less than universal, the
clear interval may almost be reckoned from the summer of 1782, a space of
over twenty years. Willan’s monthly reports of the weather and diseases in
London from March, 1796, to December, 1800, twice mention epidemic
catarrhs,--in February and March, 1797, and in February, 1800, the latter
chiefly among children. But to neither of them will he concede the name of
“influenza,” as the complaint was merely epidemical from a particular
state of the atmosphere, and not propagated by contagion, nor quite
general.

    The symptoms, however, were headache, sometimes attended with vertigo,
    a thin acrid discharge from the nostrils, slight inflammation of the
    throat, a sense of constriction in the chest, with a frequent dry
    cough, pains in the limbs, a white tongue, a quick and small pulse,
    with a sensation of languor and general debility. These symptoms,
    fairly complete for influenza of the correct type, lasted about eight
    days and ended in a gentle sweat or in a diarrhoea. Coughs had been
    remarkably severe and obstinate; they were frequently attended with
    painful stitches and spitting of blood[692].


The Influenza of 1803.

The number of the _Medical and Physical Journal_ for March, 1803,
announced that “a cold attended by symptoms of a very alarming nature has
been general in the city of Paris for some time”; but it said nothing of
the alarming disorder being in London. It is in the next number, under the
date of Soho Square, March 11th, that a correspondent identifies the Paris
epidemic with “the complaint now general in this metropolis, and called by
some the Influenza.” In a report upon the diseases “in an Eastern District
of London from February 20 to March 20, 1803,” the “catarrhal fever” is
thus described:

    “This disease has been so general as to claim the title of the
    reigning epidemic, and is very similar to one which prevailed a few
    years ago, and was denominated Influenza. It has generally been
    introduced by chilliness and shivering, which have been succeeded by
    violent pains in the head, with some discharge from the eyes and
    nostrils, as in a common catarrh, together with hoarseness and cough.
    The pains in the head have in some cases been the first symptoms and
    have been succeeded by giddiness, sickness and vomiting” &c. There
    were also rheumatic pains in the limbs, intercostals &c.

Meanwhile the information from various sources showed that the old
influenza was once more really in this country. Two collective inquiries
were made on the influenza of 1803: one by Dr Beddoes of Bristol, who
issued a circular of five queries, and received answers to them (with
other information) from one hundred and twenty-four correspondents[693];
the other by the Medical Society of London[694]. The _Medical and Physical
Journal_ and Duncan’s _Annals_ each received a few independent papers on
it; and several pamphlets were issued, mostly devoted to treatment--two in
London[695], one at Edinburgh[696], one at Bath[697], and one at
Bristol[698].

In these abundant data there is little novelty and not much variety.

    The attack began with chills and severe pain in the head, along with
    slight running of the eyes and nose, as typhus fever might have begun.
    After the slightly catarrhal onset the malady was mostly a fever, with
    dry cough, dry and hot skin, pain in the forehead and about the
    eyeballs, pains in the limbs, “spontaneous” weariness and extreme
    prostration--a group of symptoms which led Hooper to find a rheumatic
    character in the malady. Among other symptoms were vertigo, nausea,
    vomiting and diarrhoea. Much sweating is not reported; but there was
    often a gentle sweat in recovering after about a week, less or more.
    There was the usual range from mildness to severity. Pneumonia and
    pleurisy were not rare, and were commonly the cause of fatalities.

The deaths were for the most part among the phthisical, the asthmatic and
the aged; but these were not many, certainly not so many as in 1729, 1733
and 1743, and probably in about the same proportion as in 1762, 1775 and
1782. In the London bills the weekly deaths rose in March, to an average
of 537 from an average of 429 in February, and of 375 in January, falling
to an average of 417 in April. In Ireland the epidemic is said to have
been seen among the troops in garrisons as early as December, 1802; it
became universal in spring and summer. In Edinburgh the rise in the
burials at Greyfriars churchyard was in the weeks ending 5th and 12th
April, making them about a half more than usual for the brief period. When
the wave of influenza was past, the public health in nearly all places
became unusually good, as had happened immediately after the influenza of
1782.

The question most to the front in the influenza of 1803 was its manner of
spreading. Beddoes, who believed in personal contagion, had this in view
in his five queries:

    1. When did the influenza appear and disappear with you?

    2. Was its date different in remote places within your reach?

    3. After being general, did it occur for some time in single
    instances?

    4. Did it ever seem to pass from person to person?

    5. If so, is it likely that clothes or fomites conveyed it in any
    case?

The dates of commencement were earlier or later according to no rule of
direction or of distance from London. In some large towns of Yorkshire it
appeared to be unusually late, in Chester unusually early; Edinburgh,
certainly, was as long behind London as London was behind Paris. Haygarth,
who took the most narrow view of contagion, made out the incidence thus:
London first, then the towns which have the greatest intercourse with
London, such as Bath and Chester, then smaller towns, and last of all the
villages around each of the more populous centres. Several towns had the
brunt of the epidemic in the same weeks (of March) as London; in very few
was it later than the first weeks of April. In some towns it attracted
little notice. In North Devon, it was said to have been at Hartland and
Clovelly a fortnight before it was seen in Bideford; the first of it seen
by one of the doctors of that town was in a solitary potter’s house four
miles to the eastward, on a peninsula made by the confluence of a small
stream with the Torridge, all the inmates of the house being attacked; in
the town itself from first to last he saw but few cases, whereas there
were many in the adjacent country[699].

The general rule seems to have been that the more sparse populations had
it later, the nearer they were to the extremities of the kingdom, as in
Cornwall, the north of Scotland, and in Ireland. Opinion was divided as to
the part played by persons in carrying contagion from place to place, some
holding that the facts of diffusion could be explained on no other
hypothesis, while most held that the influenza was in the air. Beddoes got
as many answers favouring the doctrine of personal contagion as made a
respectable show for it; but when these had all been set forth to the best
advantage, a practitioner wrote to say that, after all, nine-tenths of
professional opinion was against the contagiousness of influenza. The
practical question for Haygarth, Beddoes, and other contagionists was
whether influenza was not a disease, like smallpox or scarlet fever, which
could be kept from spreading by means of isolation, disinfection (with the
fumes of mineral acids) and other precautions.

Some curious facts came out, showing the effect of influenza upon other
epidemic diseases, or the effect of other epidemic diseases upon
influenza. One writer applied to influenza what used to be said of the
plague or pestilential fever, that these Leviathan constitutions swallowed
up all other reigning epidemics. Holywell, a town in Flintshire, with a
large cotton-weaving industry, had not been free from a bad kind of typhus
for two years. “On the appearance of the influenza the typhus entirely
ceased, and only one case of fever has occurred since. I have not for many
years known this country so healthy as since the influenza
disappeared[700].” The influenza was said also to have superseded typhus
fever at Navan, in Meath[701]. At St Neots typhus was peculiarly prevalent
for three months before the influenza, but ceased thereafter[702]. Another
relation to typhus was seen at Clifton: “In the low, confined, and
ill-ventilated houses in the Hot Well road, where typhus often abounds,
the influenza was very unfrequent; while in the exposed high-lying
buildings on Clifton Hill it was almost universal[703].” As to ague, which
had often before stood in a remarkable relation to epidemics of catarrhal
fever, there is one possibly relevant fact related from the Lincolnshire
fens. A Wisbech physician writes:

    “The influenza which ceased here about the middle of April made its
    appearance again in May; the leading symptoms were the same as in the
    first attack. About the same time also a most malignant fever, having
    some symptoms in common with the influenza, began to rage in that part
    of Lincolnshire contiguous to us, which has proved fatal to
    hundreds[704].”

From 1803 to 1831, nothing is heard in England of a universal influenza,
although there was one such in the end of 1805 and beginning of 1806 in
Russia, Germany, France and Italy; and there were four great influenzas
in the Western Hemisphere (1807, 1815-16, 1824-25, and 1826). Catarrhs
were perhaps commoner than usual in England and Scotland in the winter of
1807-8, but they cannot be reckoned an epidemic of influenza[705]. The
summer following (1808) was unusually hot and agues became more epidemic
in the fens than at any time since the great aguish period of 1780 and
following years[706]. Agues were again unusually rife in England in 1826,
1827 and 1828, at the same time as the remarkable epidemics of them, from
inundations and subsequent drought, in Holland and along the German coast
of the North Sea. Dr John Elliotson, of London, met with cases of agues in
his practice in those years in the following scale:

  Year  Cases

  1823    8
  1824   14
  1825   15
  1826   44
  1827   53
  1828   27
  1829    8

They had increased, he says, throughout the country as well as in London,
owing, as he thought, in agreement with Macmichael, to the higher mean
temperature of the respective years; and he would apply the same law of
increase to the epidemic periods of ague in Britain in former times[707].
Christison saw his first case of ague at Edinburgh in the autumn of 1827,
in a labourer who had caught it working at the harvest in the fen-country
of Lincolnshire.


The Influenza of 1831.

The next influenza in Britain fell in the early summer of 1831. It was a
mild epidemic of the catarrhal type, which attracted hardly any notice in
England. In one of the London medical journals there is no other notice of
it but this, dated 2 July, 1831[708]: “In consequence of the sudden
variations of temperature which have prevailed since the last fortnight of
May an epidemic bronchitis has shown itself in Paris.” Another London
journal[709], on the very same day, wrote: “Influenza in a severe form is
at present prevailing in London and some of the provincial towns. It
commences like a common cold, but is soon discovered to be more serious,
&c.” The physician to the public dispensary in Chancery Lane found that
more than half of the seventy applicants on 23 June came with the symptoms
of influenza--severe, harsh, dry cough, in paroxysms, pain behind the
sternum, a fixed pain in one side, congested state of the throat, nose and
eyes, heaviness of the head, languor, debility, hot skin, foul tongue,
impaired sense of taste. The symptoms went off after three or four days
with a sweat in the night and a discharge from the nostrils[710].

This epidemic hardly affected the London bills of mortality, according to
the following figures:

  Four weeks, 25 May to 21 June, 1579 births, 1430 deaths.
  Five weeks, 22 June to 26 July, 2153 births, 2010 deaths.
  Four weeks, 27 July to 23 Aug., 1997 births, 1652 deaths.

The rise in the last four weeks was due to summer diarrhoea, or choleraic
diarrhoea, which was unusually common in 1831. This slight influenza was
also reported from Plymouth by a surgeon who had seen the disease, and
suffered from it, at Manilla in September, 1830[711], and by a Plymouth
practitioner, who wrote, on 14 July, that it had been extensively
prevalent there and in the neighbouring towns and villages[712]. It is
recorded also from the Isle of Man, Glasgow[713], and Ayr[714], and it is
supposed to have been in Aberdeen[715]. But, while there are many
accounts of this epidemic in Germany in May and June, and undoubted
evidence of it in France and Italy, as well as in Sweden, and in Poland
and Russia earlier in the year, the accounts of it in Britain are so
meagre and casual as to make one doubt whether it really was an influenza
worth reckoning.


The Influenza of 1833.

The next year, 1832, which was the first great season of Asiatic cholera
in Britain, is absolutely free from records of influenza in all Europe. It
was in the spring of the year following, 1833, that the really serious
influenza came. The continental literature of the epidemic of 1833 is
immense, the English literature of it is all but non-existent: and yet it
was a very severe influenza with us, just as with other European peoples.
There was no collective inquiry in Britain on this occasion, such as had
been made first by Fothergill in 1775, by the College of Physicians and
another Society in 1782, by Simmons in 1788, and by Beddoes and the
Medical Society of London in 1803, or such as was made in the next
influenza, that of 1837, by a committee of the Provincial Medical
Association. But enough is known of it to place it among the severer
influenzas. In London the bills of mortality, which relate only to a part
of London, showed the characteristic sudden rise and fall:

                                   Baptisms Burials

  Four weeks, 20 Feb. to 16 March   2310     2352
  Five   "    17 March to 23 April  1955     2105
  Four   "    24 April to 21 May    2016     3350
  Four   "    22 May to 18 June     2070     1685

For a whole month the burials in London were nearly doubled, and for the
two worst weeks they were nearly quadrupled. This mortality, by all
accounts, fell most on the richer classes, to whom it was a much more
serious calamity than the Asiatic cholera of the year before. The
president of the Medical Society said, on the 22nd April, that he had
“heard of nine lords or ladies who had been carried off by it or by its
indirect agency, in the course of last week[716].” Its type in the month
of May was worse than in April[717]. When it was first seen it was a
somewhat short catarrhal attack, ending in a sweat after two, three or
four days, with the usual head-pains, soreness of the ribs and limbs,
languor and prostration. Later, it became a more “adynamic” illness,
beginning indeed with slight catarrhal symptoms, but soon passing into
subacute nervous fever which might last for three weeks, involving much
risk to life[718]. Hence arose the warnings, just as in 1890-92, that the
influenza was a much more serious thing than it had been thought when the
epidemic began, and hence the delay, as it were, in the bills of mortality
to show the effects of the epidemic until it had been two or three weeks
prevalent. It is to the month of April, before the highest death-rate was
reached in London, that the following, in the _Gentleman’s Magazine_,
applies[719]:

    “During the month a severe form of catarrhal epidemic, generally
    termed influenza, has been extremely prevalent in London. It has laid
    up at once all the members of many large households, and has attacked
    great numbers in several public offices, particularly the Bank of
    England and some divisions of the new police. The performers at the
    theatres have much suffered, and their houses have been closed for
    several nights. It commences suddenly with headache and feeling of
    general discomfort, attended or soon followed by cough, hoarseness, or
    loss of voice; oppression, and sometimes severe pain in the chest,
    tenderness about the ribs, and sense of having been bruised about the
    limbs or muscles.... The disease is generally attributed to the
    constant north-east winds; but by some of the learned is regarded as
    the epidemic influenza which has lately prevailed in the eastern parts
    of Europe, and that is travelling, like many of its predecessors, to
    the west.”

It would have been in this earlier stage of the epidemic, when it was
laying up whole households, thinning workshops and closing theatres, that
a practitioner was heard to say (as reported by the _Lancet_): “Best thing
I ever had! Quite a godsend! Everybody ill, nobody dying!” The seriousness
of the disease was, however, at length recognized, so that the members of
the Medical Society debated the subject at three successive meetings. One
of the questions was, whether the malady called for blooding--a question
that had divided opinion as long ago as 1658[720]. On 13 May, the
following passed at the Medical Society:

    Mr Williams remembered the similar influenza of 1803, and said that
    depletion was then regarded as an injurious plan of treatment.

    Mr Proctor:--Yes, but the Brunonian doctrines were then in full fling,
    and practitioners had not learned the full use of the lancet.

Graves states very fairly the reasons that induced them to take blood in
the influenza of 1833, as well as the results of the practice[721]:

    “The sudden manner in which the disease came on, the great heat of
    skin, acceleration of pulse, and the intolerable violence of the
    headache,--together with the oppression of the chest, cough, and
    wheezing--all encouraged us to the employment of the most active modes
    of depletion; and yet the result was but little answerable to our
    expectations; for these means were found to induce an awful
    prostration of strength, with little or no alleviation of the
    symptoms.”

The prostration, be it said, was probably as great and as frequent in the
epidemics of 1890-93, when bleeding had gone out altogether; still it was
not understood that all these signs of sthenic action in the attack were
really paradoxical, as Whitmore, in the passage cited in the note, saw
clearly two centuries before.

The epidemic became rapidly prevalent all over England, Scotland and
Ireland in April and May, following no very definite order of progression.
The Liverpool newspapers asserted that ten thousand were down with it in
that town in one week. A doctor at Lincoln wrote, on 13 May, that few
families there had escaped it[722]. Other towns in which it is said to
have been “more or less” prevalent were Portsmouth, Sheffield, Birmingham,
Leeds, York, Halifax, Glasgow, Edinburgh[723], Dublin and Armagh; so that
we may fairly assume, although we are without the detailed evidence
available for earlier epidemics, that it was ubiquitous in town and
country.

At Birmingham[724], among the outpatients of the Infirmary, the cases of
influenza were as follows, the 25th and 26th April being the days when
cases came first in rapid succession, while the middle of May was
practically the limit:

          Cases of
          Influenza    Males    Females

  April      151         52        99
  May        464        159       305
  June        28          9        19
             ---        ---       ---
             643        220       423

The great excess of females is remarkable, but was probably due to some
local circumstances. Of the 643 cases, 122 were under ten years of age. Of
the females, 9 died, of the males 3. But the deaths in Birmingham caused
by the epidemic directly or indirectly were many; the burial registers of
four churches and chapels showed a marked increase of burials above those
of the corresponding months of 1832:

           1832      1833

  April     205       245
  May       211       434
  June      193       230
            ---       ---
            609       909

Medical opinion in 1833 was decidedly adverse to the contagiousness of
influenza. The common remark was that it was just as little contagious as
the cholera of the year before had proved to be. As in 1837 and 1847, when
the doctrine of contagiousness was equally out of favour, the disease was
observed to spread rapidly, in no very definite line, affecting most parts
of the country in the same two or three weeks, affecting the population
within a considerable radius almost at once, and the inmates of houses all
together. These, it was said, are not the marks of a disease that persons
hand on one to another, _quasi cursores_.


The Influenza of 1837.

Between the influenza of April-May, 1833, and that of January-February,
1837, it seems probable that there were minor catarrhal outbreaks,
distinguishable from ordinary colds. One writer on the influenza of 1837
refers to those “who had it in 1834 or in the intervening period between
the two epidemics.” The table of diseases of the outpatients at the
Birmingham Infirmary for the year 1836 contains a large total of catarrhs,
and, in another line, 24 cases of “epidemic catarrh” in the summer months.
The _Gentleman’s Magazine_ begins its notice of the epidemic of 1837 by
calling it “an influenza of a peculiar character,” which shows that
influenza of the ordinary kind was a familiar thing. Probably the name was
a good deal misapplied in the years following every great epidemic from
1782 onwards: thus in ‘St Ronan’s Well,’ which was written in 1823, or
twenty years from the last general influenza, a tradesman’s widow in easy
circumstances and given to good living comes to the Spa on account of a
supposed malady which she calls the _influenzy_. But our recent
experiences of four great influenza seasons in succession from 1889-90 to
1893, although it is without precedent in the history, will incline us the
more to credit what is recorded of influenza cases in the intervals
between the years of great historical epidemics[725]. However that may be
for the years following 1833, the influenza of January, 1837, was sudden,
simultaneous, universal.

The first cases, which Watson compares to the first drops of a
thunder-shower, were seen earlier in some places than in others; but from
all parts of England it was reported that the influenza was at its height
from the middle of January to the end of the first week of February.
Possibly it was a few days earlier in London than in most other towns,
inasmuch as the great increase of the deaths that is shown in the
following table, in the second and third weeks of January, would imply a
prevalence of the epidemic for at least a fortnight before.

_Weekly Mortalities in London (by the old Bills)._

1837

  Week ending   Influenza   All causes

  Jan.  10         0          284
        17        13          477
        24       106          871
        31        99          860
  Feb.   7        63          589
        14        35          558
        21        20          350
        28         8          321
  March  7         4          262

This sudden rise in the deaths from all causes is a characteristic
influenza bill, comparable with those already given from 1580 onwards.
But the bill is far from showing the whole of the mortality in London in
1837. The London bills of mortality compiled by the Parish Clerks’ Company
had fallen into the last stage of inadequacy, and were on the eve of being
superseded by the general system of registration for all England and
Wales[726].

The London bills, so long as they existed, never took in the great
parishes of St Pancras, Marylebone, Kensington and Chelsea. The area
“within the bills of mortality” was that of London about the middle of the
18th century. But, instead of becoming more and more crowded as time went
on, it had actually become much less populous, especially in the old City
and Liberties, owing to the erection of warehouses, workshops,
counting-houses and other non-residential buildings where dwelling houses
used to be; so that the decrease of mortality “within the bills” in the
19th century is in part due to the decrease of population within the same
area. This has to be kept in mind when the above table is compared with
one of those for former influenzas, such as that of 1737, exactly a
hundred years before.

It was thought that the 1837 influenza in London was worse than that of
1833, but the figures show the contrary as regards the number of deaths
from all causes[727]. Both of them, however, were in the first rank of
severity, finding their nearest parallels in the three great influenzas of
the 18th century, in 1733, 1737 and 1743, when the deaths from all causes
during the influenza rose, indeed, to a much larger total within the
bills, but rose from a much higher mean level.

In Dublin the great increase of burials from the influenza of 1837 fell
at the same time as in London, according to the following comparison with
the year before for Glasnevin Cemetery[728]:

1835-36

  Dec. 1835     355
  Jan. 1836     392
  Feb.   "      362
  Mar.   "      392
               ----
               1501

1836-37

  Dec. 1836     413
  Jan. 1837     821
  Feb.   "      537
  Mar.   "      477
               ----
               2248

At Glasgow the deaths from influenza were as follows[729]:

1837

              Males   Females   Total

  January      111      118      229
  February      37       62       99
  March          9       20       29
               ---      ---      ---
               157      200      357

But the heading of “influenza” did not nearly show the full effects of the
epidemic upon the mortality, which was enormous in Glasgow in January, as
compared with the same month of 1836:

  ---------------------------------------------------------------
            || All causes||Catarrh| Aged| Asthma| Fever| Decline
  ----------||-----------||-------|-----|-------|------|---------
  Jan. 1836 ||    790    ||    4  |  73 |   31  |   45 |   124
  Jan. 1837 ||   1972    ||  229  | 274 |  185  |  201 |   247

There was also a great increase in the deaths of infants by bowel
complaint. The only period of life which did not show a great rise of
mortality was from five to twenty; the greatest rise was between the ages
of forty and seventy, corresponding to the London experience in the
epidemic of 1847.

At Bolton, Lancashire, the great rise in the deaths, as compared with the
average of five years before, was in February:

              Average of
              five years
               1831-36     1837

  January       111·2       115
  February       79·0       205
  March          97·8       100
                -----       ---
                288·0       420

At Exeter, the burials in the two chief graveyards were 227 in January
and February, 1837, as compared with 125 in the same months of 1836. These
mortalities, although large, were but a small ratio of the attacks. In
2347 cases enumerated in the collective inquiry, there were 54 deaths, a
ratio of two deaths in a hundred cases being considered a full average.
The attacks were mostly in middle life, and the deaths nearly all among
the asthmatic, the consumptive and the aged. The ages of one hundred
persons attacked at Birmingham were as follows[730]:

  Ages   1-   5-   10-   20-   30-   40-   50-   60-   70-   80-90

  Cases   3    2    12    23    21    19    12     7     0      1

At Evesham only five out of 93 were under five years. At Leamington, in a
list of 170 cases, there were 26 under fourteen years, 119 from fourteen
to sixty-five years, and 25 above the age of sixty-five[731]. In some
places males seemed to be most attacked, just as at Birmingham in 1833
there was a great excess of female cases; but the collective inquiry
showed that the sexes shared about equally all over. The type of the
malady was on the whole catarrhal, as in 1833. Nearly all the cases had
symptoms of sneezing, coughing, and defluxions; many cases had nothing
more than the symptoms of a severe feverish cold; the more dangerous cases
had dyspnoea, pneumonia and the like; while all had the languor,
weariness, and soreness in the bones which mark every influenza, whether
it incline more to the moist type of catarrhal fever or to the dry type of
the old “hot ague.”

The influenza of 1837 having been remarkably simultaneous, sudden and
brief, the doctrine of personal contagiousness found little favour, just
as in 1833. The 12th query sent out by the committee of the Provincial
Medical Association was: “Are you in possession of any proof of its having
been communicated from one person to another?” The answers are said to
have been nearly all negative; namely, that there was “no proof of the
existence of any contagious principles by which it was propagated from one
individual to another.” Shapter, a learned physician at Exeter, inclined
to a certain modified doctrine of contagion by persons. Blakiston, of
Birmingham, an exact mathematician, declared that the question as
ordinarily stated did not admit of an answer.

At Liverpool there was an interesting observation made, exactly parallel
with those made at Gravesend in 1782 and Portsmouth in 1788. The influenza
of 1837 was practically over by the first or second week of March; but
“that the atmosphere of Liverpool was still contaminated by the epidemic
influence up to the middle and latter end of April was apparent from the
fact that many of the officers and men of the American ships, and
generally the most robust, were violently attacked shortly after their
arrival in port,”--the same being the case also with black sailors on
ships arriving from the Brazils and the West Coast of Africa[732]. At the
naval stations of Sheerness, Portsmouth, Plymouth and Falmouth, every one
of the ships of war had been attacked in January, the ships cruising on
the south coast of Spain, or lying at Barcelona, in February, the ships at
Gibraltar in April, and those at Malta in May. The ‘Thunderer,’ on the
passage from Malta to Plymouth, had the first cases of influenza at sea on
the 3rd of January, four days before reaching Plymouth[733], as if she had
sailed into an atmosphere of it somewhere near the coast of Brittany.

       *       *       *       *       *

For fully ten years, from March or April 1837 to November 1847, there was
no great and universal influenza in England. But there were several
undoubted minor, and perhaps localized, outbreaks of an epidemic malady
which was in each case judged to be truly the influenza, and not a common
cold. The earliest of these was in the spring of 1841. It was recognized
by the Registrar-General to have been in London from 20 February to 24
April, the mortality having been little affected by it. It was also
recognized in Dublin in March, and remarked upon by two physicians to the
Cork Street Fever Hospital; it was characterized by the usual languor,
weariness, and pains in the head, by defluxions of the eyes, nose and
throat, but not by any affection of the lungs, and was in all respects
mild[734]. Exactly a year after, in March, 1842, influenza was described
as epidemic at York[735]: it was noted also in London in March[736], and
is mentioned as having been again in Ireland in 1842[737]. The next
undoubted influenza is reported from a rural part of Cheshire (Holme
Chapel) in January, 1844, in the wake of an epidemic of scarlatina; it
continued in all kinds of weather until June, and had a remarkable
intercurrent episode, for some weeks from the middle of March, in the form
of an epidemic of pneumonia among young children, which passed into mild
bronchitis in the cases last attacked[738]. Coincidently with the
influenza in Cheshire, there is a report of a series of catarrhal cases in
Dublin about the beginning of January, 1844, in which the sense of
constriction and suffocation under the sternum and the paroxysmal
character of the attacks seemed to point to influenza[739]. Two years
after, a Dublin physician in extensive practice among the rich wrote, at
the request of a medical editor, an account of an epidemic of influenza in
January and February, 1847; he had sixty cases among children under
fourteen in his private practice, usually several children in one house,
and sometimes the adults in the house[740]. This was in the midst of the
great epidemic of relapsing fever in Dublin and all over Ireland, due to
the potato famine. The same prevalence of influenza to a slight extent is
recorded also for London at the end of 1846 and beginning of 1847[741]. It
is easy to object that these “influenzas” between 1837 and 1847 were but
the ordinary catarrhal maladies of the seasons. But the physicians who
took the trouble to record them--probably more might have done so--were,
of course, aware of the distinction that had to be made between many
common feverish colds concurring in the ordinary way, and a truly epidemic
influenza, however slight.


The Influenza of 1847-48.

The great influenza of 1847 began in London about the 16th or 18th of
November, was at its height from the 22nd to the 30th, had “ceased to be
very prevalent” by the 6th or 8th of December, but affected the bills of
mortality for some time longer, as in the following table:

_Weekly Mortalities in London._

1847

  Week ending All causes  Influenza  Pneumonia  Bronchitis  Asthma  Typhus

  Nov. 20      1086          4         95         61        12      86
       27      1677         36        170        196        77      87
  Dec.  4      2454        198        306        343        86     132
       11      2416        374        294        299        78     136
       18      1946        270        189        234        52     131
       25      1247        142        131        107        14      83
  Jan.  1      1599        127        148        138        26      74

In the thirteen weeks of the first quarter of 1848 the influenza deaths
declined as follows: 102, 102, 89, 56, 59, 47, 27, 33, 18, 11, 10, 16, 8.

This was the first great epidemic of influenza under the new system of
registration. According to the Superintendent of Statistics, it caused an
excess of 5000 deaths during the six weeks that it lasted, of which about
a fourth part only were set down to influenza, and the rest to pneumonia,
bronchitis, asthma, etc. During the three worst weeks it raised the deaths
in the age of childhood 83 per cent., in the age of manhood 104 per cent.,
in old age 247 per cent., whereas the deaths between fifteen years and
twenty-five were but little raised by it, and those between ten and
fifteen hardly at all. It raised the deaths during six weeks in St
George’s-in-the East to a rate per annum of 73 per 1000 living: in some
other parishes it increased the death-rate very little. But it had the
usual effect of lengthening enormously the obituary columns of the
newspapers, which shows that it fell, as usual, to a large extent upon the
richer classes. It went all over England in a short time, the month of
December being the time of excessive mortality in the towns, according to
the following sample totals of deaths from all causes:

1847

             Manchester   Sheffield     York      Places in
             (Ancoats)     (West)    (Walmgate)   Scotland

  October       169          27          61          521
  November      135          27          52          728
  December      270          85          99         1001

In some parts of England, as in Kendal, a district of Anglesea and in the
Isle of Wight, the mortality of the last quarter of 1847 was actually
lower than that of the year before. From St Albans the sub-registrar
reported that there had been “no epidemic.” In most parts of the country,
including the medium-sized towns, the mortality directly or indirectly due
to influenza was lower than in London. The principal returns did not come
in from the country until after the new year, the effects of the epidemic
having been, as usual, later in rural districts. Hence, while London had
1253 deaths put down to “influenza” in 1847 (nearly all in December), and
659 in 1848 (nearly all in the first quarter), the rest of England had
4881 influenza deaths before the New Year, and 7963 after it[742]. This
influenza in the mid-winter of 1847-8 made a great impression
everywhere[743]. As regards its range and its fatality, it was like those
of 1833 and 1837; and it had once more so much of the catarrhal type, that
the name of influenza became still more firmly joined to the idea of a
feverish cold or defluxion.

       *       *       *       *       *

By the year 1847, agues had almost ceased to be written of in England,
although they still occurred in the Fens. But Peacock begins his account
of the influenza of that winter with an enumeration of prevailing
diseases, which reads somewhat like an old “constitution” by Sydenham or
Huxham. The summers and autumns of 1846 and 1847, he says, were both
highly choleraic, and dysentery (as well as enteric fever) was unusually
common in the former year. Fatal cases of “ague and remittent fever” were
also more numerous than usual. Then came much enteric fever, “not
unfrequently complicated with catarrhal symptoms.” Throughout the spring
and early summer of the influenza year, 1847, “intermittent fevers were
common, and in March, April and May, purpura was frequently met with,
either as a primary or secondary disease. Scurvy also, owing to the
deficiency of fresh vegetables, and from the general failure of the
potato crop in the previous year was occasionally seen.” Then follows much
concerning a fever called remittent, which reads more like relapsing fever
than anything else[744]. “The remittent form of fever was frequent in the
course of the epidemic [of influenza], though seldom registered as the
cause of death.” Peacock says truly that the rather unusual concurrence of
so many sicknesses was “not peculiar to the recent influenza alone;” and
he can “scarcely refrain from acknowledging that these several affections
are not merely coetaneous but correlative, and types and modifications of
one disease, with which they have a common origin. Assuming this inference
to be admitted, we may advance to the solution of the further question of
what is the essential nature or proximate cause of the disease.” But the
inquiry led him to no result: the precise cause he leaves “involved in the
obscurity that veils the origin of epidemics generally”--which are surely
not all equally obscure[745].

       *       *       *       *       *

Influenza having continued epidemic for a few weeks in the beginning of
1848, ceased thereafter to attract popular notice in Britain during a
period of more than forty years. But a certain number of “influenza”
deaths continued to appear steadily year after year in the registration
tables. In 1851 this number was nearly doubled, in 1855 it was more than
trebled; and those two years were undoubtedly seasons (about January and
February) of real influenza epidemics in Europe, recorded by several but
not by English writers. A slight epidemic was described for Scotland in
1857, and one for Norfolk in 1878, neither of which seems to have
influenced the registration returns in an obvious degree. After the
undoubted influenza of 1855, the annual total of deaths in England set
down to that cause steadily declined from four figures, to three figures,
and then to two figures, standing at 55 in the bill of mortality for 1889.
It is improbable that those small annual totals of deaths in all England
and Wales were caused by the real influenza; the name at that time was
synonymous with a feverish cold, and would have been given here or there
to fatalities from some such ordinary cause. An epidemic ague was reported
from Somerset in 1858[746].


The Influenzas of 1889-94.

More than a generation had passed with little or no word of epidemic
influenza in this country, when in the early winter of 1889 the newspapers
began to publish long telegrams on the influenza in Moscow, St Petersburg,
Berlin, Paris, Madrid and other foreign capitals. This epidemic wave, like
those immediately preceding it in the Eastern hemisphere, in 1833, 1837
and 1847, and like one or more, but by no means all, of the earlier
influenzas, had an obvious course from Asiatic and European Russia towards
Western Europe[747]. In due time it reached London, and produced a decided
effect upon the bills of mortality for the first and second weeks of
January, 1890, but a moderate effect compared with that of 1847, which was
the first to be recorded under the same system of registration. It spread
all over England, Scotland and Ireland in the months of January and
February, 1890, proving itself everywhere a short and sharp influenza of
the old kind, but with catarrhal symptoms on the whole a less constant
feature than in the epidemics of most recent memory. At the end of
February it looked as if Great Britain and Ireland had got off lightly
from the visitation which had caused high mortalities in many countries of
Continental Europe. But this epidemic in the beginning of 1890 was only
the first of four, and less severe than the second and third. It returned
in the spring and early summer of 1891, in the first weeks of 1892, and in
the winter of 1893-94. To understand this influenza prevalence as a whole,
its four great seasons should be compared. The following tables show its
incidence upon London on each occasion:

_Four epidemics of Influenza in London, 1890-94._

1890

             Annual
           death-rate   Deaths
  Week      per 1000   from all
  ending     living     causes    Influenza    Bronchitis    Pneumonia

  Jan.  4     28·0       2371          4           530          215
       11     32·4       2747         67           715          253
       18     32·1       2720        127           630          281
       25     26·3       2227        105           468          193
  Feb.  1     21·8       1849         75           339          145
        8     20·6       1749         38           369          117

1891

             Annual
           death-rate   Deaths
  Week      per 1000   from all
  ending     living     causes    Influenza    Bronchitis    Pneumonia

  April 25    21·0       1809         10           240          179
  May    2    23·3       2006         37           280          241
         9    25·6       2069        148           302          230
        16    27·7       2245        266           352          207
        23    27·6       2235        319           337          219
        30    28·9       2337        310           353          189
  June   6    27·0       2189        303           320          176
        13    23·3       1886        249           255          166
        20    23·0       1865        182           248          159
        27    19·0       1538        117           151          113
  July   4    16·8       1363         56           108          103

1891-92

             Annual
           death-rate   Deaths
  Week      per 1000   from all
  ending     living     causes    Influenza    Bronchitis    Pneumonia

  Dec. 26     21·9       1771         19           355          131
  Jan.  2     42·0       3399         37           927          256
        9     32·8       2679         95           740          246
       16     40·0       3271        271           867          285
       23     46·0       3761        506          1035          317
       30     41·0       3355        436           844          255
  Feb.  6     30·6       2500        314           492          215
       13     24·6       2010        183           368          140
       20     20·7       1693         79           259          137

1893-94

             Annual
           death-rate   Deaths
  Week      per 1000   from all
  ending     living     causes    Influenza    Bronchitis    Pneumonia

  Nov.  4     20·2       1695          8           191          125
       11     21·4       1679         20           220          137
       18     24·4       2016         22           318          228
       25     26·5       2190         36           384          215
  Dec.  2     27·1       2235         74           426          248
        9     31·0       2556        127           491          266
       16     29·1       2401        164           421          232
       23     26·3       2170        147           387          203
       30     23·3       1920        108           306          157
  Jan.  6     24·5       2040         87           342          169
       13     29·5       2462         75           490          211
       20     23·7       1975         69           320          172
       27     19·8       1655         41           232          152

It will be seen that the third epidemic, that of Jan.-Feb. 1892, had the
highest maximum weekly mortality from influenza (506) as well as the
highest maxima from bronchitis and pneumonia not specially associated in
the certificates with influenza; that the second epidemic, of 1891, had
the next highest maxima, and that the first and last of the four outbreaks
were both milder than the two intermediate ones. All but the second, which
fell in early summer, are strictly comparable as regards season
(mid-winter). But although the second, in 1891, had the advantage of
falling in some of the healthiest weeks of the year, it was more
protracted than the original outbreak, much more fatal than it in the
article influenza, more fatal also in the article pneumonia, and less
fatal only in the article bronchitis. The third outbreak was not only more
protracted than the first, in the same season of the year, but much more
fatal in all the associated articles. As to the deaths referred to
influenza (whether as primary or secondary cause), the numbers are not
strictly comparable in all the outbreaks; they are probably too few in the
first table, more nearly exact in the second, third, and fourth, the
diagnosis having at length become familiar and the fashion of nomenclature
established. It is undoubted that many of the deaths from bronchitis and
pneumonia in January, 1890, were due to the epidemic; for, “while the
ordinary rise of mortality in cold seasons is mainly among the very aged,
the increased mortality in this fatal month was mainly among persons
between 20 and 60 years” (Ogle).

While the first epidemic of the series was universal and of short duration
all over the kingdom, the second and third were more partial in their
incidence and more desultory or prolonged. The second, which began in Hull
(and at the same time on the borders of Wales), produced the following
highest weekly death-rates per annum from all causes among 1000 persons
living:

_Highest Weekly Death-rates in the Second Influenza._

1891

                        Annual death-rate
                            from all
                Week       causes per
               ending     1000 living

  Hull        Apr. 11        42·5
  Sheffield     May 2        70·5
  Halifax        "  2        42·1
  Leeds          "  9        48·5
  Manchester     "  9        43·6
  Bradford       " 16        56·7
  Huddersfield   " 16        54·5
  Leicester      " 16        44·6
  Oldham         " 23        50·4
  London         " 30        28·9
  Salford        " 30        45·9
  Blackburn    June 6        48·5

The third was heard of first in the west of Cornwall and in the east of
Scotland, in the last quarter of 1891. It was in the following English
towns that it produced the maximum weekly death-rates per annum from all
causes:

_Highest Weekly Death-rates in the Third Influenza._

1892

                             Annual death-rate
                  Week        from all causes
  Town           ending       per 1000 living

  Portsmouth    Jan. 16           57·0
  London         "   23           46·0
  Norwich        "   23           44·7
  Brighton       "   23           60·9
  Croydon        "   30           47·2

These highest death-rates in the third successive season of influenza were
all in the southern or eastern counties; in the latter, Colchester also
had a maximum death-rate during one week of about 80 per 1000 per annum.
Liverpool, among the northern great towns, appears to have had most of the
third influenza. The fourth outbreak, in the end of 1893, was noticed
first in the Midlands (Birmingham especially), and was afterwards heard of
in the mining and manufacturing districts of Staffordshire, South Wales,
Lancashire, Yorkshire and Durham, as well as in Scotland and Ireland,
London, as in the table, having a share of it. The tables given of the
London mortality in each of the four outbreaks, from influenza and the
chest-complaints which were its most usual secondary effects, are a fair
index both of the period and of the severity of the disease all over the
kingdom in each of its successive appearances[748]. Everywhere the first
and the fourth were the mildest, the second and third the most fatal.
Deaths from “influenza” were reported from all the counties of England and
Wales in the first and second epidemics, the highest rates of mortality
per 1000 inhabitants in the corresponding calendar years having been in
the following counties, while in all the counties the greater fatality of
the second epidemic is equally marked:

1890

  Cumberland            ·35
  North Wales           ·28
  Herefordshire         ·28
  Salop                 ·28
  Wilts                 ·28
  Somerset              ·26
  Dorset                ·25
  Bucks                 ·25

1891

  Rutland              1·36
  Lincolnshire         1·19
  North Wales          1·09
  Westmoreland         1·02
  Monmouth             1·00
  E. Riding Yorks       ·98
  Herefordshire         ·98
  Northamptonshire      ·95

In London the entry of influenza is in the weekly bills of mortality
throughout the whole period, with the exception of a few weeks; but the
deaths were often reduced to unity, and there was perhaps only one
occasion, besides the four great outbursts, namely the months of March and
April, 1893, when cases were so numerous or so close together in
households or neighbourhoods as to constitute a minor epidemic.

The type of the influenza of 1890-93 was not quite the same as on the last
historical occasions. When it was announced as approaching from the
Continent, everyone looked for “influenza colds”; but the catarrhal
symptoms, although not wanting, were soon found to be unimportant beside
the nameless misery, prostration and ensuing weakness. Some, indeed,
contended that the disease was not influenza but dengue, so pronounced
were the symptoms of break-bone fever[749]. Many cases had a decided
aguish or intermittent character. The name of ague itself was once more
heard in newspaper paragraphs, and more freely used in private talk; but,
as we have long ceased to write of epidemic agues, equally as of marsh
intermittents, in this country, it is not probable that there will remain
any record of agues in Britain accompanying the influenzas of the years
1890-94. On the other hand the complications and after-effects of our
latest influenza, more especially as affecting the nervous system, have
been very fully studied[750].

That which chiefly distinguishes the influenza of the end of the 19th
century from all other invasions of the disease is the revival of the
epidemic in three successive seasons, the first recurrence having been
more fatal than the original outbreak, and the second recurrence more
fatal (in London at least) than the first. The closest scrutiny of the old
records, including the series of weekly bills of mortality issued by the
Parish Clerks of London for nearly two hundred years, discovers no such
recurrences of influenza on the great scale in successive seasons. It is
true that several of the old influenzas came in the midst of sickly
periods of two or more years’ duration, such as the years 1557-58,
1580-82, 1657-59, 1678-80, 1727-29 and 1780-85. But in those periods the
bulk of the sickness was aguish, the somewhat definite episodes of
catarrhal fever having been distinguished from the epidemic agues by
Willis in 1658, by Sydenham in 1679, by several in 1729, and by Baker,
among others, in 1782. It is probable, indeed, that there were two
strictly catarrhal epidemics in successive years in the periods 1657-59
and 1727-29, just as we know that, in New England, there was a catarrhal
epidemic in the autumn of 1789 and an equally severe influenza, less
catarrhal in type, in the spring of 1790[751]. But history does not appear
to supply a parallel case to the four successive influenzas in the period
1889-94, unless we count the seasonal epidemic agues of former
“constitutions” as equivalent to influenzas for the purpose of making out
a series.


The Theory of Influenza.

Influenza is not an infection which lends itself to a simple theory of its
nature or a neat formula of its cause. All that one can do is to indicate
the direction in which the truth lies. Something broad, comprehensive,
steady from age to age, telluric if not cosmic, must be sought for. Some
have thought that the legendary or representative universal sickness at
the siege of Troy was influenza, because it began upon the horses and
dogs, as so many historical influenzas have done. But it will be
sufficient to show that influenza was the same in the Middle Ages as now;
for what circumstances make a broader contrast than medieval and modern?
The first writer in England to mention influenza--of course not under that
name--was a dean of St Paul’s in the reign of Henry II., Radulphus de
Diceto[752]. He is narrating the journey to Rome of the archbishop-elect
of Canterbury: his election in England was in June, 1173, he had got as
far as Placentia by Christmas, whence he turned aside to Genoa, and at
length reached Rome, to have his election confirmed by the pope in the
nones of April, 1174. It is in the midst of this account of the
archbishop’s journey, that reference is made to an influenza, otherwise
known, from German and Italian chronicles, to have happened in December,
1173: “In those days the whole world was infected by a nebulous corruption
of the air, causing catarrh of the stomach and a general cough, to the
detriment of all and the death of many”--_universus orbis infectus ex
aeris nebulosa corruptione_. What kind of infection can that be which has
befallen men on both sides of the Alps within the same short time in the
12th century as in the 19th? And what kind of infection is it which has
outlived so many changes in the great pestilences of mankind, has seen the
extinction of plague and the rise of cholera, and all other variations,
most of them for the better, in the reigning types of epidemic sickness?
To have lasted unchanged through so many mutations of things, from
medieval to modern, and from modern to ultra-modern, and to have become
more inveterate or protracted at the end of the 19th century than it had
ever been, is unique in this history. Influenza appears to correspond with
something broadly the same in human life at all times. Or is it rather a
thing telluric, of the crust of the earth or the bowels of the earth? Or
is it perhaps cosmic, affecting men as the vintage is affected by a comet,
or as if it came from the upper spheres? My belief is that we need not
transcend the globe to look for its source, and that, upon the earth, we
need not go deeper than the surface, nor beyond the inhabited spots. I
shall come back to this from giving the history of English opinion upon
it.

The best known influenzas of the 16th century all came in summer, as some
of the later ones have done, so that no one thought of them as exaggerated
common colds. But it happened that the influenzas observed by Willis in
1658, and by Sydenham in 1675 and 1679, came in spring or winter and in
such weather as to suggest to each of those physicians that the catarrhal
symptoms corresponded to the season. Robert Boyle, their great
philosophical contemporary, was also a witness of one or more of these
influenzas, and it appeared to him that there was more than season and
weather in them.

    “I have known a great cold,” he says, “in a day or two invade
    multitudes in the same city with violent, and as to many persons,
    fatal symptoms; when I could not judge (as others also did not), that
    the bare coldness of the air could so suddenly produce a disease so
    epidemical and hurtful; and it appeared the more probable that the
    cause came from under ground, by reason that it began with a very
    troublesome fog[753].”

I am unable to say whether Boyle was the first to apply the doctrine of
telluric or subterranean emanations to influenza; he was certainly not the
first to apply it to pestilences in general, for it is found in Seneca
among the ancients[754], and it is clearly stated in Ambroise Paré’s essay
“Sur les Venins,” having been probably a familiar notion of the sixteenth
century, although a mystical and undefined one. Sydenham also, who must
have discussed these questions with Boyle, referred all the more obscure
or “stationary” epidemic constitutions to effluvia discharged into the air
from “the bowels of the earth”: those hypothetical miasmata were for him
the τὸ θεῖον of Hippocrates, the mysterious something which had to be
assumed so as to explain plague, pestilential fever, intermittent and
remittent fevers, the “new fever” of 1685-6, and all other epidemic
constitutions which were not caused by obvious changes of season and
weather. But it does not appear, and it is not probable, that he ascribed
to that mysterious cause the two transient waves of influenza which fell
within his own experience, those of November, 1675, and of November, 1679.
On the other hand, Boyle certainly did so; he included influenza in his
hypothesis explicitly; and if one examines its general terms, it will
appear as if it had been made specially for influenza.

Boyle’s general expression, for both endemial and epidemic maladies, is
that they are due to subterranean effluvia sent up into the air. As a
chemist, and as dealing with the new knowledge then most in vogue, he
assumed the sources of these miasmata to be for the most part mineral
deposits in the crust of the globe, especially “orpimental and other
mischievous fossiles”; but later in his writing he says:

    “To speak candidly I do not think that these minerals are the causes
    of even all those pestilences whose efficients may come from under
    ground”; there were many mischievous fossils of which physicians and
    even chymists had no knowledge, and “the various associations of
    these, which nature may, by fire and menstruums, make under ground and
    perhaps in the air itself, may very much increase the number and
    variety of hurtful matters.”

He makes provision, also, for the hurtful matters multiplying in their
underground seats, according to a principle which we know now to be true
for organic, instead of mineral matters, and to be true for them above
ground, or in the air, as well as under ground:

    “I think it possible that divers subterraneal bodies that emit
    effluvia may have in them a kind of propagative or self-multiplying
    power. I will not here examine whether this proceeds from some seminal
    principle, which many chymists and others ascribe to metals and even
    to stones; or (which is perhaps more likely) to something analogous to
    a ferment, such as, in vegetables, enables a little sour dough to
    extend itself through the whole mass, or such as, when an apple or
    pear is bruised in one part, makes the putrefied part by degrees to
    transmute the sound into its own likeness; or else some maturative
    power ... as ananas in the Indies, and medlars ... after they are
    gathered, acquire (as it were spontaneously) in process of time a
    consistence and sweetness and sometimes colour and odour, and, in
    short, such a state as by one word we call maturity or ripeness.”

Other of Boyle’s fruitful principles (I am separating them out from amidst
much other matter not specially related to influenza) are these:

    “It is possible that these effluvia may be, in their own nature,
    either innocent enough, or at least not considerably hurtful, and yet
    may become very noxious if they chance to find the air already imbued
    with certain corpuscles fit to associate with them.”

    Again, the effluvia sent up into the air may pass by certain places
    without causing an epidemic, because these “are not inhabited enough
    to make their ill qualities taken notice of; but, more frequently,
    because by being diffused through a greater tract of air, they are
    more and more dispersed in their passage, and thereby so diluted (if I
    may so speak) and weakened as not to be able to do any notorious
    mischief.”

    Again, the effluvia may not produce epidemic disease at the part of
    the globe where they had emerged from under ground; an illustration of
    which may be intended in the case of the Black Death, which, as he
    says, came from China, yet plague is little heard of in that country,
    a Jesuit, Alexander de Rhodes, who spent thirty years in those parts,
    testifying that the plague is not so much as spoken of there. Again,
    why are some epidemics of so short duration at a given place? Either,
    he answers, because the morbific expiration from under ground had
    ascended almost at once, and been easily spent; or the subterraneal
    commotion which sends up the miasmata “may pass from one place to
    another and so cease to afford the air incumbent on the first place
    the supplies necessary to keep it impregnated with noxious exhalation;
    and it agrees well with this conjecture that sometimes we may observe
    certain epidemical diseases to have, as it were, a progressive motion,
    and leaving one town free, pass on to another”--as notably in the case
    of sweating sickness and influenza.

    Lastly there are ever new forms of epidemic disease appearing, not to
    count every variation of an autumnal ague “which the vulgar call a New
    Disease.” Of the really new types Boyle offers the following
    explanation: “Some among the emergent variety of exotick and hurtful
    steams may be found capable to disaffect human bodies after a very
    uncommon way, and thereby to produce new diseases, whose duration may
    be greater or smaller according to the lastingness of those
    subterraneal causes that produce them. On which account it need be no
    wonder that some new diseases have but a short duration, and vanish
    not long after their appearing, the sources or fumes being soon
    destroyed or spent; whereas some others may continue longer upon the
    stage, as having under ground more settled and durable causes to
    maintain them.”

As a chemist, Boyle sought for the source of the pestilential emanations
in underground minerals, in the new combinations of these under the action
of “fire and menstruums,” in their self-multiplying power as if by
subterraneous fermentation (“which many chymists and others ascribe to
metals and even to stones”), and in their meeting with suitable
“corpuscles” in the air of an inhabited spot wherewith to combine for
their morbific effects. He assumed, also, their discharge into the air at
particular spots of the globe (where they might not be directly morbific
in their effects), or in a series of localities from the wave-like
progress of the underground commotion; in which assumption he seems to be
applying the very old idea of classical times that earthquakes and
volcanic eruptions were a cause or antecedent of epidemics. Sometimes his
mineral fossils were deep in the crust of the globe, touched only by the
greater cataclysms; and then we might expect novelties in the forms of
epidemic disease. But he does not exclude emanations from the earth’s
surface proceeding more gently or insensibly.

It would be a mistake to set aside Boyle’s hypothesis of epidemical
miasmata as made altogether void by his choosing strange minerals to be
the source of them, and by his assuming a kind of fermentation in these
inorganic matters so as to explain the continuance and spreading of the
infections. Substitute organic matters in the soil for minerals in the
crust of the earth, and read a modern meaning into the doctrine of
underground or aërial fermentation or leavening, and we shall find Boyle’s
hypothesis, especially as applied to influenza, far from obsolete. Some
such adaptation of the doctrine of miasmata was made two generations later
by Dr John Arbuthnot in his ‘Essay concerning the Effects of Air upon
Human Bodies,’ the immediate occasion of which was the London influenza of
1733. There is nothing to note between Boyle and Arbuthnot; for Willis
and Sydenham, using the Hippocratic language of “constitutions,”
explained, as we have seen, the epidemic catarrhs of the spring or winter
as the reigning febrile constitution modified to suit the season and
weather.

Arbuthnot’s essay makes more modern reading than Boyle’s. He assumes
emanations from the ground, but they are no longer from the bowels of the
earth, or from deposits of strange minerals requiring earthquakes to set
them free, or “fire and menstruums” to give potency to them. Of all the
things that pass into the atmosphere, he makes most of the various steams
and other volatile decomposing matters of men and animals; and when he
brings in the earth, it is as the storehouse or receptacle of such
matters, in a surface stratum no deeper than the effects of drought and
rainfall could reach. While he accepts the Hippocratic doctrine of
epidemic constitutions, and recognizes the air with its various organic
contents as the τὸ θεῖον, the _quid divinum_ or mysterious something of
epidemical causation, he does not forget that the earth is inhabited by
creatures, human and other, who befoul the atmosphere by “their own
steams”; again, he lays stress upon alternations of drought and moisture
in the soil and subsoil as a cause of morbific emanations, not, indeed,
stating the matters of fact in the very terms of Pettenkofer’s law, but
assuming the presence of special organic matters in the soil as much as
that does. Although Arbuthnot was hardly a serious epidemiologist, any
more than Boyle, yet in the growth of opinion on the subject of morbific
matters in the air, he may be said to have shifted the interest from
inorganic or mineral substances and gases, to organic matters chiefly of
human or animal origin, and from the deeper regions of the globe, such as
only earthquakes reach, to the surface stratum of soil and subsoil which
is affected by every rise and fall of the ground-water. I shall now give a
few extracts, to bear out the above summary, from Arbuthnot’s essay.

    “Air,” he says, “is the τὸ θεῖον in diseases, which Hippocrates takes
    notice of. Air is what he means by the powers of the universe, which,
    he says, human nature cannot overcome; and he lays it down as a maxim
    ‘that whoever intends to be master of the art of physick must observe
    the constitution of the year; that the powers and influence of the
    seasons (what are seldom uniform) produce great changes in human
    bodies.’” He then pays a compliment to Sydenham as “endowed with the
    genius of Hippocrates,” and passes on to his own analytic method.
    “Many great effects must follow, and many sudden changes may happen in
    human bodies by absorbing outward air with all its qualities and
    contents. Nothing accounts more clearly for epidemical diseases
    seizing human creatures inhabiting the same tract of earth, who have
    nothing in common that affects them except air: such as that
    epidemical catarrhous fever of 1728 and of this present year
    [1733].... It seems to be occasioned by effluvia, uncommon either in
    quantity or quality, infecting the air.... It is likewise evident that
    these effluvia were not of any particular or mineral nature, because
    they were of a substance that was common to every part of the surface
    of the earth: and therefore one may conclude that they were watery
    exhalations, or, at least, such mixed with other exhalable substances
    that are common to every spot of ground.”

    In his account of the qualities and contents of the air, he enumerates
    them, not so much as detected in the air on analysis, but as having of
    necessity passed into it, and in some instances been deposited again
    from it, as in strange dews. One class of substances that pass into
    the air are the oils, salts, seeds and insensible abrasions of
    vegetables. Also all excrements and all the carcases of animals vanish
    into air. Another ingredient of the air is the perspirable matters of
    animals, the amount of which for human beings he works out by a
    curious calculation of a column of their own steams raised so many
    feet high in so many days. Perhaps there are insects in the air
    invisible to human eyes: one may observe, in that part of a room which
    is illuminated with the rays of the sun, flies sometimes darting like
    hawks as if it were upon a prey. Some have imagined the plague to
    proceed from invisible insects: this system agrees with many of the
    appearances in the progress or manner of propagation of that disease,
    but is altogether inconsistent with others. Air replete with the
    steams of animals, especially such as are rotting, has often produced
    pestilential fevers in that place: of which there are many instances.

    But why should certain years or seasons have a pestilential
    atmosphere, for example the season of the catarrhous fever of 1733?
    There had been, he says, an unusual drought for these two years past,
    the best estimate of the dryness of the surface of the earth being
    taken from the falling of the springs, “the consequence of which has
    been unusual diseases amongst several animals, and a great mortality
    amongst mankind. It is true, this did not happen during the dry
    weather.... The previous great drought must have been particularly
    hurtful to mankind. Great droughts exert their effects after the
    surface of the earth is again opened by moisture, and the perspiration
    of the ground, which was long suppressed, is suddenly restored. It is
    probable that the earth then emits several new effluvia hurtful to
    human bodies: this appeared to be the case by the thick and stinking
    fogs which succeeded the rain that had fallen before.”

Arbuthnot knew the progress of the influenza of 1732-33. Its worst week in
London was from the 23rd to the 30th January, 1733; but he tells us that
it had been at a height in Saxony from the 15th to the 29th November,
1732, had been earlier in Holland than in England, earlier in Edinburgh
than in London, in New England before Great Britain. Again, it appeared in
Paris in February, somewhat later than in London, and in Naples in March.
This progress, he says, was often against the wind. Nor does he assume a
progressive infection of regions of atmosphere. The effluvia, he says,
were of a substance that was common to every part of the surface of the
earth; they were exhalable substances that were common to every spot of
ground; the excessive drought of two years, followed by heavy rains in the
end of 1732, is also assumed to have been common, for, in Germany and
France, especially in November, 1732, the air was filled with frequent
fogs. It is clear that Arbuthnot traced the universality of influenza, the
uniform symptoms of which he recognized, to certain conditions of soil and
atmosphere common to all the countries visited by the epidemic.

Throughout the rest of the 18th century there were numerous and varied
experiences of influenza, in summer and winter, spring and autumn, coming
up from the south as if from Africa, or from the east as if from Central
Asia, or appearing in America sooner than in Europe--experiences which
made a theory of the disease difficult. Some inclined to Arbuthnot’s view
of unusual seasons and weather producing the same effects everywhere;
others favoured the hypothesis of contagion from a remote source, which
might be China or might be some other territory. Geach, a surgeon at
Plymouth who was a Fellow of the Royal Society, actually went back to the
astrological cause, pointing out that Jupiter and Saturn were in a certain
conjunction during the influenza of 1775. The only elaborate theory of the
strange disease that calls for notice, besides those of Boyle and
Arbuthnot, is that of Noah Webster, the famous lexicographer of Hartford,
Connecticut.

While Webster was a journalist in New York about the years 1794-6, the
subject of yellow fever, which was then of great practical moment, set him
reading and speculating about pestilences in general. Writing to
Priestley, he said that in the course of his inquiries he found the
American libraries ill supplied with books[755]; but he certainly made
diligent and skilful use of his literary materials, and produced in his
‘Brief History of Epidemic and Pestilential Diseases,’ a work which was
better than any before it in the chronological part, and remains to the
present time unique in its philosophical part for the boldness of its
generalities[756]. He saw that influenza was the crux of epidemiology, and
paid special attention to it.

In looking for the antecedents of influenza, he kept in view the greater
telluric changes and convulsions, such as earthquakes and volcanic
eruptions. He did not regard these as the cause of influenza, but as the
index of some hidden cause to which both they and the universal catarrh
were due.

    “It is probable to me,” he says, “that neither seasons, earthquakes,
    nor volcanic eruptions are the causes of the principal derangements we
    behold in animal and vegetable life, but are themselves the _effects_
    of those motions and invisible operations which affect mankind. Hence
    catarrh and other epidemics often appear _before_ the visible
    phenomena of eruptions and earthquakes[757].” As to influenza, he
    found “reason to conclude the disease to be the effect of some access
    of stimulant powers to the atmosphere by means of the electrical
    principle. No other principle in creation, which has yet come under
    the cognizance of the human mind, seems adequate to the same effects.”

    And again: “It is more probable that it is to be ascribed to an
    insensible action of atmospheric fire, which is more general and
    violent about the time of eruptions, and which fire is probably
    agitated in all parts of the globe, although it produces visible
    effects in explosions in some particular places only.” It is due to
    Webster to give his reason for preferring a physical force to an
    organic poison: “If a deleterious vapour were the cause, I should
    suppose its effects would be speedy, and its force soon expended, the
    atmosphere being speedily purified by the winds. But if stimulus is
    the cause, it may exist for a long time in the atmosphere, and the
    human body not yield to its force in many weeks or months. This would
    better accord with facts. For, although diseases appear soon after an
    earthquake, yet the worst effects are often many months or years
    after[758].”

Dr Blagden also saw a difficulty in “the prodigious quantity of matter
required in the air to infect the space not only of the Chinese land, but
to a hundred leagues of the coast, or, as in this instance [1782] all
Europe and the circumjacent sea,” and was accordingly driven to
Arbuthnot’s view of an origin in the unusual weather of each locality.

Webster drew up a chronological table of influenzas in either Hemisphere,
with the volcanic eruptions, earthquakes, comets, etc., to suit[759]. A
few instances from near the beginning may serve as samples:

    1647. First catarrh mentioned in American annals, in the same year
    with violent earthquakes in South America, and a comet.

    1655. Influenza in America, in the same year with violent earthquakes
    in South America and an eruption of Vesuvius. It began about the end
    of June.

    1658. Influenza in Europe after a severe winter: the summer cool.

    1675. Influenza in Europe while Etna was still in a state of
    explosion: the winter mild.

    1679-80. Influenza in Europe during or just after the eruption of
    Etna: the season wet: a comet.

    1688. Influenza in Europe in the same year with an eruption of
    Vesuvius, after a severe winter, and earthquakes: it began in a hot
    summer.

    1693. Influenza in Europe in the same year with an eruption in Iceland
    and great earthquakes: the season cool.

    1697-98. Influenza in America after a great earthquake in Peru: a
    comet the same year: the winter severe.

In most instances the region of the earthquake is not specified in the
table; but it is sometimes named in the text of the annals under the
respective years. Volcanoes are on the whole made more of than
earthquakes, Webster’s object being to find evidence of “electrical
stimulus,” and not of material miasmata discharged into the air. Etna and
Hecla are much in request. Any earthquake suits, as if “earthquake” and
“volcano” were like algebraic symbols, always _a_ and _b_, and never
anything but _a_ and _b_, “influenza” being always _x_. One begins to
realize the difficulties of the volcano or earthquake theory of influenza
on turning to Mallet’s Catalogue of Earthquakes[760]. Here, indeed, is an
embarrassing choice between China and Peru, Asia Minor and North Africa,
Portugal and Sicily or Calabria, Iceland and Jamaica, the Azores and the
Philippines, Caracas or Acapulco and Valparaiso, Hungary and Savoy,
Kamtschatka and Amboina; between earthquakes great and small; between
earthquakes and volcanoes. Any influenza year might be suited with one or
more earthquakes, perhaps in either Hemisphere; but there are some long
clear intervals between the greater influenzas in Europe, for example the
interval from 1803 to 1831, which seem to occupy as many pages of the
catalogue of earthquakes as the years wherein influenzas came thickest,
for example from 1729 to 1743, or from 1831 to 1847.

None the less, Webster, like Boyle, obeyed a true impulse when he looked
for the cause of influenzas in something telluric, occasional, phenomenal.
A wave of influenza comes up unexpectedly from a particular point of the
compass, passes quickly over many degrees of latitude and longitude,
lasting a few weeks at any given place, disappears in the distance, and
does not return again perhaps for a whole generation. Influenza has the
qualities of suddenness, swiftness, transitoriness; it has a certain
sameness in its symptoms; it can be identified as certainly in the brief
phrases of medieval chronicles as in elaborate modern descriptions; it has
had no season for its own, as plague and cholera have had the summer and
autumn, but has reached a height in Europe sometimes in midsummer,
sometimes in midwinter. No other epidemic malady can compare with it in
these respects; all the rest seem to have been provoked more or less by
the turns and changes in human affairs, some being of a medieval colour,
others of a modern, each in its own way admitting of explanation from
unwholesome living, or from famine, or from over-population, or from
something more recondite but still within the sphere of things insanitary
in an intelligible sense. Other plagues besides influenza were, it is
true, once reckoned mysterious, or associated in the popular mind with
earthquakes and comets. But several such plagues have disappeared from
among us, while their alleged causes, the earthquakes or comets, continue
as before. Influenza alone returns at intervals as of old, untouched by
civilization, by sanitation, by the immense differences between medieval
and modern, making the same impression upon England in the year 1890 as it
did in 1173, or 1427, or 1580, or, if changed at all, then changed for the
worse inasmuch as the epidemic came back more severely in 1891, and still
more severely in 1892. It is not surprising that for such a disease
something telluric or even cosmic should have been assigned as the cause,
something as occasional as itself, phenomenal, if not cataclysmic. It may
be proper, therefore, that we should try over again the philosophic
generalities of Boyle, Arbuthnot and Webster, peradventure a combination
of them may yield a true theory. From Boyle we may take the great
principle of a progressive infection through regions of air (or leagues of
ground), which was expressed once for all by Lucretius in the sixth book
of the ‘De Rerum Natura’:

        ... atque aer inimicus serpere coepit;
  Ut nebula ac nubes paulatim repit, et omne
  Qua graditur, conturbat et immutare coactat;
  Fit quoque ut in nostrum quum venit denique coelum
  Corrumpat reddatque sui simile atque alienum.

From Arbuthnot we may take the organic source and nature of the influenzal
miasmata, and the association with changes in the level of the water in
the soil. From Webster we may take the idea that the historic influenzas,
having been sudden, occasional or phenomenal, must have had phenomenal
causes somewhere in either Hemisphere. Instead of sketching a theory in
the abstract, and safeguarding it by following all its ramifications, I
shall proceed by the way of instances, choosing them so as to bring out
particular points in order.

The only generality which may be indicated at starting is one that has
presented itself time after time in the foregoing history, namely that
there is something more than accident in the association between epidemics
of influenza and epidemics of ague. So close was this association in
former times that both the influenza and the widely prevalent ague were
included together under such names as “the new ague,” “the new fever,”
“the new distemper.” As late as 1679, Morley did not distinguish the
epidemic of influenza from the epidemic agues in the midst of which it was
set, although the distinction was real, and was actually made by Sydenham
on that occasion, as it had been made by Willis and in a manner by
Whitmore on the occasion immediately preceding, and as it was made by
everyone on the last great occasion when an influenza made an interlude
among epidemic agues in the year 1782. It has often been suspected that
influenza was related to some other infection: at one time it was taken
for a volatile emanation of plague, in our own time it has been regarded
as a volatile emanation of Asiatic cholera. In a wider historical view the
question may arise, whether the real relation is not rather to those
remarkable agues which have been epidemic in company with influenza when
there was no plague and no cholera.

I come now to certain influenzas, as illustrating particular points of
theory, in order.


I.

It is probable that Webster’s theory of influenza as related to
earthquakes and volcanoes, first published in 1799, was suggested to him
by a communication to the Royal Society on the volcanic waves seen at
Barbados on the 31st of March, 1761, and on the epidemic of influenza
thereafter ensuing all over the island. At Bridgetown, in the afternoon of
the 31st of March, 1761, the water in the bay and harbour ebbed and flowed
to the extent of eighteen inches or two feet at intervals of eight
minutes, and continued to do so for the space of three hours, the
oscillation regularly decreasing till night when it was no more
observable. These tidal waves were due to volcanic upheavals somewhere;
and it was found that the centre of disturbance had been in the Atlantic
near the coast of Portugal, and the time some hours earlier than the waves
were felt at Bridgetown. The Barbados chronicler proceeds:

    “It is very remarkable that since that time the island has been in a
    very deplorable condition, having suffered under the severest colds
    that have been ever known. The distress has been so general that I may
    venture to assert (with confidence) that nineteen twentieths of the
    inhabitants of the island have felt the effects of the contagion; and
    to some it has been repeated several times. It has puzzled all the
    adepts in pharmacy to find out the cause and cure of it. One
    favourable circumstance has attended it, viz. few have died with it.
    The Leeward Islands have not escaped, it having raged there more
    violently and more fatal. His Majesty’s ships have severely felt the
    effects of it, some of them not being capable of keeping the seas for
    want of men fit for service. This happening at a season of the year
    remarkably the healthiest, makes it the more surprising[761].”

This is as good an instance as we shall find, of explaining something
sudden, swift, and phenomenal, by something else sudden, swift, and
phenomenal, in a purely empirical way and without pausing to ask whether
the latter could have been a _vera causa_ of the former. That the
influenza came to Barbados in the wake, as it were, of the volcanic waves,
had been a common subject of talk among the residents; and that common
opinion of the colony had found expression in the paper sent to the Royal
Society. The influenza was not only in Barbados, in the Leeward Islands,
and in the ships on the West Indian Station, but also in New England and
“over the whole country” of the North American Colonies. Dr Tufts, of
Weymouth, New England, wrote to Webster that “it began in April, and in
May ran into a malignant fever which proved fatal to aged persons. It
spread over the whole country and the West India Islands[762].” It was not
until some nine months after that influenza appeared in Europe, at first
in the east of that continent,--Hungary, Vienna, Breslau, Copenhagen--in
February and March, 1762, in central Germany and Scotland in April, in
London about the first of May and all over England and Ireland thereafter,
but not in France until June and July.

Precisely the same order was followed by the influenza twenty years after:
it began in North America in March, 1781, and, says Webster, spread over
that continent; it appeared in the East Indies in October and November,
1781, and on the eastern confines of Europe in January, 1782, having been
traced from Tobolsk, made a slow progress westwards, and was at its height
in London about the end of May or beginning of June. Assuming, says
Webster, that the American influenza of 1781 had been continuous with the
European of 1782, it must have “passed the Pacific in high northern
latitudes,” traversed Siberia and Tartary, and so reached Russia in
Europe. In like manner, if the European influenza of 1762 were continuous
with the American of 1761, it must have made the circuit of the globe in
the same order, as if it were following the first impulse of the volcanic
waves across the Atlantic from the coast of Portugal westwards, and so
round the earth until it came back to Europe on its eastern frontier. So
much may be fairly advanced on the ground of a particular set of facts.
But then there were many other facts, both in 1761-62, and in 1781-82.
Meanwhile let us take another instance of volcanic waves felt at Barbados
six years before, on the same afternoon as the great earthquake of Lisbon.


II.

At Bridgetown, on the 1st November, 1755, Dr Hillary saw the peculiar flux
and reflux of the water in the harbour from 2.20 p.m. to 9 p.m. and
pronounced that there must have been an earthquake somewhere. The waves
came at first at intervals of five minutes, and at last at intervals of
twenty minutes. The day was calm, and the ships in the bay were not
touched; but small craft lying in the channel over the bar were driven to
and fro with great violence. There was no motion of the earth, and no
noise. The distance from Lisbon was 3400 miles, the vibrations having
taken seven and a half hours to reach Barbados. The one notable effect in
the harbour of Bridgetown was that the water flowed in and out with such a
force that it tore up the black mud in the bottom of the channel, so that
a great stench was sent forth and the fishes caused to float on the
surface, many of them being driven a considerable distance on to the dry
land where they were taken up by the negroes[763].

It so happened that there was an epidemic catarrh prevalent at that very
time all over the island of Barbados, chiefly among children, few or none
of whom, white or black, escaped it. It had begun in October, says
Hillary[764] (who chronicled the epidemiology very exactly), and continued
into November, so that it both preceded and followed the great convulsion
in the bed of the Atlantic, which destroyed Lisbon and tore up the mud in
the harbour of Bridgetown, disengaging a great stench therefrom and
poisoning the fish. Webster’s theory of a relation between earthquakes and
influenzas provides for such discrepancies in the dates of each: it is
probable, he says, that seasons, earthquakes and volcanic eruptions are
themselves the effects of those motions and invisible operations which
affect mankind, so that catarrh and other epidemics often appear _before_
the visible phenomena of eruptions and earthquakes. In like manner, the
chronicler of the earthquake of Lisbon in the _Philosophical Transactions_
drew attention to the fact that there had been a remarkable drought for
several years before, and that some of the springs near Lisbon were
actually dried up at the time. That droughts precede earthquakes is
perhaps the most instructive generality that has yet been reached as to
the cause of the latter.

Let us see, then, whether any such remote antecedents, in a possible
relation to the influenza epidemics, hold good for the island of Barbados.
Hillary’s chronicle is sufficiently full to let us answer the question.

    Following the seasons and prevalent maladies backwards from the
    influenza of children in October-November, 1755, we find a catarrhal
    fever all over Barbados in February of the same year, which “few
    escaped having more or less of.” The immediate precursor of that
    influenza had been a very definite constitution, eighteen months long,
    of a “slow nervous fever,” from February, 1753 to September, 1754,
    which corresponds in every respect to the “remittent” fever of nearly
    the same period in England and Ireland, described by Fothergill,
    Rutty, Huxham and Johnstone, and to the famous Rouen fever described
    by Le Cat. Hillary is clear that the “slow nervous fever” was not seen
    again so long as he remained in the colony (1758). Just before it
    began, there had been an influenza so general in December, 1752, and
    January, 1753, “that few people, either white or black, escaped having
    it,” and that, in turn, was preceded by a season of agues, which, says
    Hillary, “are never seen in Barbados now [1758], unless brought hither
    from some place of the Leeward Islands.”

So many influenzas in Barbados, and so many things possibly relevant to
them among their antecedents. So also in New England, the influenza which
seemed to follow the earthquake along the coast of Portugal on the 31st
of March, 1761, had the same remittent and intermittent fevers among its
antecedents.

    In the winter and spring of 1760-61 there had been much fever in New
    England, which was believed to be malarious. Webster, however, says:
    “There is no necessity of resorting to marsh exhalations for the
    source of this malady. The same species of fever [as at Bethlem]
    prevailed in that winter and the spring following in many other parts
    of Connecticut where no marsh existed. In Hartford it carried off a
    number of robust men, in two or three days from the attack.... In
    North Haven it attacked few persons, but everyone of them died. In
    East Haven died about forty-five men in the prime of life, mostly
    heads of families. The same disease prevailed in New Haven among the
    inhabitants and students in college.” In Bethlem the sickness began in
    November, 1760, and carried off about forty of the inhabitants in the
    winter following. This was the fever, generally reckoned malarious,
    which preceded the influenza of April and May, 1761[765].


III.

The next great influenza, twenty years after, which was in America in the
spring of 1781 and in Europe in the winter and spring following, will
repay the same kind of scrutiny. There had been influenza here or there in
Europe since the beginning of 1780, but no great epidemic of it; and in
England, as elsewhere, there had been epidemic agues and dysenteries since
that year, or the autumn before. The epidemic agues became worse in
England in 1783, 1784, and 1785, appearing in places which had never been
thought malarious. The whole period from 1780 to 1784 was remarkable for
hot and dry summers and great earthquakes. Italy and Sicily were troubled
by earthquakes to an unusual extent in 1780, 1781, 1782, and 1783; they
were so frequent in 1781 that the pope ordered public prayers. The great
earthquake of the period was in Calabria at half an hour after noon of the
5th of February, 1783, about six months after the great influenza of the
period was over. Sir William Hamilton, the British ambassador at Naples,
visited the numerous scenes of the earthquake in Calabria and Sicily in
the first fortnight of May, 1783, and sent to the Royal Society an account
of what he saw. At several places he found fever epidemic, part of it from
the overcrowding and filth of the temporary barracks in which the people
were living, part of it malarious from the damming of water by changes in
the river beds. At Palmi the spilt oil mixed with the corn of the
overthrown granaries, and the corrupted bodies, had a sensible effect on
the air, which threatened an epidemic; at the village of Torre del
Pezzolo an epidemical disorder had already manifested itself[766].

But the most striking effect of the earthquake was that a dry fog began in
Calabria in February, and overspread until autumn the greater part of
Europe, extending even to the Azores. This fog, though not consisting
apparently of moisture, was so dense that the sky was quite obscured,
appearing a light grey colour instead of blue, while the sun became a
blood-red disc. In Calabria the darkness was so great that lights were
needed in the houses, and ships came into collision at sea. There was a
most disagreeable odour[767]. The fog spreading over all Europe from
Calabria was not at all mythical, as we are apt to suppose that similar
recorded phenomena of the wonder-loving Middle Ages may have been. The
phenomenon was independently reproduced in Iceland the same year, from the
1st to the 11th of June, causing the same darkness at sea, the same
atmospheric effects at a distance, but not to so great a distance, and
some amount of sickness, but seemingly not aguish or febrile, among the
population[768].

Those two great convulsions of the year 1783, each of them the cause of a
widely spreading dry fog, may have been conceivably the cause of
pestiferous miasmata in the air, such as the corresponding hypothesis of
influenza requires; but how little comparable or equivalent were the
miasmata--in the one case from the ancient and well-peopled soil of
Southern Italy, in the other from the inhospitable Danish colony just
without the Arctic Circle! In any case, the earthquakes of 1783 were both
too late for the great influenza of the period. The antecedent common
alike to the influenza and the earthquakes was the extraordinary droughts,
which caused famine and famine-fever in Iceland, and, according to old
experience, was probably related to the epidemic prevalence of agues in
Britain and on the continent of Europe.


IV.

What kind or kinds of epidemic sickness earthquakes may produce as an
effect immediate and at the place, will appear from other instances. One
of the most remarkable of earthquakes was that which destroyed Port Royal
and nearly all the planters’ houses and sugar-works throughout the island
of Jamaica on the 7th of June, 1692. Jamaica had been an English colony
for little more than thirty years, during which time it had passed from
its state of lethargy under the Spaniards into an emporium of commerce
with a rapidly growing population of slaves and whites. The business
capital was at Port Royal, wholly built since the British occupation. The
site of it was a sandy key or shoal which was said to have risen
perceptibly within the memory of original settlers; a writer in September,
1667, said of it: “wherever you dig five or six feet, water will appear
which ebbs and flows as the tide. It is not salt, but brackish[769].” A
quay had been built along this spit of land, at which vessels of 700 tons
could lie afloat. It was here that the havoc of the earthquake was most
complete.

Sloane, who had visited Jamaica a few years before, said that the
inhabitants expect an earthquake every year, and that some of them were of
opinion that they follow their great rains[770]. The year 1692 began in
Jamaica with very dry and hot weather which continued until May: then came
gales and heavy rains until the end of the month, and from that time until
the day of the earthquake, the 7th of June, the weather was excessively
hot, calm and dry. The shakes began at 11.40 a.m., and at the third shake,
the ground of nearly all Port Royal fell in suddenly, so that in the
course of a minute or two most of the houses were under water and the
whole wharf was covered by the sea to the depth of several fathoms. The
loss of life was, of course, greatest where population was densest; but in
the interior of the island the effects on the soil were greater than at
the shore: in the north a thousand acres of land sank and thirteen people
with it; mountains on either side of a narrow gorge came together and
blocked the way; wide chasms appeared in the ground, and on one mountain
side there were some dozen openings from which brackish water spouted
forth. The first effect in the streets of Port Royal was that men and
women seemed all at once to be floundering up to the neck in the wet
shifting sand, and were speedily drowned or floated away by the inrushing
water. The shakes ceased for days at a time, and then began again, five or
six perhaps in twenty-four hours; so that those who had escaped to ships
in the bay remained on board for two months, being afraid to come ashore.
The weather was hotter after the earthquake than before, and mosquitoes
swarmed in unheard of numbers.

During the upheavals or subsidences in Port Royal, and the rushing of
water into or from the gapings in the ground, “ill stenches and offensive
smells” arose, so that “by means of the openings and the vapours at that
time belcht forth from the earth into the air, the sky, which before was
clear and blue, was in a minute’s time become dull and reddish looking (as
I have heard it compared often) like a red-hot oven.” A very great
mortality followed among those who had escaped the earthquake. Some of
them settled at Leguanea, others at the place on the bay which became the
Kingston of later history, enduring many hardships in their hastily built
shelters, from the heavy rains that followed the earthquake, and from want
of clothes, food and comforts.

    One writes: “Our people settled a town at Leguanea side; and there is
    about five hundred graves already [20th September, 1692], and people
    every day is dying still. I went about once to see it, and I had like
    to have tipt off.” Another says: “Almost half the people that escaped
    upon Port Royal are since dead of a malignant fever”: and another,
    referring to the hasty settlement on the bay at Kingston, says “they
    died miserably in heaps.” But the most interesting information is his
    next sentence: “Indeed there was a general sickness (supposed to
    proceed from the hurtful vapours belched from the many openings of the
    earth) all over the island, so general that few escaped being sick:
    and ’tis thought it swept away in all parts of the island three
    thousand souls, the greatest part from Kingstown, only yet an
    unhealthy place[771].”

That great mortality from a malignant fever after the earthquake of 7th
June, 1692, is usually counted an epidemic of the yellow fever which
became established at Kingston and Port Royal from that time for at least
a century and a half. I have not found any contemporary medical account of
it, but all the later writers on yellow fever at Kingston and Port Royal
have accepted the tradition that it was yellow fever. But there was one
peculiarity, which marks it off from all subsequent epidemics of yellow
fever--the sickness was all over the island, so general that few escaped
being sick, and was supposed to proceed from the hurtful vapours belched
from the many openings of the ground in and near Port Royal. In all
subsequent experience yellow fever has been almost confined to the shore
or to the ships in the bay[772]. Certainly it has never been all over the
island as in 1692, “so general that few escaped being sick”: that is
rather in the manner of influenza, although there is nothing to show that
the sickness of the interior was so different from that of the shore as to
be counted an influenza, or that the mortality of the sick was other than
that of a “malignant fever.”

The earthquake at Port Royal in 1692 produced “ill stenches and offensive
smells.” The tidal waves, or the subterranean vibrations which caused
them, in tearing up the mud at the bottom of the channel at Bridgetown,
Barbados, in 1755, had in like manner sent forth a great stench which
poisoned the fish. Such offensive vapours were supposed in former times to
come, as in a figure, from “the bowels of the earth”; and undoubtedly the
sulphurous fumes which have overhung the region of Sicilian earthquakes
must have had a source as deep as the strange minerals or “fossils” of
Boyle’s hypothesis. But, while the commotion of an earthquake is deep, it
is also superficial; whatever miasmata issue from the ground in the
ordinary alternations of wet and drought, would be discharged into the
atmosphere in unusual quantity and with unusual force in such disturbances
of soil as sunk Port Royal in 1692 or were felt at Barbados across the
whole width of the Atlantic in 1755. Nor is that effect upon miasmata
instantaneous or quickly past; in Jamaica the rumblings and shakes lasted
for nearly two months, during which time the pressure upon the gases in
the subsoil must have been such as to make them pass into the atmosphere
in stronger ascending currents than the mere alternations of moisture and
drought would have done. And just as the ordinary seasonal changes in the
level of the ground-water are of little or no account for
miasmatic-infective disease unless the soil in which they occur be full of
organic impurities from human occupancy, so one may reason that the great
cataclysmic changes of the earth’s crust are, in this hypothesis of
influenza, of most account as touching the stratum of soil wherein lie
organic impurities, and as touching those areas of the surface,--the sites
of cities, the populous plains, the shores of bays, the bottoms of
harbours or any other definite spots--in which the products of organic
decomposition are present in largest amount and, perhaps, of somewhat
special kind. Such impurities of the soil are indeed a _vera causa_ of
infective disease, known to be capable of the effect which has to be
accounted for; and, as discharged into the air in great volume and with
great force by some upheaval, they would make a local beginning of that
“aer inimicus” which the Roman poet figures as creeping like a mist from
one region of the heavens to another so that it corrupts each successive
tract of air with its own baleful qualities, “reddatque sui simile atque
alienum.”

But, as soon as we begin to apply this formula to particular historic
cases, difficulties and ambiguities arise[773]. To come back to the
instance of Jamaica in 1692, did the general sickness of the island,
manifestly miasmatic as it was, and due to disturbances of soil, become an
influenza for other regions of the globe? About fifteen months after there
was, indeed, a universal catarrh in Britain and Ireland, of no great
fatality, which is said by Molyneux, of Dublin, to have prevailed also in
the northern parts of France, Flanders, and Holland, but is not reported
in the usual way from Europe generally nor from America. Let us suppose a
miasmatic cloud formed over the island of Jamaica in June, July, August
and September, a cloud of infective particles which might produce
influenza at a distance from its place of origin, whatever disease the
miasmata after the earthquake may have produced in Jamaica itself. Let
this invisible cloud, or emanation, get into the warm atmosphere over the
great oceanic current that sets out from the Gulf of Mexico. The vehicle
lies ready to hand,--to receive the miasmata not far from their place of
origin, to carry them far into the Atlantic, and to bring them, perhaps,
to the shores of Britain. This may seem a sufficiently plausible source of
the influenza of October and November, 1693, which appears to have been
felt only in the British Isles and on the opposite shores of the North
Sea. But Webster’s own choice is the volcanic eruption in Iceland in the
same year as the influenza; and if we prefer, in this hypothesis, an
earthquake to an active volcano, there is a rival source for the British
influenza of 1693, nearer both in place and time than that of Jamaica in
1692, and not less important in respect of miasmatic disease in its own
locality. This was the disastrous series of earthquakes in Calabria and
Sicily, culminating on the 9th of January, 1693. The following extracts
from the account sent to the Royal Society will show how great was the
commotion of soil, of underground water, and of atmosphere, and how close
the connexion of these with the sickness ensuing[774]:

    “In the plain of Catania, an open place, it is reported that from one
    of the clefts in the ground, narrow but very long and about four miles
    off the sea, the water was thrown forth altogether as salt as that of
    the sea, [as in Jamaica the year before]. In Syracuse and other places
    near the sea, the waters in many wells, which at first were salt, are
    become fresh again.... The fountain Arethusa for the space of some
    months was so brackish that the Syracusans could make no use of it,
    and now that it is grown sweeter the spring is increased to near
    double. In the city of Termini all the running waters are dried up....
    It was contrary with the hot-baths, which were augmented by a third
    part.

    Darkness and obscurity of the air has always been over us, but still
    inferior to that on the 10th and 11th of January; and often these
    clouds have been thin and light, and of a great extent, such as the
    authors call _rarae nubeculae_. The sun often and the moon always
    obscured at the rising and setting, and the horizon all day long
    dusky....

    The effects it has had on humane bodies (although I do not believe
    they have all immediately been caused by the earthquake) have (yet)
    been various: such as foolishness (but not to any great degree),
    madness, dulness, sottishness, and stolidity everywhere:
    hypochondriack, melancholick and cholerick distempers. Every-day
    fevers have been common, with many continual and tertian: malignant,
    mortal and dangerous ones in a great number, with deliria and
    lethargies. Where there has been any infection caused by the natural
    malignity of the air, infinite mortality has followed. The smallpox
    has made great destruction among children.”

Thus we find in Sicily a great disturbance of soil followed, as in
Jamaica, by a great increase of local sickness, and by an atmosphere
visibly charged with products of the earthquake for months after. This is
a nearer source than the Jamaican for the British influenza of Oct.-Nov.
1693,--nearer in time, if that be any advantage for the theory, nearer
also in place. There are, however, no intermediate stages to connect the
influenza on the northern edge of the European continent with the
disturbance of soil and the miasmata arising therefrom in Sicily and
Calabria. If there had been any such dry fog as spread all over Europe
from the Calabrian earthquake of January, 1783, it would have been a help
at least to the imagination in bridging over a gulf of space and time.

As to the interval of time, it should at all events be kept in mind that
the same difficulty has to be reckoned with in any hypothesis of influenza
and in every great historic instance. In the instance still before us, the
infection began in England, according to Molyneux, in October, 1693, and
was in Dublin a month later. But we must assume it to have been in the air
for some time before it became effective upon mankind. Influenza has been
observed, with curious uniformity, to attack the horses, say of London, of
Plymouth, of Edinburgh, or of Dublin (as on the occasion before this,
1688) two months or more in advance of the inhabitants of the respective
places; and if it had waited, so to speak, for two months before it showed
its effects upon men, it may have waited equally long, or longer, before
it showed its effects upon horses. That would give at least four months;
and then we know, from such an influenza as that of 1743, that there may
be weeks, perhaps months, between its prevalence in Naples, Rome or Milan,
and its prevalence in London or Edinburgh, and, from the influenza of 1693
itself, that it was a month later in Dublin than in London. An earthquake
in Sicily on the 9th of January, 1693, with effects there for months after
upon the water, the air, and the prevalent diseases, is not excluded by
lapse of time from being a _vera causa_ of an influenza in England in
October of the same year, and in Ireland in November. The sort of proof
which most men desire, a proof such as we rarely get, and one that is
suspiciously neat when we do get it, would be to find an influenza in
Sicily and Calabria following the earthquake, and to trace the same step
by step over Europe. But the miasmatic sickness in the countries of the
earthquakes was not influenza, so far as is known; and there was no
epidemic catarrh, so far as is known, in any other part of Europe but the
British Isles and the neighbouring shores of the North Sea.


V.

Molyneux, who recorded with a good deal of circumstance the influenza of
1693, is the principal authority, along with Dr Walter Harris, of London,
for another influenza in 1688, seemingly peculiar to the British Isles.
Its effects can be discovered with the utmost certainty in the London
bills of mortality for two or three weeks at the end of May and beginning
of June, and it is mentioned as “the new distemper” in letters of the
time. Is it possible to find an earthquake for it? Webster’s note is: “in
the same year with an eruption of Vesuvius, after a severe winter and
earthquakes”--which is somewhat general. Turning to Evelyn’s diary, where
these matters are often recorded, we find, in the very weeks when the
influenza was at a height in London, this entry: “News arrived of the most
prodigious earthquake that was almost ever heard of, subverting the city
of Lima and country in Peru, with a dreadfull inundation following it”--as
if the influenza and the news of the earthquake had reached London at the
same time. This was the earthquake of 20th October, 1687, which destroyed
Lima, Callao and an immense district along the coast of Peru. The rocking
of the earth was most violent, the sea retreated like a sudden immense ebb
and filled again like a sudden immense flood, the effect of the commotion
being felt on board ships a hundred and fifty leagues out in the Pacific.
It was remarked that wheat and barley would not thrive in Peru after that
earthquake[775]. Here was undoubtedly a great disturbance of soil and of
subsoil, almost certainly attended with the discharge of effluvia or
miasmata into the air, as in other great earthquakes. But the universal
slight fever of the British Isles in the months of June and July, 1688, is
remote from the earthquake of Lima in place; and, if it be a question of
earthquakes at all, there are others nearer to it both in place and time,
such as that in the Basilicata province of Naples in January, 1688, and
the Jamaica earthquake, felt through all the island, on the 1st of March,
1688. The greatest of them all, that of Smyrna, on the 10th of July, was a
few weeks too late for the hypothesis.


VI.

A continent so subject to earthquakes as South America might be expected,
in this hypothesis, to have had some corresponding influenzas. It has
indeed had influenzas, some of them peculiar to itself. The Western
Hemisphere as a whole has, on several great occasions, had influenzas
which were not felt in the Old World. Again, there are one or two
instances in which the infection, while it spread widely over the
table-lands of Bolivia and Peru, does not appear by existing testimony to
have been carried north of the Isthmus. One of these was the influenza of
1720, as special to a region of South America as that of 1688 was to the
British Isles. The account of it was given in an essay by Botoni ‘On the
Circulation of the Blood,’ published at Lima in 1723[776]. He calls it
_catarro maligno_; it was popularly known as _fierro chuto_ or “iron cap.”
It appeared at Cuzco in the end of March, or beginning of April, 1720, and
was over about November. Four thousand are said to have died of it in the
diocese of Cuzco, and it is said to have made so great a scarcity of hands
that the first harvest after it was imperfectly gathered. It had all the
marks of an influenza, with the addition of bleeding from the nose and
lungs. It had also the grand characteristic common to influenza and
epidemic ague: “the symptoms were so diverse and even contradictory that
no correct diagnosis, or curative plan, could be fixed.” The Lima writer
of 1723 says that it followed an eclipse of the sun on the 15th of August,
1719, having begun on the eastern side of the Andes, in the basin of La
Plata, about that time, and travelled northwards and westwards, as the
South American influenza of 1759 did.

This is a localized influenza in a country of earthquakes. But the two
great earthquakes in 1719 are not South American. They both happened in
July: one along the coast of Fez and Morocco, which ruined many villages
and a part of the city of Morocco (there is also a later disturbance in
the Azores in December, followed by the upheaval of a new island), the
other in North China. Here we have the choice of following the “aer
inimicus” of Lucretius either from China or from the African coast; and if
it be the case that the influenza began in the latter part of the year
1719 in the basin of the La Plata, to cross the Andes next year, it may
seem, in this hypothesis, that a course from east to west, bringing the
infection across the Atlantic from Africa, is to be preferred to a course
from west to east, bringing it across the Pacific from North China. In
either case there need be no difficulty in finding local clouds of
miasmata. Some traces of the corresponding great earthquake in China were
found in November of the following year, by Bell, an English traveller who
crossed from Moscow to Peking:

    “Jumy,” he says, “suffered greatly by the earthquakes that happened in
    the month of July the preceding year [1719], above one half of it
    being thereby laid in ruins. Indeed more than one half of the towns
    and villages through which we travelled this day had suffered much on
    the same occasion, and vast numbers of people had been buried in the
    ruins. I must confess it was a dismal scene to see everywhere such
    heaps of rubbish[777].”

The atmospheric effects of Chinese earthquakes have been pictured since
medieval times, in obviously superstitious colours; and there are reasons
why a great disturbance of soil in that country should produce remarkable
miasmata. The surface soil of China is peculiar in having the bodies of
the dead dispersed at large in it, insomuch that excavations for the
foundations of houses, or for roads and railway cuttings, can hardly be
made without the constant risk of exposing graves[778].

If the soil of China is peculiar in one way, that of the West Coast of
Africa is peculiar in another. Without entering on the large question of
“malaria” in each of them, I shall take an old illustration of the
miasmata of the West Coast of Africa as a cause of dengue-fever, a
disease curiously like influenza in its symptoms, and like it also in its
occasional wave-like dispersion over wide regions. The authority is Dr
Aubrey, who resided many years on the coast of Guinea, saw much of the
slave-trade, and wrote a very sensible book in 1729, called ‘The Sea
Surgeon, or the Guinea Man’s Vade Mecum.’ He describes quite clearly the
fever which was long after described by West Indian physicians as dengue,
or three-days’ fever, or break-bone fever, including in his description
the characteristic exanthems of it and the penetrating odour of the sweat.
He gives also, in clinical form, a series of cases on board the galley
‘Peterborough’ in December, 1717, which are exquisite examples of
break-bone fever. This disease, he says, “many times runs over the whole
ship, as well negroes as white men, for they infect one the other, and the
ship is then in a very deplorable condition unless they have an able man
to take care of them.” But the original source of infection, he believed,
was the fogs that hung at nightfall over the estuaries of the rivers; and
he gives an experimental proof, remarkable but not quite incredible, of
the poisonous nature of the miasmata:

    “But to let you see the evil, malevolent, contagious, destructive
    quality of those fogs that fall there in the night, and how far they
    are inimical to human nature, I will tell you of an experiment of my
    own. I made a lump of paste with oat-meal somewhat hard, and about the
    bigness of a hen’s egg, which was exposed to the fog from twilight to
    twilight, i.e. from the dusk of the evening till daybreak in the
    morning; after which I crumbled it, and gave it to fowls, which we had
    on board, and soon after they had eaten it, they turned round and in a
    kind of vertigo dropt down and expired.”

A great mortality in Guinea in 1754 or 1755 was ascribed by Lind, the
least credulous in such matters, to “a noxious stinking fog[779].”

What the alternations of heat and chill, of moisture and drought, produce
ordinarily in the way of miasmata, the same, we may suppose, is produced
on the great scale, as a phenomenon at some particular time and place, by
one of those cataclysms which break the surface of the earth or the bed of
the sea, lower or raise the level of wells and springs, and fill the air
with particles of dust or vapour which may overhang the locality for
months and visibly disperse themselves to a great distance. Nothing
relating to miasmata in the air need be hard for belief after the
wonderful diffusion and permanence in the atmosphere of the whole globe,
for two years or more, of finely divided particles shot up by the
earthquakes and eruptions of Krakatoa in the Straits of Sunda on the 27th
and 28th of August, 1883[780].

A theory of influenza constructed from such generalities as those of
Boyle, Arbuthnot and Webster will have attractions for many over the
theory that influenza is always present in some remote country and becomes
dispersed now and then over the world by contagion from person to person:
it will have superior attractions, for the reason that influenza is a
phenomenal thing which needs a phenomenal cause to account for it. But if
anyone were to attempt to fit each historic wave of influenza with its
particular earthquake, or to find the precise locality where clouds of
infective matter had arisen, or the particular circumstances in which they
arose, he would certainly find his fragile structure of probabilities
pulled to pieces by the professed discouragers and depravers. I make no
such attempt; but I am not the less persuaded of the direction in which
the true theory of influenza lies.


Influenza at Sea.

There is no point more essential to a correct theory of influenza than to
find out in what circumstances it has occurred among the crews of ships on
the high seas. If it be true that a ship may sail into an atmosphere of
influenza, just as she may sail into a fog, or an oceanic current, or the
track of a cyclone, then the possible hypotheses touching the nature,
source, and mode of diffusion of influenza become narrowed down within
definite limits.

    One of the first observations was made in the case of a Scotch vessel
    in the influenza of 1732-33[781]. The epidemic was earlier in Scotland
    than in England; it beg