The Project Gutenberg eBook, A History of Epidemics in Britain, Volume II (of 2), by Charles Creighton

A HISTORY
OF
EPIDEMICS IN BRITAIN.

London: C. J. CLAY and SONS,
CAMBRIDGE UNIVERSITY PRESS WAREHOUSE,
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.

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.

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]:

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.

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.

Weekly Mortalities in London.

1686.

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 51/1d. per quarter, while the average of next year falls to 37/8d. 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:

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.

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.

Tables from Short’s Abstracts of Parish Registers.

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.

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 44s. 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:

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 1s. 2d. or 1s. 4d. 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].

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 25s. 6d. 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:

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.

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.

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 33s. 9d. per quarter, in 1712, the peace next year sending it no lower than 30s. But at Michaelmas, 1713, it rose with a bound to 56s. 11d., 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.

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.

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.

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:

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.

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.

Norwich.

Country Parishes.

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 4s. to 8s. 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 31s. 6d. per quarter, and it rose 10s. 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 56s. 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. 10s. 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.

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

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]