CHAPTER I._A History of Epidemics in Britain, Volume 2 (of 2) From the Extinction of Plague to the Present Time

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A HISTORY OF EPIDEMICS IN BRITAIN.

London: C. J. Clay and Sons,

Cambridge University Press Warehouse,

Ave Maria Lane.

and

H. K. Lewis,

136, Gower Street, W.C.

Cambridge: Deighton, Bell and Co.

Leipzig: F. A. Brockhaus.

New York: Macmillan and Co.

A HISTORY OF EPIDEMICS IN BRITAIN.

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

Cambridge:

Printed by C. J. Clay, M.A. and Sons,

At the University Press.

PREFACE.

This volume is the continuation of ‘A History of Epidemics in Britain from

A.D. 664 to the Extinction of Plague’ (which was published three years

ago), and is the completion of the history to the present time. The two

volumes may be referred to conveniently as the first and second of a

‘History of Epidemics in Britain.’ In adhering to the plan of a systematic

history instead of annals I have encountered more difficulties in the

second volume than in the first. In the earlier period the predominant

infection was Plague, which was not only of so uniform a type as to give

no trouble, in the nosological sense, but was often so dramatic in its

occasions and so enormous in its effects as to make a fitting historical

theme. With its disappearance after 1666, the field is seen after a time

to be occupied by a numerous brood of fevers, anginas and other

infections, which are not always easy to identify according to modern

definitions, and were recorded by writers of the time, for example

Wintringham, in so dry or abstract a manner and with so little of human

interest as to make but tedious reading in an almost obsolete phraseology.

Descriptions of the fevers of those times, under the various names of

_synochus_, _synocha_, nervous, putrid, miliary, remittent, comatose, and

the like, have been introduced into the chapter on Continued Fevers so as

to show their generic as well as their differential character; but a not

less important purpose of the chapter has been to illustrate the condition

of the working classes, the unwholesomeness of towns, London in

particular, the state of the gaols and of the navy, the seasons of dearth,

the times of war-prices or of depressed trade, and all other vicissitudes

of well-being, of which the amount of Typhus and Relapsing Fever has

always been a curiously correct index. It is in this chapter that the

epidemiology comes into closest contact with social and economic history.

In the special chapter for Ireland the association is so close, and so

uniform over a long period, that the history may seem at times to lose its

distinctively medical character.

As the two first chapters are pervaded by social and economic history, so

each of the others will be found to have one or more points of distinctive

interest besides the strictly professional. Smallpox is perhaps the most

suitable of all the subjects in this volume to be exhibited in a

continuous view, from the epidemics of it in London in the first Stuart

reigns to the statistics of last year. While it shares with Plague the

merit, from a historical point of view, of being always the same definite

item in the bills of mortality, it can be shown to have experienced, in

the course of two centuries and a half, changes in its incidence upon the

classes in the community, upon the several age-periods and upon town and

country, as well as a very marked change relatively to measles and

scarlatina among the infective scourges of infancy and childhood. For

certain reasons Smallpox has been the most favoured infectious disease,

having claimed an altogether disproportionate share of interest at one

time with Inoculation, at another time with Vaccination. The history of

the former practice, which is the precedent for, or source of, a whole new

ambitious scheme of prophylaxis in the infectious diseases of men and

brutes, has been given minutely. The latter practice, which is a radical

innovation inasmuch as it affects to prevent one disease by the

inoculation of another, has been assigned as much space in the chapter on

Smallpox as it seems to me to deserve. Measles and Whooping-cough are

historically interesting, in that they seem to have become relatively more

prominent among the infantile causes of death in proportion as the public

health has improved. Whooping-cough is now left to head the list of its

class by the shrinkage of the others. It is in the statistics of Measles

and Whooping-cough that the principle of population comes most into view.

The scientific interest of Scarlatina and Diphtheria is mainly that of

new, or at least very intermittent, species. Towards the middle of the

18th century there emerges an epidemic sickness new to that age, in which

were probably contained the two modern types of Scarlet Fever and

Diphtheria more or less clearly differentiated. The subsequent history of

each has been remarkable: for a whole generation Scarlatina could prove

itself a mild infection causing relatively few deaths, to become in the

generation next following the greatest scourge of childhood; for two whole

generations Diphtheria had disappeared from the observation of all but a

few medical men, to emerge suddenly in its modern form about the years

1856-59.

The history of Dysentery, as told by the younger Heberden, has been a

favourite instance of the steady decrease of a disease in London during

the 18th century. I have shown the error in this, and at the same time

have proved from the London bills of mortality of the 17th and 18th

centuries that Infantile Diarrhoea, which is now one of the most important

causes of death in some of the great manufacturing and shipping towns, was

formerly still more deadly to the infancy of the capital in a hot summer

or autumn. Asiatic Cholera brings us back, at the end of the history, to

the same great problem which the Black Death of the 14th century raised

near the beginning of it, namely, the importation of the seeds of

pestilence from some remote country, and their dependence for vitality or

effectiveness in the new soil upon certain favouring conditions, which

sanitary science has now happily in its power to withhold. I have left

Influenza to be mentioned last. Its place is indeed unique among epidemic

diseases; it is the oldest and most obdurate of all the problems in

epidemiology. The only piece of speculation in this volume will be found

in the five-and-twenty pages which follow the narrative of the various

historical Influenzas; it is purely tentative, exhibiting rather the

_disjecta membra_ of a theory than a compact and finished hypothesis. If

there is any new light thrown upon the subject, or new point of view

opened, it is in bringing forward in the same context the strangely

neglected history of Epidemic Agues.

Other subjects than those which occupy the nine chapters of this volume

might have been brought into a history of epidemics, such as Mumps,

Chickenpox and German Measles, Sibbens and Button Scurvy, together with

certain ordinary maladies which become epidemical at times, such as

Pneumonia, Erysipelas, Quinsy, Jaundice, Boils and some skin-diseases.

While none of these are without pathological interest, they do not lend

themselves readily to the plan of this book; they could hardly have been

included except in an appendix of _miscellanea curiosa_, and I have

preferred to leave them out altogether. It has been found necessary, also,

to discontinue the history of Yellow Fever in the West Indian and North

American colonies, which was begun in the former volume.

I have, unfortunately for my own labour, very few acknowledgements to make

of help from the writings of earlier workers in the same field. My chief

obligation is to the late Dr Murchison’s historical introduction to his

‘Continued Fevers of Great Britain.’ I ought also to mention Dr Robert

Willan’s summary of the throat-distempers of the 18th century, in his

‘Cutaneous Diseases’ of 1808, and the miscellaneous extracts relating to

Irish epidemics which are appended in a chronological table to Sir W. R.

Wilde’s report as Census Commissioner for Ireland. For the more recent

history, much use has naturally been made of the medical reports compiled

for the public service, especially the statistical.

_September, 1894._

CONTENTS.

PAGE

CHAPTER I.

TYPHUS AND OTHER CONTINUED FEVERS.

The Epidemic Fever of 1661, according to Willis 4

Sydenham’s epidemic Constitutions 9

Typhus Fever perennial in London 13

The Epidemic Constitutions following the Great Plague 17

The Epidemic Fever of 1685-86 22

Retrospect of the great Fever of 1623-25 30

The extinction of Plague in Britain 34

Fevers to the end of the 17th Century 43

Fevers of the seven ill years in Scotland 47

The London Fever of 1709-10 54

Prosperity of Britain, 1715-65 60

The Epidemic Fevers of 1718-19 63

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

The Epidemic Fever of 1741-42 78

Sanitary Condition of London under George II. 84

The Window-Tax 88

Gaol-Fever 90

Circumstances of severe and mild Typhus 98

Ship-Fever 102

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

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

The “Putrid Constitution” of Fevers in the middle third of the

18th Century 120

Miliary Fever 128

Typhus Fever in London, 1770-1800 133

Typhus in Liverpool, Newcastle and Chester in the last quarter

of the 18th century 140

Fever in the Northern Manufacturing Towns, 1770-1800 144

Typhus in England and Scotland generally, in the end of the

18th century 151

Fevers in the Dearth of 1799-1802 159

Comparative immunity from Fevers during the War and high

prices of 1803-15 162

The Distress and Epidemic Fever (Relapsing) following the Peace

of 1815 and the fall of wages 167

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

The Relapsing Fever of 1827-28 181

Typhoid or Enteric Fever in London, 1826 183

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

of the Working Class 188

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

Relapsing Fever in Scotland, 1842-44 203

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

Subsequent Epidemics of Typhus and Relapsing Fevers 208

Relative prevalence of Typhus and Enteric Fevers since 1869 211

Circumstances of Enteric Fever 216

CHAPTER II.

FEVER AND DYSENTERY IN IRELAND.

Dysentery and Fever at Londonderry and Dundalk, 1689 229

A generation of Fevers in Cork 234

Famine and Fevers in Ireland in 1718 and 1728 236

The Famine and Fever of 1740-41 240

The Epidemic Fevers of 1799-1801 248

The Growth of Population in Ireland 250

The Famine and Fevers of 1817-18 256

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

Dysentery and Relapsing Fever, 1826-27 271

Perennial Distress and Fever 274

The Great Famine and Epidemic Sicknesses of 1846-49 279

Decrease of Typhus and Dysentery after 1849 295

CHAPTER III.

INFLUENZAS AND EPIDEMIC AGUES.

Retrospect of Influenzas and Epidemic Agues in the 16th and

17th centuries 306

The Ague-Curers of the 17th Century 315

The Peruvian Bark Controversy 320

The Influenza of 1675 326

The Influenza of 1679 328

The Epidemic Agues of 1678-80 329

The Influenza of 1688 335

The Influenza of 1693 337

The Influenza of 1712 339

Epidemic Agues and Influenzas, 1727-29 341

The Influenza of 1733 346

The Influenza of 1737 348

The Influenza of 1743 349

Some Localized Influenzas and Horse-colds 352

The Influenza of 1762 356

The Influenza of 1767 358

The Influenza of 1775 359

The Influenza of 1782 362

The Epidemic Agues of 1780-85 366

The Influenza of 1788 370

The Influenza of 1803 374

The Influenza of 1831 379

The Influenza of 1833 380

The Influenza of 1837 383

The Influenza of 1847-48 389

The Influenzas of 1889-94 393

The Theory of Influenza 398

Influenza at Sea 425

The Influenzas of Remote Islands 431

CHAPTER IV.

SMALLPOX.

Retrospect of earlier epidemics 434

Smallpox after the Restoration 437

Sydenham’s Practice in Smallpox 445

Causes of Mild or Severe Smallpox 450

Pockmarked Faces in the 17th Century 453

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

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

Circumstances of the great Epidemic in 1710 461

Inoculation brought into England 463

The popular Origins of Inoculation 471

Results of the first Inoculations; the Controversy in England 477

Revival of Inoculation in 1740: a New Method 489

The Suttonian Inoculation 495

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

The Epidemiology continued from 1721 517

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

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

The range of severity in Smallpox, and its circumstances 544

Cowpox 557

Chronology of epidemics resumed from 1801 567

The Smallpox Epidemic of 1817-19 571

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

The Smallpox Epidemic of 1825-26 593

A generation of Smallpox in Glasgow 597

Smallpox in Ireland, 1830-40 601

The Epidemic of 1837-40 in England 604

Legislation for Smallpox after the Epidemic of 1837-40 606

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

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

CHAPTER V.

MEASLES.

Derivation and early uses of the name 632

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

Measles in the 18th century 641

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

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

Measles in the Period of Statistics 660

CHAPTER VI.

WHOOPING-COUGH.

Earliest references to whooping-cough 666

Whooping-cough in Modern Times 671

Whooping-cough as a Sequel of other Maladies 674

CHAPTER VII.

SCARLATINA AND DIPHTHERIA.

Nosological difficulties in the earlier history 678

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

Angina maligna in England from 1739 691

An epidemic of Throat-disease in Ireland, 1743 693

Malignant Sore-throat in Cornwall, 1748 694

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

“Scarlet Fever” at St Albans, 1748 698

Epidemics of Sore-throat with Scarlet rash in the period

between Fothergill and Withering 699

Scarlatina anginosa in its modern form, 1777-78 708

History of Scarlatina after the Epidemic of 1778 713

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

same observer 715

Scarlatinal Epidemics, 1796-1805 719

Scarlatina since the beginning of Registration, 1837 726

Reappearance of Diphtheria in 1856-59 736

Conditions favouring Diphtheria 744

CHAPTER VIII.

INFANTILE DIARRHOEA, CHOLERA NOSTRAS, AND DYSENTERY.

Summer Diarrhoea of Infants in London, 17th century 748

Summer Diarrhoea of Infants, 18th century 754

Modern Statistics of Infantile Diarrhoea 758

Causes of the high Death-rates from Infantile Diarrhoea 763

Cholera Nostras 768

Dysentery in the 17th and 18th centuries 774

Dysentery in the 19th century 785

CHAPTER IX.

ASIATIC CHOLERA.

Asiatic Cholera at Sunderland in October, 1831 796

Extension of Cholera to the Tyne, December, 1831 802

The Cholera of 1832 in Scotland 805

The Cholera of 1832 in Ireland 816

The Cholera of 1832 in England 820

The Cholera of 1848-49 in Scotland 835

The Cholera of 1849 Ireland 839

The Cholera of 1849 in England 840

The Cholera of 1853 at Newcastle and Gateshead 849

The Cholera of 1854 in England 851

The Cholera of 1853-54 in Scotland and Ireland 855

The Cholera of 1865-66 856

The Antecedents of Epidemic Cholera in India 860

Note on Cerebro-Spinal Fever 863

CHAPTER I.

TYPHUS AND OTHER CONTINUED FEVERS.

It was remarked by Dr James Lind, in 1761, that a judicious synopsis of

the writings on fevers, in a chronological sense, would be a valuable

book: it would bring to light, he was fain to expect, treasures of

knowledge; “and perhaps the influence of a favourite opinion, or of a

preconceived fancy, on the writings of some even of our best instructors,

such as Sydenham and Morton, would more clearly be perceived[1].” Lind

himself was the person to have delivered such a history and criticism. He

was near enough to the 17th century writers on fevers to have entered

correctly into their points of view; while so far as concerned the

detection of theoretical bias or preconceived fancies, he had shown

himself a master of the art in his famous satire upon the “scorbutic

constitution,” a verbal or mythical construction which had been in great

vogue for a century and a half, and was still current, at the moment when

Lind destroyed it, in the writings of Boerhaave and Haller. A judicious

historical view of the English writings on fevers, such as this 18th

century critic desired to see, may now be thought superfluous. The

theories, the indications for treatment, the medical terms, have passed

away and become the mere objects of a learned curiosity. But the actual

history of the old fevers, of their kinds, their epidemic prevalence,

their incidence upon rich or poor, upon children or adults, their

fatality, their contagiousness, their connexion with the seasons and other

vicissitudes of the people--all this is something more than curious.

Unfortunately for the historian of diseases, he has to look for the

realities amidst the “favourite opinions” or the “preconceived fancies” of

contemporary medical writers. Statements which at first sight appear to be

observations of matters of fact are found to be merely the necessary

truths or verbal constructions of some doctrine. One great doctrine of the

17th and 18th centuries was that of obstructions: in this doctrine, as

applied to fevers, obstructions of the mesentery were made of central

importance; the obstructions of the mesentery extended to its lymphatic

glands; so that we come at length, in a mere theoretical inference, to

something not unlike the real morbid anatomy of enteric fever. Another

great doctrine of the time, specially applied by Willis to fevers, was

that of fermentations and acrimonies. “This ferment,” says a Lyons

disciple of Willis in 1682, “has its seat in the glandules of the velvet

coat of the stomach and intestines described by Monsieur Payer[2].” But

the Lyons physician is writing all the while of the fevers that have

always been common in the Dombes and Bresse, namely intermittents; the

tertian, double tertian, quotidian, quartan, or double quartan paroxysm

arises, he says, from the coagulation of the humours by the ferment which

has its seat in the glandules described by M. Payer, even as acids cause a

coagulation in milk, the paroxysm of ague continuing, “until this sharp

chyle be dissipated and driven out by the sweat or insensible

perspiration.” The lymphatic follicles of the intestine known by the name

of Payer, or Peyer, were then the latest anatomical and physiological

novelty, and were chosen, on theoretical grounds, as the seat of

fermentation or febrile action in agues. On the ground of actual

observation they were found about a century and a half after to be the

seat of morbid action in typhoid fever.

While there are such pitfalls for the historian in identifying the several

species of fevers in former times, there are other difficulties of

interpretation which concern the varieties of a continued fever, or its

changes of type from generation to generation. Is change of type a reality

or a fiction? And, if a reality, did it depend at all upon the use or

abuse of a certain regimen or treatment, such as blooding and lowering, or

heating and corroborating? A pupil of Cullen, who wrote his thesis in

1782 upon the interesting topic of the change in fevers since the time of

Sydenham[3], inferred that the great physician of the Restoration could

not have had to treat the low, putrid or nervous fevers of the middle and

latter part of the 18th century, otherwise he would not have resorted so

regularly to blood-letting, a practice which was out of vogue in continued

fevers at the time when the thesis was written, as well as for a good many

years before and after. Fevers, it was argued, had undergone a radical

change since the time of Sydenham, in correspondence with many changes in

diet, beverages and creature comforts, such as the greatly increased use

of tea, coffee and tobacco, and of potatoes or other vegetables in the

diet, changes also in the proportion of urban to rural population, in the

use of carriages, and in many other things incident to the progressive

softening of manners. In due time the low, putrid, nervous type of typhus

fever, which is so much in evidence in the second half of the 18th

century, ceased to be recorded, an inflammatory type, or a fever of strong

reaction, taking its place; so that Bateman, of London, writing in 1818,

said: “The putrid pestilential fevers of the preceding age have been

succeeded by the milder forms of infectious fever which we now witness”;

while Armstrong, Clutterbuck, and others, who had revived the practice of

blood-letting in fevers shortly before the epidemic of 1817-18, claimed

the comparatively slight fatality and short duration of the common fever

of the time as an effect of the treatment. After 1831, typhus again became

low, depressed, spotted, not admitting of the lancet; on which occasion

the doctrine of “change of type” was debated in the form that the older

generation of practitioners still remember.

Thus the task of the historian, whose first duty is to ascertain, if he

can, the actual matters of fact, or the realities, in their sequence or

chronological order, is made especially difficult, in the chapter on

continued fevers, by the contemporary influence of theoretical pathology

or “a preconceived fancy,” by the ascription of modifying effects to

treatment, whether cooling or heating, lowering or supporting, and, most

of all, by the absence of that more exact method which distinguishes the

records of fever in our own time. Nor can it be said that the work of

historical research has been made easier in all respects, by the exact

discrimination and perfected diagnosis to which we are accustomed in

present-day fevers. In the years between 1840 and 1850, the three grand

types of fever then existing in Britain, namely, spotted typhus, enteric,

and relapsing fever, were at length so clearly distinguished, defined and

described that no one remained in doubt or confusion. Thereupon arose the

presumption that these had always been the forms of continued fever in

Britain, and that the same fevers, presumably in the same relative

proportions to each other, might have been left on record by the

physicians of former generations, if they had used the modern exactness

and minuteness in observing both clinical history and anatomical state,

which were seen at their best in Sir William Jenner. It would simplify

history, indeed it would make history superfluous, if that were really the

case. There are many reasons for believing that it was not the case. As

Sydenham looked forward to his successors having experiences that he never

had, so we may credit Sydenham with having really seen things which we

never see, not even those of us who saw the last epidemics of relapsing

fever and typhus. It is due to him, and to his contemporaries and nearest

successors, to reciprocate the spirit in which he concludes the general

chapter on epidemics prefatory to his annual constitutions from 1661 to

1676:

“I am far from taking upon myself the credit of exhausting my subject

in the present observations. It is highly probable that I may fail

even in the full enumeration of the epidemics. Still less do I warrant

that the diseases which during the years in question have succeeded

each other in the sequence about to be exhibited shall remain the same

in all future years. One thing most especially do I aim at. It is my

wish to state how things have gone lately; how they have been in this

country, and how they have been in this the city which we live in. The

observations of some years form my ground-work. It is thus that I

would add my mite, such as it is, towards the foundation of a work

that, in my humble judgment, shall be beneficial to the human race.

Posterity will complete it, since to them it shall be given to take

the full view of the whole cycle of epidemics in their mutual

sequences for years yet to come[4].”

The epidemic fever of 1661, according to Willis.

On the very threshold of the period at which the history is resumed in

this volume, we find a minute account by Willis of an epidemic in the year

1661, which at once raises the question whether a certain species of

infectious fever did really exist at that time which exists no longer, or

whether Willis described as “a fever of the brain and nervous stock” what

we now call enteric fever. Willis’s fever corresponds in every respect to

the worm fever, the comatose fever, the remittent fever of children, the

acute fever with dumbness, the convulsive fever, which was often recorded

by the medical annalists and other systematic observers as late as the

beginning of the 19th century[5]. It ceased at length to be recorded or

described, and it has been supposed that it was really the infantile or

children’s part of enteric fever, which had occurred in former times as

now[6]. The epidemic fever which Willis saw in the summer of 1661, after a

clear interval of two years from the great epidemics of agues, with

influenzas, in 1657-59, is called by him “a certain irregular and

unaccustomed fever[7].” It was not, however, new to him altogether; for he

had seen the same type, and kept notes of the cases, in a particular

household at Oxford in 1655, as well as on other occasions. It was an

epidemical fever “chiefly infestous to the brain and nervous stock.” It

raged mostly among children and youths, and was wont to affect them with a

long and, as it were, a chronical sickness. When it attacked the old or

middle-aged, which was more rarely, it did sooner and more certainly kill.

It ran through whole families, not only in Oxford and the neighbouring

parts, “but in the countries at a great distance, as I heard from

physicians dwelling in other places.” Among those other witnesses, we

shall call Sydenham; but meanwhile let us hear Willis, whose account is

the fullest and least warped by theory.

Its approach was insidious and scarce perceived, with no immoderate

heat or sharp thirst, but producing at length great debility and

languishing, loss of appetite and loathing. Within eight days there

were brain symptoms--heavy vertigo, tingling of the ears, often great

tumult and perturbation of the brain. Instead of phrensy, there might

be deep stupidity or insensibility; children lay sometimes a whole

month without taking any notice of the bystanders, and with an

involuntary flux of their excrements; or there might be frequent

delirium, and constantly absurd and incongruous chimaeras in their

sleep. But in men a fury, and often-times deadly phrensy, did succeed.

If, however, neither stupidity nor great distraction did fall upon

them, swimmings in the head, convulsive movements, with convulsions of

the members and leaping up of the tendons did grievously infest them.

In almost all, there were loose and stinking motions, now yellow, now

thin and serous; vomiting was unusual; the urine deep red. The

sufferers in this prolonged sickness wasted to a skeleton, with no

great heat or evacuations to account for the wasting. Some, at the end

of the disease, had a severe catarrh. In others, with little infection

of the head, soon after the beginning of the fever a cruel cough and a

stinking spittle, with a consumptive disposition, grew upon them, and

seemed to throw them suddenly into a phthisis, from which, however,

they recovered often beyond hope. In some there were swellings of the

glands near the hinder part of the neck, which ripened and broke, and

gave out a thin stinking ictor for a long time. “I have also seen

watery pustules excited in other parts of the body, which passed into

hollow ulcers, and hardly curable. Sometimes little spots and

_petechiales_ appeared here and there.” But none of the spots were

broad and livid, nor were there many malignant spots.

Willis then gives several cases clinically, in his usual manner. The

first is of a strong and lively young man, who was sick above two

months and seemed near death, but began to mend and took six weeks to

recover, sweating every night or every other night of his convalescent

period. The second case, aged twelve, was restored to health in a

month. Numbers three and four were children of a nobleman, who both

died, the convulsive type being strongly marked; one of the two was

examined after death, and found to have several sections of the small

intestine telescoped, but all the abdominal viscera free from

disease[8], the lungs engorged, the vessels of the brain full, much

water in the sub-arachnoid space, and more than half a pint in the

lateral ventricles.

In farther illustration of this type of fever, epidemic in 1661,

Willis goes back to his notes of a sporadic outbreak of what he thinks

was the same disease in a certain family at Oxford in the winter of

1653-4[9]: “yea I remember that sometime past very many laboured with

such a fever.” In the family in question, five children took the fever

one after another during a space of four months, two of the cases

proving fatal; the domestics also took it, and some strangers who came

in to help them, “the evil being propagated by contagion.” The cases

in the children are fully recorded[10], the following being some of

the symptoms:

In case 1, aged seven, the illness began at the end of December, 1653

(or 1655): there were contractions of the wrist tendons, red spots

like fleabites on his neck and other parts, drowsiness, and

involuntary passage of the excrements. At the end of a fortnight, a

flux set in and lasted for four days; next, after that, a whitish

crust or scurf, as it were chalky, began to spread over the whole

cavity of his mouth and throat, which being often in a day wiped away,

presently broke forth anew. He mended a little, but had paralysis of

his throat and pharynx, was reduced to a living skeleton, but at

length got well.

Case 2, a brother, aged nine, had frequent loose and highly putrid

motions on the eleventh day; and next day, the flux having ceased, the

most severe colic, so that he lay crying out day and night, his belly

swollen and hard as a drum, until, on the 24th day, he died in an

agony of convulsions.

Case 3, a brother, aged 11, was taken with similar symptoms on the

13th February, and died on the 13th day.

Case 4, a sister, was taken ill in March, with less marked symptoms,

and recovered slowly, having had no manifest crisis.

Case 5, a boy of the same family, and the youngest, fell ill about the

same time as No. 4, and after the like manner, “who yet, a looseness

arising naturally of itself, for many days voiding choleric and

greenish stuff, was easily cured.”

Then comes a general reference to the domestics and visitors, who fell

sick of the same and all recovered.

The prolonged series of cases in the household of this “venerable man”

appears to have made a great impression upon Willis, as something new in

his experience, as well as in the experience of several other physicians

who gave their services. That it was malignant he considers proved “ex

contagio, pernicie, macularum pulicularum apparentia, multisque aliis

indiciis.” He adds that he had seen the same disease sporadically at other

times; and again “I remember that formerly several laboured under such a

fever.” Those cases were all previous to the general prevalence of the

fever which he identifies with them in the summer of 1661, under the name

of a “fever of the brain and spinal cord.”

The signs given by Willis are as nearly as may be the signs of infantile

remittent fever, or worm fever, or febris synochus puerorum, or hectica

infantilis, or febris lenta infantum, or an acute fever with dumbness, of

which perhaps the first systematic account in this country was given by Dr

William Butter of Lower Grosvenor Street, in 1782[11]. It is, he says,

both a sporadical and an epidemical disease, “and when epidemical it is

also contagious.” The age for it is from birth up to puberty; but “similar

symptoms are often observed in the disorders of adults.” Morton, writing

in 1692-94, clearly points to the same fever under the name of worm fever

(febris verminosa). He adds it at the very end of his scheme of fevers, as

if in an appendix, having been unable to find a place for it in any of his

categories owing to its varying forms--hectic, acute, intermittent,

continued, συνεχής, inflammatory, but for the most part colliquative or

σύνοχος, “and malignant according to the varying degrees of the venomous

miasm causing it[12].” Butter also recognizes its varying types: it has

many symptoms, but they seldom all occur in the same case; there are three

main varieties--the acute, lasting from eight to ten days up to two or

three weeks; the slow, lasting two or three months; and the low, lasting

a month or six weeks. The slow form, he says, is only sporadic; the low is

only epidemic, and is never seen but when the acute is also epidemical; it

is rare in comparison with the latter, and not observed at all except in

certain of the epidemical seasons. Waiving the question whether the

remittent fever of children, thus systematically described, was not a

composite group of maladies, of which enteric fever of children was one,

we can hardly doubt that Willis found a distinctive uniform type in the

epidemic of 1661, in Oxford as he saw it himself, in other parts of

England by report. It had symptoms which were not quite clearly those of

enteric fever: spots, like fleabites, on the neck and other parts,

swelling and suppuration of the glands in the hinder part of the neck,

effusion of fluid on the brain and in the lateral ventricles, and the

intestine free from disease[13].

Confirming Willis’s account for Oxford, is the case of Roger North, when a

boy at Bury St Edmunds Free School in 1661, as related by himself in his

‘Autobiography[14].’ Being then “very young and small,” after a year at

school he had “an acute fever, which endangered a consumption.” Elsewhere

he attributes his bad memory with “confusion and disorder of thought,” to

that “cruel fit of sickness I had when young, wherein, I am told, life was

despaired of, and it was thought part of me was dead; and I can recollect

that warm cloths were applied, which could be for no other reason, because

I had not gripes which commonly calls for that application.” That “great

violence of nature,” while it had impaired his mental faculties, had

sapped his bodily vigour somewhat also, of which he gives a singular

illustration.

This special prevalence of epidemic fevers in the summer and autumn of

1661 is noticed also by the London diarists.

Evelyn says that the autumn of 1661 was exceedingly sickly and wet[15].

Pepys has several entries of fever[16]. On 2 July, 1661: “Mr Saml. Crewe

died of the spotted fever.” On 16 August: “At the [Navy] Office all the

morning, though little to do; because all our clerks are gone to the

burial of Tom Whitton, one of our Controller’s clerks, a very ingenious

and a likely young man to live as any in the office. But it is such a

sickly time both in the city and country everywhere (of a sort of fever)

that never was heard of almost, unless it was in a plague-time. Among

others the famous Tom Fuller [of the ‘Worthies of England’] is dead of it;

and Dr Nichols [Nicholas], Dean of St Paul’s; and my Lord General Monk is

very dangerously ill.” On 31 August: “The season very sickly everywhere of

strange and fatal fevers.” On 15 January, 1662: “Hitherto summer weather,

both as to warmth and every other thing, just as if it were the middle of

May or June, which do threaten a plague (as all men think) to follow; for

so it was almost the last winter, and the whole year after hath been a

very sickly time to this day.”

The great medical authority of the time is Sydenham. His accounts of the

seasons and reigning diseases of London extend from 1661 to 1686, so that

they begin with the year for which Willis described the epidemic fever

“chiefly infestous to the brain and nervous stock,” popularly called the

new disease. But Sydenham did not describe the epidemic in the same

objective way that Willis did. He records a series of “epidemic

constitutions of the air,” the particular constitution of each year being

named from the epidemic malady that seemed to him to dominate it most. It

was, perhaps, because it had to conform to Sydenham’s “preconceived

fancy,” as Lind said, that his account of the dominant type of fever in

1661 differs somewhat from that given by Willis.

Sydenham’s epidemic Constitutions.

Sydenham adopted the epidemic constitutions from Hippocrates, as he did

much else in his method and practice. In the first and third books of the

‘Epidemics,’ Hippocrates describes three successive seasons and their

reigning diseases in the island of Thasos, as well as a fourth

plague-constitution which agrees exactly with the facts of the plague of

Athens as described by Thucydides. The Greek term translated

“constitution” is κατάστασις, which means literally a settling,

appointing; ordaining, and in the epidemiological sense means the type of

reigning disease as settled by the season. The method of Hippocrates is

first to give an account of the weather--the winds, the rains, the

temperature and the like,--and then to describe the diseases of the

seasons[17]. Sydenham followed his model with remarkable closeness. The

great plague of London has almost the same place in his series of years

that the plague-constitution, the fourth in order, has in that of

Hippocrates. It looks, indeed, as if Sydenham had begun with the year

1661, more for the purpose of having several constitutions preceding that

of the plague than because he had any full observations of his own to

record previous to 1665. He is also much influenced by the example of

Hippocrates in giving prominence to the intermittent type of fevers. It

was remarked by one of our best 18th century epidemiologists, Rogers of

Cork, and with special reference to Sydenham’s “intermittent

constitutions,” that fevers proper to the climate of Thasos were not

likely to be identified in or near London excepted by a forced

construction.

_Sydenham’s Constitutions._

-----------------------------------------------------------------------

| | in | |Spotted| | |

----|-------------------------|-------|------|-------|--------|-------|

1661|“Intermittent” | 16,665| 20| 3,490 | 1,246 | 188 |

1662| constitution: with a | 13,664| 12| 2,601 | 768 | 20 |

1663| continued fever | 12,741| 9| 2,107 | 411 | 42 |

1664| throughout. | 15,453| 5| 2,258 | 1,233 | 311 |

| | | | | | |

1665|Constitution of plague | 97,306|68,596| 5,257 | 655 | 7 |

1666| and pestilential fever.| 12,738| 1,998| 741 | 38 | 3 |

| | | | | | |

1667|Constitution of smallpox,| 15,842| 35| 916 | 1,196 | 83 |

1668| with a continued | 17,278| 14| 1,247 | 1,987 | 200 |

1669| “variolous” fever. |} | | | | |

| |}19,432| 3| 1,499 | 951 | 15 |

1669|Constitution of dysentery|} | | | | |

1670| and cholera nostras, | 20,198| 0| 1,729 | 1,465 | 295 |

1671| with a continued fever.| 15,729| 5| 1,343 | 696 | 17 |

1672| Measles in 1670. | 18,230| 5| 1,615 | 1,116 | 118 |

| | | | | | |

1673|Constitution of | 17,504| 5| 1,804 | 853 | 15 |

1674| “comatose” fevers. | 21,201| 3| 2,164 | 2,507 | 795 |

1675|Influenza in 1675. | 17,244| 1| 2,154 | 997 | 1 |

1676| | 18,732| 2| 2,112 | 359 | 83 |

| | | | | | |

1677|Not recorded. | 19,067| 2| 1,749 | 1,678 | 87 |

| | | | | | |

1678|Return of the | 20,678| 5| 2,376 | 1,798 | 93 |

1679| “intermittent” | 21,730| 2| 2,763 | 1,967 | 117 |

1680| constitution, absent | 21,053| 0| 3,324 | 689 | 49 |

| | | | | | |

1681|“Depuratory” fevers, | 23,951| 0| 3,174 | 2,982 | 121 |

1682| or dregs of the | 20,691| 0| 2,696 | 1,408 | 50 |

1683| intermittents. | 20,587| 0| 2,250 | 2,096 | 39 |

1684| | 23,202| 0| 2,836 | 1,560 | 6 |

| | | | | | |

1685|Constitution of a | 23,222| 0| 3,832 | 2,496 | 197 |

1686| “new” continued fever. | 22,609| 0| 4,185 | 1,062 | 25 |

--------

|Griping

| in the

| Guts

|-------

| 1,061

| 835

| 866

| 1,146

| 1,288

| 676

| 2,108

| 2,415

| 4,385

| 3,690

| 2,537

| 2,645

| 2,624

| 1,777

| 3,321

| 2,083

| 2,602

| 3,150

| 2,996

| 3,271

| 2,827

| 2,631

| 2,438

| 2,981

| 2,203

| 2,605

The foregoing is a Table of Sydenham’s epidemic constitutions from 1661 to

1686, compiled from his various writings, with the corresponding

statistics from the London Bills of Mortality.

I give this Table both as a convenient outline and in deference to the

great name of Sydenham. But we should be much at fault in interpreting the

figures of the London Bills, or the history of epidemic diseases in the

country at large, if we had no other sources of information than his

writings. Only some of the figures in the Table concern us in this

chapter; plague has been finished in the previous volume, smallpox,

measles and “griping in the guts” are reserved each for a separate

chapter, as well as the influenzas and epidemic agues which formed the

chief part of the “strange” or “new” fevers. If this work had been the

Annals of Epidemics in Britain, it would have been at once proper and easy

to follow Sydenham’s constitutions exactly, and to group under each year

the information collected from all sources about all epidemic maladies.

But as the work is a history, it proceeds, as other histories do, in

sections, observing the chronological order and the mutual relations of

epidemic types as far as possible; and in this section of it we have to

cull out and reduce to order the facts relating to fevers, beginning with

those of 1661.

Cases of fever, says Sydenham, began to be epidemic about the beginning of

July 1661, being mostly tertians of a bad type, and became so frequent day

by day that in August they were raging everywhere, and in many places made

a great slaughter of people, whole families being seized. This was not an

ordinary tertian intermittent; indeed no one but Sydenham calls it an

intermittent at all, and he qualifies the intermittence as follows:

“Autumnal intermittents do not at once assume the genuine type, but in

all respects so imitate continued fevers that unless you examine the

two respectively with the closest scrutiny, they cannot be

distinguished. But, when by degrees the impetus of the ‘constitution’

is repelled and its strength reined in, the fevers change into a

regular type; and as autumn goes out, they openly confess themselves,

by casting their slough (_larva abjecta_) to be the intermittents that

they really were from the first, whether quartans or tertians. If we

do not attend to this diligently” etc. And again, in a paragraph which

does not occur in the earlier editions, he writes as follows in the

context of the “Intermittent Fevers of the years 1661-1664:”

“It is also to be noted that in the beginning of intermittent fevers,

especially those that are epidemic in autumn, it is not altogether

easy to distinguish the type correctly within the first few days of

their accession, since they arise at first with continued fever

superadded. Nor is it always easy, unless you are intent upon it, to

detect anything else than a slight remission of the disease, which,

however, declines by degrees into a perfect intermission, with its

type (third-day or fourth-day) corresponding fitly to the season of

the year.”

The intermittent character of these fevers seems to have struck Sydenham

himself in a later work as forced and unreal. Writing in 1680, when the

same kind of fevers were prevalent, after the epidemic agues of 1678 and

1679, he calls them “depuratory,” and says that “doubtless those

depuratory fevers which reigned in 1661-64 were as if the dregs of the

intermittents which raged sometime before during a series of years,” i.e.

the agues of 1657-59[18].

Theory or names apart, Sydenham’s account of the fatal epidemic fever of

the summer and autumn of 1661, comes to nearly the same as Willis’s.

Without saying expressly, as Willis does, that the victims were mostly

children or young people, he speaks in one place of those of more mature

years lying much longer in the fever, even to three months, and he

specially mentions the same sequelae of the fever in children that Willis

mentions, and that Roger North remembered in his own case--namely that

they sometimes became hectic, with bellies distended and hard, and often

acquired a cough and other consumptive symptoms, “which clearly put one in

mind of rickets.” He refers also to pain and swelling of the tonsils and

to difficulty of swallowing, which, if followed by hoarseness, hollow

eyes, and the _facies Hippocratica_, portended speedy death. Among the

numerous other _accidentia_ of the fever, was a certain kind of mania.

Among the symptoms were phrensy, and coma-vigil; diarrhœa occurred in some

owing, as he thought, to the omission of an emetic at the outset; hiccup

and bleeding at the nose were occasional.

But, although Sydenham must have had the same phenomena of fever before

him that Willis had, the epidemic being general, according to the

statements of both, one would hardly guess from his way of presenting the

facts, that the fever was what Willis took it to be--a slow nervous fever,

with convulsive and ataxic symptoms, specially affecting children and the

young. Both Willis and Sydenham recognised something new in it; the common

people called it, once more, the “new disease,” and Pepys calls it a “sort

of fever,” and “strange and fatal fevers.”

As Sydenham maintains that the same epidemic constitution continued until

1664 (although the fever-deaths in London are much fewer in 1662-3-4 than

in the year 1661, which was the first of it), we may take in the same

connexion Pepys’s account of the Queen’s attack of fever in 1663. The

young princess Katharine of Portugal, married to Charles II. in 1662, had

the beginning of a fever at Whitehall about the middle of October, 1663;

Pepys enters on the 19th that her pulse beat twenty to eleven of the

king’s, that her head was shaved, and pigeons put to her feet, that

extreme unction was given her (the priests so long about it that the

doctors were angry). On the 20th he hears that the queen’s sickness is a

spotted fever, that she was as full of the spots as a leopard: “which is

very strange that it should be no more known, but perhaps it is not so.”

On the 22nd the queen is worse, 23rd she slept, 24th she is in a good way

to recovery, Sir Francis Prujean’s cordial having given her rest; on the

26th “the delirium in her head continues still; she talks idle, not by

fits, but always, which in some lasts a week after so high a fever, in

some more, and in some for ever.” On the 27th she still raves and talks,

especially about her imagined children; on the 30th she continues

“light-headed, but in hopes to recover.” On 7th December, she is pretty

well, and goes out of her chamber to her little chapel in the house; on

the 31st “the queen after a long and sore sickness is become well again.”

Typhus fever perennial in London.

Sydenham says that a continued fever, the symptoms of which so far as he

gives them suggest typhus, was mixed with the masked intermittent, (or the

convulsive fever of children, as in Willis’s account), in every one of the

years 1661-4; and that statement raises a question which may be dealt with

here once for all. Fever in the London bills is a steady item from year to

year, seldom falling below a thousand deaths and in the year 1741, during

a general epidemic of typhus, rising to 7500. The fevers were a composite

group, as we have seen, and shall see more clearly. But the bulk of them

perennially appears to have been typhus fever. Where the name of “spotted

fever” is given there can be little doubt. Every year the bills have a

small number of deaths from “spotted fever,” and the number of them

always rises in the weekly bills in proportion to the increase of “fever”

in general, sometimes reaching twenty in the week when the other fevers

reach a hundred. It would be a mistake to suppose that only the fevers

called spotted were typhus, the other and larger part being something

else. The more reasonable supposition is that the name of spotted was

given by the searchers in cases where the spots, or vibices or petechiae

of typhus were especially notable. If a score, or a dozen or half-a-dozen

deaths in a week are set down to spotted fever, it probably means that a

large part of the remaining hundred, or seventy, or fifty cases of “fever”

not called spotted were really of the same kind, namely typhus. In the

plague itself, the “tokens,” which were of the same haemorrhagic nature as

the larger or more defined spots of typhus, were exceedingly variable[19].

One of the synonyms of typhus (the common name in Germany) is spotted

typhus; but the spots were of at least two kinds, a dusky mottling of the

skin and more definite spots, sometimes large, sometimes like fleabites.

Assuming that the cases specially called “spotted” in the London Bills

were only a part of all that might have been called by the same name in

the wider acceptation of the term (as in Germany), it is a significant

fact that there are few of the weekly bills for a long series of years in

the 17th and 18th centuries without some of the former. Such a case as

that of Mr Samuel Crewe, brother of Lord Crewe, who died of the “spotted

fever” on 2 July, 1661, probably means that there were more cases of the

same kind in the poorer parts of the town, from which no account of the

reigning sicknesses ever came unless it were the number of deaths in the

bills. The conditions of endemic typhus were there long before we have

authentic accounts, towards the end of the 18th century, of that disease

being ever present in the homes of the lower classes. In the time of

Sydenham, and even in the time of Huxham two generations after, there was

no thought of the unwholesome domestic life graphically described by

Willan and others, as a cause of typhus--the overcrowding, the want of

ventilation, the foul bedding and the excremental effluvia.

If there had been any reason to suppose that the London of the

Restoration, or of the time of Queen Anne, or of the first Georges had

enjoyed better public health in its crowded liberties and out-parishes

than we know it to have done from the time when the authentic accounts of

Lettsom and other dispensary physicians begin, then one might err in

assuming the perennial existence of typhus fever and in assigning to that

cause the bulk of the deaths under the heading of “fevers” in the Parish

Clerks’ bills. But the public health was undoubtedly worse in the earlier

period. A writer as late as the year 1819, who is calling for that reform

of the dwellings of the working classes in London which was soon after

carried out, namely the construction of regular streets instead of mazes

of courts and alleys, speaks of the “silent mortality” that went on in the

latter[20]. It was still more silent in earlier times, when the west end

of London knew nothing of what was passing in the east end[21].

In all matters of public health, after the somewhat romantic interest in

plague had ceased, the poorer parts of London were for long an unexplored

territory. Dr John Hunter, who had been an army physician and was

afterwards in practice in Mayfair, began about the year 1780 to visit the

homes of the poor in St Giles’s or other parishes near him, and was

surprised to find in them a fever not unlike the hospital typhus of his

military experience. I quote at this stage only a sentence or two[22].

“It may be observed, that though the fever in the confined habitations

of the poor does not rise to the same degree of violence as in jails

and hospitals, yet the destruction of the human species occasioned by

it must be much greater, from its being so widely spread among a class

of people whose number bears a large proportion to that of the whole

inhabitants. There are but few of the sick, so far as I have been able

to learn, that find their way into the great hospitals in London.” I

shall defer the subject of the dwellings of the working class in

London until a later stage.

The “constitution” in Sydenham’s series which succeeded the febrile one of

1661-64 was “pestilential fever.” It began in the end of 1664, lasted into

the spring of 1665, and passed by an easy transition into the plague

proper. The bills for those months have very large weekly totals of deaths

from “fever,” as well as a good many deaths from “spotted fever,” before

they begin to have more than an occasional death from plague. It is this

particular form of typhus fever that Bateman had in mind when he wrote, in

1818, “We never see the pestilential fever of Sydenham and Huxham”;

although Willan, who preceded him at the Carey Street dispensary,

described in 1799 a fever of so fatal a type that it gave rise to the

rumour that the plague was back in London. The term “pestilential” was

technically applied to a kind of fever a degree worse than the

“malignant.”

Willis, the earliest of the Restoration authorities on fevers, had three

names in an ascending scale of severity--putrid, malignant and

pestilential. The putrid fevers were what we might call idiopathic,

engendered within the body in some way personal to the individual from

“putrefaction” or fermentation of the humours; all the intermittents were

included in that class, and the theory of their cure by bark was that the

drug corrected putridity. In the malignant and pestilential, an altogether

new element came in--the τὸ θεῖον of Hippocrates, the mysterious something

which we call infection; and of these two infectious fevers, the malignant

was milder than the pestilential[23].

Morton drew out the scale of fevers in an elaborate classification, of

which only the last section of continued contagious fevers concerns us at

present[24]:

{ {Fever mostly with sweats and

{Simple Malignant Fever {other signs of malignity, but

{ {without buboes, carbuncles,

{ {petechiae or miliary rash.

Synochus {

{ {Fever with petechiae, purple

{Pestilential Fever {spots, miliaria, morbillous rash

{ {on the chest.

{

{Plague {With buboes, carbuncles and

{ {black spots.

The order in this Table was also the order in time: the fever of 1661,

which Willis calls malignant, remained as the constitution of the years

following until the end of 1664; then began the pestilential, which passed

definitely in the spring of 1665 into the plague proper. Willis, Sydenham

and Morton, differing as they did on many points of theory and treatment,

all alike taught the scale of malignity in fevers and plague, and all used

the language of “constitutions.” The Great Plague of 1665 was, in their

view, the climax of a succession of febrile constitutions of the air,

being attended by much pestilential fever and followed by a fever which

Morton places in the milder class of συνεχής.

The epidemic Constitutions following the Great Plague.

During the ten or twelve years following the Great Plague of London, the

epidemic maladies which Sydenham dwelt most upon as the reigning types

will appear on close scrutiny to have been on the whole proper to the

earlier years of life. This cannot be shown in the simple way of figures;

for the ages at death from the several maladies, although they were in the

books of the Parish Clerks, were not published.

There was some continued fever every year, which we may take to have been

chiefly the endemic typhus of a great city, and there were also deaths

among adults due to those reigning epidemics which fell most on the young.

In 1667 and 1668 the leading epidemic was smallpox, with a continued fever

towards the end of the period which Sydenham called “variolous,” for no

other reason, apparently, than that it was part of a variolous

constitution. In the autumn of 1669, and in the three years following, the

epidemic mortality was peculiarly infantile, in the form of diarrhoea or

“griping in the guts,” with some dysentery of adults, and some measles in

1670. From 1673 to 1676, the constitution was a comatose fever, which

chiefly affected children, with a sharp epidemic of measles in the first

half of 1674, attended by a very high mortality from all causes, and a

severe smallpox in the second half of 1674, attended by a much lower

mortality from all causes. There was also an influenza for a few weeks in

1675. In 1678 the “intermittent” constitution returned, having been absent

for thirteen years, and continued through 1779-80, until its “strength was

broken.” In 1681 smallpox was unusually mortal, the deaths being more than

in any previous year. Most of these constitutions fall to be dealt with

fully in other chapters: but as we are here specially concerned with the

succession to the plague, it is to be noted how largely the epidemic

mortality in London fell upon the age of childhood for a number of years

after the Great Plague of 1665. It was observed both by English and

foreign writers that the next epidemic following the Black Death of

1348-49, namely, that of 1361 in England and of 1359-60 in some other

parts of Europe, fell mostly upon children and upon the upper classes of

adults. There is doubtless some particular application of the population

principle in the earlier instance as in the later, but not the same

application in both. The conditions at the beginning of the three hundred

years’ reign of plague in Britain were different from those at the end of

it. The increased prevalence of smallpox in the generation before the last

great outburst of plague, and the infantile or puerile character of the

epidemic fever of 1661, as described by Willis, show that the incidence of

infectious mortality had already begun to shift towards the age of

childhood. It looks as if the conditions of population, intricate and

obscure as they must be confessed to be, were somehow determining what the

reigning infectious maladies, with their special age-incidence, should be.

Such a gradual change is the more probable for the reason that infectious

mortality came in due time to be mostly an affair of childhood. The

plague, which was the great infection of the later medieval and earlier

modern period, was peculiarly fatal to adult lives; on the other hand, the

mortality from infectious diseases in our own time falls in much the

larger ratio upon infants and children. It looks as if this change, now so

obvious, had begun before the end of plague in Britain, having become more

marked in the generation following its extinction. The direct successor of

plague, so far as concerns age-incidence and nosological affinity, was the

pestilential or malignant typhus, which came into great prominence in

1685-86, in circumstances that seemed to contemporaries to forebode a

return of the plague. But before we come to that, there remains a little

to be said of some other fevers, especially of the comatose fever of

1673-76, which was largely an affair of childhood.

Pepys says that he went on 3 May, 1668, to Old Street (St Luke’s) to see

Admiral Sir Thomas Teddiman, “who is very ill in bed of a fever,” and, in

a later entry, that he “did die by a thrush in his mouth” on the 12th of

May. Next year, 1669, Pepys and his wife went on tour through several

parts of Europe, and had hardly returned to their house in Seething Lane

when the lady fell ill of a fever; on 2nd November, it was “so severe as

to render her recovery desperate,” and on 10th November she died, in her

29th year,--a surprising sequel, as her husband felt, to a “voyage so full

of health and content.” These two years, for which we have a sample of the

London fevers, were marked in the Netherlands by epidemics of fevers which

are among the most extraordinary in the whole history. At Leyden in 1669

the fever reached such a height as to cut off 7000--a mortality which

would not have been surprising if the disease had been plague; but it was

not plague, it wanted the buboes, carbuncles &c., was longer in its

course, and, strangest of all, affected the upper classes far more

severely than the poor, so much so “that of seventy men administering the

public affairs, scarcely two were left[25],” while, according to Fanois,

who was the Leyden poor’s doctor, the lower classes, “protected as it were

by having survived the simpler forms of fever,” suffered from this

malignant epidemic far less than the rich[26]. The mortality is said to

have risen as high as three-fourths of the attacks. At Haarlem the burials

in a week rose to three or four hundred (which was a fair week’s average

for London itself in an ordinary season), the epidemic lasting four months

and leaving hardly one family untouched. Among the symptoms were extreme

praecordial anxiety, weight at the pit of the stomach, constant nausea and

loathing, vomiting, in part bilious but chiefly “pituitous,” thirst and

restless tossing. It was attended by an affection of the throat and

mouth--an angina with aphthae or thrush of the palate. The pools and other

sources of water for domestic use were unusually stagnant that summer in

Holland, and were commonly blamed for the epidemic; but Fanois points out

that at Haarlem and Emden, where similar fevers raged, “salubriores non

desunt aquae[27].”

After such an instance as the Leyden fever of 1669, nothing is incredible

in the records of fever subsequent to the extinction of plague. Turning to

Sydenham’s account of the continued fever which occurred in London during

the same season, the latter half of 1669, as well as in the three years

following, we find that it was characterized rarely by diarrhoea or

sweats, commonly by pain in the head, by a moist white tongue which

afterwards became covered by a dense skin, and by a greater tendency than

Sydenham had ever seen to aphthae (the “thrush in the mouth” of Admiral

Teddiman in 1668) when death threatened--the same being a “deposition from

the blood of foul and acrid matter upon the mouth and throat.” But London

in 1668 and 1669 suffered little from fevers in comparison to Leyden,

Haarlem and other Dutch towns, its high mortality in the summer and autumn

of 1669 being from infantile diarrhoea, cholera nostras and dysentery.

Sydenham’s continued fever from 1673 to 1676 (he was absent from his

practice in 1677 owing to ill health) was a malady which affected adults

as well as children, but, it would appear, the latter especially. The only

characteristic case given is of a boy of nine who did not begin to mend

until the thirtieth day. Many recovered in a fortnight, while others were

not clear of the fever in a month. On account of the remarkable stupor

which almost always attended it, Sydenham called the fever of this

constitution a comatose fever. It began with sharp pains in the head and

back, pains in the limbs, heats and chills, etc. His account of the

comatose state is exactly like that given by Willis for the fever of

children in 1661--profound stupor, sometimes for a week long, so profound

in some as to pass into absolute aphonia (the “acute fever with dumbness”

of later writers), while others would talk a few words in their sleep, or

would seem to be angry or perturbed by something (the chimaeras mentioned

by Willis) and would then become tranquil again; when roused to take

physic or to drink they would open the eyes for a moment and then fall

back into stupor. When they began to mend, they would crave for absurd

things to eat or drink. During convalescence the head, through weakness,

could not be kept straight but would incline first to one side and then to

the other[28].

The years 1678-1680 witnessed remarkable epidemics of ague, such as had

occurred on several occasions before, the last in the years 1657-59. They

engross so much of Sydenham’s writing, especially in connexion with the

Peruvian-bark controversy, that we hear little of any other fever until

the great epidemic of continued fever, or typhus, in 1685-6. But he does

mention briefly that the interval between the decline of the agues in 1680

and the beginning of the “new fever” of 1685, was occupied by “continued

depuratory” fevers--depuratory of the dregs of the preceding intermittent

constitution, and comparable in that respect to the fevers of 1661-64

which followed the agues of 1657-59[29].

Sydenham’s term “depuratory” does not help us much; but we learn something

from Morton as to what fevers were prevalent, besides the epidemical

intermittents, in the years preceding the epidemic of 1685-86. Morton

classes them as continued συνεχής (_Synocha_), by which he means something

less malignant than _Synochus_. A fever which began in the milder form

would often degenerate into the more malignant, the cause assigned, in the

usual recriminatory manner of the time between rival schools, being

mistaken treatment. But sometimes the fever was malignant from the outset,

with purple spots, petechiae, morbillous efflorescence, watery vesicles on

the neck and breast, buboes, and anthraceous boils. All these fevers, says

Morton, whether they were spurious forms of synocha, or malignant from the

outset, were sporadic, “neque contagione, ut in pestilentiali

constitutione, sese propagabant[30].” This points to their having been

part of that strange aguish epidemic of which an account is given in

another chapter. In Short’s abstracts of parish registers, the year 1680

seems to have been the most unhealthy of the series in country parishes,

and that is borne out by one Lamport, or Lampard, an empiric who practised

in Hampshire: “I will tell you somewhat concerning a malignant fever. In

the year ’80 or ’81 there were great numbers of people died of such

fevers, many whereby were taken with vomitings, etc., yet I had the good

fortune to cure eighteen in the parish of Aldingbourn, not one dying, in

that great compass, of that disease[31].” The moral is that the empiric

recovered his cases, whereas the regular faculty lost theirs; which means

that the fevers were of various degrees, some aguish, some typhus, as in

the exactly similar circumstances a century after, 1780-85.

In the London Bills from 1681 to 1684, the deaths from fever were many,

with some from “spotted fever” nearly every week, while the annual

mortalities from all causes were high. It is the more remarkable,

therefore, that Sydenham should have discovered, in the beginning of 1685,

the outbreak of a new fever, different from any that had prevailed for

seven years before. The explanation seems to be that a malignant typhus

fever, such as might have been discovered in any year in the crowded

parishes where the working classes lived, broke out at the Court end of

the town, where Sydenham’s practice lay.

The epidemic fever of 1685-86.

A letter of 12 March, 1685, says: “Sir R. Mason died this morning in his

lodging at Whitehall. A fever rages that proves very mortal, and gives

great apprehensions of a plague[32].” Sydenham also was reminded of the

circumstances preceding the Great Plague of London in 1665. In his first

account of the epidemic of fever in 1685[33], which began with a thaw in

February, he points out that the thaw in March, 1665, had been followed by

pestilential fever and thereafter by the plague proper. In a later

reference, when the epidemic of fever was in its second year (1686) he

says: “How long it may last I shall not guess; nor do I quite know whether

it may not be a certain more spirituous, subtle beginning, and as if

_primordium_, of the former depuratory fever (1661-64) which was followed

by the most terrible plague. There are some phenomena which so far incline

me to that belief[34].” However, no plague followed the malignant, if not

pestilential, fever of 1685-86. The reign of plague, as the event showed,

was over; the fever which had been on former occasions its portent and

satellite, came into the place of reigning disease. It is true that

Sydenham does not identify the fever of 1685-86 by name as pestilential

fever; on the contrary, he entitles his essay “De Novae Febris Ingressu.”

But the novelty of type was partly in contrast to the fevers immediately

preceding, which admitted treatment by bark, and its principal difference

from the pestilential fever of former occasions seems to have been that it

was not followed by plague[35]. Its antecedents and circumstances were

very much those of plague itself. Its mortality was greatest in the old

plague-seasons of summer and autumn, it had slight relation to famine or

scarcity, or to other obvious cause of domestic typhus. Sydenham can find

no explanation of the new constitution but “some secret and recondite

change in the bowels of the earth pervading the whole atmosphere, or some

influence of the celestial bodies.” He enlarges, however, on the character

of the seasons preceding, which would have affected the surface, if not

the bowels, of the earth, and the levels of the ground-water.

The winter of 1683-84 was one of intense frost; an ice-carnival was held

on the Thames during the whole of January. The long dry frost of winter

was followed by an excessively hot and dry summer, the drought being such

as Evelyn did not remember, and as “no man in England had known.” For

eight or nine months there had not been above one or two considerable

showers, which came in storms. The winter of 1684-85 set in early, and

became “a long and cruel frost,” more interrupted, however, than that of

the year before. The spring was again dry, and it was not until the end of

May 1685 that “we had plentiful rain after two years’ excessive drought

and severe winters[36].”

The two years of excessive drought, with severe winters, had their effect

upon the public health, as will appear from Short’s abstracts of parish

registers in town and country[37]; the years 1683-85 being conspicuous for

the excess of burials over baptisms:

_Country Parishes._

Year Registers Registers with Deaths in Births in

examined excess of death them them

1683 140 37 923 685

1684 140 31 900 629

1685 140 19 574 478

1686 140 16 419 301

1687 143 19 522 427

1688 143 11 327 267

_Towns._

1683 25 8 1398 1169

1684 25 8 1243 865

1685 25 4 1191 741

1686 25 2 555 418

1687 25 1 313 269

1688 25 2 191 146

There is no clue to the forms of sickness that caused the excessive

mortality in country parishes and provincial towns. But in London it

appears from the Bills that the one great cause of the unusual excess of

deaths in 1684 was an enormous mortality from infantile diarrhoea, from

the end of July to the middle of September, during the weather which

Evelyn describes as excessively hot and dry with occasional storms of

rain.

It was in the second year of the long drought, February, 1685, that

Sydenham dated the beginning of his new febrile constitutions. The

mortality of 1685 was just twenty deaths more than in 1684 (23,222); but

fever (with spotted fever) and smallpox had each a thousand more out of

the total than in the year before. Sydenham says that the fever did not

spare children, which might be alleged of typhus at all times; but a fever

of the kind, even if it ran through the children of a household, seldom

cut off the very young, the mortality being in greatest part of adults and

adolescents. Excepting smallpox for the year 1685, infantile and

children’s maladies were not prominent during the constitution of the “new

fever;” the usual items of high infantile mortality, such as convulsions

and “griping in the guts” or infantile diarrhoea, were moderate and even

low. Hence, although the weekly fever-deaths in the following Table may

not appear sufficient for the professional and other interest that they

excited, it is to be kept in mind that they had been mostly of adult

lives. It is probable also that a good many of them had been among the

well-to-do, and perhaps at first in the West End; for there is nothing in

the height of the weekly bills for all London to bear out the remark of

the letter of 12 March, already quoted, “A fever rages that proves very

mortal and gives apprehensions of a plague.”

_Weekly Mortalities in London._

1685.

Week Of spotted Of Of griping

ending Dead Of fever fever smallpox in the guts

March 3 376 49 0 11 35

10 458 73 2 30 31

17 367 53 1 25 17

24 441 63 3 33 27

31 366 53 5 24 36

April 7 421 47 10 28 30

14 433 64 8 32 27

21 473 66 6 47 45

28 470 68 3 49 45

May 5 385 50 6 35 39

12 447 75 3 59 41

19 437 79 4 58 43

26 452 61 2 74 39

June 2 469 65 8 65 36

9 521 88 14 62 41

16 499 91 9 66 34

23 478 76 12 71 53

30 526 82 13 84 45

July 7 497 81 8 87 53

14 478 82 11 78 51

21 464 79 11 87 47

28 488 62 6 68 54

Aug. 4 493 82 5 86 51

11 529 109 13 89 47

18 580 74 13 99 71

25 536 91 7 67 85

Sept. 1 556 94 13 53 104

8 539 82 10 81 77

15 485 90 7 63 70

22 459 90 10 37 51

29 502 114 3 58 53

Oct. 6 444 108 11 40 54

13 445 89 13 61 38

20 369 86 5 40 28

27 379 73 7 29 45

Nov. 3 443 96 8 55 43

10 410 84 7 26 35

17 432 103 8 35 39

24 471 107 6 56 31

Dec. 1 384 87 4 36 24

8 452 98 8 49 24

15 403 69 3 29 47

22 438 99 2 34 27

29 432 80 9 28 28

_Weekly Mortalities in London._

1686.

Week Of spotted Of Of griping

ending Dead Of fever fever smallpox in the guts

Jan. 5 394 80 5 28 29

12 400 80 3 27 48

19 396 67 5 36 32

26 366 76 2 21 30

Feb. 2 452 87 8 16 30

9 416 78 5 37 30

16 405 94 9 20 25

23 419 74 7 16 40

March 2 417 84 1 20 37

9 455 95 6 18 30

16 415 71 10 31 21

23 453 78 11 22 46

30 372 58 8 17 35

April 6 392 80 11 13 27

13 393 72 7 21 29

20 420 61 10 26 37

27 471 99 9 27 22

May 4 429 78 21 28 46

11 374 71 6 16 22

18 395 69 5 17 3 (sic)

25 395 66 11 24 36

June 1 383 63 4 15 49

8 404 66 6 26 38

15 523 88 9 43 64

22 503 99 9 25 73

29 473 90 10 31 62

July 6 430 71 6 18 62

13 401 76 2 19 56

20 464 87 14 24 74

27 508 99 3 23 76

Aug. 3 506 86 9 14 90

10 493 74 7 14 104

17 522 99 7 26 101

24 536 115 5 18 104

31 520 90 8 22 93

Sept. 7 531 94 4 21 104

14 498 84 6 18 110

21 540 100 3 17 101

28 443 90 5 13 67

Oct. 5 425 81 4 13 60

12 432 96 2 9 56

19 391 73 1 9 33

26 402 79 3 11 43

Nov. 2 373 64 1 23 39

9 456 85 1 19 31

16 401 73 2 9 23

23 359 61 4 10 54

30 397 68 1 7 34

Dec. 7 359 76 0 9 21

14 438 60 0 8 46

21 354 49 1 8 39

28 356 53 2 9 32

Sydenham says that he regarded the new fever at first as nothing more than

the “bastard peripneumony” which he had described for previous seasons;

but he had soon cause to see that it wanted the violent cough, the racking

pain in the head during coughing, the giddiness caused by the slightest

movement, and the excessive dyspnoea of the latter (Huxham likewise

distinguished typhus from “bastard peripneumony”). The early symptoms of

the “new fever” were alternating chills and flushings, pain in the head

and limbs, a cough, which might go off soon, with pain in the neck and

throat. The fever was a continued one, with exacerbation towards evening;

it was apt to change into a phrensy, with tranquil or muttering delirium;

petechiae and livid blotches were brought out in some cases (Sydenham

thought they were caused by cordials and a heating regimen), and there

were occasional eruptions of miliary vesicles. The tongue might be moist

and white at the edges for a time, latterly brown and dry. Clammy sweats

were apt to break out, especially from the head. If the brain became the

organ most touched, the fever-heat declined, the pulse became irregular,

and jerking of the limbs came on before death.

Later writers, for example those who described the great epidemic fever of

1741, have identified the fever of 1685-86 with the contagious malignant

fever afterwards called typhus, and Murchison, in his brief retrospect of

typhus in Britain, has included it under that name. Sydenham mentions

petechiae and livid blotches in some cases, and the Bills give a good many

of the deaths in the worst weeks of the epidemic under the head of

“spotted fever.” It is not at first easy to understand why Sydenham should

have written an essay specially upon it, in September, 1686, to claim it

as a new fever[38] and not rather as the old pestilential

fever--“populares meos admonens de subingressu novae cujusdam

Constitutionis, a qua pendet Febris nova species, a nuper grassantibus

multum abludens.” It should be kept in mind that his motive was correct

treatment, and that the fashionable treatment of the day by Peruvian bark

was, in his judgment, unsuited to this fever, however much it may have

suited the epidemical intermittents of 1678-79 and the “depuratory” dregs

of them for several years after. Physicians, he says, had learned to drive

off by bark the fevers of the former constitution, from 1677 to the

beginning of 1685, even when the fever intermitted little and sometimes

when it intermitted not at all; and they saw an indication for bark in the

nocturnal exacerbations of the new fever. Sydenham found that even large

doses of bark did not free the patient from fever, and that restoration to

health under treatment with the bark was due “magis fortunato alicui morbi

eventu quam corticis viribus.” He seeks to establish the indications for

another treatment by setting forth the symptoms minutely; and as the

question of bark in fevers was the great medical question of the time,

this may well have been Sydenham’s motive for discovering in the epidemic

of 1685-6 a “new fever” although he does not say so in as many words. We

have a good instance of how the bark-craze was at this time influencing

the very highest circles of practice in the case of Lord Keeper Guildford,

in July, 1685, as related in another chapter.

It will be seen from the table of weekly deaths that the second of the two

hard winters was over before the fever began to attract notice. Sydenham

compares its beginning after the thaw in February, 1685, to the beginning

of the plague when the frost broke in March, 1665.

If it had been merely the typhus of a hard winter, of overcrowding

indoors, of work and wages stopped by the frost, and of want of fuel

(which things Evelyn mentions as matters of fact), it would have come

sooner than the spring of 1685. The Bills for years before have regularly

a good many deaths from fever, and always some from spotted fever; but

these may have come from parishes wholly beyond the range of Sydenham’s

practice. The fever began definitely for him in February, 1685, and was at

its worst in the old plague-seasons of summer and autumn. If the seasons

had any relation at all to it, the epidemic was a late effect of the long

drought, an effect which was manifested most when the rain came, in the

summer of 1685 and throughout the mild winter and normal summer of

1685-86. It must have been for that reason that Sydenham traced the source

of it to “some secret and recondite change in the bowels of the earth,”

rather than to a change in the sensible qualities of the air. One must

ever bear in mind that the physicians of the Restoration gave no thought

to insanitary conditions of living; in that respect the later Stuart

period seems to have been behind the Elizabethan or even the medieval; we

cannot err in assuming, behind all Sydenham’s speculative causes, a great

deal of unwholesomeness indoors. Sydenham’s fullest reference to the

subterranean sources of poisonous miasmata occurs in his tractate on Gout:

“Whether it be that the bowels of the earth, if one may so speak,

undergo various changes, so that by the accession of vapours exhaled

therefrom the air is disturbed, or that the whole atmosphere is

infected by a change which some peculiar conjunction of certain of the

heavenly bodies induces in it;--the matter so falls out that at this

or that time the air is furnished with particles that are adverse to

the economy of the human body, just as at another time it is

impregnated with particles of a like kind that agree ill with the

bodies of some species of brute animals. At these times, as often as

by inspiration we draw into the naked blood miasmata of this kind,

noxious and inimical to nature, and we fall into those epidemical

diseases which they are apt to produce, Nature raises a fever,--her

accustomed means of vindicating the blood from some hostile matter.

And such diseases are commonly called _epidemical_; and they are short

and sharp because they have thus a quick and violent movement[39].”

It was Sydenham’s intimate friend Robert Boyle who worked out the

hypothesis of subterraneous miasmata as a cause of epidemic (and endemic)

diseases. An account of his theory will be found in the chapter on

Influenzas and Epidemic Agues. It may be said here that it needs only a

few changes, especially the substitution of organic for inorganic matters

in the soil, to bring it into line with the modern doctrine of miasmatic

infective disease as expounded by the Munich school.

It has not been usual to think of spotted fever, (or of influenzas), in

that connexion; but a telluric source of the epidemic constitution of

1685-86 was clearly Sydenham’s view; and as the fever came in

circumstances like those of the last great plague, and was thought at the

time to be the forerunner of another great plague, its connexion with

recondite decompositions in the soil, dependent on the phenomenal drought

of two whole years before, cannot be set aside as a possibility, the less

so that the fever, although of the type of typhus, was not a fever of

cold, hunger, and domestic distress, but mainly of the warm, or mild, or

soft weather following the long drought, and of many well-to-do-people, as

in the great Netherlands fever of 1669. My view of it is that it was the

modified successor of plague, the _pestis mitior_, which used to precede

and accompany the plague, now become the dominant constitution. The

authentic figures of its mortality come from London; but Sydenham says

that its “effects were felt far more in other places”; although Short’s

abstracts of parish registers, given above, do not indicate excessive

mortality throughout England.

Retrospect of the great Fever of 1623-25.

The most instructive instance of _pestis mitior_ in Britain is not the

pestilential fever which led up to the last plague (1665-6), but the great

epidemic of fever all over England and Scotland which reigned for two or

three years before the great outburst of plague in 1625. I go back to this

because it was not wholly or even mainly a famine fever (although it was

as general as one of the medieval famine-fevers), and because in that

respect it furnishes a close parallel to the fever of 1685-86, which I

regard as the successor of the plague. After this interlude in the

history, we shall proceed to consider the question of the final extinction

of plague.

In Scotland the fever of 1622-23 was directly connected with famine,

but in England it was not obviously so according to the records that

remain. The dearth in Scotland began as early as the autumn of 1621:

“Great skarsitie of cornes throw all the kingdome,” the harvest having

been spoiled by wet weather and unheard of river floods; however,

abundance of foreign victual came in, and the scarcity was got

over[40]. In England the same harvest of oats was abundant, and

probably yielded the “foreign victual” which relieved the Scots; but

the price of wheat rose greatly[41]. It was the year following, 1622,

that really brought famine and famine-sickness to Scotland, as the

second of two bad harvests had always done. On 21 July, 1622, a fast

was proclaimed at Aberdeen for “the present plague of dearth and

famine, and the continuance thereof threatened by tempests,

inundations and weets likely to rot the fruit on the ground[42].”

In an entry of the Chronicle of Perth, subsequent to July, 1622, it is

said: “In this yeir about the harvest and efter, thair wes suche ane

universall seikness in all the countrie as the ellyke hes not bene

hard of. But speciallie in this burgh, that no familie in all the

citie was frie of this visitation. Thair was also great mortalitie

amonge the poore.” From which it appears that the autumnal fever of

1622 was among all classes in Scotland. The famine in Scotland became

more acute in the spring and summer of 1623; the country swarmed with

beggars, and in July, says Calderwood, the famine increased daily

until “many, both in burgh and land, died of hunger.” At Perth ten or

twelve died every day from Midsummer to Michaelmas; the disease was

not the plague, but a fever[43]. At Dumfries 492 died during the first

ten months of 1623, perhaps a ninth part of the inhabitants, about one

hundred of the deaths being specially marked as of “poor[44].” The

“malignant spotted fever” which caused numerous deaths in 1623 in

Wigton, Penrith and Kendal is clearly part of the famine-fever of

Scotland extending to the Borders and crossing them. This is a

famine-fever of the old medieval type, like that of 1196 which,

according to William of Newburgh “crept about everywhere,” always the

same acute fever, putting an end to the miseries of the starving, but

attacking also those who had food.

The same spotted fever was all over England in 1623, but it did not,

as in Scotland, come in the wake of famine. It is true that the

English harvest of 1622 was a good deal spoiled; a letter of 25

September says[45]: “Though the latter part of this summer proved so

far seasonable, yet the harvest is scant, and corn at a great price by

reason of the mildews and blasting generally over the whole realm,”

rye being quoted a few weeks later at 7/- the bushel and wheat at

10/-, although the average of wheat for the year, in Rogers’s tables,

is not more than 51/1_d._ per quarter, while the average of next year

falls to 37/8_d._ These were not famine-prices in England, and there

is no evidence of general sickness directly after the harvest of 1622,

when corn was dearest. Also, although the autumn of 1623 was a time of

“continual wet” in England[46], the price of wheat remained moderate,

and even low as compared with the rather stiff price of the winter of

1622-23. But it was not until the summer and autumn of 1623 that the

spotted fever became epidemic in England. Short’s abstracts of the

registers of market towns show how sickly that year was:

Year. No. of No. with Buried Baptised

registers excess of in the in the

examined. burials. same. same.

1622 25 4 442 345

1623 25 16 2254 439 (sic)

1624 25 9 978 714

1625 25 9 666 563

In September, 1623, the corporation of Stamford made a collection “in

this dangerous time of visitation,” and sent £10 of it to Grantham,

the rest to go “to London or some other town, as occasion offered.” A

London letter of 6 December, 1623, from Chamberlain to Carleton

says[47]:--

“Here is a contagious spotted or purple fever that reigns much, which,

together with the smallpox, hath taken away many of good sort, as well

as meaner people.” He then gives the names of notables dead of it, and

adds: “Yet many escape, as the dean of St Paul’s [Dr Donne, who used

the occasion to compile a manual of devotion] is like to do, though he

were in great danger.” One of the Coke family writes early in January,

1624, from London[48]: “Having two sons at Cambridge, we sent for them

to keep Christmas with us, and not many days after their coming my

eldest son Joseph fell suddenly into the sickness of the time which

they call the spotted fever, and which after two days’ extremity took

away his life.” From another letter it appears that one of his

symptoms was “not being able to sleep,” the unmistakable vigil of

typhus. Although there is no word of the epidemic continuing in

Scotland in 1624, it was undoubtedly as prevalent in England in that

year as the year before, and prevalent in country houses as well as

in towns and cities. Thus, on 7 August, 1624, Chamberlain writes: “The

[king’s] progress is now so far off that we hear little thence, but

only that there be many sick of the spotted ague, which took away the

Duke of Lennox in a few days. He died at Kirby,” a country house in

Northamptonshire[49]. On 21 August he writes again: “This spotted

fever is cousin-german to it [the plague] at least, and makes as quick

riddance almost. The Lady Hatton hath two or three of her children

sick of it at her brother Fanshaw’s in Essex, and hath lost her

younger daughter, that was buried at Westminster on Wednesday night by

her father; a pretty gentlewoman, much lamented.” A letter of 4

September says there was excessive mortality in London, in great part

among children (doubtless from the usual infantile trouble of a hot

autumn, diarrhoea), while “most of the rest are carried away by this

spotted fever, which reigns almost everywhere, in the country as ill

as here.” Sir Theodore Mayerne, the king’s physician, confirms this,

under date 20 August, 1624: the purple fever, he says, was “not so

much contagious as common through a universal disposing cause,”

seizing upon many in the same house, and destroying numbers, being

most full of malignity[50]. It was clearly an inexplicable visitation.

The summer was hot and dry, from which character of the season, says

Chamberlain, “some have found out a far-fetched speculation, which yet

runs current, and would ascribe it [the spotted fever] to the

extraordinary quantity of cucumbers this year, which the gardeners, to

hasten and bring forward, used to water out of the next ditches, which

this dry time growing low, noisome and stinking, poisoned the fruit.

But,” adds Chamberlain, “that reason will reach no farther than this

[London] town, whereas the mortality is spread far and near, and takes

hold of whole households in many places.” He then gives the names of

several eminent persons dead of it, and speaks of others who were

“still in the balance[51].” On 9 October, “the town continues sickly

still,” and Parliament had been put off, “in consideration of the

danger,” from 2 November, 1624, to 15 February, 1625. On Ash

Wednesday, 1625, the Marquis of Hamilton died of the pestilent fever

at Moor Park, Rickmansworth. Thus far there had been no plague; and if

the spotted fever were cousin-german to the plague, as Chamberlain

said, it was remarkable in this that it prevailed in the mansions of

the rich in town and country and took off more victims among the upper

classes than the plague itself even in its most terrific outbursts.

However, a plague of the first rank followed in London and elsewhere

in the summer and autumn of 1625.

The cucumber-theory, above mentioned, shows how puzzled people must

have been to account for the spotted fever, or “spotted ague” as it

was also called, in 1624. Sir Theodore Mayerne did not think contagion

from person to person could explain it, but referred it to “some

universal disposing cause.” It is conceivable that the famine-fever of

1622 and 1623 in Scotland and the Marches may have spread by contagion

into England in the latter year; but in 1624 there is nothing said of

fever in Scotland or of scarcity as a primary cause in England.

Besides the famine-fever of Scotland in 1622-23, there was another

associated thing which should not be left out of account. Before the

famine and fever had begun in that country, the notorious Hungarian

fever was raging in the Palatinate, and continued to rage for four

years. “Hungarian fever” had become the dreaded name for war-typhus of

a peculiar malignity and diffusive power. It had been so often

engendered since the 16th century in campaigns upon Hungarian soil as

to have become known everywhere under the name of that country. Its

infection spread, also, everywhere through Europe; thus it is said to

have even reached England in 1566, and again in 1589, although it is

not easy to find English evidence of it for either year. It was this

type of fever which broke out in the Upper Palatinate, occupied by

troops of the Catholic powers, in 1620, and continued through the

years 1621, 1622 and 1623; as the title of one of the essays upon this

outbreak somewhat fantastically declares, it spread “ex castris ad

rastra, ex rastris ad rostra, ab his ad aras et focos[52].” Was the

epidemic constitution of “spotted ague” in England in 1623 and 1624

derived from the centre of famine-fever in Scotland, or from the

centre of camp-fever in the Palatinate? In the last years of James I.

communications were frequent with the latter country, and there was of

course much intercourse with Scotland.

The spotted fever or spotted ague of 1623-24, the plague of 1625, and the

country agues of the same autumn make really a more instructive series of

epidemic constitutions than any that fell under Sydenham’s observation, so

instructive, indeed, that it has seemed worth while to revert to it for

the sake of illustrating the doctrine of epidemics then in vogue. That

doctrine made little of contagion from person to person; yet the idea of

contagion was familiar, and had been so since medieval times. If we might

assume contagion to explain such cases as those that occurred in the

houses of squires and nobles, we might find a source of it either in the

famine-fever of Scotland or in the war-fever of the Palatinate. But the

teaching of the time was that it was in the air; and if the infective

principle had been generated either in Scotland or on the upper Rhine it

had diffused itself in some inscrutable way. The doctrine of epidemic

constitutions seems strange to us; but some of the facts that it was meant

to embrace are also strange to us. Were it not for an occasional reminder

from influenza, we should hardly believe that any fevers could have

travelled as the Hungarian fevers, the spotted fevers or “spotted agues”

of former times are said to have done.

On the other hand, we have now a scientific doctrine of the effects of

great fluctuations of the ground-water upon the production of telluric

miasmata, which may be used to rationalize the theory of emanations

adopted by Sydenham and Boyle. From this modern point of view the

remarkable droughts preceding the pestilential fevers and plagues of

1624-25 and 1665, and preceding the fever of 1685-86, which is the one

that immediately concerns us, may be not without significance.

The London fever of 1685-86 having been suspected at the time to be the

forerunner of a plague, as other such fevers in the earlier part of the

century had been, and no plague having ensued, the question arises most

naturally at this stage, why the plague should have never come back in

London or elsewhere in Britain after the great outbreak of 1665-66.

The extinction of Plague in Britain.

Plague had been the grand infective disease of Britain from the year of

the Black Death, 1348-9, for more than three centuries, down to 1666. The

last of plague in Scotland was in 1647-8, in the west and north-west of

England about 1650 (in Wales probably in 1636-8), in Ireland in 1650, and

in all other parts of the kingdom including London in 1666, the absolute

last of its provincial prevalence having been at Peterborough in the first

months of 1667[53], while two or three occasional deaths continued to

occur annually in London down to 1679. False reports of plague,

contradicted by public advertisement, were circulated for Bath in

1675[54], and for Newcastle in 1710[55]; while in London as late as 1799,

during a bad time of typhus fever, the occurrence of plague was

alleged[56].

It is not easy to say why the plague should have died out. It had been

continuous in England from 1348, at first in general epidemics, all over

the country in certain years, thereafter mostly in the towns, either in

great explosions at long intervals or at a moderate level for years

together. The final outburst in 1665, which was one of the most severe in

its whole history, had followed an unusually long period of freedom from

plague in London, and was followed, as it were, by a still longer period

of freedom until at last it could be said that the plague was extinct. In

some large towns it had been extinct, as the event showed, at a much

earlier date; thus at York the last known epidemic was in 1604, and it can

hardly be doubted that many other towns in England, Scotland and Ireland

would have closed their records of plague earlier than they did had not

the sieges and military occupations of the Civil Wars given especial

occasion for the seeds of the infection to spring into life. Plague seemed

to be dying out all over England and Scotland (in Ireland it is little

heard of except in connexion with the Elizabethan and Cromwellian

conquests) for some time before its final grand explosion in London in

1665.

In seeking for the causes of its decline and extinction we must keep

prominently in view the fact that the virus was brought into the country

from abroad as the Black Death of 1348-9. But for that importation it is

conceivable that there would have been no signal history of plague in

Britain. Its original prevalence was on a great scale, and there were

several other widespread epidemics throughout the rest of the 14th

century. In the first volume of this history I have collected evidence

that plague was endemic or steady for long periods of the 15th and 16th

centuries in London, with greater outbursts at intervals, and that in the

17th century it came chiefly in great explosions. Something must have

served to keep the virus in the country, and more especially in the towns,

until at length it was exhausted. An exotic infection, or one that had not

arisen from indigenous conditions, and would probably never have so

arisen, does not remain indefinitely in the country to which it is

imported. Thus Asiatic cholera, imported into Europe on six, or perhaps

five, occasions in the 19th century, has never become domesticated; and

yellow fever had a career in the southern provinces of Spain during some

twenty years only. Plague did become domesticated for about three

centuries in England, and for longer in some other countries of Europe;

but it died out at length, and it would almost certainly have died out

sooner had it not found in all European countries some conditions not

altogether unsuited to it. What were the favouring conditions?

If, as I believe, the virus of plague had its habitat in the soil, from

which it rose in emanations, and if it depended therein, both remotely for

its origin in some distant country, as well as immediately for its

continuance in all countries, upon the decomposition of human bodies, then

it is easy to understand that the immense mortalities caused by each

epidemic would preserve the seeds of the disease, or the crude matters of

the disease, in the soil. Buried plague-bodies would be the most obvious

sources of future plagues. But if the theory given of the Black Death be

correct, bodies dead of famine or famine-fever would also favour in an

especial way the continuance of the plague-virus in certain spots of

ground, although they would probably never have originated it in this

country. Moreover, the products of ordinary cadaveric decomposition would

be so much pabulum or nutriment for the continuance of the virus. But all

those things being constant, the continuance of plague would largely

depend upon the manner in which the dead, after plague, or after famine

and fever, or in general, were disposed of. The soil of all England in

1348-9 was filled with multitudes of the dead laid in trenches, and there

were several general revivals of plague in the fifty or sixty years

following. In London there were plague-pits opened in the suburbs in many

great epidemics during three centuries. Even when there was no epidemic

the dead were laid in the ground in such a manner that their resolution

was speedy, and the diffusion of the products unchecked. But it is

undoubted that greater care in the disposal of the dead did at length come

into vogue. Thus, in the Black Book of the Corporation of Tewkesbury there

is an entry under the year 1603, that all those dead of plague, “to avoid

the perill, were buried in coffins of bourde,” the disease having carried

off no fewer than 560 the year before (1602) and being then in its second

season.[57]. The reason given is “to avoid the peril,” and it is beyond

question that burial in a coffin did in fact delay decomposition (unless

in peculiar circumstances which need not be particularized), and kept the

cadaveric products from passing quickly and freely into the pores of the

ground. Again, if the burial were in such coffins as the Chinese commonly

use, the decomposition would proceed almost as slowly as if the body had

been embalmed, and with as little risk of befouling the soil. For a long

time in England such burials were the privilege only of the rich; but as

wealth increased by commerce they became the privilege of all classes; and

in the last great plague of London, as I said in my former volume, “even

at the worst time coffins would seem to have been got for most.” Defoe’s

account of the burials in heaps in plague-pits is so exactly like that of

Dekker for the plague of 1603, and of other contemporaries for the plague

of 1625, that one may reasonably suspect him to have used these earlier

accounts as his authority for the practice in 1665, which he had no

direct knowledge of. However, I do not contend that there were no such

burials in 1665; just as one learns from Dekker that the coffin-makers in

1603 were busily employed and grew rich, although he also describes how a

husband “saw his wife and his deadly enemy whom he hated” launched into

the pit “within a pair of sheets.” In ordinary times, as we learn from the

tables of burial-dues, there were poorer interments without coffins as

late as 1628, according to a document printed by Spelman, the name of the

parish being withheld, and even as late as 1672 in the parish of St

Giles’s, Cripplegate. Spelman’s object in writing in 1641 was to protest

against the mercenary practices of the clergy in the matter of burial,

recalling the numerous canons of the medieval Church directed against all

such forms of simony; and incidentally he mentions that it was testified

before the Commissioners that a certain parson “had made forty pound of

one grave in ten yeeres, by ten pounds at a time”[58]--a “tenancy of the

soil” short enough to satisfy even the so-called Church of England Burial

Reform Association. The use of coffins in the burial of the very poorest

is now so universal that we hardly realize how gradually it was

introduced. I am unable to say when burial in a sheet or cerecloth ceased;

but it became less and less the rule for the poorer classes throughout the

17th century. In 1666 was passed the Act for burial in woollen, which was

re-enacted more strictly in 1678[59]. The motive of it was to encourage

the native woollen manufactures, or to prevent the money of the country

from being expended on foreign-made linen; and its clauses ordained that

woollen should be substituted for linen in the lining of the coffin and in

the shrouding of the corpse, but that no penalty should be exacted for

burying in linen any that shall die of the plague. Whether it prohibited

in effect the use of linen cerecloths to enshroud corpses where no coffin

was used does not appear clearly from the terms of the Act; but, as the

intention was to discourage the use of linen, and to bring in the use of

woollen, for all purposes of burial, it is probable that it served to put

an end to coffinless burials altogether, wherever it was enforced,

inasmuch as the prescribed material was wholly unsuited for the purpose of

a cerecloth.

The history of the London plague-pit between Soho and the present Regent

Street shows that, after the last great plague of 1665-66, more caution

was used against infection from the buried plague-bodies. Macaulay says it

was popularly believed that the earth was deeply tainted with infection,

and could not be disturbed without imminent risk to human life; and he

asserts that no foundations were laid in the pest-field till two

generations had passed and till the spot had long been surrounded with

buildings, the space being left blank in maps of London as late as the end

of George I.’s reign[60].

After 1666 the old churchyards were not less crowded than before, but more

crowded, perhaps because coffined corpses occupied more space and decayed

more slowly. On 17 October, 1672, Evelyn paid a visit to Norwich: “I

observed that most of the churchyards (tho’ some of them large enough)

were filled up with earth, or rather the congestion of dead bodys one upon

another, for want of earth, even to the very top of the walls, and some

above the walls, so as the churches seemed to be built in pitts.” The same

day he had visited Sir Thomas Browne, the author of the famous essay on

urn burial or cremation, (suggested to him by the digging up of forty or

fifty funeral urns in a field at Old Walsingham). The essay is full of

curious learning and equally curious moralizing. But Sir Thomas, though a

physician, has not a word to say on so proximate a topic as the state of

the Norwich churchyards, which came under his eyes and perhaps under his

nose every day of his life[61].

The practice of burying in coffins, which came at length within the means

of all classes, may seem too paltry a cause to assign, even in part, for

so remarkable an effect as the absolute disappearance of plague after a

duration of more than three centuries. My view of the matter is that the

virus would have died out of itself had it not been continually augmented,

or fed by its appropriate pabulum, and that the gradual change in the mode

of interment helped to check such augmentation or feeding.

But the more elaborate interment of the dead was itself an index of the

greater spending power of the community, and it may be said that it was

the better condition of the people, and not this one particular thing in

it, which put an end to the periodical recurrences of plague. In all but

its earliest outbursts in the fourteenth, and perhaps the fifteenth

century, plague had been peculiarly an infection of the poor, being known

as “the poor’s plague.” Perhaps the chief reason why the richer classes

usually escaped it was that they fled from the plague-tainted place,

leaving the poorer classes unable to stir from their homes, exposed to the

infectious air, and all the more exposed that their habitual employments

and wages would cease, their sustenance become precarious, their condition

lowered, and their manners reckless. Again, it was not unusual for the

plague to break out in a season of famine or scarcity, during which the

ordinary risks of the labouring class would be aggravated. Famines ceased

(except in Ireland, where there had been comparatively little plague), and

scarcities became less common. The sieges and occupations of the Civil

Wars in the middle of the 17th century, which undoubtedly were the

occasion of the last outbursts of plague in many of the towns, were a

brief experience, followed by unbroken tranquillity. Whatever things were

tending to the removal of plague in all its old seats had free course

thereafter.

On the other hand, one may make too much of the increase of well-being

among the labouring class which coincided with the cessation of plague. As

a check upon population plague worked in a very remarkable way. In London,

as well as in towns like Newcastle and Chester, plague towards the end of

its reign arose perhaps once in a generation and made a clean sweep of a

fifth or a fourth part of the inhabitants, including hardly any of the

well-to-do. It destroyed, of course, many bread-winners and many that were

not absolutely sunk in poverty; but its broad effect was to cut off the

margin of poverty as if by a periodical process of pruning. The Lord Mayor

of London wrote to the Privy Council at the end of the great plague of

1625: “The great mortality, although it had taken many poor people away,

yet had made more poverty by decay of tradesmen”--a decay of trade which

they might reasonably expect to recover from before long. No such ruthless

shears was ever applied at intervals to the growing fringe of poverty in

after times. The poor were a more permanent residue, pressing more upon

each other; but they did not press more upon the rich, except through the

poor rate; on the contrary, the separation of classes became more marked.

Perhaps I ought to give an illustration of this, so as not to leave so

radical a change in the vague and disputable form of a generality. I shall

take the instance of Chester; its circuit of walls, remaining from the

Roman conquest, is something fixed for the imagination to rest upon amidst

changes within and without them.

Passing over its medieval and its not infrequent Tudor experiences of

epidemic sickness, let us come to the beginning of the 17th century.

In two or three successive seasons from 1602 to 1605 it lost 1,313

persons by plague, as well as about 250 from other causes. The

population was then mostly within the walls, and probably did not

exceed 5000. There was a shipping quarter on the west side, with

egress by the Water-gate to the landing-places on the Dee; a millers’

quarter, with corn-market and hostelries, on the south, connecting by

the South gate and bridge with a hamlet across the river along the

road to Wales; a Liberty or Freedom of the city outside the walls on

the east, along the road to Warrington and Manchester, with a Bar, a

short distance out, as in London, to mark the limit of the mayor’s

jurisdiction; and on the north side, within the walls, the

cattle-market and shambles, with the market for country produce, and a

few straggling houses without the gate on the road leading to

Liverpool. Chester was a characteristic county town, with its

cathedral clergy, its garrison, its resident nobility and gentry, its

professional classes, its tradesmen, market people and populace, with

the addition of a shipping trade to Ireland and afterwards to foreign

and colonial ports. Plague continuing from 1602 to 1605 cut off a

fourth or a fifth of its population, and these the poorest. The gaps

in the population would gradually have filled up, and the fringe of

poverty grown again[62].

The plague came again in 1647, and cut off 2053 in the short space of

twenty-three weeks from 22 June to 30 November. The bills of it are

extant[63], and show on what parishes the plague fell most. All the

parishes were originally within the walls but one, St John’s, the

ancient collegiate church of Mercia, built upon a rocky knoll in the

south-east angle made by the walls with the river. The other nine

parish churches and their graveyards were within the walls; but the

parishes of three of them extended beyond the gates, just as the three

parishes dedicated to St Botolph at the gates of London did. These

three were St Oswald’s, which included the Liberty on the east side,

Trinity, which included the shipping quarter on the west as well as

the houses along the Liverpool road on the north, and St Mary’s, which

included the millers’ suburb across the Dee on the south. Hollar’s

map, made a few years after the plague of 1647, shows very few houses

beyond the walls, except in the ancient Liberty on the east. But it

will appear from the following table that the parishes which had

extended beyond the walls must either have been very crowded close up

to the walls (as the Gate parishes were always apt to be), or there

must have actually been a greater population outside the gates than

the contemporary map shows:

_Burials from Plague in the several Parishes of Chester in 23 weeks,

June 22-Nov. 30, 1647._

_5 parishes wholly within the walls._

Total. First Worst (7th)

week. week.

St Peter 75 0 14

St Bridget 85 7 9

St Martin 173 9 23

St Michael 133 26 9

St Olave 59 3 5

_3 parishes extending beyond the walls._

St Oswald 396 11 37

St Mary 314 5 20

Trinity 232 1 32

_1 parish wholly without the walls._

St John 358 2 26

Pesthouse 228 0 34

---- -- ---

2053 64 209

This was the last plague of Chester, but for a small outbreak in 1654.

The next vital statistics that we get for the city are more than a

century after, in 1774[64]. The population of 14,713 was then divided

into two almost distinct parts, separated by the wall. The old city

was being rebuilt, all but some ancient blocks of buildings held in

the dead hand of the cathedral chapter; it was becoming a model 18th

century place of residence for a wealthy and refined class, who were

remarkably healthy and not very prolific, the parishes wholly within

the walls having 3502 inhabitants. The poorer class had gone to live

mostly outside the walls in new and mean suburbs, the three parishes

at the Gates and extending now far beyond the walls, together with the

original extramural parish of St John’s, having a population of

11,211. There was no town in Britain where the separation of the rich

from the poor was more complete; there was hardly another town of the

size where the health of the rich was better; and although the health

of the populace was not so bad as in the manufacturing towns of

Lancashire and Cumberland, close at hand, yet it is hardly possible to

find so great a contrast as that between the clean and wholesome

residential quarter within the walls and the mean fever-stricken

suburbs as described by Haygarth in 1774:

“The inhabitants of the suburbs,” he says, “are generally of the

lowest rank; they want most of the conveniences and comforts of life;

their houses are small, close, crowded and dirty; their diet affords

very bad nourishment, and their cloaths are seldom changed or

washed.... These miserable wretches, even when they go abroad, carry a

poisonous atmosphere round their bodies that is distinguished by a

noisome and offensive smell, which is peculiarly disgustful even to

the healthy and vigorous, exciting sickness and a sense of general

debility. It cannot therefore be wondered that diseases should be

produced where such poison is inspired with every breath.”

The case of Chester shows by broader contrasts than anywhere else the

change from the public health of plague-times to that of more modern

times. But it can hardly be said to show the populace better off than

before; it shows them changed into a proletariat, and separated from the

richer classes by walls several feet thick. Such, at least, was the result

after four generations of immunity from plague, a result which indicates,

as I have said, that we may easily make too much of the improved

well-being of the poorer classes as a cause of the cessation of plague.

An easy explanation of plague ceasing in London has long been current, and

just because it is an easy explanation it will probably hold the field for

many years to come. It is that the fire of 1666 burnt out the seeds of

plague. Defoe, writing in 1723, ascribed this opinion to certain “quacking

philosophers,” but he would hardly have said so if he could have foreseen

the respectable authority for it in after times. The plague had ceased in

most of its provincial centres after the Civil Wars, and in some of them,

such as York, from as early a date as 1604. It ceased in all the principal

cities of Western Europe within a few years of its cessation in London. In

London itself it ceased after 1666, not only in the City which was the

part burned down in September of that year, but in St Giles’s, where the

Great Plague began, in Cripplegate, Whitechapel and Stepney, where it was

always worst, in Southwark, Bermondsey and Newington, in Lambeth and

Westminster. Nor can it be said that the City was the source from which

the infection used to spread to the Liberties and out-parishes. All the

later plagues of London, perhaps even that of 1563, began in the Liberties

or out-parishes and at length invaded the City. The part of London that

was rebuilt after 1666 contained many finer dwelling-houses than before,

built of stone, with substantial carpentry, and elegantly finished in fine

and rare woods. The fronts of the new houses did not overhang so as to

obstruct the ventilation of the streets and lanes; but the streets, lanes,

alleys and courts were somewhat closely reproduced on the old foundations.

A side walk in some streets was secured for foot-passengers by means of

massive posts, which, with the projecting signs of houses and shops, were

at length removed in 1766. The improvements in the City after the fire

were mostly in the houses of the richer citizens. The City was the place

of residence of the rich, with perhaps as many poorer purlieus in close

proximity as the residential districts of London now have. But four-fifths

of London at the time of the fire were beyond the walls of the City. It is

in these extramural regions that the interest mostly lies for epidemical

diseases. They remain, says Defoe in 1723, “still in the same condition

they were in before.” Unfortunately we know little of their condition,

whether in the 17th century or in the 18th. But there must have been

something in it most unfavourable to health; for we find from the Bills of

Mortality that the cessation of plague made hardly any difference to the

annual average of deaths, the increase of population being allowed for.

This fact makes the disappearance of plague all the more remarkable.

Fevers to the end of the 17th century.

The epidemical seasons of 1685-86 were the last that Sydenham recorded; he

was shortly after laid aside from active work by gout, and died in 1689.

Morton, who made notes of fevers and smallpox until 1694, is more a

clinical observer than a student of “epidemic constitutions”; and although

his writings are of value to the epidemiologist, he does not help us to

understand the circumstances in which epidemic diseases prevailed more at

one time than another. To the end of the century there is no other medical

source of information, and little besides generalities to be collected

from any source. It is known that the years from 1693 to 1699 were years

of scarcity all over the kingdom, that the fever-deaths in London reached

the high figure of 5036 in 1694, and that there was a high mortality in

many country parishes and market towns during the scarcity. But there are

few particular illustrations of the type of epidemic sickness. There is,

therefore, little left to do but to give the figures, and to add some

remarks.

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

Spotted Deaths

Fever fever from all

Year deaths deaths causes

A History of Epidemics in Britain, Volume 2 (of 2) From the Extinction of Plague to the Present Time · 第 1 / 24 章