The newer parts of London were built over cesspools, which were probably

more dangerous than the visible nuisances of the streets satirized by

Swift and Gay. There were also the “intramural” graveyards; of one of

these, the Green Ground, Portugal Street, it was said by Walker, as late

as 1839; “The effluvia from this ground are so offensive that persons

living in the back of Clement’s Lane are compelled to keep their windows

closed.” But that which helped most of all to make a foul atmosphere in

the houses of the working class, an atmosphere in which the contagion of

fever could thrive, was the window-tax. It is hardly possible that those

who devised it can have foreseen how detrimental it would be to the public

health; it took nearly a century to realize the simple truth that it was

in effect a tax upon light and air.

The Window-Tax.

Willan, writing of fever in London in 1799, mentions that even the

passages of tenement houses were “kept dark in order to lessen the

window-tax,” and the air therefore kept foul[153]. Ferriar, writing of

Manchester in the last years of the 18th century, mentions, among other

fever-dens, a large house in an airy situation which had been built for a

poor’s-house, but abandoned: having been let to poor families for a very

trifling rent, many of the windows and the principal entrance were built

up, and the fever then became universal in it[154]. The Carlisle typhus

described by Heysham for 1781 began in a house near one of the gates,

tenanted by five or six very poor families; they had “blocked up every

window to lessen the burden of the window-tax[155].” John Howard’s

interest having been excited in the question of gaol-fever, he noted the

effects of the window-tax not only in prisons but in other houses. The

magistrates of Kent appear to have paid the tax for the gaols in that

county from the county funds; but in most cases the burden fell on the

keepers of the gaols.

“The gaolers,” says Howard, “have to pay it; this tempts them to stop

the windows and stifle their prisoners;” and he appends the following

note: “This is also the case in many work-houses and farm-houses,

where the poor and the labourers are lodged in rooms that have no

light nor fresh air; which may be a cause of our peasants not having

the healthy ruddy complexions one used to see so common twenty or

thirty years ago. The difference has often struck me in my various

journeys[156].”

Such impressions are known to be often fallacious; but in the history of

the window-tax, which we shall now follow, it will appear that there was a

new law, with increased stringency, in the years 1746-1748, corresponding

to the “twenty or thirty years ago” of Howard’s recollection.

The window-tax was originally a device of the statesmen of the Revolution

“for making good the deficiency of the clipped money.” By the Act of 7 and

8 William and Mary, cap. 18, taking effect from the 25th March, 1696,

every inhabited house owed duty of two shillings per annum, and, over and

above such duty on all inhabited houses, every dwelling-house with ten

windows owed four shillings per annum, and every house with twenty

windows eight shillings. In 1710 houses with from twenty to thirty windows

were made to pay ten shillings, and those with more than thirty windows

twenty shillings. Various devices were resorted to to check the evasions

of bachelors, widows and others. A farmer had to pay for his servants,

recouping himself from their wages. A house subdivided into tenements was

to count as one; which would have made the tax difficult to gather except

from the landlord. The machinery of collection was a board of

commissioners, receivers-general and collectors.

But in the 20th of George II. (1746) the basis of the law was changed. The

tax was levied upon the several windows of a house, so much per window, so

that it fell more decisively than before upon the tenants of

tenement-houses, and not on the landlords. The two-shillings house duty

was continued; but the window-tax became sixpence per annum for every

window of a house with ten, eleven, twelve, thirteen or fourteen windows,

or lights, ninepence for every window of a house with fifteen, sixteen,

seventeen, eighteen or nineteen windows, and one shilling for every window

of a house with twenty or more windows. An exemption in the Act in favour

of those receiving parochial relief was decided by the law officers of the

Crown not to apply to houses with ten or more windows or lights, which

would have included most tenement-houses; on the other hand they ruled

that hospitals, poor-houses, workhouses, and infirmaries were not

chargeable with the window duty. To remove doubts and check evasions

another Act was made in 21 George II. cap. 10. All skylights, and lights

of staircases, garrets, cellars and passages were to count for the purpose

of the tax; also certain outhouses, but not others, were to count as part

of the main dwelling whether they were contiguous or not. The 11th

paragraph of the Amendment Act shows how the law had been working in the

course of its first year: “No window or light shall be deemed to be

stopped up unless such window or light shall be stopped up effectually

with stone or brick or plaister upon lath,” etc.

This remained the law down to 1803, when a change was made back to the

original basis of rating houses as a whole, according to the number of

their windows, the rate being considerably raised and fixed according to a

schedule. The tax for tenement houses was at the same time made

recoverable from the landlord. The window-tax thus became a form of the

modern house-tax, rated upon windows instead of upon rental, and so lost a

great part of its obnoxious character.

The law of 1747-48, which taxed each window separately, and was enforced

by a galling and corrupt machinery of commissioners, receivers-general and

collectors paid by results, could not fail to work injuriously; for light

and air, two of the primary necessaries of life, were in effect taxed.

Even rich men appear to have taken pleasure in circumventing the

collectors[157]. But it was among the poor, and especially the inhabitants

of tenement houses, that the effect was truly disastrous; a tax on the

skylights of garrets and on the lights of cellars, staircases and

passages, taught the people to dispense with them altogether. Towards the

end of the 18th century the grievance became now and then the subject of a

pamphlet or a sermon.

Gaol-Fever.

Besides these ordinary things favouring contagious epidemic fever both in

town and country, there were two special sources of contagion, the gaols

and the fleets and armies. I shall take first the state of the gaols,

which has been already indicated in speaking of the window-tax. In the

opinion of Lind, a great part of the fever, which was a constant trouble

in ships of the navy, came direct from the gaols through the pressing of

newly discharged convicts.

The state of the prisons in the first half of the 18th century was

certainly not better than Howard found it to be a generation after; it was

probably worse, for the administration of justice was more savage. About

the beginning of the century, many petitions were made to Parliament by

imprisoned debtors, complaining of their treatment, and a Bill was

introduced in 1702. Sixty thousand were said to be in prison for

debt[158]. On 25 February, 1729, the House of Commons appointed a

committee “to inquire into the state of the gaols of this Kingdom”; but

only two prisons were reported on, the Fleet and the Marshalsea, in

London, the inquiries upon these being due to the energy of Oglethorpe,

then at the beginning of his useful career. The committee found a

disgraceful state of things:--wardens, tip-staffs and turnkeys making

their offices so lucrative by extortion that the reversion of them was

worth large sums, prisoners abused or neglected if they could not pay,

some prisoners kept for years after their term was expired, the penniless

crowded three in a bed, or forty in one small room, while some rooms stood

empty to await the arrival of a prisoner with a well-filled purse. On the

common side of the Fleet Prison, ninety-three prisoners were confined in

three wards, having to find their own bedding, or pay a shilling a week,

or else sleep on the floor. The “Lyons Den” and women’s ward, which

contained about eighteen, were very noisome and in very ill repair. Those

who were well had to lie on the floor beside the sick. A Portuguese debtor

had been kept two months in a damp stinking dungeon over the common sewer

and adjoining to the sink and dunghill; he was taken elsewhere on payment

of five guineas. In the Marshalsea there were 330 prisoners on the common

side, crowded in small rooms. George’s ward, sixteen feet by fourteen and

about eight feet high, had never less than thirty-two in it “all last

year,” and sometimes forty; there was no room for them all to lie down,

about one-half of the number sleeping over the others in hammocks; they

were locked in from 9 p.m. to 5 a.m. in summer (longer hours in winter),

and as they were forced to ease nature within the room, the stench was

noisome beyond expression, and it seemed surprising that it had not caused

a contagion; several in the heat of summer perished for want of air.

Meanwhile the room above was let to a tailor to work in, and no one

allowed to lie in it. Unless the prisoners were relieved by their friends,

they perished by famine. There was an allowance of pease from a casual

donor who concealed his name, and 30 lbs. of beef three times a week from

another charitable source. The starving person falls into a kind of

hectic, lingers for a month or two and then dies, the right of his corpse

to a coroner’s inquest being often scandalously refused[159]. The prison

scenes in Fielding’s _Amelia_ are obviously faithful and correct.

Oglethorpe’s committee had done some good since they first met at the

Marshalsea on 25th March, 1729, not above nine having died from that date

to the 14th May; whereas before that a day seldom passed without a death,

“and upon the advancing of the spring not less than eight or ten usually

died every twenty-four hours.” Two of the chief personages concerned were

found by a unanimous vote of the House of Commons to have committed high

crimes and misdemeanours; but when they were tried before a jury on a

charge of felony they were found not guilty.

About a year after these reports to the Commons there was a tragic

occurrence among the Judges and the Bar of the Western Circuit during the

Lent Assizes of 1730. The Bridewell at Taunton was filled for the occasion

of the Assizes with drafts of prisoners from other gaols in Somerset,

among whom several from Ilchester were said to have been more than

ordinarily noisome. Over a hundred prisoners were tried, of whom eight

were sentenced to death (six executed), and seventeen to transportation.

As the Assize Court continued its circuit through Devon and Dorset several

of its members sickened of the gaol fever and died: Piggot, the

high-sheriff, on the 11th April, Sir James Sheppard, serjeant-at-law, on

13th April at Honiton, the crier of the court and two of the Judge’s

servants at Exeter, the Judge himself, chief baron Pengelly, at Blandford,

and serjeant-at-law Rous, on his return to London, whither he had posted

from Exeter as soon as he felt ill[160]. It is said that the infection

afterwards spread within the town of Taunton, where it arose, “and carried

off some hundreds”; but the local histories make no mention of such an

epidemic in 1730, and no authority is cited for it[161]. Something of the

same kind is believed to have happened at a gaol delivery at Launceston

in 1742, but the circumstances are vaguely related, and it does not appear

that any prominent personage in the Assize Court died on the

occasion[162].

The great instance of a Black Assize in the 18th century, comparable to

those of Cambridge, Oxford and Exeter in the 16th[163], was that of the

Old Bailey Sessions in London in April, 1750. It has been fully related by

Sir Michael Foster, one of the justices of the King’s Bench, who had

himself been on the bench at the January sessions preceding, and was the

intimate friend of Sir Thomas Abney, the presiding judge who lost his life

from the contagion of the April sessions[164].

“At the Old Bailey sessions in April, 1750, one Mr Clarke was brought

to his trial; and it being a case of great expectation, the court and

all the passages to it were extremely crowded; the weather too was

hotter than is usual at that time of the year[165]. Many people who

were in court at this time were sensibly affected with a very noisome

smell; and it appeared soon afterwards, upon an enquiry ordered by the

court of aldermen, that the whole prison of Newgate and all the

passages leading thence into the court were in a very filthy

condition, and had long been so. What made these circumstances to be

at all attended to was, that within a week or ten days at most, after

the session, many people who were present at Mr Clarke’s trial were

seized with a fever of the malignant kind; and few who were seized

recovered. The symptoms were much alike in all the patients, and in

less than six weeks time the distemper entirely ceased. It was

remarked by some, and I mention it because the same remark hath

formerly been made on a like occasion [Oxford, 1577], that women were

very little affected: I did not hear of more than one woman who took

the fever in court, though doubtless many women were there.

“It ought to be remembered that at the time this disaster happened

there was no sickness in the gaol more than is common in such places.

This circumstance, which distinguisheth this from most of the cases of

the like kind which we have heard of, suggesteth a very proper

caution: not to presume too far upon the health of the gaol, barely

because the gaol-fever is not among the prisoners. For without doubt,

if the points of cleanliness and free air have been greatly neglected,

the putrid effluvia which the prisoners bring with them in their

clothes etc., especially where too many are brought into a crowded

court together, may have fatal effects on people who are accustomed to

breathe better air; though the poor wretches, who are in some measure

habituated to the fumes of a prison, may not always be sensible of any

great inconvenience from them.

“The persons of chief note who were in court at this time and died of

the fever were Sir Samuel Pennant, lord mayor for that year, Sir

Thomas Abney, one of the justices of the Common Pleas, Charles Clarke,

esquire, one of the barons of the exchequer, and Sir Daniel Lambert,

one of the aldermen of London. Of less note, a gentleman of the bar,

two or three students, one of the under-sheriffs, an officer of Lord

Chief Justice Lee, who attended his lordship in court at that time,

several of the jury on the Middlesex side, and about forty other

persons whom business or curiosity had brought thither.”

The same thing was remarked here as at Exeter in 1586 that those who sat

on the side of the Court nearest to the dock were most attacked by the

infection[166]. When the cases of fever began to occur, after the usual

incubation of “a week or ten days,” there was much fear of the infection

spreading, so that many families, it is said, retired into the

country[167]. But Pringle wrote on 24 May, “However fatal it has been

since the Sessions, it is highly probable that the calamity will be in a

great measure confined to those who were present at the tryal[168];” and

Justice Foster gives no hint of anyone having taken the fever who was not

present in court.

The tragedy of gaol-fever at the Old Bailey in 1750 secured increased

attention to the subject of scientific ventilation. The great bar to fresh

air indoors throughout the 18th century was the window-tax. It bore

particularly hard on prisoners, for the gaolers had to pay the window-tax

out of their profits, and they naturally preferred to build up the

windows. Scientific ventilation of gaols was something of a mockery in

these circumstances; but it is the business of science to find out cunning

contrivances, and ingenious ventilators were devised for Newgate, the

leading spirit in this work being the Rev. Dr Hales, rector of a parish

near London, and an amateur in physiology at the meetings of the Royal

Society.

A ventilating apparatus had been erected at Newgate about a year before

the fatal sessions of 1650, but it does not seem to have answered. It

consisted of tubes from the various wards meeting in a great trunk which

opened on the roof. A committee of the Court of Aldermen in October 1750

resolved, after consulting Pringle and Hales, to add a windmill on the

leads over the vent, and that was done about two years after. Pringle, who

inspected the ventilator on 11 July, 1752, says that a considerable

stream of air of a most offensive smell issued from the vent; and it

appeared that no fewer than seven of the eleven carpenters who were

working at the alterations on the old ventilator caught gaol-fever (of the

petechial kind), which spread among the families of some of them[169].

Pringle and Hales were of opinion that the wards furnished with tubes were

less foul than the others; and they claimed, on the evidence of the man

who took care of the apparatus, that only one person had died in the gaol

in two months, whereas, before the windmill was used, there died six or

seven in a week[170]. But Oglethorpe had claimed an improvement of the

same kind at the Marshalsea in 1729 merely from having the prisoners saved

from hunger; and Lind, who was a most matter-of-fact person, did not think

that the ingenious contrivances for ventilation had answered their

end[171].

Howard’s visitations of the prisons, which began in 1773 and were

continued or repeated during several years following, brought to light

many instances of epidemic sickness therein, which was nearly always of

the nature of gaol-typhus. The following is a list compiled from his

various reports, the two or three instances of smallpox infection being

given elsewhere.

_Wood Street Compter, London._ About 100 in it, chiefly debtors.

Eleven died in beginning of 1773; since then it has been visited by Dr

Lettsom at the request of the aldermen.

_Savoy, London._ On 15 March, 1776, 119 prisoners. Many sick and

dying. Between that date and next visit, 25 May, 1776, the gaol-fever

has been caught by many.

_Hertford._ Inmates range from 20 to 30. In the interval of two

visits, the gaol-fever prevailed and carried off seven or eight

prisoners and two turnkeys. (The interval probably corresponded to the

admission of an unusual number of debtors.)

_Chelmsford._ Number of inmates varies from 20 to 60, about one-half

debtors. A close prison frequently infected with the gaol-distemper.

_Dartford, County Bridewell._ A small prison. About two years before

visit of 1774 there was a bad fever, which affected the keeper and his

family and every fresh prisoner. Two died of it.

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

gaol-fever.

_Petworth, Bridewell._ Allowance per diem a penny loaf (7½ oz.). Th.

Draper and Wm. Godfrey committed 6 Jan., 1776: the former died on 11

Jan., the other on 16th. Wm. Cox, committed 13 Jan., died 23rd. “None

of these had the gaol-fever. I do not affirm that these men were

famished to death; it was extreme cold weather.” After this the

allowance of bread was doubled, thanks to the Duke of Richmond.

_Southwark, the new gaol._ Holds up to 90 debtors and felons. “In so

close a prison I did not wonder to see, in March, 1776, several felons

sick on the floors.” No bedding, nor straw. The Act for preserving the

health of prisoners is on a painted board.

_Aylesbury._ About 20 prisoners. First visit Nov., 1773, second Nov.,

1774: in the interval six or seven died of the gaol-distemper.

_Bedford._ About twenty years ago the gaol-fever was in this prison;

some died there, and many in the town, among whom was Mr Daniel, the

surgeon who attended the prisoners. The new surgeon changed the

medicines from sudorifics to bark and cordials; and a sail-ventilator

being put up the gaol has been free from the fever almost ever since.

(This was the gaol which is often said to have started Howard on his

inquiries when he was High Sheriff.)

_Warwick._ Holds up to fifty-seven. The late gaoler died in 1772 of

the gaol-distemper, and so did some of his prisoners. No water then;

plenty now.

_Southwell, Bridewell._ A small prison. A few years ago seven died

here of the gaol-fever within two years.

_Worcester._ Has a ventilator. Mr Hallward the surgeon caught the

gaol-fever some years ago, and has ever since been fearful of going

into the dungeon; when any felon is sick, he orders him to be brought

out.

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

years.

_Monmouth._ At first visit in 1774, they had the gaol-fever, of which

died the gaoler, several of his prisoners, and some of their friends.

_Usk (Monmouth) Bridewell._ The keeper’s wife said that many years ago

the prison was crowded, and that herself, her father who was then

keeper, and many others of the family had the gaol-fever, three of

whom, and several of the prisoners, died of it.

_Gloucester, the Castle._ Many prisoners died here in 1773; and always

except at Howard’s last visit, he saw some sick in this gaol. A large

dunghill near the stone steps. The prisoners miserable objects: Mr

Raikes and others took pity on them.

_Winchester._ The former destructive dungeon was down eleven steps,

and darker than the present. Mr Lipscomb said that more than twenty

prisoners had died in it of the gaol-fever in one year, and that the

surgeon before him had died of it.

_Liverpool._ Holds about sixty, offensive, crowded. Howard in March,

1774, told the keeper his prisoners were in danger of the gaol-fever.

Between that date and Nov., 1775, twenty-eight had been ill of it at

one time.

_Chester, the Castle._ Dungeon used to imprison military deserters.

Two of them brought by a sergeant and two men to Worcester, of which

party three died a few days after they came to their quarters. (For

fever in this prison in 1716 see the text, p. 60.)

_Cowbridge._ The keeper said, on 19 August, 1774, that many had died

of the gaol-fever, among them a man and a woman a year before, at

which time himself and daughter were ill of it.

_Cambridge, the Town Bridewell._ In the spring of 1779, seventeen

women were confined in the daytime, and some of them at night, in the

workroom, which has no fireplace or sewer. This made it extremely

offensive, and occasioned a fever or sickness among them, which so

alarmed the Vice-Chancellor that he ordered all of them to be

discharged. Two or three of them died within a few days.

_Exeter, the County Bridewell._ Between first visit in 1775 and next

on 5 Feb., 1779, the surgeon and two or three prisoners have died of

the gaol-fever. In 1755 a prisoner discharged from the gaol went home

to Axminster, and infected his family, of whom two died, and many

others in that town afterwards.

_Exeter, the High Gaol for felons._ Mr Bull, the surgeon, stated that

he was by contract excused from attending in the dungeons any

prisoners that should have the gaol-fever.

_Winchester, Bridewell._ Close and small. Receives many prisoners from

other gaols at Quarter Sessions. It has been fatal to vast numbers.

The misery of the prisoners induced the Duke of Chandos to send them

for some years 30 lbs. of beef and 2 gallon loaves a week.

_Devizes, Bridewell._ Two or three years ago the gaol-fever carried

off many. An infirmary added since then.

_Marlborough._ The rooms offensive. Saw one dying on the floor of the

gaol-fever. One had died just before, and another soon after his

discharge.

_Launceston._ Small, with offensive dungeons. No windows, chimneys, or

drains. No water. Damp earthen floor. Those who serve there often

catch the gaol-fever. At first visit, found the keeper, his assistant

and all the prisoners but one sick of it (on 19 Feb., 1774, eleven

felons in it). Heard that, a few years before, many prisoners had died

of it, and the keeper and his wife in one night. A woman confined

three years by the Ecclesiastical Court had three children born in the

gaol.

_Bodmin, Bridewell._ Much out of repair. The night rooms are two

garrets with small close-glazed skylight 17 in. × 12 in. A few years

ago the gaol-fever was very fatal, not only in the prison but also in

the town.

_Taunton, Bridewell._ Six years ago, when there was no infirmary

provided, the gaol-fever spread over the whole prison, so that eight

died out of nineteen prisoners.

_Shepton Mallet._ Men’s night room close, with small window. So

unhealthy some years ago that the keeper buried three or four in a

week.

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

_Carlisle._ During the gaol-fever which some years ago carried off

many of the prisoners, Mr Farish, the chaplain, visited the sick every

day.

I shall add some medical experiences of gaol-fever in London from the

notes of Lettsom[172]:--

May, 1773. A person released from Newgate “in a malignant or

jail-fever” was brought into a house in a court off Long Lane,

Aldersgate Street; soon after which fourteen persons in the same

confined court were attacked with a similar fever: one died before

Lettsom was called in, one was sent to hospital, eleven attended by

him all recovered, though with difficulty. Two deaths in Wood Street

Compter: 1. Rowell, an industrious, sober workman, who had supported

for many years a wife and three children; some of these having been

lately sick, he fell behind with his rent, a little over three

guineas; he offered all he had (more than enough) to the landlord, but

the latter preferred to throw the man and his family into the Compter,

where Rowell died of fever. 2. Russell, once a reputable tradesman on

Ludgate Hill, fell into a debt of under three guineas, sent to the

Compter with his wife and five children, took fever and died; attended

in his sickness in a bare room by his eldest daughter, elegant and

refined, aged seventeen; his son, aged fourteen, took the fever and

recovered.

There was one Black Assize at this period, at Dublin in April 1776. A

criminal, brought into the Court of Sessions without cleansing, infected

the court and alarmed the whole city. Among others who died of the

contagion were Fielding Ould, High Sheriff, the counsellors Derby, Palmer,

Spring and Ridge, Mr Caldwell, Messrs Bolton and Eriven, and several

attorneys and others whose business it was to attend the court[173].

There were two notorious outbreaks of malignant fever among foreign

prisoners of war, one in 1761[174] and another in 1780[175], the first

among French and Spaniards at Winchester and Portchester, the second among

Spaniards at Winchester.

Howard found so little typhus in the gaols in his later visits that it

seemed as if banished for good. But it was heard of frequently about

1780-85--at Maidstone, at Aylesbury, at Worcester, costing the lives of

some of the visiting physicians.

Circumstances of severe and mild Typhus.

The circumstances of the gaol distemper bring out one grand character of

typhus which will have to be stated formally before we go farther.

Ordinary domestic typhus was not a very fatal disease. Haygarth says that

of 285 attacked by it in the poorer quarters of Chester in the autumn of

1774, only twenty-eight died. Ferriar, in Manchester, had sometimes an

even more favourable experience than that: “The mortality of the epidemic

was not great, ... out of the first ninety patients whom I attended, only

two died.” This was before the House of Recovery was opened; so that the

low mortality was of typhus in the homes of the people.

The fever was often an insidious languishing, without great heat, and

marked most by tossing and wakefulness, which might pass into delirium;

when it went through the members of a family or the inmates of a house,

there would be some cases concerning which it was hard to say whether they

were cases of typhus or not. Misery and starvation brought it on, and

often it was itself but a degree of misery and starvation. “I have found,”

says Ferriar, “that for three or four days before the appearance of

typhus in a family consisting of several children, they had subsisted on

little more than cold water.” “It has been observed,” says Langrish, “that

those who have died of hunger and thirst, as at sieges and at sea, etc.,

have always died delirious and feverish.” The fever was on the whole a

distinct episode, but in many cases it had no marked crisis. “Those women

who recovered,” says Ferriar, “were commonly affected with hysterical

symptoms after the fever disappeared;” and again: “Fevers often terminate

in hysterical disorders, especially in women; men, too, are sometimes

hysterically inclined upon recovering from typhus, for they experience a

capricious disposition to laugh or cry, and a degree of the globus

hystericus.” These were probably the more case-hardened people, inured to

their circumstances, their healthy appetite dulled by the practice of

fasting or “clemming,” or by opium, and their blood accustomed to be

renovated by foul air. If the limit of subsistence be approached

gradually, life may be sustained thereat without any sharp crisis of

fever, or with only such an interlude of fever as differs but little from

a habit of body unnamed in the nosology.

The worst kind of typhus, often attended with delirium, crying and raving,

intolerable pains in the head, and livid spots on the skin, ending fatally

perhaps in two or three days, or after a longer respite of stupor or

waking insensibility, was commonly the typhus of those not accustomed to

the minimum of well-being--the typhus of hardy felons newly thrown into

gaol, of soldiers in a campaign crowded into a hospital after a season in

the open air, of sailors on board ship mixing with newly pressed men

having the prison atmosphere clinging to them, of judges, counsel,

officials of the court and gentlemen of the grand jury brought into the

same atmosphere with prisoners at a gaol-delivery, of the wife and

children of a discharged prisoner returned to his home, of the

gaol-keeper, gaol-chaplain, or gaol-doctor, of the religious and

charitable who visited in poor localities even where no fever was known to

be, and most of all of country people who crowded to the towns in search

of work or of higher wages or of a more exciting life.

It was in these circumstances that the most fatal infections of typhus

took place. Such extraordinary malignancy of typhus happened often when

the type of sickness (if indeed there was definite disease at all) among

the originally ailing failed to account for it; it was the great

disparity of condition that accounted for it. There were, however, more

special occasions when a higher degree of malignancy than ordinary was

bred or cultivated among the classes at large who were habitually liable

to typhus. But even the old pestilential spotted fever which used to

precede, accompany, and follow the plague itself, was fatal to a

comparatively small proportion of all who had it. Thus, towards the end of

the great London plague of 1625, on 18th October, Sir John Coke writes to

Lord Brooke: “In London now the tenth person dieth not of those that are

sick, and generally the plague seems changed into an ague[176].” One in

ten is probably too small a fatality for the old pestilential fever; but

that is the usually accepted proportion of deaths to attacks in the typhus

fever of later times. The rate of fatality is got, naturally, by striking

an average. But in truth an aggregate of typhus cases, however homogeneous

in conventional symptoms or type-characters, was not always really

homogeneous. We have seen that ninety cases of typhus could occur in the

slums of Manchester with only two deaths. On the other hand there were

outbreaks of gaol-fever in which half or more of all that were attacked

died; and I suspect that the average fatality in typhus of one in ten was

often brought up by an admixture of cases of healthy and well-conditioned

people who caught a much more malignant type of fever from their contact

with those inured to misery. To strike an average is in many instances a

convenience and a help to the apprehension of a truth; but for the average

to be instructive, the members of the aggregate must be more or less

comparable in their circumstances. It has been truly said that there is no

common measure between Lazarus and Dives as regards their subjective views

of things; it is not a little strange to find that they are just as

incommensurable in their risk of dying from the infection of typhus fever.

The rule seems to be that the degree of acuteness or violence of an attack

of typhus was inversely as the habitual poor condition of the victim. In

adducing evidence of the tragic nature of typhus infection conveyed across

the gulf of misery to the other side, I shall endeavour to keep strictly

to the scientific facts, leaving the moral, if there be a moral (and it is

not always obvious), to point itself.

Let us take first the common case of country-bred people migrating to the

towns. Any lodging in a crowded centre of industry and trade would be

high-rented compared with the country cottage which they had left, and

they would naturally gravitate to the slums of the city.

“Great numbers of the labouring poor,” says Ferriar of Manchester,

“who are tempted by the prospect of large wages to flock into the

principal manufacturing towns, become diseased by getting into dirty

infected houses on their arrival. Others waste their small stock of

money without procuring employment, and sink under the pressure of

want and despair.... The number of such victims sacrificed to the

present abuses is incredible.” And again:

“It must be observed that persons newly arrived from the country are

most liable to suffer from these causes, and as they are often taken

ill within a few days after entering an infected house, there arises a

double injury to the town, from the loss of their labour, and the

expense of supporting them in their illness. A great number of the

home-patients of the Infirmary are of this description. The horror of

these houses cannot easily be described; a lodger fresh from the

country often lies down in a bed filled with infection by its last

tenant, or from which the corpse of a victim to fever has only been

removed a few hours before[177].”

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

The tenant of a house in Manchester, who was herself ill of typhus

along with her three children, took in a lodger, a girl named Jane

Jones, fresh from the country. The lodger fell ill, but the fact was

kept concealed from the visiting physician until her screams

discovered her: “She was found delirious, with a black fur on the lips

and teeth, her cheeks extremely flushed, and her pulse low, creeping,

and scarcely to be counted.” Treatment was of no use; she “passed

whole nights in shrieking,” and in her extremity, she was saved, as

Ferriar believed, by affusions of cold water. Another case, exactly

parallel, proved fatal in three days:

“In 1792 I had two patients ill of typhus in an infected

lodging-house. I desired that they might be washed with cold water;

and a healthy, ruddy young woman of the neighbourhood undertook the

office. Though apparently in perfect health before she went into the

sick chamber, she complained of the intolerable smell of the patients,

and said she felt a head-ache when she came down stairs. She sickened,

and died of the fever in three days[178].”

These are instances of country-bred people, plunging abruptly into the

fever-dens of cities and catching a typhus severe in the direct ratio of

their ruddy, healthy condition. Another class of cases is that of persons

carrying the atmosphere of a gaol into the company of healthy and

otherwise favourably situated people. Howard gives a case: at Axminster a

prisoner discharged from Exeter gaol in 1755 infected his family with the

gaol-distemper, of which two of them died, and many others in that town.

The best illustrations of the greater severity and fatality of typhus

among the well-to-do come from Ireland, in times of famine, and will be

found in another chapter. But it may be said here, so that this point in

the natural history of typhus fever may not be suspected of exaggeration,

that the enormously greater fatality of typhus (of course, in a smaller

number of cases) among the richer classes in the Irish famines, who had

exposed themselves in the work of administration, of justice, or of

charity, rests upon the unimpeachable authority of such men as Graves, and

upon the concurrent evidence of many.

Ship-Fever.

The prevalence of fevers in ships of war and transports from the

Restoration onwards can be learned but imperfectly, and learned at all

only with much trouble. Sir Gilbert Blane, who was not wanting in aptitude

and had the archives of the Navy Office at his service, goes no farther

back than 1779, from which date an account was kept of the causes of death

in the naval hospitals. But the deaths on board ships of the fleet were

not systematically recorded until 1811, when the Board of Admiralty

instructed all commanders of ships of war to send to the Naval Office an

annual account of all the deaths of men on board[179]. The sources of

information for earlier periods are more casual.

The war with France, which dated from the accession of William III. and

continued until the Peace of Ryswick in 1697, led to numerous conflicts

with French and Spaniards in the West Indies, and to naval expeditions

year after year. The loss of life from sickness in the British ships for a

few years at the end of the century was such as can hardly be realized by

us. Some part of it happened on the outward voyages, but by far the

greater part of it was from the poison of yellow fever which had entered

the ships in the anchorages of West Indian colonies. It was probably to

that cause that the enormous mortality in the fleet under Sir Francis

Wheeler was owing. After some ineffective operations against the French in

the Windward Islands in the winter of 1693-4, he sailed for North America

with the intention of attacking Quebec. This he failed to do, having

sailed from Boston for home on the 3rd of August without entering the St

Lawrence. The reason of the failure was probably the extraordinary

fatality which Cotton Mather, of Boston, professes to have heard from the

admiral himself, namely, that he lost by a malignant fever on the passage

from Barbados to Boston 1300 sailors out of 2100, and 1800 soldiers out of

2400[180].

Another instance comes from Carlisle Bay, Barbados. The slave ship

‘Hannibal’ arrived there in November, 1694, during a disastrous epidemic

of yellow fever. Phillips, the captain, whose journal of the voyage is

published[181], had great difficulty in saving his crew from being pressed

into the king’s ships, which were short of men owing to the yellow fever.

Captain Sherman, of the ‘Tiger,’ who convoyed the ‘Hannibal’ and other

merchantmen back to England in April, 1695, told Phillips that he buried

six hundred men out of his ship during the two years that he lay at

Barbados, though his complement was but 220, “still pressing men out of

the merchant ships that came in, to recruit his number in the room of

those that died daily.”

These and other similar experiences of yellow fever in the West Indies,

which might be collected from the naval history, do not come properly into

this chapter; and I pass from them to ship-fever proper, having indicated

how much of the loss of life abroad was due to yellow fever.

Some light is thrown upon the state of health on board ships of war on the

home station by Dr William Cockburn, physician to the fleet, afterwards

the friend of Swift, who calls him “honest Dr Cockburn.” He had a secret

remedy for dysentery, which he succeeded in getting adopted by the

Admiralty, greatly to his own emolument for many years after. Dining on

board one of the ships at Portsmouth, in 1696, with Lord Berkeley of

Stratton, he brought up the subject of his electuary, and arranged for a

public trial of it next day on board the ‘Sandwich.’ An uncertain number,

which looks to have been about seven in Cockburn’s own account, but became

seventy in the pamphlet which advertised the electuary after his death,

were available for the trial and were speedily cured. Cockburn’s three

essays on the health of seamen[182] leave no doubt as to the extensive

prevalence of scurvy and the causes thereof; while his references to

“malignant fever,” although they are, as usual, brought in to illustrate

some doctrinal or theoretical point, give colour to the belief that

ship-typhus may have been as common then as we know it to have been in the

ships at Portsmouth and Plymouth, on the more direct testimony of Huxham

in 1736, and of Lind twenty years later.

A naval surgeon of the time of William III. and Anne, was induced by his

enthusiasm for blood-letting in fevers to record some of his experiences

on board ship[183]. It was usually the lustiest, both of the young, strong

and healthy people, and likewise of the elder sort, that died of fevers,

the symptoms which proved so mortal having been delirium, phrenitis, coma

or stupor, whether they occurred in the συνόχοι (of Sydenham) or in the

συνεχεῖς (of the same author):

“I had observed in a ship of war whose complement was near 500, in a

Mediterranean voyage in the year 1694, where we lost about 90 or 100

men, mostly by fevers, that those who died were commonly the young,

but almost always the strongest, lustiest, handsomest persons, and

that two or three escaped by means of such [natural] haemorrhagies,

which were five or six pounds of blood”--the point being that the

amount of blood drawn by phlebotomy should be in proportion to the

robustness and body-weight of the patient.

In 1703 and 1704 he was surgeon to two of Her Majesty’s ships “where a

delirium, stupor and phrenitis” were found as symptoms of the fevers. In

the summer of 1704, cruising in the latitudes of Portugal and Spain, the

men brought on board from Lisbon unripe lemons with which they made great

quantities of punch. This was the evident cause of a cholera morbus and

dysentery: “after this we had a pretty many taken with the _synochus

putris_, and some with the _causus_” [malignant fever]. Most of these

fevers went off by a crisis in sweating, “which was so large I had good

reason to believe it judicatory.” In several the fevers left on the 9th,

10th or 11th day, and in almost all by the 14th. “About the latter end of

July, and in August, there were many taken with a delirium and stupor or

coma, and some with the phrenitis in their fever.” Among the symptoms was

one which we find described for fevers on board ship on the West Coast of

Africa at the same time--“soreness all over as if from blows with a cane,”

a symptom afterwards associated with dengue. “Sometimes the bones (as they

term it) don’t pain them much.” In some cases there were petechial spots

as well as a stupor. In the month of August “the fevers with a stupor and

phrenitis” came on apace. The treatment was to take ten ounces of blood

every day from the second to the eighth day of the fever, to give tartar

emetic in five-grain doses at the outset, and to administer cathartic

glysters in the second half of the fever. “Seeing the lustiest men now ran

no more hazard of their lives than any other who were usually taken with

this fever, nor indeed so much, in the beginning of September I resolved,

after all the phlebotomy was done in these fevers, to try the cathartic

sooner.” Many of these who had accustomed themselves to the liberal use of

spirituous liquors miscarried in the phrenitis.

White left the navy in 1704 and settled in practice at Lisbon, where he

saw much fever. He had seen epidemics break out in British ships of war at

anchor in the Tagus, crowded with men and prisoners. One case he mentions

in a Lisbon woman, with continual synochus, stupor, and petechiae on the

fifth day: “This was contagious, for she got it by going often to assist a

gunner of a man-of-war, who came to her house with this distemper upon

him: for many at the same time on board that ship were sick of that

disease.” Among the causes of fever on board ship he mentions the effluvia

of the bilge-water.

Exposed to these emanations were “a multitude of people breathing and

constantly perspiring in a close place, such as a ship’s _allop_ or

lower deck next the hould, where is the entry to a certain vacant

space near the ship’s center, which leadeth to the bottom, for

gathering all the water together which the ship draweth by leakage,

and is called the well. Several times there is occasion for some

people to go down to examine the quantity of the water, and in some

ships to bore an augur hole to let in as much as will preserve a good

air. I have often known two or three men killed at a time, as it is

said; and the reason may be understood from what I said of the general

effects of that fluid in ordinary fever [he is now writing on heat

apoplexy], where there is not above two or three inches, but just as

much as may make a surface, almost equal to the square of the well, of

stagnant salt water which had been a long while in gathering; and the

air over the whole _allop_ extremely rarified, and here not at all

ventilated[184].”

We owe it to the accident of the celebrated Dr Freind having accompanied

Lord Peterborough’s expedition to Spain in 1705 that some account has been

preserved of the sickness among the troops ashore and afloat[185].

The expedition of some 8000 men being then in its second year, fever and

dysentery were by far the most common diseases, so common that “we can

hardly turn, whether at sea or in camp, without finding them as if our

inseparable companions and as if domesticated among us.” In the summer of

the previous year there had been much fever both in the ships of the fleet

and in the camp before Barcelona: “It was of the continual kind, though it

usually remitted in the day time, and seemed to approach nearly to the

stationary one which Sydenham has described in the years 1685 and 1686.”

He then gives symptoms, which were on the whole those of the hospital

fever to be afterwards described from Pringle’s medical account of the

campaigns in 1743-48. Persons of a robust habit were affected more than

others, and more severely, and carried off sooner. The others were

generally taken away by a lingering death. “Some, when the fever seemed to

have been wholly gone off lay four or five days without pain or sickness,

though weak; afterwards being suddenly seized with convulsions of the

nerves they in a short time expired”--perhaps the phenomenon of relapse,

which Lind recorded for ship-fever fifty years after and was seen among

the troops landed from Corunna in 1809. In some few the parotids, or

abscesses formed about the groin, carried off the disease.

He then gives the case of a lieutenant on board the ‘Barfleur.’ At

first he was restless and delirious; on the 7th and 8th days he had

_subsultus tendinum_; on the 8th day his tongue was sometimes fixed,

and his eyes sparkled; on the 9th day, he was wholly deprived of his

understanding; he pulled off the fringe of the bed and plucked the

flocks; when he had before faultered in his speech, he was sometimes

seized with hiccough. But on the 10th day, after 12 oz. of blood had

been drawn from the jugular vein, his delirium went off on a sudden,

and he began to mend, making a perfect recovery.

Until the middle of the 18th century there are few other notices of

ship-fever, but it is probable that Huxham’s accounts of a very malignant

typhus among the crews of ships of war at Plymouth in 1735 (as well as at

Portsmouth according to report), and again in 1741, are to be taken as

samples of what might have been recorded on many occasions[186].

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

The war in Ireland after the accession of William III. produced two

remarkable instances of war-sickness, which are fully given in another

chapter. The campaigns of Marlborough against the armies of Louis XIV.,

from 1704 to the Treaty of Utrecht in 1713, appear to have found no

historian from the medical side, nor does the duke refer to these matters

in his dispatches or letters, beyond a remark in a letter to his wife from

near Munich, 30 July, 1704, a fortnight before the battle of Blenheim:

“There having been no war in this country for above sixty years, these

towns and villages are so clean that you would be pleased with them[187].”

The war of 1742-48, in which George II. joined Austria against France,

produced the first good accounts of war typhus, on land and on board ship,

in the writings of Pringle[188]. After the battle of Dettingen, 27 June,

1743, the men were exposed all night in the wet fields; during the next

eight days five hundred of them were attacked with dysentery, and in a few

weeks near half the army were either ill of it or had recovered from it.

The dysentery continued all July and part of August, while the army lay at

Hanau. The village of Feckenheim, a league from the camp, was used as a

hospital, some 1500 being quartered in it, most of them ill at first of

dysentery. The latrines appear to have been ill designed and badly kept.

“A malignant fever began among the men, from which few escaped: for

however mild or bad soever the flux was for which the person was sent to

hospital, this fever almost surely supervened. The petechial spots,

blotches, parotids, frequent mortifications, and the great mortality,

characterized a pestilential malignity: in this it was worse than the true

plague.... Of 14 mates employed about the hospital five died; and,

excepting one or two, all the rest had been ill and in danger. The

hospital lost nearly half of the patients; but the inhabitants of the

village of Feckenheim, where the sick were, having first received the

bloody flux, and afterwards the fever by contagion, were almost utterly

destroyed[189].” The survivors from the sick troops in Feckenheim were

removed to Neuwied, where they were relieved; “but the rest, who were

mixed with them, caught the infection.” The mixed troops were sent still

down the Rhine in bilanders, during which voyage “the fever became so

virulent that above half the number died in the boats, and many of the

remnant soon after their arrival.” A parcel of tents sent in these

bilanders to the Low Countries were given to a Ghent tradesman to refit;

he employed twenty-three journeymen upon them, “but these unhappy men were

quickly seized with this fever, whereof seventeen died.” They had no

other communication with the infected but through the tents.

“These,” says Pringle, “are instances of high malignity. The common course

of the infection is slow, and only catching to those constantly confined

to the bad air. Sometimes one will have this fever about him for several

days before it confines him to his bed; others I have known complain for

weeks of the same symptoms without any regular fever at all; and some,

after leaving the infectious place, have afterwards fallen ill of

it[190].”

After the battle of Fontenoy on 11 May, 1745, the army was in good health:

“the smallpox was the only new disease; it came with the recruits from

England, but did not spread; and indeed we have never known it of any

consequence in the field.”

On the Jacobite rebellion breaking out in Scotland later in the same year,

some of the returning troops were ordered to disembark at Newcastle, Holy

Island and Berwick. They had a long voyage, so that a kind of remitting

fever which some of them had acquired in the autumn in the Low Countries

was “by the crowds and the foul air of the hold soon converted into the

jail distemper and became infectious.” At Newcastle most of the nurses and

medical attendants of the extemporized hospital were seized with it, of

whom three apothecaries, four apprentices and two journeymen died. But the

most remarkable experience was on Holy Island. Of ninety-seven men taken

out of the ships there, ill of the gaol-fever, forty died, “and the people

of the place receiving the infection, in a few weeks buried fifty, the

sixth part of the inhabitants of that island.” At Nairn and Inverness

there was a singular experience in the spring of 1746. The ships which

brought Houghton’s brigade to Nairn carried also thirty-six deserters to

be tried by court-martial at the headquarters at Inverness: these men had

deserted to the French in Flanders, had been found on board of a captured

French transport carrying men to aid the Pretender, and had been thrown

into gaol in England till an opportunity arose of sending them to their

trial. Three days after the landing at Nairn of the force with which these

deserters sailed, six of the officers were seized with fever and many of

the men, of whom eighty were left sick at Nairn; in the ten days that the

regiment remained at Inverness it sent one hundred and twenty more to

hospital, ill of the same fever, which became frequent also among the

inhabitants of the town. “Though the virulence of the distemper diminished

afterwards in their march to Fort Augustus and Fort William, yet the corps

continued sickly for some time.” From the middle of February, 1746, when

the army crossed the Forth, to the end of the campaign, there were two

thousand sick in hospital, including wounded, of which number near three

hundred died, mostly of the contagious fever[191].

After the Peace of Aix-la-Chapelle in 1748, the English troops embarked at

Willemstad for home; “but the wind being contrary, several of the ships

lay above a month at anchor, and, after all, meeting with a tedious and

stormy passage, during which the men kept mostly below deck, the air was

corrupted and produced the jail or hospital fever.” The ships that came to

Ipswich were in the worst state, about four hundred men having been landed

sick there, most of them ill of this contagious fever. The infection was

at first as active and the mortality as great on shore as on board; but

the virulence of the fever was at length subdued by dispersing the sick

and convalescents as much as possible[192].

Monro gives a similar account of the camp sickness among the British

troops during the campaigns in North Germany in 1760-63. In the autumn of

1760, before he joined the forces, there had been much malignant fever and

dysentery: the camp at Warburg was near the battlefield (31 July, 1760),

where many of the dead were scarce covered with earth; there were also

many dead horses, and in a time of heavy rains, the camp, with the

neighbouring villages and fields, was filled with the excrements of a

numerous army. Not only the soldiers, but the inhabitants of the country,

who were reduced to the greatest misery and want, were infected, and whole

villages almost laid waste. When Monro joined at Paderborn in January,

1761, he found the hospitals overcrowded, and the malignancy of the fever

thereby much increased, so that a great many died. “The 1st and 3rd

regiments suffered most, owing to all the sick of each regiment being put

into a particular hospital by themselves, which kept up the infection, so

that they lost one-third of those left ill of this fever, and many of the

nurses and people who attended them were seized with it.” He distributed

the sick men of the Coldstreams among the houses in the town, and lost few

in comparison with the 1st and 3rd regiments. The contagion, under this

bold policy, did not spread.

Two points in the symptoms are noteworthy: first the occurrence of

suppurating buboes of the groins and armpits in several; and, secondly,

the frequency of round worms.

“In this fever it was common for patients to vomit worms, or to pass

them by stool, or, what was more frequent, to have them come up into

the throat or mouth, and sometimes into their nostrils, while they

were asleep in bed, and to pull them out with their fingers. The same

thing happened to most of the British soldiers brought to the

hospitals for other feverish disorders as well as this.”

He cannot explain the commonness of round worms in the sick, unless it was

from the great quantity of crude vegetables and fruits eaten, and the bad

water. Patients in convalescence often suffered from deafness, and from

suppurating parotids. Some had frequent relapses into the fever, “which

seemed to be owing to the irritation of these insects,” namely the worms.

Most of those who fell into profuse, kindly, warm sweats recovered, the

sweats lasting from twelve to forty-eight hours, and carrying off the

fever. He never saw any miliary eruptions, and only sometimes petechiae,

or small spots, or marbling as in measles[193].

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

Ship-fever would appear to have been at its worst after the middle of the

18th century. Dr James Lind joined Haslar Hospital in 1758, and brought to

the naval medical service the same high qualities which Pringle and Monro

brought to that of the army[194]. The smaller ships, such as the ‘Saltash’

sloop, the ‘Richmond’ frigate, and the ‘Infernal’ bomb were full of fever

of the most malignant kind; of 120 men in the ‘Saltash,’ 80 were infected

with a contagion much more virulent and dangerous than that in the

guard-ships. The explanation was that the smaller ships were receiving

vessels for the larger ships, and were manned from the gaols; drafts from

them carried the infection to the guard-ships and to the ships fitting out

for foreign service. Malignant fever also arose on the voyage home from

America[195]. In September and October 1758, after the reduction of

Louisburg, several of the ships arriving at Spithead were infected with a

malignant fever; three hundred men were received from them at Haslar

Hospital (some with scurvy), of whom twenty-eight died. The ‘Edgar,’

having been manned at the Nore from gaols, sailed for the Mediterranean,

and lost sixty men from fever and scurvy. The ‘Loestoffe,’ having lain in

the St Lawrence for eight months in perfect health, took on board six

convalescent men from Point Levi Hospital before sailing for home; in

forty-eight hours, fifty out of her two hundred men were seized with

fevers and fluxes, and six died on the voyage home. The ‘Dublin’ on the

homeward voyage from Quebec buried nineteen, and on her arrival reported

ninety men sick of fever, fluxes and scurvy. The ‘Neptune’ was said to

have lost one hundred and sixty men in a few months, and reported 136

sick. The ‘Cambridge,’ with 650 men in health, sent three of her crew to

the ‘Neptune’ laid up, to prepare her for the dock; of these three, one on

the fifth day became spotted and died, and another narrowly escaped with

life. The ‘Diana’ developed fever during a rough passage home from

America. The ‘St George,’ having sailed from Spithead in 1760, met with

rough weather and had to return on account of sickness. On the other hand,

Hawke’s fleet of twenty ships of the line with fourteen thousand men,

which defeated the French in November 1759, kept the Bay of Biscay for

four months in the most perfect health.

From 1 July, 1758, to 1 July, 1760, there were 5743 admissions to Haslar

Hospital, the chief diseases being as follows:

Fevers 2174

Scurvy 1146

Consumption 360

Rheumatism 350

Fluxes 245

Of the fevers some were of an intermittent type, but by far the most were

continued ship-typhus. Relapses were common, even to the sixth or seventh

time. The fever varied a good deal in malignity, but never produced

buboes, livid blotches or mortifications, and seldom parotids. Twenty-four

men received from January to March 1760 out of the ‘Garland’ had most of

them petechial spots accompanied with other symptoms of malignity, and of

these, five died or 20 per cent. But of 105 received during the same

months from the ‘Postilion’ and ‘Liverpool’ only eight died, and those

mostly of a flux. The infection had little tendency to spread among the

attendants at Haslar. In the first six months only one nurse died; in

1759, two labourers and two nurses died, one of the nurses by infection,

having concealed some infected shirts under her bed, the other by decay of

nature. Of more than a hundred persons employed in various offices about

the sick there died only those five in the course of eighteen months.

Although Lind’s account of ship-fever in the British navy is bad

enough, he has collected some far worse particulars of foreign ships.

Febrile contagion destroyed two-thirds of the men in the Duc

d’Anville’s fleet at Chebucto (now Halifax), in 1746, the complete

destruction of which was afterwards accomplished by the scurvy. It was

ship-fever which ravaged the Marquis d’Antin’s squadron in 1741, the

Count de Roquesevel’s in 1744, and the Toulon squadron in 1747. He

takes the following from Poissonnier’s _Traité de Maladies des Gens de

Mer_: The fleet commanded by M. Dubois de la Mothe sailed in 1757 from

Rochefort for Louisburg, Canada, having some men sickly. The ships

touched at Brest, and sent 400 ashore sick. They sailed from Brest on

3 May, and arrived at Louisburg on 28 June. There was then sickness in

only two ships, but in a short time it appeared in all the fleet. On

14 October the fleet sailed from Louisburg for home, embarking one

thousand sick, and leaving four hundred supposed dying. In less than

six days from sailing most of the thousand sick were dead. When the

fleet arrived at Brest on 22 November there were few seamen well

enough to navigate the ships; 4000 men were ill, the holds and decks

being crowded with the sick. The hospitals at Brest were already

occupied, two ships from Quebec shortly before having sent a thousand

men to them. Fifteen hospitals were soon filled, attended by five

physicians and one hundred and fifty surgeons. Two hundred almoners

and nurses fell victims. The infection passed to the lower class of

the citizens, the havoc became general, and houses everywhere were

filled with the dying and the dead. At length it got among the

prisoners in the hulks. This dreadful infection began to abate in

March, 1758, and ceased in April, having carried off in less than five

months upwards of 10,000 people in the hospitals alone, besides a

great number of the Brest townspeople. The stench was intolerable. No

person could enter the hospitals without being immediately seized with

headache; and every kind of indisposition quickly turned to fatal

fever, as in the old plague times. The state of the bodies showed the

degree of malignity that had been engendered: the lungs were engorged

with blood, and looked gangrenous; the intestines often contained a

green offensive liquor, and sometimes worms. Lind’s other instances

are chiefly of the Dutch East Indiamen that anchored at Spithead with

fever on board. In Nov., 1770, the ‘Yselmonde’ bound to Batavia, came

to anchor at Spithead, and buried a number of men every day; two

custom-house officers caught the fever and died. He gives two other

instances of Dutch ships bound to Batavia, which came in to

Portsmouth with fever[196]. The Dutch were said to send annually 2000

soldiers to Batavia, and to lose three-fourths of them by the

ship-fever before they arrived. In 1769 Lind saw ship-fever in the

Russian fleet at Spithead.

Brownrigg, of Whitehaven, gives a good instance of the diffusion of typhus

in a newly-commissioned ship of war, and thence to the civil population,

which bears out Lind’s favourite notion that the gaols and the press-gang

had far-reaching effects. In the year 1757 a sloop of war had been hastily

manned at the Nore to protect the shipping between the Irish and

Cumberland ports. She reached Whitehaven in May, with fever on board. The

men were landed and lodged in small houses. Brownrigg found about forty

lying on the floor of three small rooms, very close together, many of them

in a dying state; seven days after he was himself seized with fever, and

had a narrow escape with life. The ship’s surgeon died of it, his mate

recovered with difficulty, two surgeons of the town died of it, and two

more in Cockermouth. The contagion spread widely among the inhabitants of

Whitehaven, Cockermouth and Workington[197].

Lind showed to Howard in one of the wards of Haslar Hospital a number of

sailors ill of the gaol fever; it had been brought on board their ship by

a man who had been discharged from a prison in London, and it spread so

much that the ship had to be laid up[198].

With the outbreak of the American War we begin to hear of still more

disastrous epidemics of fever in the English fleets. Some instances from

Robertson’s full collection must suffice[199]. The ‘Nonsuch’ left England

in March, 1777, and fifty of her men were carried off by fever before

December; in that month, the ‘Nonsuch,’ ‘Raisonable’ and ‘Somerset’ had

each from 130 to 150 men on the sick list, chiefly fever in the

‘Somerset,’ and scurvy in the other two. In April, 1778, the ‘Venus,’ with

a crew of 240, was at Rhode Island very sickly; the surgeon told Robertson

that they had lost about fifty men of fever, which still continued to rage

on board: they became sickly from being crowded with prisoners and

cruising with them on board in bad weather. The ‘Somerset’ had buried 90

men of the fever since she left England, 70 of them being of the best

seamen. On arriving at Spithead in October, 1779, Robertson found much

fever in the Channel Fleet which had lately come in, especially in the

‘Canada,’ ‘Intrepid,’ ‘Shrewsbury,’ ‘London’ and ‘Namur,’ three or four of

which were put past service, so much were they disabled by sickness. At

Gibraltar Hospital from 12 January to 31 March, 1780, there were admitted

570 men from twenty-seven ships, of whom 57 died; of 110 sick from the

‘Ajax,’ 18 died; of 437 Spanish prisoners, 37 died. Next year, in May,

1781, at Gibraltar, the ‘Bellona’ had buried 27 men since she left

England, and had 108 on the sick list. The ‘Cumberland’ had buried 15; of

the ‘Marlborough’s’ men, 40 had died at the hospital. Robertson had to

purchase at his own expense vegetable acids, fruit and vegetables for the

sick.

Some statistics remain of the loss of men in the navy by sickness in

the Seven Years’ War (1756-62) and in the American War[200]. The House

of Commons had ordered a return of the number of seamen and marines

raised and lost in the former; but the return was too general to be of

much use, the number “lost” having included all those men who had been

sent to hospital and never returned to their ships, all those who had

been discharged as unserviceable, and all deserters. The number raised

was 184,899, and the number “lost” 133,708, besides 1512 killed. The

Return by the Navy Board for the period of the American War was more

specific, showing only the number of the dead and killed.

_Seamen and Marines raised, dead or killed, during the American War,

29 Sept., 1774, to 29 Sept., 1780_:

Year Raised Dead Killed

1774 345 -- --

1775 4,735 -- --

1776 21,565 1679 105

1777 37,457 3247 40

1778 31,847 4801 254

1779 41,831 4726 551

1780 28,210 4092 293

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

175,990 18,545 1243

Fully a tenth part of the men raised were lost by sickness. Fever was the

chief sickness, and as it happened rarely that more than one in ten cases

of fever died, it will be easy to form an approximate estimate of the

proportion of all the men raised for the ships that were on the sick list

at one time or another with fever--nearly the whole, one might guess.

During the three last years of the period Haslar Hospital was constantly

full of typhus fever. Admiral Keppel’s fleet arrived at Spithead on 26

October, 1778, and soon began to be infected with contagious fever; before

the end of December, 3600 men had been sent to Haslar, which could make up

at a pinch 1800 beds. But the great epidemic at Portsmouth was the next

year, 1779, when the very large Channel Fleet under Sir Charles Hardy came

in. During the month of September, 2500 men were received into hospital,

and more than 1000 ill of fevers remained on board for want of room in the

hospitals. In the last four months of 1779, 6064 sick were sent to Haslar,

which had 2443 patients on 1 January, 1780. There was an additional

hospital at Foston, holding 200, as well as two hospital ships holding

600. The infection was virulent during the winter, when Portsmouth was

crowded with ships; and in the first five months of 1780, when 3751 cases

of fever were admitted during the decline of the epidemic, one in eight

died. The following shows how much fever preponderated at Haslar Hospital

in 1780. In 8143 admissions on the medical side, the chief forms of

sickness were as follows[201]:

Continued Fevers 5539

Scurvy 1457

Rheumatism 327

Flux 240

Consumption 218

Smallpox 42

Blane gives the instance of the ‘Intrepid,’ one of the Channel Fleet

under Hardy in 1779: “Almost the whole of her crew either died at sea

or were sent to the hospital upon arriving at Portsmouth. This ship,

after refitting, was pretty healthy for a little time; but probably

from the operation of the old adhering infection, she became extremely

sickly immediately after joining our fleet and sent 200 men to the

hospital after arriving in the West Indies. Most of these were ill of

dysentery[202].” During a voyage of three weeks of the ‘Alcide’ and

‘Torbay’ from the Windward Islands to New York in September, 1780,

nearly a half of the men were unfit. In the ‘Alcide’ it was a fever

that raged, in the ‘Torbay’ it was a dysentery[203].

These experiences of fever in the ships of the Royal navy continued to the

end of the 18th century. In Trotter’s time, as in Lind’s, receiving ships

were a source of contagion to others, one ship of the kind, the

‘Cambridge’ having diffused fever among many ships of the Channel Fleet by

men drafted from her[204].

Ship typhus was also an incident of the voyages of the East India

Company’s ships, which nearly always carried troops. In the voyage of the

‘Talbot,’ 22 March--25 August, 1768, with 240 persons on board, “towards

the end of July a fever of a very bad kind made its appearance, attended

with delirium, low pulse, petechiae or livid vibices and hæmorrhages from

the nose, of which one died and three or four escaped hard.” The sick were

isolated, and the infection did not spread. Such outbreaks of typhus were

not uncommon at sea, although the loss of life from them was small beside

that from the fevers of Madagascar, Sumatra, Batavia and Bengal. The ship

typhus usually began on board among the soldiers. The most notable point

is that relapses were common, as Lind also observed at Haslar Hospital;

some on board the ‘Lascelles’ in 1783 (150 attacks among 151 soldiers) had

relapsed seven times. It does not appear, however, that the best class of

merchantmen suffered greatly from fevers. Dr Clark, who compiled a report

of the practice in fevers in the ships of the East India Company from 1770

to 1785, had reason to congratulate the Company on the general healthiness

of their fleet:

“When ships set out at a proper season, when they are not too much

crowded, when the weather is favourable, and no mismanagement appears,

fewer lives are lost in these long voyages than in the most healthy

country villages. And in perusing the medical journals I have the

peculiar pleasure of finding that many ships have arrived in India

without the loss of a single life by disease,” e.g. the ‘Valentine’ in

1784, seven months out, with 300 souls, no deaths, and the

‘Barrington’ in 1789, no deaths outward bound[205].

On the other hand, these English reports give incidentally the most

unfavourable accounts of the Dutch East Indian ships. Three Dutch ships,

then in Praya Bay, St Jago (Cape de Verde Islands), had buried 70 to 80

men each, and had some hundreds of sick on board. Another report says:

“Before we left Table Bay several Dutch ships arrived, some of which had

buried 80 people in the voyage from Holland. None lost less than 40 men. I

am informed that some of their ships last year buried 200 men”--the causes

of the sickness being overcrowding, filth, and the slowness of the

voyages. One experience of the very worst kind happened to an English

expedition consisting of the 100th regiment, the 98th regiment, the second

battalion of the 42nd, and four additional companies. They had formed part

of the force for the reduction of the Cape of Good Hope, whence they

re-embarked for Bombay. During the voyage from Saldanha Bay a contagious

fever and scurvy broke out among the troops, who were crowded and badly

clothed; dead men were thrown overboard by dozens, and the regiments were

reduced to a third of their original numbers. Six officers of the 100th

regiment died, and an equal if not greater proportion of those of the 98th

and 42nd.

The other chief occasion of ship typhus was the emigration to the American

and West Indian colonies from Britain and Ireland. The Irish emigration

was especially active from the beginning of the 18th century, owing to

rack-renting and other causes. Madden[206] professed to know that

one-third of the Irish who went to the West Indies (perhaps he should have

included Carolina) perished either on the voyage or by diseases caught in

the first weeks after landing; and as we know that typhus attended the

Irish emigration in the 19th century, we may infer that the same was the

cause of mortality in the 18th.

The trouble from ship-fever in the navy was so great all through the 18th

century that many ingenious shifts were tried to overcome it. Towards the

end of the century, the favourite device was fumigation with the vapour of

mineral acids; one such plan, for which the Admiralty paid a good sum,

ended in the burning of several ships to the water’s edge. An earlier plan

was ventilation of the hold and ’tween decks by means of Sutton’s

pipes[207], which found a strong advocate in the Rev. Stephen Hales, of

the Royal Society[208].

Twice in the course of a paper to that learned body[209] he asserts that

the noxious, putrid, close, confined, pestilential air of ships’ holds and

’tween decks “has destroyed millions of mankind”; on the other hand,

according to the testimony of a captain of the navy, Sutton’s pipes had

kept his ship free from fever. Lind caps this with the case of H.M.S.

‘Sheerness,’ bound to the East Indies. She was fitted with Sutton’s pipes,

the dietary being at the same time so arranged that the men had salt meat

only once a week. After a very long passage of five months and some days

she arrived at the Cape of Good Hope without having had one man sick. “As

the use of Sutton’s pipes had been then newly introduced into the king’s

ships, the captain was willing to ascribe part of such an uncommon

healthfulness in so long a run to their beneficial effects; but it was

soon discovered that, by the neglect of the carpenter, the cock of the

pipes had been all this while kept shut[210].”

Ship-fever was at length got rid of by more homely and more radical means

than scientific ingenuity. Lind had shown one root of the evil to lie in

the pressing of men just out of gaol. Admiral Boscawen, by his unaided

wits, discovered another means of checking it. He avoided the mixing of

fresh hands with crews seasoned to their ships, unless when some evident

utility or necessity of service made it proper; “and upon this principle

he used to resist the solicitation of captains, when they requested to

carry men from one ship to another when changing their command[211].”

Towards the end of the 18th century many reforms were made in the naval

service--in the dietary, in the allowance of soap, in keeping the bilges

clean, in the use of iron and lead instead of timber; so that Blane dates

from the year 1796 a new era in the health of the navy[212].

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

Century.

Resuming the history of fevers among the people at large from the great

typhus epidemic of 1741-42 to the end of the century, we find the

conditions somewhat different in the earlier and later divisions of the

period. The time of prosperity, when England exported large quantities of

wheat in every year except two or three, is reckoned from 1715 to 1765;

after the latter date England gradually ceased to be an exporting country,

owing to various causes, including the increase of pasture farming and the

growth of industrial populations in the northern counties. The year 1765

marks the beginning of what has been called the Industrial Revolution; and

it is also an important point of time in the history of the fevers of the

country, for it is in the generation after that we obtain all the best

information on what may be called industrial typhus, in the writings of a

group of physicians who were at once philanthropic and exact. But there

was an earlier period of fever, which is somewhat difficult to the

historian. It is perhaps the last period in which Sydenham’s language of

“epidemic constitutions” seems to be appropriate, whether it be that the

writers of the time were still under his influence, or because the

prevalent maladies could not well be accounted for in any other way. The

constitution in question was a “putrid” one. It coincided with the great

outburst of putrid or gangrenous sore-throat, to be described elsewhere;

and it included an extensive prevalence of fevers which were also called

putrid or nervous, and sometimes called miliary. Fevers of the same kind,

and with the same miliary rash, are described by earlier writers, such as

Huxham. Perhaps the most correct view of the matter is to consider this

type of fever as corresponding roughly to the middle third of the century,

and as having been interrupted by the typhus epidemic of 1741-42, during a

time of special distress. Besides the great outburst of putrid or

malignant sore-throat, there was also a disastrous murrain of cattle for

several years; and at Rouen there was a remarkable fever which some

English writers of the time took to be the highest manifestation of the

same “putrid” constitution that they discovered also in the English and

Irish fevers.

The fever at Rouen which Le Cat specially described to the Royal

Society was an outbreak from the end of November, 1753, to February,

1754. This outbreak was only one of a series; but as it attacked a

great number of persons of distinction and made great havock among

them, it attracted unusual notice and was regarded as something new,

the rumour spreading over Europe that Rouen had been visited by

plague. The same fever, however, had occurred there in previous years;

and allied forms of sickness, of the same gangrenous character,

including gangrenous sore-throat, could be traced back for twenty or

thirty years. It will suffice to mention of these the malignant fever

which appeared in 1748 and continued in 1749, 1750 and 1751. There was

a fixed pain in the head, pain about the heart, a low fever with

delirium, often miliary eruptions, continual faint sweating,

drowsiness, scanty or suppressed urine, abdominal distension. After

death the stomach was found “inflamed” at places, as well as the small

intestine. In some cases there were ulcerations which almost

penetrated the coats. The lungs were engorged with blood. In one case,

of a young woman aged twenty, the mesentery was filled with obstructed

glands and the intestines mortified in different places. In another,

almost the whole mesentery was mortified and there was an anthrax or

carbuncle at the upper fore part of the armpit. At the same time some

cases of smallpox, with miliary eruption, also had ulcerations of the

stomach, with inflammatory spots on other parts of it and of the

intestine, the mesenteric glands being enlarged and hard. Some of the

cases at the Hôtel Dieu in 1750 were traced to infection from bales of

horse-hair; but the type of the disease in those cases did not differ

essentially from that of other cases. Some rapidly fatal cases in the

winter of 1752-53 had suppurative inflammation about the heart. (In

1739 there had been deaths from continued fever at the Hôtel Dieu,

after an illness of six or seven days, marked by frequent faintings,

small abscesses being found after death in the substance of the heart

near the auricles.) The fever among the upper classes in the winter of

1753-54 was marked, in its most mortal form, by lowness, continued

fever, pain in the head, cough, sore-throat, nausea, dry black tongue,

delirium, sweats, stupor, some oppression of the heart, spitting of

blood, sometimes swelling of the belly, these symptoms being followed

often by miliary eruption, and sometimes by a slight flux with blood.

Many were affected with a dejection of spirits, and with a feeling of

terror which made them tremble at the ordinary sound of the voice. The

fever ran a full course of thirty or forty days (the miliary eruption

coming about the 21st day), while death usually ensued about the 25th.

The appearances after death were remarkable (many bodies were opened):

“In some a part of the villous coat of the stomach and of the small

guts was inflamed; and the rest of these organs were filled with an

eruption of the miliary crystalline kind, except that it was larger;

and there was likewise an obstruction in the glands of the mesentery.

In others a strong inflammation had seized the whole stomach and a

small portion of the oesophagus, but the intestines were free.... In

those cases where the delirium had continued long and violent, we

found either ulceration on the stomach, or its villous coat separated,

together with a great inflammation, and even some gangrenous spots, on

the other coats of that organ.” Some recovered by critical abscesses.

Others who escaped death by the poison carried its terrible effects

for many months; their limbs and joints were feeble, and they were

troubled with vertigo, lassitude and fears[213].

Exactly covering the period of these fevers at Rouen, there were low

putrid fevers in London, in Worcestershire, in Ireland, and among the

English colonists in Barbados. It was certainly not a mere fashion in

medicine which produced the accounts of a similar fever, for these

accounts came from places far apart and were independent of each other. Dr

Fothergill, of Lombard Street, published in the _Gentleman’s Magazine_

every month for five years a short account of the weather and prevalent

diseases of London, beginning with April, 1751, and ending with December,

1755. He had the weekly bills of mortality before him, and he makes

various comments upon them; but his accounts of prevalent diseases are

from his own observation and by way of illustrating the bills. His first

reference to a fever is under October, 1751: “A slow continual fever, with

acute pain in the forehead: not many attacked, few mortally.” The year

1752 was remarkably free from fevers until November, when we read of a

fatal fever which had rheumatic symptoms at first (as at Rouen in 1744),

attacking the head later, with coma-vigil and a dark-coloured ichor on the

tongue and lips. It continued into January and February, 1753, proving

fatal to several. In the summer and autumn months there were fevers of the

low, depressed kind, sometimes called “remittents,” with copious sweats,

or “slow, remitting, dangerous fever,” or “slow, treacherous, remittent

fever, too often fatal.” The references to it are most numerous in the

months from November, 1753, corresponding to Le Cat’s Rouen narrative. It

was slow and imperceptible in its approach, the sick often going about ill

for a week before seeking advice; it was attended with profuse sweats

which never relieved, and was fatal to many. It continued more or less

through the summer, and from August, 1754, it is again prominent. In

September, it was the most alarming form of disease, and was then commonly

vehement in its access, with lassitude, and pain in the head and back;

unrelieving sweats are again mentioned, with dry tongue, delirium,

coma-vigil, and death about the 14th-15th day. Fothergill was at a loss to

know whether he should order blood to be drawn, owing to the low depressed

nature of the fever. In February, 1755, the fever is still “too much of

the nature of those which prevailed in the preceding months to allow a

repetition of bleeding.” In April it is called the petechial and miliary

fever, the miliary eruption being of a white sort with a very noisome

scent; the petechial spots turned livid, black and gangrenous; few

patients escaped who had been sweated at the beginning. The fever was

truly malignant, the patient restless from the outset, the sweats

weakening. Fothergill’s last entries of it are important, under the months

of May and June, 1755. In May, 1755, the fevers were “for the most part

allied to that dangerous remittent which has for some years past more or

less prevailed in different places of this kingdom.” In June: “It does not

appear that either in the hospitals or any part of the city a disease has

broken out of so dangerous a nature as has been reported. The same kind of

fever that has long continued in this city with some small variations in

its type, still remains, but it is by no means more frequent than it has

been in the preceding months, nor is it attended with more unfavourable

symptoms.”

It is impossible to say how general over England this fever may have been

in the years 1751-57. Our fullest accounts come from Worcestershire; but

the putrid fever is heard of more widely. Thus a short Latin piece in the

_Gentleman’s Magazine_, dated 14 April, 1755, is on the putrid fever

lately epidemic, and not yet extinct, in some parts of the county of

Somerset and adjoining places; its signs were contagiousness, pains of the

head and loins, nausea and vomiting, diarrhoea, quick weak pulse, purple

spots, delirium and coma[214]. Grainger, writing from Edinburgh in 1753,

declares his motive for publishing an account of the anomalous fever of

the Netherlands in 1746-48 to be that the same had lately been raging over

almost the whole of Britain.

We have some particulars for Kidderminster, which can hardly have been

exceptional for an industrial town, and according to the accounts were

true also for villages and market towns near. Kidderminster was, in the

year 1756, a town of about four thousand inhabitants, mostly hand-loom

weavers of worsted and silk. There were no power-looms anywhere in England

at that time; and the condition of the Kidderminster weavers’ houses was

doubtless what that of the Tiverton community had been fifteen years

before. Many of the weavers, we are told, are lodged in small nasty

houses, for the most part crowded with looms and other utensils[215]. Many

of these houses were built on a low flat of the river Stour, whence rose

putrid vapours after floods. Its situation had served to render the town

specially unhealthy before, as in the epidemic of 1727-29[216].

The first notice by Dr Johnstone is of a low miliary fever from Midsummer

1752 to the end of the year. This was a comparatively mild affair,

although it carried off several. But after Christmas it was succeeded by a

fever which would then have been classed as of the putrid kind. The first

great season was in 1753, it ceased in the fine years 1754-55, but came

back in 1756 and 1757. It began with languor, lowness, flutterings,

faintness, vague pains in the limbs, a low quick pulse, giddiness and

slight sickness. Some had a propensity to loose stools and to profuse

hurtful sweats; some bled at the nose, others coughed and spit blood; some

had pain in the throat, and crimson-red tongue, the sweat and breath of

the sick had a strong, offensive, putrid smell. In some of the worst cases

livid petechiae, large livid blotches, and dark brown spots occurred over

the trunk and limbs. The successful treatment was by mineral acids, bark,

port wine, and vesication. “This malignant fever was very often (though

not constantly) complicated with, and in general bore great analogy to the

malignant sore-throat which at this time prevailed in many parts of

England.” The fever which prevailed during that remarkable year (1753) was

very evidently contagious, for whole families were either all together or

one after another seized with it. One of the most distinctive symptoms was

a tendency to trembling of the whole body, as well as leaping of the

tendons at the wrists. In some the tonsils were beset with aphthous

sloughs, and towards the decline there would be aphthae of the mouth, but

symptomatic only, and not the dominant lesion as in the ulcerous

sore-throat. About the 15th day the fever was generally at its height. The

miliary eruptions were critical to the few that had them; the flat livid

petechiae appeared at all times of the disorder. Johnstone then compares

the fever with that described by Le Cat at Rouen in the winter of the same

year; and although he had been unable to satisfy his curiosity by opening

any body dead of the fever, he felt sure that these dreadful symptoms

arose from some affection of the stomach and small guts, at first

erysipelatous, afterwards gangrenous, and at last truly sphacelous.

Johnstone’s statement that the putrid fever in Worcestershire in 1752-53

was often complicated with and bore great analogy to the malignant

sore-throat is borne out by Huxham’s accounts for Plymouth during the same

season:

“In all sorts of fevers,” he writes, “there was a surprising

disposition to eruptions of some kind or other [including miliary], to

sweats, soreness of throat and aphthae.” It is hardly possible to make

out all his cases of “malignant anginose fever” to have been scarlet

fever with sore-throat. Thus there occurred stench, swelling, and

samious haemorrhages “commonly in those that died of malignant

anginose fever above described. I have known the whole body swell

vastly, even to the ends of the fingers and toes, with a cadaveric

lividity, though almost quite cold, and an intolerable stench, even

before the person was actually dead, blood issuing at the same time

from the ears, nose, mouth and guts[217].”

The first years of this putrid or miliary fever were not seasons of

scarcity, there having been no failure of the crops since 1741 (unless in

Ireland, in the province of Ulster mostly, in 1744); on the contrary, many

of the seasons had been unusually fine and abundant, the exports from

England of wheat, barley, malt and rye in the three years 1748, 1749 and

1750 amounting to four million quarters. Prices were at the same time

favourable to the poorer classes[218]. But there had been a destructive

murrain for several years (30,000 cows are said to have died in Cheshire

in 1751), and the harvest of 1756 was a failure.

To the month of February, 1756, the season had been very forward, but the

early promise of spring was blighted by cold, a wet summer and autumn

ensued, the fruit crop was ruined, and the corn harvest spoiled by long,

heavy rains. A dearth, bread-riots, &c. ensued[219]; but it is to be noted

that the revival of the dangerous malignant contagious fever began at

Kidderminster as early as April, becoming much worse after harvest. “Many

for weeks or months laboured under an uncommon depression of spirits, felt

their strength abate, with great lassitude, and very often a great

proneness to faint away.” As the summer advanced the fever became truly

epidemic not only in Kidderminster but in many other parts of the West and

North-west of England.

It went through whole families, who succumbed either all together or

one member after the other, and was carried from place to place by the

attendants on the sick. “It prevailed chiefly in poor families, where

numbers were lodged in mean houses, not always clean, but sordid and

damp. It seemed to affect such poor families most where there was

reason to think a sufficiency of the necessaries of life, on account

of the dearth, had for some time been scantily supplied; yet the other

poor persons, given to the intemperate use of malt liquors and ardent

spirits, were observed to be very much liable to its influence. And

not a few persons in easy circumstances of life were affected with

this fever like others.”

Frost in October checked it, and then measles of a malignant type had its

turn among the children, the whooping-cough succeeding the measles. From

November to Christmas the putrid fever, which chiefly affected persons

from ten to fifty, and more women than men, returned with increased force.

In fatal cases, the face was ghastly, sunken and livid (the facies

Hippocratica), the patient sweated profusely, but seldom became cold till

death was at hand. There was an abominable cadaverous stench in the

breath, perspiration and stools. In these cases death took place from the

12th to the 14th day.

The intense and long frost of the opening months of 1757 nearly put a stop

to the fever at Kidderminster.

“But in other neighbouring villages and market towns it has since the

spring hitherto (Dec. 1757) been very frequent in places that were

little affected with it last year. The families of the poorer sort of

people universally are the most subject to it. And it is observable

that the fever in some places first broke out in the parish

workhouses, and from thence spread among the neighbouring people with

great malignity. Wherever it has appeared it has given very apparent

and fatal evidence of its infectious nature[220].”

Parliament was summoned to meet in December, 1756, on account of the

dearth, which formed the topic of the Speech from the throne. The export

of corn (which had reached a million quarters a year not long before) was

prohibited, and the use of grain in distilling stopped for two months. The

distress was more acute in 1757, and was enhanced by the greed of

corn-dealers and millers, who used French bolting-mills to grind the mere

husks of wheat, pease, rye and barley together into meal. Short, who

practised at Sheffield, says that the fever in October and November, 1757,

“was neither so rife nor fatal as in 1741[221].” It raged fiercely in

several towns at a distance, “where it went by the name of the miliary

fever,” and was mostly among the poor, half-starved in the dearth of

1756-57. It is heard of again in the district of Cleveland in the winter

of 1759-60, where it seems to have been mostly a disease of children

complicated with sore-throat, and allied more to scarlet fever than to the

putrid fever of adults[222]. But at Sunderland, near at hand, there was

spotted fever at the same time, and in Newcastle there was dysentery.

The accounts of fever in Ireland in the same period as in England (see

chapter II.) are not without value, as showing that the “putrid” or

nervous type of fever, contrasting with the ordinary typhus of the

country, had been remarked there also. Rutty and Sims describe, during a

certain period, the symptoms of the low, putrid fever, sometimes with

miliary eruptions, identifying it both by name and in character with the

fever then prevalent in England. The most significant thing in Rutty’s

annals is that there occurred in the midst of the low, putrid fever with

miliary pustules in 1746, a more acute fever, ending after five or seven

days in a critical sweat, and relapsing. The same fever, not very fatal,

reappeared in 1748. Sims brings the history of the nervous or putrid or

miliary fever in Ireland (Tyrone) continuously down to the year 1772, as

elsewhere related. The remarkable phenomenon of tremors or shakings, which

most witness to, was seen by him in perfection in the year 1771:

The tremulousness of the wrists, he says, extended to all the body,

“insomuch that I have seen the bed-curtains dancing for three or four

days, to the no small terror of the superstitious attendants, who, on

first perceiving it, thought some evil spirit shook the bed. This

agitation was so constant a concomitant of the fever as to be almost a

distinguishing symptom.” These were not the shakings of an ague, for

there might be no intermission for days[223].

Perhaps the most surprising testimony to the existence of an “epidemic

constitution” of slow, continued nervous fever comes from the island of

Barbados. Hillary, who had kept a record of the prevalent diseases at

Ripon, continued the same when he settled in Barbados in 1751[224]. There

can be no doubt as to the appearance of this fever in February 1753, its

prevalence all over the island for eighteen months, and its disappearance

in September 1754, when, as he writes, “It now totally disappeared and

left the island, and, I think, has not been seen in it since” (1758). He

gives the same account of it as the observers in England and Ireland,

except that he does not describe miliary eruptions and describes jaundice

in convalescent children. It was insidious in its onset (as in London),

the patient often keeping afoot five or six days; the symptoms included

pains in the head, vertigo, torpor, lassitude, vigil, delirium, faintings,

partial sweats, involuntary evacuations, gulpings, tremors, twitchings,

catchings, coma and convulsions. Recovery was marked by copious equable

sweats and plentiful spitting. “This slow, nervous fever was certainly

infectious, for I observed that many of those who visited, and most of

them that attended the sick in their fever were infected by it, and got

the disease, and especially those who constantly attended them and

performed the necessary offices of the sick.” It was last heard of in the

remoter parts of the island.

Miliary Fever.

It will have been observed in the foregoing accounts of the predominant

fevers of the years (roughly) from 1750 to 1760 that there was often a

miliary eruption, but that it was far from constant. The constant things

were the lowness, depression, ill-smelling sweats, tremors of the whole

body or of the wrist-tendons, and other nervous or ataxic symptoms. But we

hear more of a miliary eruption in connexion with that than with any other

period of fevers in the history; and this was the time when a controversy

arose as to whether there was in reality a distinctive kind of fever

marked by miliary eruption. Some of the school of Boerhaave contended that

the phenomenon of miliary vesicles was due solely to the heating and

sweating treatment of the alexipharmac physicians. De Haën and others

answered that miliary fever was a natural form, independent of the mode of

treatment. The Boerhaavian contention may be admitted as good for such

miliary fevers as were described under that name in 1710 by Sir David

Hamilton[225]; nearly the whole of his sixteen cases appear to have been

made miliary by treatment, in so far as they became miliary at all. What

this physician did was to foretell the approach of miliary symptoms in

various maladies (about one-half of the cases being of lying-in women, and

the rest various), and then to prescribe Gascoign’s powder, Goa stone,

Gutteta powder, Venice treacle or other diaphoretics, along with diluents

and the application of blisters; the miliaria appeared about the breast,

neck, and clefts of the fingers in due course (tenth to fourteenth day).

So far as his clinical cases are concerned, the late appearance of miliary

vesicles, lasting a few days, is sufficiently explained by the powerful

drenches administered; and it can hardly be doubted that much of what was

called miliary fever was of that factitious kind. But even in Hamilton’s

essay we find indications of a real miliary type of fever; thus he

mentions a class of cases which look to be the same as those described by

Johnstone, Rutty, Sims and others forty years after--cases with

wakefulness, depression, tremblings of the tongue and hands, convulsive

movements and delirium. He mentions also a complication of this with

sore-throat in 1704, which destroyed many.

As to the association of miliary eruption with the low putrid fever so

characteristic of the sixth decade of the 18th century, it is asserted by

too many and in too various circumstances for any doubt as to its reality.

There is nothing to show that the alexipharmac treatment was the one

always used; and it is not certain that some in Ireland and elsewhere who

had miliary eruption received any medical treatment at all. Again, miliary

vesicles, not always with perspiration, were commonly found in the

relapsing fever of Irish emigrants in London during the great famine of

Ireland in 1846-47, by which time the powerful drenches of the

alexipharmac treatment had been long disused[226]. The controversy as to

the reality of miliary fever was one of the kind usual in medicine:

certain physicians, of whom Hamilton in 1710 was an obvious instance, took

up an untenable position; they were answered according to the weakness of

their argument; and that has been held in later times to be an answer to

all who alleged the existence of a type of fever marked by miliary

eruptions. There can be no question as to a low, “putrid” kind of fever in

which miliary eruptions were usual; but offensive sweats were perhaps

more usual, whence the name of putrid in a literal sense, different from

the theoretical sense of Willis; more constant also were the starting of

tendons, the tremors and shakings, together with very varied hysteric

symptoms, from which the fevers received the name of nervous. Dr John

Fordyce in his ‘History of a Miliary Fever’ (1758) really describes under

that name the symptoms of the low, nervous, putrid fever, often attended

with miliary vesicles, which had been the common type in England in the

years immediately preceding, and was a common type for some time after,

although less is heard of the miliary eruptions in the later history[227].

About the last quarter of the 18th century medical writers were inclined

to drop the names of nervous and putrid as distinctive of certain fevers.

Pringle, in his edition of 1775, says he had been careful to avoid the

terms nervous, bilious, putrid and malignant, which conveyed either no

clear idea or a false one. Armstrong, another army physician, writing in

1773, says: “Nervous, putrid, bilious, petechial or miliary, they are all

of the malignant family; and in this great town [London] these are almost

the only fevers that have for many years prevailed, and do so still, to

the great destruction of mankind. For inflammatory fevers ... have for

many years been remarkably rare[228].” Dr John Moore becomes sarcastic

over the variety of names given to continued fever, some such generic name

as Cullen’s “typhus,” then newly introduced, being what he desired[229].

Haygarth, writing of the Chester fevers in 1772, said that the miliary

fever had been “supposed” endemic there for more than thirty years past,

but he thought it probable that the eruption had generally, or always,

been fabricated “by close, warm rooms, too many bed-cloaths, hot medicines

and diet.” He had seen only one case in the epidemic that year, and he

believed its rarity at that time was due to the treatment by fresh air and

by “such regimen and medicines as are cooling and check

putrefaction[230].” We shall see later that Percival, for Manchester,

contents himself with saying that miliary fevers, which were formerly very

frequent in that town and neighbourhood, now [1772] rarely occur[231]. In

Scotland as late as 1782 the type was still nervous or low, and hardly

ever inflammatory[232].

_Mortalities in London from fever and all causes._

Fever All

Year deaths deaths

1741 7528 32169

1742 5108 27483

1743 3837 25700

1744 2670 20606

1745 2690 21296

1746 4167 28157

1747 4779 25494

1748 3981 23069

1749 4458 25516

1750 4294 23727

1751 3219 21028

1752 2070 20485

1753 2292 19276

1754 2964 22696

1755 3042 21917

1756 3579 20872

1757 2564 21313

1758 2471 17576

1759 2314 19604

1760 2136 19830

1761 2475 21063

1762 3742 26326

1763 3414 26148

1764 3942 23202

1765 3921 23230

1766 3738 23911

1767 3765 22612

1768 3596 23639

1769 3430 21847

1770 3214 22434

It is singular to observe that in the five successive years in this period

with lowest fever-deaths and deaths from all causes, the years 1757-61

England was at war on the Continent. A similar low fever-mortality

corresponded with the wars under Marlborough and Wellington.

The era of agricultural prosperity in England, which had its only

considerable interruptions in the years 1727-29 and 1740-42, may be said

to have met with a more serious check from the bad harvest of 1756. There

was a recurrence of agrarian troubles in 1764-67, partly through actual

scarcity caused by the extreme drought of 1764, partly through the pulling

down of cottages and the discouragement of country villages, which

Goldsmith has pathetically described in his poem of the time. Short says

that the country in 1765 was in general very healthy but for children’s

diseases. “In some parts the putrid fever roamed about from place to place

in the highest degree of putrefaction, so as several dead bodies were

obliged to be buried the same day as they died.” The price of provisions

was excessive, meal riots broke out, and the export of corn was stopped,

Parliament having been summoned for the occasion in November, 1766[233].

In 1769, at the time of the formation of Chatham’s ministry, the same

train of incidents recurred,--bread-riots, flour-mills wrecked, corn and

bread seized by the populace and sold at low prices, collisions with the

military, the gaols full of prisoners[234]. The long period of cheapness,

having lasted half a century, was coming to an end. Moralists and

economists had much to say as to the meaning of the national distress

which began to be felt in the sixties. Want of industry, want of

frugality, want of sobriety, want of principle, said one, had brought

trouble on the working class. “The tumults that have lately arisen in many

counties of England are no other than the murmurs of the people, which

have been heard for some years, bursting forth at last into riot and

confusion.” The English, it seems, had returned to their old medieval

taste for the best food they could get; they would not give up the finest

bread, although the Irish lived on potatoes, and the French on turnips and

cabbage: “The ploughman, the shepherd, the hedger and ditcher, all eat as

white bread as is commonly made in London, which occasions a greater

consumption of wheat.” Women must have tea and snuff, though children go

naked and starved. Another writes: “The poorest people will have the

finest or none.” The enclosures had made a want of tillage. “What must

become of our poor, destitute of work for want of tillage?” The country

had for the most part been sickly, labourers scarce, and the farmers not

able to get their usual quantity threshed out. The profligacy of the poor,

profane swearing, etc., are remarked upon[235].

In the last thirty years of the 18th century the accounts of fever in

England became more detailed as to its circumstances, and more numerically

precise. I shall accordingly bring together all that I can find relevant

to fever in London, Liverpool, Newcastle and Chester, and thereafter in

those towns, such as Manchester, Leeds, and others in the North, which

were specially touched in their public health by the movement known as the

Industrial Revolution.

Typhus Fever in London, 1770-1800.