In the London bills of mortality the item of fevers diminishes steadily

during the latter part of the 18th century, the deaths from all causes

diminish, the births come nearer to the number of the deaths, and in three

years of the last decade they exceed them. This statistical result is

doubtless roughly correct; but the bills were becoming more and more

inadequate to the whole metropolitan area; and even for the original

parishes which they included they have not the same value for fever in the

later period as they had for plague at their beginning[236]. On the other

hand, from about the year 1770 we begin to have more exact medical

accounts of fever in London, which are not indeed numerically exhaustive,

but good as samples of what was going on. Whatever improvement there was

in the prevalence of typhus fever touched the richer classes. The Paving

Act of 1766 is credited with having improved the health of the City, and

there were many new streets and squares being built in the west end that

were, of course, free from typhus. It is to these desirable residential

quarters that the eulogies of Sir John Pringle[237], Dr John Moore[238]

and others apply. The slums of London were as yet unimproved, and but

little known to the physicians. Lettsom, who was one of the first of his

class to visit among the poor in their homes, has much to say of typhus

fever; but he is emphatic that it was nearly all an infection of the poor.

“In the airy parts of this city,” he writes in 1773, “and in large, open

streets, fevers of a putrid tendency rarely arise.... In my practice I

have attentively observed that at least forty-eight out of fifty of these

fevers have existed in narrow courts and alleys.” The same is remarked by

Currie for Liverpool, by Clark for Newcastle, by Percival and Ferriar for

Manchester, by Haygarth for Chester, and by Heysham for Carlisle.

The quarters of the rich had gradually become detached from those of the

poor. I have shown this more especially for Chester, where the old walls

made a clear division; but it was general in the second half of the 18th

century[239].

Medical practice lay mostly among the richer classes; the physicians knew

little of the state of health in the cellars and tenement-houses of large

towns. Those physicians who did know how much typhus fever there was in

these purlieus had to enter a caveat against the incredulity of the rest.

Dr Currie of Liverpool, whose facts I shall give in their place, protested

that he was not exaggerating; a protest the more necessary that a

contemporary of his own, Mr Moss, a middle-class practitioner, who wrote a

book specially on the medical aspects of Liverpool, declares that fever is

“rare” in that city, while Currie was treating from his dispensary a

steady average of three thousand cases of typhus every year. In the same

years, in February, 1779, a physician to the army, Dr John Hunter, who had

commenced practice in Mayfair, found on visiting in the homes of the

poorer classes in the west of London cases of fever for which he had no

other name than the gaol or hospital fever of his military experience; it

was so much a novelty to him, apart from campaigns or transport ships,

that he gave an account of his discovery of domestic typhus to the College

of Physicians[240]. At length he found so many cases steadily winter after

winter that he had them sent to the infirmary of the Marylebone Workhouse.

The practitioners who knew most of the sicknesses of the poor were such as

Robert Levett, Dr Samuel Johnson’s dependant, who lived with the doctor

in the house in Gough Square. Levett had been a waiter in a Paris

coffee-house frequented by the medical fraternity, and had acquired a

taste for and perhaps some knowledge of the healing art. He made his

modest living by the small fees or articles of food and drink which his

poor patients gave him. He had only to issue from the back of Gough Square

by the courts and alleys behind Fleet Street, and he would find in the

region between Chancery Lane and Shoe Lane hundreds of families seldom

visited by a physician or by a qualified surgeon-apothecary. The good

Levett was only one of a class. There had always been such humble medical

attendants of the poor in London. An Act of the third year of Henry VIII.

was directed against them at the instance of the privileged practitioners;

but the regular faculty is said to have proved in the sequel both greedy

and incompetent, and after thirty years there came another Act, couched in

terms that the bluff king himself might have indited (31-32 Henry VIII.),

which asserts those qualities of the profession in so many words, and

establishes the right of any subject of the king to practise minor surgery

and the medicine of simples upon his or her neighbours. That Act is still

part of the law of England, and under it Levett exercised a statutory

right, perhaps without knowing it[241]. There were many other regions of

courts and alleys all round the City on both sides of the water, which

must have been medically served by such as Levett, if served at all. It

was there that typhus was found and at length clinically described by

competent physicians, among the earliest of whom was Lettsom.

The General Dispensary in Aldersgate Street having been started in 1770

with one physician, Lettsom was chosen additional physician in 1773, and

threw himself into the work with great zeal[242]. In the first twelvemonth

he saw many cases of fever, as in the following table:

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

1773

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

hectica 2 2 4 13 4 2 3 4 9

inflammatoria -- -- -- -- -- -- -- 1 1

intermittens 3 1 7 1 1 1 1 -- 2

nervosa 4 3 4 14 7 11 4 5 1

putrida 14 19 14 25 14 21 34 22 11

remittens 6 10 5 4 3 6 7 3 12

simplex vel -- 2 1 6 2 5 4 5 --

diarium

1774

Total in

Febris Jan. Feb. March 12 months Died

hectica 12 18 13 86 3

inflammatoria 1 -- 2 5 --

intermittens 1 2 2 22 --

nervosa 1 5 4 65 3

putrida 6 7 5 192 8

remittens 13 10 3 82 --

simplex vel -- -- 4 29 --

diarium

The nervous, putrid and remittent fevers, belonging, to the same group,

make up the bulk of the fevers. The hectic fevers were almost all of

children. The fatal cases of fever were fourteen, the fatal cases in all

diseases for the year having been forty-four. What these putrid, nervous

and remittent fevers were, will now appear from some of Lettsom’s

descriptions. Fevers with symptoms of putrescency were marked by nausea,

bitter taste, and frequent vomiting, by laboured breathing and deep

sighing, offensive breath, sweats offensive and sometimes tinged with

blood, almost constant delirium, the tongue dry, the tongue, teeth and

lips covered with black or brown tenacious foulness, thrush and ulceration

in the mouth and throat, the urine with a dark sediment, the stools

excessively nauseous and foetid, and blackish or bloody, the eyes horny or

glassy, with the whites often tinged of a deep blood colour, spots on the

skin like fleabites, or larger haemorrhagic vibices, bleeding from the

gums, nose or old ulcers, hiccup near death, often a cough through the

fever. Lettsom’s treatment consisted in good liquors, Peruvian bark, and

above all fresh, or “cold” air: “When it is considered that putrid fevers

originate in close unventilated places, the introduction of fresh air

seems so natural a remedy that I have often admired its aid should have

been so long neglected[243].” Accordingly he persuaded the poor people to

open their windows, and dragged the sick out of doors as soon as it was

safe to do so; the effects, he says, were wonderful. His fifty-one cases

are most valuable illustrations of the perennial fever in the crowded

parts of London:

Case 1 is of a man aged forty who had occasion to visit a miserable

crowded workhouse in Spitalfields. He was instantly seized with such a

nausea and debility as induced him to keep his room as soon as he got

home. At the end of a week Lettsom found him in “the true jail-fever,

or, what is the same, a true workhouse-fever.” He had involuntary

stools and leaping of the tendons, and took more wine in a week than

he had done for many years.

Cases 2 to 12 were of several families in one house in a court in Long

Lane, Aldersgate Street, who had been infected by a discharged

prisoner from Newgate. Other cases follow, where the infection was

caught from visiting the sick. In Case 17, Lettsom applied blisters

“owing to the importunity of the friends,” but without advantage. Case

30, on 26th October, 1773, was of a family of six persons near Christ

Church, Lambeth, father, mother, boy of seventeen, child of two

(slight attack) and two maids. Other localities were courts off

Whitecross Street, Jewin Street, Little Moorfields, Chiswell Street,

and St Martin’s-le-Grand. Case 43 was of a woman, aged thirty, in

Bunhill Row; she attended a relation who died of a putrid fever, and

was herself attacked; her eyes were bloodshot, her skin marbled and

interspersed with a general deep-coloured eruption, her cheeks and

nose mortified. Cases 44-47 were of people in a “very helpless

situation” in Gloucester Court, Whitecross Street.

The year 1773, to which these experiences in a small part of London

relate, was one of high febrile mortality, according to the Bills. Two

years after, Dr William Grant was moved to write an ‘Essay on the

Pestilential Fever of Sydenham, commonly called Gaol, Hospital, Ship and

Camp Fever[244],’ which, as he said in his preface, “I often see in this

city: and though so common and fatal, appears not at present to be

generally understood.” It was, he says, “an indigenous plant, frequent in

this city, being produced by close confinement; but it often passes

unnoticed, because unknown.” The deaths by “fever” in the London Bills

were as follows until the end of the century:

_Deaths from Fever and from all causes in London._

Fever All

Year deaths deaths

1771 2273 21780

1772 3207 26053

1773 3608 21656

1774 2607 20884

1775 2244 20514

1776 1893 19048

1777 2760 23334

1778 2647 20399

1779 2336 20420

1780 2316 20517

1781 2249 20719

1782 2552 17918

1783 2313 19029

1784 1973 17828

1785 2310 18919

1786 2981 20454

1787 2887 19349

1788 2769 19697

1789 2380 20749

1790 2185 18038

1791 2013 18760

1792 2236 20213

1793 2426 21749

1794 1935 19241

1795 1947 21179

1796 1547 19288

1797 1526 17014

1798 1754 18155

1799 1784 18134

1800 2712 23068

There were higher figures in the years immediately before 1771, the years

to which the generalities of Fordyce and Armstrong relate. There is a

decline in the fever-mortality towards the end of the century; but it is

just from the years 1799-1800 that we have an account by Willan of the

prevalence and conditions of London typhus, than which nothing can well be

imagined worse. The intermediate glimpses we get of typhus in London in

the writings of Dr Hunter, physician, and of Dr James Sims, show that the

disease was perennial.

“In the month of February, 1779,” says Hunter[245], “I met with two

examples of fever in the lodgings of some poor people whom I visited

that resembled in their symptoms the distemper which is called the

jail or hospital fever. It appeared singular that this disease should

show itself after three months of cold weather. Being therefore

desirous of learning the circumstances upon which this depended I

neglected no opportunity of attending to similar cases. I soon found a

sufficient number of them for the purpose of further information. It

appeared that the fever began in all in the same way and originated

from the same causes. A poor family, consisting of the husband, the

wife, and one or more children, were lodged in a small apartment not

exceeding twelve or fourteen feet in length, and as much in breadth.

The support of them depended on the industry and daily labour of the

husband, who with difficulty could earn enough to purchase food

necessary for their existence, without being able to provide

sufficient clothing or fuel against the inclemencies of the season. In

order therefore to defend themselves against the cold of the winter,

their small apartment was closely shut up, and the air excluded by

every possible means. They did not remain long in this situation

before the air became so vitiated as to affect their health and

produce a fever in some one of the miserable family. The fever was not

violent at first, but generally crept on gradually ... soon after the

first a second was seized with the fever, and in a few days more the

whole family perhaps were attacked, one after another, with the same

distemper. I have oftener than once seen four of a family ill at one

time and sometimes all lying on the same bed. The fever appeared

sooner or later as the winter was more or less inclement, as the

family was greater or smaller, as they were worse or better provided

with clothes for their persons and beds, and with fuel, and as their

apartment was more or less confined. The slow approach of the fever,

the great loss of strength, the quickness of the pulse with little

hardness or fulness, the tremors of the hands, and the petechiae or

brown spots upon the skin, to which may be added the infectious nature

of the distemper, left no doubt of its being the same with what is

usually called the jail or hospital-fever.”

Dr James Sims, who had seen much of Irish typhus in Tyrone in his earlier

years, and had removed to London, wrote of typhus among the poor there in

1786, ten years before the more systematic and more circumstantial

descriptions by Willan[246].

This fever was exceedingly mortal, several medical men, he had reason to

believe, falling sacrifices to it. Sims never saw the cases till the 7th

or 8th day, when they were desipient, insensible, with pulse scarcely to

be felt and not to be counted, all having petechiae. None had scarlet rash

or sore-throat. They sank and died quietly; the strongest cordials did not

produce the smallest effect, and blisters in many did not even raise the

skin[247].

It is in the year 1796 that we begin to have the full and accurate records

by Willan of the prevailing diseases of London month by month as he saw

them at the Carey Street Dispensary, situated in the crowded quarter

between Holborn and the Strand[248]. His first reference to typhus is as

follows:

“In September, also, fevers usually appear which from their

commencement exhibit symptoms of malignancy; being attended with a

brown dry tongue, violent pain of the head, delirium, or coma,

deep-seated pains of the limbs, petechial spots and haemorrhagy. These

fevers become highly contagious, especially when they occur in close,

confined situations, and in houses where little attention is paid to

ventilation or cleanliness. The disease is extended by infection

during the months of October and November, but its progress is

generally stopped by the frosts of December.”

Willan says little more of fever in London until September, 1798, when

these contagious malignant fevers became more numerous, both in the city

and adjacent villages, than had been known for many years before; also the

fever was more fatal than usual, one in five or six dying, whereas one in

seven was formerly a very unfavourable death-rate, and one in twenty not

unknown. Haemorrhages, aphthae, diarrhoea, starting of the tendons,

picking the bedclothes, violent delirium, ending in deafness, stupor,

hiccough and involuntary evacuations, were the usual accompaniments of

this fever. In the corresponding months of 1799 he recurs to the symptoms

of this “malignant contagious fever,” and depicts typhus as clearly as may

be. In September, 1799, it was “attended with a dull pain of the head,

great debility or sense of lassitude and pains referred to the bones,

tremblings, restlessness with slight delirium, a querulous tone of voice,

a small and frequent pulse, heat of the skin, thirst and a fur upon the

tongue, first of a dirty white colour, but turning in the latter stage of

the disease to a yellowish brown. In this form the fever continued

thirteen days without any dangerous symptoms, and then suddenly

disappeared, leaving the patient, for some time after, languid and

dispirited. All the individuals of a family were successively affected

with the same train of symptoms; many of them so slightly as not to be

much confined to their beds.” In October and November he describes the

symptoms of the disease in a more dangerous form. By this fever, he was

informed, some houses of the poor had been almost depopulated, the

infection having extended to every inmate. “The rumour of a plague was

totally devoid of foundation.”

He then describes the state of the dwellings where such fevers

occurred--the unwashed bed-linen, the numbers in one bed, the rooms

encumbered with furniture or utensils of trade, the want of light and air

in the cellars and garrets and in the passages thereto, the excremental

effluvia from the vault at the bottom of the staircase. It cannot be

wondered at, he concludes, that contagious diseases should be thereby

formed, and attain their highest degree of virulence; and he estimates

that “hundreds, perhaps thousands” of labourers in and near London, heads

of families and in the prime of life, perished annually from such fevers.

He denies that his account is exaggerated, and appeals for the truth of it

to medical practitioners whose “situation or humanity has led them to be

acquainted with” the localities[249].

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

century.

Liverpool, in the last quarter of the 18th century, came next in size to

London, having a population (in 1790) of 56,000 to the capital’s estimated

800,000. According to a medical author, whose experiences lay among the

middle classes, it was everything that could be wished in the way of

healthfulness and prosperity; but it had a dark side as well. About 7,000

of the people lived in cellars underground, and nearly 9,000 in back

houses, in small confined courts with a narrow passage to the street.

“Among the inhabitants of the cellars,” says Currie[250], “and of these

back houses, the typhus is constantly present; and the number of persons

under this disease that apply for medical assistance to the charitable

institutions, the public will be astonished to hear, exceeds three

thousand annually.... In sixteen years’ practice I have found the

contagious fever of Liverpool remarkably uniform among the poor. Seldom

extending itself in any considerable degree among the other classes of the

community, it has been supposed that Liverpool was little subject to

fever; but this will be shewn from authentic documents to be a great and

pernicious error.” At the Dispensary in the year 1780 the cases of typhus

averaged 160 per month, the numbers being as remarkably steady from month

to month as from year to year. In the ten years from 1 January, 1787, to

31 December, 1796, 31,243 cases of fever were entered on the books of the

Dispensary, an average of 3124 per annum[251].

Of 213,305 cases of all diseases at the Dispensary in seventeen years,

1780 to 1796, 48,367, nearly one-fourth, were labouring under typhus.

Supposing that these were all the cases of typhus in Liverpool, and that 1

in 15 died, we should have some 150 deaths from typhus in a year.

Supposing also that typhus was relatively as common at that time in

London, it will follow that nearly all the deaths under “fever” in the

bills of mortality might well have been from typhus fever; for London in

its several densely populated out-parishes was the fever-quarter of

Liverpool a dozen times over[252].

The Newcastle Dispensary was opened in October, 1777, by the exertions of

Dr John Clark, who was in correspondence with Lettsom in London[253]. Dr

Clark had been in the East India Company’s service, and had seen much of

ship-fever and of the fevers of the East. During a visit to his home in

Roxburghshire in the summer of 1770, between his voyages, he attended

several persons in continued fever. When he settled at Newcastle he saw

the worst kinds of contagious fever, in workhouses and “in the sordid and

crowded habitations of the indigent.” Putrid fever, or typhus, was by far

the most common disease attended from the new dispensary, although less

than at Liverpool, the operations of the charity being on a much smaller

scale. It was seldom out of Newcastle a whole year; and in some years, as

1778, 1779, 1783, 1786 and 1787 it was unusually rife in particular

districts, often attacking whole families. Scarlet fever was epidemic and

very fatal in 1778 and 1779, while dysentery attacked great numbers of the

poor in the autumns of 1783 and 1785. The following Table shows the

principal diseases attended from the Dispensary during the first

twenty-three months of its working, 1 Oct. 1777, to 1 Sept. 1779:

_Newcastle Dispensary 1777-79._

Cases Too far

visited Cured advanced Dead

Putrid fever 391 357 9 16

Ulcerated sore-throat 146 125 11 9

Dysentery 72 55 5 4

Smallpox 45 29 5 6

From 1 Oct. 1777, to 1 Sept. 1789, the cases of typhus visited were 1920,

of which 121 were fatal. During the winter of 1790 and the spring and

summer of 1791 it was prevalent amongst the poor, and was frequently

introduced into genteel families and sometimes even into those of the

first distinction. That outbreak was supposed to have been generated in

the Gateshead poorhouse. For some time its ravages were confined chiefly

to the low, ill-aired, narrow street called Pipewell Gate. In September

it made its appearance in Newcastle; at first the contagion was easily

traced from Pipewell Gate, and afterwards from one house to another. In

that outbreak, 188 poor persons were visited from the Newcastle

Dispensary, the Gateshead poor having been attended by the parochial

surgeon. Clark’s ten cases recorded of the epidemic were all of people in

good circumstances. The Dispensary Tables show cases of typhus every year

down to 1850, the largest totals being in 1793 (374, 18 deaths), 1801

(435, 20 deaths), and 1819 (368, 14 deaths); and these, we may take it,

were but a small fraction of all the cases in Newcastle.

Perhaps the most unexpected revelation of typhus is at Chester, from the

time when Haygarth began to write upon its public health in 1772. Chester

was then one of the most desirable places of residence in England. Boswell

wrote to Johnson, “Chester pleases me more than any town I ever saw.” The

old city within the walls was occupied by a superior class of residents,

including the cathedral clergy, county families, retired officers and

Anglo-Indians, professional men, merchants and tradesmen. It had the best

theatre out of London. Squares, crescents and broad streets were replacing

most of the old buildings. The six parishes that lay entirely within the

walls had a population, in 1774, of 3502, and an annual average death-rate

(in the ten years 1764 to 1773) of 1 in 58 or 17·2 per 1000, the central

parish of St Peter having a rate of 1 in 62, and the cathedral parish 1 in

87. It passed as one of the healthiest cities in the kingdom, being far

before Shrewsbury and Nottingham, to say nothing of the large towns where

the burials exceeded the baptisms. But its moderate death-rate over all, 1

in 42 living, would have been much lower but for the four poor suburban

parishes, with a population of 11,211, which had a death-rate of 1 in 35.

Haygarth gives a deplorable account of them. The houses were small, close,

crowded and dirty, ill supplied with water, undrained, and built on ground

that received the sewage from within the walls. The people were ill-fed

and they seldom changed or washed their clothes; when they went abroad

they were noisome and offensive to the smell. Many of them worked on the

large farms around Chester, others at shipbuilding and shipping (Chester

had then a considerable foreign trade), others at the mills and markets,

others at a nail-factory, while others were employed by the tradesmen

within the walls. Fever seems to have been perennial among them, the

deaths from typhus having been 23 in 1772, 33 in 1773 and 35 in 1774. “In

these poor habitations,” says Haygarth, “when one person is seized with a

fever, others of the family are generally affected with the same fever in

a greater or less degree.” It became rifer than usual in August, 1773, and

attacked 285, proving fatal to 28, or to one in ten. It had the common

symptoms of malignant fevers produced by human effluvia, and particularly

affected the head with pain, giddiness and delirium. It attacked in

general the lowest, few of the middle rank, and none (or only one) of the

highest rank[254].

Chester had no manufactures. Its population had grown rapidly of late, as

that of Liverpool had grown, the poorer classes being the prolific part of

the community; but it had no share in the industrial revolution, it did

not employ its women and children in factories, and it was in some

respects better than Leeds, Warrington, Manchester, or Carlisle. It is a

good illustration of a town growing rapidly without manufactures, and of a

community divided by the old walls into two quite distinct sections, a

rich and a poor. Such had been the drift of things in England apart from

the industrial revolution; but it is the latter which furnishes the best

illustrations of a poor prolific populace, of a growing struggle, and of

the attendant typhus fever.

Fever in the Northern Manufacturing Towns, 1770-1800.

The prosperity of the first two-thirds of the 18th century had been

attended with a very small increase of population. From 1700 to 1750 the

numbers in England are estimated to have grown no more than from about six

millions to six millions and a half. The fecundity of many rural parishes

was swallowed up by emigration to the American and West Indian colonies,

by the army and navy, and by the great waste of life in London and some

other towns. The increase was nearly all north of the Trent, while the old

weaving towns of the south-west had actually declined. Gloucestershire,

Somerset and Wilts were the most crowded counties in 1700. During the next

fifty years, the greatest increase was as in the following rough

estimate[255]:

Increase

1700 1750 per cent.

Lancashire 166,200 297,400 78

West Riding of Yorks. 236,700 361,500 52

Warwickshire 96,600 140,000 45

Durham 95,500 135,000 41

Staffordshire 117,200 160,000 36

Gloucestershire 155,200 207,800 34

In the counties where population had increased most, much of the increase

was still rural or semi-rural. Defoe describes how the land near Halifax

was divided into lots of from two to six or seven acres, hardly a house

out of speaking distance from another, at every house a tenter, and on

almost every tenter a piece of cloth, or kersey or shalloon. Every

clothier kept one horse at least, to carry his manufactures to the market,

and nearly every one kept a cow, or two or more, for his family. The

houses were full of lusty fellows, some at the dye-vat, some at the looms,

others dressing the cloths, the women and children carding or spinning,

being all employed from the youngest to the oldest: not a beggar to be

seen, nor an idle person[256]. We have no accounts of the health of this

population, except Nettleton’s statistics of smallpox in and around

Halifax in 1721 and 1722, given elsewhere, and the “epidemic

constitutions” recorded by Wintringham at York during the same period, and

by Hillary at Ripon.

Before the earliest of the inventions of spinning by machinery, the

weavers were gathering to the towns of Yorkshire, Lancashire and other

counties north of the Trent. The spinning-jenny of Hargreaves was wrecked

by a Blackburn mob in 1768, and a mob wrecked the cotton-mill built by

Arkwright at Chorley eleven years later. This was decidedly a time of

movement from the country to the towns, a movement which preceded the

spinning ingenuity of the sixties and may have been stimulated by the

earlier use of the fly-shuttle in weaving.

Much of the country round Manchester, though it doubtless retained those

farm-houses, hedgerows, and field paths which come into the idyllic

opening of ‘Mary Barton’ more than half a century later, was “crowded with

houses and inhabitants,” as Percival says: so populous were the environs

of Manchester that every house in the township had been found by a late

survey to contain an average of six persons. The proportion of deaths was

less than in 1757; but that was chiefly due to the accession of new

settlers from the country, which raised the ratios of marriages and

births[257]. Manchester had increased from a population of about 8000 in

1717 to one of 19,839 (inclusive of Salford) in 1757. When the inhabitants

were next counted in 1773, they were found to be 22,481 in Manchester

(5317 families in 3402 houses) and 4765 in Salford (1099 families in 866

houses). According to Percival, who gives these figures, the death-rate in

1773 was 1 in 28·4, the births exceeding the deaths by forty in a year.

The poor, he says, were now better lodged, and some of the most dangerous

malignant distempers were less violent and less mortal. Manchester,

however, was still an unhealthy place compared with the country,

especially to young children. Thus, the thirty-one townships in the parish

of Manchester contained, exclusive of the city, 13,786 inhabitants (2525

families in 2371 houses), and of these only 1 in 56 died annually

(compared with 1 in 28 in the city)--the births being to the deaths as 401

to 246 in the year 1772.

Again, the bleak upland parish of Darwen with a population in the year

1774 of 1850 souls mostly occupied in the cotton manufacture, had, during

the seven years before, more than twice as many baptisms as burials (508

to 233), the birth-rate (1 in 25·5) being high and the death-rate (1 in

56) low.

Leeds had a population of some six or seven thousand at the time of the

Civil Wars, and lost 1325 in nine months of the year 1645 from plague, all

of them the poorer class. A generation or two later, in the time of

Thoresby’s ‘Diary,’ it was a centre of the cloth trade; and it appears to

have grown steadily throughout the 18th century. In 1775 it had a

population of 17,117. We hear from Lucas of an epidemic typhus in it

previous to 1779[258]. Eighty persons had died of that fever in one year,

and many who struggled through the disease died afterwards of lingering

complaints. In two courts or yards (such as might have been the Lantern

Yard which Silas Marner found pulled down when he revisited Leeds) forty

persons were affected with the fever; some families had received ten

shillings a week from the assessment for the poor. As early as 1779 Lucas

proposed a house of reception for contagious fever, a proposal which was

carried into effect in 1804, after a whole generation of typhus and at a

time when there was little fever in Leeds or elsewhere. The infectious

fevers, being chiefly confined to the poor, often prevailed, says this

writer, for a length of time without exciting much alarm, or without their

fatality being attended to; but, he adds about the year 1790, “should a

few of the higher rank receive the infection, then the disease is

described in most exaggerated terms.”

Carlisle was a good instance of the increase of urban population and the

breeding of typhus. In seventeen years, from 1763 to 1780, the inhabitants

had increased from 4158 to 6229, many of the immigrants being Scots and

Irish with their families. The chief industry was the making of calico, in

which the women and children were employed as well as the men. When Dr

Heysham surveyed the town and suburbs for his census of 1779, he had

“opportunity of seeing many scenes of poverty and filth and

nastiness[259]”; and in the bill of mortality for that year he confesses

himself astonished that there should be so little fever.

The great outburst of typhus at Carlisle began in the end of March, 1781,

with no very obvious special provocation[260]. Upwards of 600 had typhus

to February 7th, 1782, at which date 12 or 15 were still suffering from

it. The deaths were less than 1 in 10 of all attacked: viz. 2 in May, 4 in

June, 8 in July, 8 in August, 7 in September, 9 in October, 8 in November,

6 in December, and 3 in January, 1782, a total of 55. Of this total of

fatal cases, 3 were boys, 4 bachelors, and 15 husbands: 3 girls, 2 maids,

22 wives, and 6 widows. Two-thirds of all the deaths were of married

people; Heysham saw no case in a child under three years. It affected

about a tenth part of the inhabitants of Carlisle (6299), and raged most

among the lower class who lived in narrow, close, confined lanes and in

small crowded apartments, of which there were a great many in Carlisle,

generally going through all the inmates of a house where it had once

begun. On seeking to trace the origin of the epidemic, he found that it

began in the end of March, 1781, in a house in Richard-gate, which

contained about half-a-dozen very poor families. Every window that could

be spared was shut up, to save the window-tax. The surgeon who attended

some of these poor wretches told Dr Heysham that the smell was so

offensive that it was with difficulty he could stay in the house. One of

the typhus patients in this house was a weaver, who, on his recovery, went

to the large workshop where he worked, and there, it was supposed, gave

the infection (in his clothes) to his fellow workmen, by whom new centres

of infection were made in various other houses. In August, a young man

just recovered from the fever went to his mother’s in the small village of

Rockliffe, four or five miles from Carlisle, to get back his strength in

the country air; his mother soon took the fever and died, and a neighbour

woman who came to her in her sickness likewise caught it and died. These

were all the cases known in the village, and they show the enormously

greater fatality of typhus in those not inured to its atmosphere and

conditions.

The state of population and health at Warrington was peculiar, and is

given fully in another chapter. There could be no more striking instance

of the growth of what the foreign writers call the proletariat; an old

market-town, with a small sail-cloth industry from Elizabethan times, it

became a busy weaving town owing to the demand for sail-cloth during the

war with the American colonies. The whole population of some 9000 men,

women and children, were wage-earners; the women were all the while

unusually prolific, and the sacrifice of infant life was enormous,

especially by smallpox. We have no particular accounts of fevers; but in

the bill of mortality for 1773, the year of a disastrous smallpox

epidemic, there were 25 deaths from fever, of which 10 were of “worm

fever,” or the remittent of children[261].

By the year 1790, when Ferriar’s accounts of fever in Manchester begin,

the industrial revolution had been accomplished, mills were everywhere,

and the characteristic hardships and maladies of a prolific working class

in a time of slack trade were already much the same as we find them

pictured with fidelity and pathos in the pages of Mrs Gaskell half a

century after.

But, so as not to exaggerate the ill health of the working class in

Manchester at the end of the 18th century, let us compare the births with

the deaths according to the doubtless imperfect registers[262]:

_Manchester, Births and Deaths, 1770-91._

Year Births Deaths

1770 1050 988

1771 1169 993

1772 1127 904

1773 1168 923

1774 1245 958

1775 1359 835

1776 1241 1220

1777 1513 864

1778 1449 975

1779 1464 1288

1780 1566 993

1781 1591 1370

1782 1678 984

1783 1615 1496

1784 1958 1175

1785 1942 1734

1786 2319 1282

1787 2256 1761

1788 2391 1637

1789 2487 1788

1790 2756 1940

1791 2960 2286

The mean lodging-houses in the outskirts of the town, says Ferriar, in

1790[263], were the principal nurseries of febrile contagion: some of

these were old houses with very small rooms, into each of which four or

more people were crowded to eat, sleep, and frequently to work. They

commonly bore marks of a long accumulation of filth, and some of them had

been scarcely free from infection for many years past. As soon as one poor

creature dies or is driven out of his cell he is replaced by another,

generally from the country, who soon feels in his turn the consequences of

breathing infected air. There was hardly any ventilation possible, many of

these old houses being in dark narrow courts or blind alleys. In other

parts of the town the lodging-houses were new, and not yet thoroughly

dirty; but in these there was a long garret under the tiles, in which

eight or ten people often lodged, the beds almost touching. Again, many

lived in cellars, sleeping on the damp floor with few or no bedclothes;

the cellars of Manchester, however, were better ventilated than those of

Edinburgh, and freer from fever. These cellar-tenants were subject to the

constant action of depressing passions of the mind. “I have seen

patients,” says Ferriar, “in agonies of despair on finding themselves

overwhelmed with filth and abandoned by everyone who could do them any

service, and after such emotions I have seldom found them recover.”

Addressing the Literary and Philosophical Society of Manchester previous

to 1792, he pointed out in an _argumentum ad hominem_ that “the situation

of the poor at present is extremely dangerous, and often destructive to

the middle and higher ranks of society[264].” And again, “the poor are

indeed the first sufferers, but the mischief does not always rest with

them. By secret avenues it reaches the most opulent, and severely revenges

their neglect or insensibility to the wretchedness surrounding them[265].”

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

following cases:

A family of the name of Turner in a dark cellar behind Jackson’s Row:

they have been almost constantly patients of the Infirmary for three

years past on account of disorders owing to their miserable dwelling.

There are other instances of the same kind in Bootle Street.

In Blakely Street, under No. 4, is a range of cellars let out to

lodgers, which threatens to become a nursery of disease. They consist

of four rooms communicating with each other, of which the two centre

rooms are completely dark; the fourth is very ill-lighted and chiefly

ventilated through the others. They contain four or five beds in each,

and are already extraordinarily dirty.

In a nest of lodging-houses in Brook’s entry near the bottom of

Longmill-gate, a very dangerous fever constantly subsists, and has

subsisted for a considerable number of years. He had known nine

patients confined in fevers at the same time in one of those houses

and crammed into three small dirty rooms without the regular

attendance of any friend or of a nurse. Four of these poor creatures

died, absolutely from want of the common offices of humanity and from

neglect in the administration of their medicines. Another set of

lodging-houses constantly infected is known by the name of the Five

Houses, in Newton Street[266].

The fever in Manchester was not always malignant typhus: sometimes it had

the symptoms and low rate of mortality that suggest relapsing fever. Thus,

in the winter epidemic of 1789-90, very prevalent in Manchester and

Salford, out of Ferriar’s first ninety patients only two died; in some the

skin had a remarkable, pungent heat, in others there were profuse watery

sweats; women were commonly affected with hysterical symptoms during

convalescence, which was often tedious[267]. A certain number of these

cases would run into “a formed typhus,” with petechiae and all the other

signs of malignity; and in some seasons, as in the distressful year 1794,

typhus was the usual form. Two fatal cases in children, examined after

death, had peritonitis; “in the one no marks of the disease were

discernible within the cavity of the [intestinal] tube;” in the other, the

patient was covered with petechiae[268]. These cases of localized

inflammation in typhus he compares with Pringle’s cases of spotted fever

complicated with abscess of the brain.

The years 1792 and 1793 passed, says Ferriar, without any extraordinary

increase of fever patients, although the noxious influences were always

present. But in the summer and autumn of 1794 “the usual epidemic fever”

became very prevalent among the poor in some quarters of the town,

particularly after a bilious colic had raged among all ranks of people.

This was a time when work was slack; many workmen enlisted and left their

families. In November and December 1794, as many as 156 sent applications

to the Infirmary in a week to be visited in fever at their homes.

This was a memorable time of scarcity and distress all over the country,

the beginning of a twenty-years’ period of so-called “war-prices,” when

farmers’ profits were so large that they could afford to double or treble

their rents to the landlords. The history of epidemics comes at this point

into close contact with the economic history, which I shall touch on in

the sequel, after giving a few more particulars of typhus in England and

Scotland generally, previous to the outbreak of the war with France in

1793.

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

The introduction of machinery and the building of mills brought typhus

fever to places much less crowded than Leeds, or Manchester, or Carlisle.

Dr David Campbell of Lancaster saw much of typhus in that town, and in

mill villages near it, in the years 1782, 1783, and 1784. In Lancaster

town he saw about 500 cases, of which 168 were in men, with 20 deaths, 236

in women, with 11 deaths, and 94 in children under fourteen, with 3

deaths. At Backbarrow cotton mill, twenty miles from Lancaster, there were

180 cases, of which 38 were in men, with 5 deaths, 11 in women, with 2

deaths, and 131 in children under fourteen, with no deaths[269]. At this

mill there was an extremely offensive smell in the rooms, which came from

the privy; the doors of the latter, “for indispensable reasons in the

economy of these works, where so many children are employed, always

communicate with the workrooms.” Every care had been taken to keep the air

sweet, but without effect. The offensive smell was in all the cotton mills

from the same cause; and in the Radcliffe mill belonging to Mr Peel, the

typhus was ascribed to that source, the nuisance having been at length got

rid of. Both at Backbarrow and Radcliffe the houses of the workpeople were

new, airy and comfortable. In the same years typhus raged with uncommon

severity at Ulverston and in various parts of Lancashire, where

cotton-mills had been set up[270].

The typhus of Liverpool and Newcastle was reproduced in Whitehaven and

Cockermouth on a scale proportionate to their size. Whitehaven, the port

of the Cumberland coal-field, was the Newcastle of the west coast, and had

a large trade with Ireland. Many of the labourers lived in cellars.

Brownrigg’s experiences of typhus fever in it went back to near the middle

of the 18th century. The Whitehaven Dispensary was opened in 1783, the

occasion for it being thus explained:--

“Previous to the establishment of dispensaries Whitehaven and

Cockermouth were infested by nervous and putrid fever. Many of their

respectable inhabitants became its victims; and among the lower class

of people it prevailed with deplorable malignancy. The present period

happily exhibits a different picture. Notwithstanding our connection

with the metropolis of Ireland, and other commercial places, contagion

rarely appears; or, when accidentally introduced, is readily

suppressed[271].”

The following is the abstract of “contagious fever cases” from the records

of the Whitehaven Dispensary from 30 June, 1783, to 9 June, 1800[272]:

Year Cured Dead Total

1783 75 1 76

1784 401 9 410

1785 350 20 370

1786 91 6 97

1787 21 1 22

1788 53 7 60

1789 103 2 105

1790 288 21 309

1791 74 6 79

1792 17 2 19

1793 7 3 10

1794 13 1 14

1795 28 2 30

1796 48 1 49

1797 35 2 37

1798 12 1 13

1799 11 1 12

---- --- ----

Total 1627 85 1712

The year 1790 is indicated as an unhealthy one, by the excess of burials

over christenings, also at Macclesfield, where there were 316 christenings

to 380 burials, the proportion being usually the other way[273].

Dr John Alderson of Hull wrote in 1788 an essay on the contagion of fever,

in which there are no authentic details for Hull: “The calamity itself is

the constant complaint of every neighbourhood, and almost every newspaper

presents us with an example of the direful consequences of infection”--the

reference being to gaols more particularly[274]. Whatever was the reason,

there was undoubtedly a great deal of typhus in England in the eighties of

the eighteenth century. Oxfordshire, Gloucestershire, Worcestershire,

Wiltshire and Buckinghamshire experienced much typhus from 1782 to 1785,

although we have few particulars. “The remembrance of its ravages at

Gloucester, Worcester and Marlborough,” says Dr Wall of Oxford, “is still

fresh in every mind, where its virulence proved so peculiarly fatal to the

medical world.” At Aylesbury, Dr Kennedy survived an attack of the

“contagious fever,” to write an account (1785) of the epidemic, which he

traced to the gaol (the date, be it observed, is subsequent to Howard’s

visitations)[275]. At Maidstone, also, in 1785, the gaol fever was the

subject of a special account[276].

At Worcester in 1783 the younger Dr Johnstone caught typhus while visiting

the gaol, which was thereafter rebuilt at great expense. A prisoner took

it to Droitwich where 14 died[277].

Dr Wall gives clinical details of fifteen cases of typhus treated by him

in private practice at Oxford in 1785; one of his patients was an

apothecary whose business had exposed him very much to the influence of

contagion, as he was much employed amongst the poor in the suburbs of the

town and neighbouring villages and in the House of Industry[278]. In the

year 1783-85, much of the epidemic fever was of the nature of ague, as

described in another chapter. It is not always easy to separate it from

typhus; but there is no doubt that both were prevalent together. Thus in

the parish of Painswick, Gloucestershire, in the spring of 1785 there

occurred both “a contagious fever” and an “epidemic ague,” the latter

having left a good many persons dropsical and cachectic[279]. This had

been part of an epidemical fever which had raged for some time in the

county of Gloucestershire, and is said to have lately carried off a great

number of poor. At Norton, within five miles of Gloucester, there lived in

two adjoining tenements two families: in one a man and his wife and three

children, in the other a man and his wife, of whom only one remained alive

on the 1st of March, 1785[280].

The extraordinary failure of the harvest in Scotland in 1782 produced much

distress, and with it fever, in the winter following. The Glasgow and

Edinburgh municipalities imported grain for the public benefit. Various

traces of the scarcity and fever appear in the Statistical Account written

a few years after. Thus, in Holywood parish, Dumfriesshire, some fevers

were wont to appear in February and March among people of low

circumstances living in a narrow valley; and the unusual mortality in the

dear year 1782 was owing to an infectious fever in the same cottages. In

the regular bills of mortality of Torthorwald parish, Dumfriesshire, the

deaths from “fever” fall in the dear years, 1782-3, 1785, &c. In Dunscore

parish, in the same county, the burials of 1782 rose to the most unusual

figure of 30 (the baptisms being 17), “owing to a malignant fever[281].”

But Scotland was now past the danger of actual famine from even a total

failure of the harvest. Some farmers were ruined, and many more were

unable to pay the year’s rent; but the very poorest were enabled to find

food, one source being “the importation of white pease from America.” From

Delting, in Shetland, one of the poorest parishes, the report is: “There

is reason to believe that none died from mere want; but there is no doubt

that many, from the unwholesome food, contracted diseases that brought

them to their graves.”

The following relating to the parishes of Keithhall and Kinkell,

Aberdeenshire, in the scarcity following the lost harvest of 1782, is a

curiously detailed glimpse of the time:

“Several families who would not allow their poverty to be known lived

on two diets of meal a day. One family wanted food from Friday night

till Sunday at dinner. On the last Friday of December, 1782, the

country people could get no meal in Aberdeen, as the citizens were

afraid of a famine; and a poor man, in this district, could find none

in the country the day after. But the distress of this family being

discovered, they were supplied. Next day the [Kirk] session bought at

a sale a considerable quantity of bere, which was made into meal. This

served the poor people until the importation at Aberdeen became

regular, and every man of humanity rejoiced that the danger of famine

was removed[282].”

We hear most of fevers in the Highland parishes, with their subdivisions

of holdings and an excess of population. Thus of Gairloch, Ross-shire, it

is said: “Fevers are frequent, sometimes they are of a favourable kind, at

other times they continue long and carry off great numbers”--the poor in

this parish, upon the Kirk Session roll, numbering 84 in the year 1792,

and the aggregate money paid to the whole number averaging £6. 7_s._ in a

year, whereas the fertile parish of Ellon, Aberdeenshire, with 40 on the

poor’s roll, paid them £43 per annum.

Again, of the fishing village of Eyemouth, it is said: “The only

complaints that prove mortal in this place are different kinds of fevers

and consumptions; and these are mostly confined to the poorest class of

people, and ascribed to their scanty diet.” And of another fishing parish,

in Banffshire, Fordyce, including Portsoy, it is said: “The most prevalent

distemper is a fever, and that for the most part not universal, but

confined to particular districts. It is sometimes thought to arise from

infection and communication with other parts of the country; at other

times from local situations and circumstances of the people’s houses and

habits of living in particular districts[283].”

The beginning of the great French war was the occasion of a considerable

increase of fever; although no records make it appear so fatal a time as

the years 1783-86. The commercial distress and want of work which began in

the autumn of 1792, were intensified by the bad harvests of 1794 and 1795,

which followed two harvests also deficient. This was the period of

distress and of epidemic fever to which Wordsworth referred in the passage

in the first book of the ‘Excursion,’ where he is relating the story of

Margaret’s ruined cottage[284].

There is little medical writing upon the epidemic fever of 1794-95; and,

in the very district of Wordsworth’s story, the records of the Whitehaven

Dispensary bear no traces of a great concourse of patients. There is

reason to think that the fever, if slow and weakening, was seldom fatal,

that it was _typhus mitior_, and that it was sometimes, perhaps often,

relapsing. One glimpse we get of it in the family of the afterwards

celebrated Dr Edward Jenner of Berkeley, in the winter of 1794-95. He thus

writes to a friend about the visitation of “grim-visaged typhus:”

“You shall hear the history of our calamities. First fell Henry’s [his

nephew and assistant] wife and sister. From the early use of bark,

they both appeared to recover; but the former, after going about her

ordinary business for some days, had a dreadful relapse which nearly

destroyed her. It was during my attendance on this case that the

venomed arrow wounded me.... Like Mrs Jenner’s fever, at an early

period there was a clear intermission for four days.... On the eighth

day after the first seizure it again set in, in good earnest, and

continued one-and-twenty days.... Dr Parry was with me from Bath five

times, Dr Hicks and Dr Ludlow as many, and my friend George was never

absent from my bedside.... But, to return to that mansion of

melancholy, Henry’s. His infant girl has now the fever; a servant maid

in the house is dying with it; and to complete this tragical

narrative, about five days ago fell poor Henry himself. His symptoms

at present are such as one might expect: violent pain in the head,

vertigo, debility, transient shiverings.... His pulse this evening is

sunk from 125 to 100. The stench from the poor girl is so great as to

fill the house with putrid vapour; and I shall remove him this morning

by means of a sedan-chair to a cottage near my own house[285].”

This is a tolerably clear picture of a short-period fever with relapses,

or of relapsing fever strictly so-called; the stench, also, of one patient

is characteristic. Barker, of Coleshill or Birmingham, has much to say

under the same year 1794, of a slow, tedious fever, marked by “sluggish

action and comatose symptoms,” and much subject to relapses; but he does

not give the duration of the first or subsequent paroxysms, as Jenner

does, or the usual length of the clear intervals, his most definite case

being of a young woman who died in twenty-four hours from a relapse which

came on about three weeks after the fever had left her[286].

It was the access of fever in 1794-5, and the alarm that it caused among

the richer classes, that led to the opening of the Manchester House of

Recovery in 1796. In certain streets in the neighbourhood chosen for the

hospital, Portland Street, Silver Street and others in the same block, the

cases of contagious fever for nearly three years before the hospital was

opened are given by Ferriar as follows:

Sept. 1793 to Sept. 1794, cases of fever, 400

Sept. 1794 to Sept. 1795, " " " 389

Sept. 1795 to May 1796, " " " 267

The cases began to be sent to the hospital on the 27th May, 1796, and an

attempt was made to extinguish contagion in the houses, by white-washing,

disinfecting and the like; so that in the same group of streets there were

only 25 cases of fever from 13 July, 1794 to 13 March, 1797. Meanwhile the

admissions to the hospital were few until the dearth of 1799-1802. One of

the manufacturing towns which is known to have shared in the epidemic

fever of 1794-96 was Ashton-under-Lyne, where upwards of three hundred

cases (with few deaths) occurred in less than three months at the end of

1795. This epidemic must have been somewhat special to Ashton, for it

produced much alarm in neighbouring places and caused Ashton to be avoided

from fear of infection.

Shortly after 1796, Ferriar made an inquiry into an epidemic of fever at a

village within a mile of Manchester; the houses were many of them new,

built for the convenience of a large cotton mill; but even the new houses

were offensive, with cellars occupied by lodgers, and almost every house

overcrowded. This was the first fever in the village, and it was traced to

a family who had come from Manchester with infected clothes. Stockport

about the same time erected a House of Recovery, having “the same general

causes of fever which render the disease so common in Manchester”; and

Ferriar adds: “I believe there is not a town in the kingdom containing

four thousand inhabitants which would not be greatly benefited by similar

establishments.”

The bad harvest of 1794 raised the price of wheat to 55_s._ 7_d._ on 1

January, 1795, and the prospect of another short harvest to 77_s._ 2_d._

on 1 July. A famine being threatened, the Government caused neutral ships

bound to French ports with corn to be seized, and brought into English

ports, the owners receiving an ample profit. Agents were also sent to the

Baltic to buy corn. By these means the price of wheat, which had risen in

August to 108_s._ 4_d._, fell in October to 76_s._ 9_d._ Parliament met on

the 29th October, and various measures were taken[287]. In the spring of

1796, the climax of distress was reached, wheat being at 100_s._ per

quarter. The harvest of 1796 was abundant and wheat fell to 57_s._ 3_d._

The harvests of 1797 and 1798 were not equally good, but they were not

altogether bad, and the price of wheat kept about 50_s._ for nearly three

years, which were years of comparative comfort between the dearth of

1794-96 and the dearth of 1799-1802.

Fevers in the Dearth of 1799-1802.

Although Willan chooses the end of the year 1799 to enlarge upon the

London fever, he does not connect it with the dearth that was already

beginning to be felt (soup kitchens having been opened in various parts of

London). The price of wheat, which had been steadily about 50_s._ in 1797

and 1798, rose in May, 1799 to 61_s._ 8_d._, after a hard winter which had

probably injured the autumn-sown corn. The harvest turned out ill, and the

price of wheat rose in December, 1799, to 94_s._ 2_d._ Bounties were

offered on imported foreign grain, but in June, 1800, the price was

134_s._ 5_d._, falling in August to 96_s._ 2_d._ on the crops promising

well. The latter end of harvest proved wet, much of the grain being lost,

so that the price per quarter of wheat rose to 133_s._ in December. There

was much suffering, and some rioting. Parliament met on the 11th November,

1800, on account of the dearth, the opinions of the members being much

divided as to the causes of the high prices. In March, 1801, wheat was at

156_s._ 2_d._ per quarter, beef from 10_d._ to 10½_d._ per pound, mutton

11_d._ to 12_d._ per pound. It is to this year, when the quartern loaf was

at one-and-eightpence, that a comparison by Arthur Young belongs, showing

the great change in the purchasing power of wages[288]. By the end of

summer, 1801, wheat rose to 180_s._, and the quartern loaf was for four

weeks at 1_s._ 10½_d._

Whatever statistics were then kept of fever-cases, show a decided rise in

the years 1800 and 1801:

Manchester Glasgow London

House of Royal Newcastle Bills of

Recovery Infirmary Dispensary Mortality

Year (fever-cases) (fever-cases) (fever-cases) (fever-deaths)

1796 371 43 201 1547

1797 339 83 65 1526

1798 398 45 67 1754

1799 364 128 -- 1784

1800 747 104 -- 2712

1801 1070 63 425 2908

1802 601 104 -- 2201

1803 256 85 352 2326

1804 184 97 255 1702

1805 268 99 74 1307

The London Fever Hospital was not opened until February, 1802, a small

house in Gray’s Inn Lane containing sixteen beds. It came at the end of

the epidemic, and was in small request during the next fifteen years. The

same epidemic at Leeds was the occasion of opening a House of Recovery

there in 1804, twenty-five years after Lucas had first called for it. The

state of affairs in Leeds, which at length moved the richer classes to

that step, is thus described by Whitaker[289]:

“In the years 1801 and 1802 an alarming epidemic fever spread in Leeds

and the neighbourhood. The contagion extended so rapidly and proved so

fatal that some hundreds were affected at the same time, and two

medical gentlemen, with several nurses, fell victims to the

disease.... In 1802 whole streets were infected house by house; in one

court, of crowded population, typhus raged for four months

successively.”

One of the Leeds physicians, Dr Thorp, seized the occasion to urge the

need of a fever hospital, in a pamphlet written in 1802, in which he said:

“In a visit made a few days ago to those abodes of misery, I saw in

one particular district upwards of twenty-five families ill in

contagious fever. In some houses two, in others six or seven

[families] were confined, many of whom appeared to be in extreme

danger.” The superintendent of the sick poor stated to Dr Thorp “that

sixty families in epidemic fever are under his care at this time. New

applications are making daily. In some families three, in others six

or seven, are in the disease. Forty persons in fever have applied to

him for medical aid within the present week[290].”

The wonder is that, with the enormous prices of food, things were not

worse. At the time when provisions were dearest, work was slack in several

industries. A commercial report of 1 April, 1801, speaks of the trade of

Birmingham as very distressed, a large proportion of the men being out of

work; the ribbon trade of Coventry was deplorable, and the woollen trade

of Yorkshire still worse. Evidence of epidemic typhus in various parts of

England came out in connexion with the reports on influenza in 1803.

Holywell, in Flintshire, with a large cotton-making industry, had not been

free from a bad kind of typhus for two years previous to the influenza of

1803[291]. In Bristol there was a good deal of fever in 1802-3, which

found its way, through domestic servants, into good houses in Clifton,

“and proved fatal in some instances[292].” It is probable that these are

only samples, the writings on epidemics being singularly defective at this

period. The following, dated 10th April, 1802, by a surgeon at Earlsoham,

near Framlingham, Suffolk, gives us a glimpse of malignant contagious

fever in a farm-house:

“The most prevailing epidemics for the last twelve months have been

typhus maligna and mitior, scarlatina anginosa, measles, and mumps.

Many of the former have proved alarmingly fatal in several of our

villages, whilst those of the second class of typhoid fevers have put

on the appearance of the low nervous kind attended with great

prostration of strength, depression of spirits, loss of appetite,

etc., which frequently continue many weeks before a compleat recovery

ensues.” Five cases, of “the most malignant kind of typhus,” occurred

in a farmer’s family: one of the sons, aged eighteen, died in a few

days with delirium, and black sordes of the mouth, tongue and throat;

then the father, two daughters, and another son, took the infection

but all escaped with their lives. Of four persons who nursed them, one

caught the fever, and died. Four persons in a neighbouring family, who

visited them, took infection, of whom two died[293].

There was perhaps nothing very unusual in such instances of country fevers

at the beginning of the century. The incident is exactly in the manner of

one that figures prominently in a story of Scottish life and customs at

the same period, which long passed current as a faithful picture and as

enforcing a much-needed moral[294].

Comparative immunity from Fevers during the War and high prices of

1803-15.

From 1803 to 1816 there was comparatively little fever in this country.

This was notably the case in London, but it was also true of all the

larger towns where fever-hospitals had been established, and it was as

true of Ireland as of England. This was, indeed, a time of great

prosperity, which reached to all classes, the permanent rise of wages

having more than balanced the increased cost of the necessaries of life.

The following prices of wheat will show that a dear loaf did not

necessarily mean distress while the war-expenditure lasted:

Prices of wheat (from Tooke).

_s._ _d._

1802 57 1

1803 52 3

1804 Lady Day 49 6

Dec. 86 2

1805 Aug. 98 4

Dec. 74 5

1806 73 5

1807 Nov. 66

1808 May 73 6

Dec. 92

1809 March 95

July 86 6

Dec. 102 6

1810 June 113 5

Dec. 94 7

1811 June 86 11

Nov. 101 6

1812 Aug. 155

Nov. 113 6

1813 Aug. 112

Dec. 73 6

1814 July 66 5

1815 Dec. 53 7

1816 May 74

Dec. 103

1817 June 111 6

1817 Sept. 77 7

1818 Dec. 78 10

1819 Aug. 75

1820 72

1821 July 51

Dec. 50

1822 42

1823 Feb. 40 8

June 62 5

Oct. 46 5

Dec. 50 8

1824 65

The only years in the period from 1803 to 1816 in which there was some

slight increase of fever were about 1811-12. There was undoubtedly some

distress in the manufacturing districts at that time, owing to the much

talked-of Orders in Council, which had the effect of closing American

markets to British manufactures[295].

The small amount of fever in London between the year 1803 and the

beginning of the epidemic of 1817-19 rests on the testimony of

Bateman[296], who in 1804 took up Willan’s task of keeping a systematic

record of the cases at the Carey Street Dispensary. He has only two

special entries relating to typhus: one in the autumn of 1811, when some

cases occurred in the uncleanly parts of Clerkenwell and St Luke’s (“but I

have not learned that it has existed in any other districts of London”);

the other in October and November 1813, when there was more typhus among

the Irish in some of the filthy courts of Saffron Hill, near Hatton

Garden, than for several years past, the infection having spread rapidly

and fatally in several houses. The best evidence of this lull in typhus in

London is the almost empty state of the new fever-hospital:

Year Admissions

1802 164

1803 176

1804 80

1805 66

1806 93

1807 63

1808 69

1809 29

1810 52

1811 43

1812 61

1813 85

1814 59

1815 80

1816 118

1817 760

Until it was removed to Pancras Road, in September, 1816, the London

fever-hospital had only sixteen beds. But Bateman says that no one was

refused admission, and that for several years the house was frequently

empty three or four weeks together. Also at the Dispensary, in Carey

Street, he had an opportunity during the period 1804-1816,

“Of observing the entire freedom from fevers enjoyed by the

inhabitants of the numerous crowded courts and alleys within the

extensive district comprehended in our visits from that charity.” And

again, writing in the winter of 1814-15, Bateman says: “To those who

recollect the numerous cases of typhoid fevers [this term did not then

mean enteric] which called for the relief of dispensaries twelve or

fourteen years ago, and the contagion of which was often with great

difficulty eradicated from the apartments where it raged, and even

seized the same individuals again and again when they escaped its

fatal influences, the great freedom from these fevers which now

exists, even in the most close and filthy alleys in London, is the

ground of some surprise.” And once more, in the summer of 1816, just

as the new epidemic period was about to begin, he says: “The

extraordinary disappearance of contagious fever from every part of

this crowded metropolis during the long period comprehended by these

Reports [since 1804], cannot fail to have attracted the attention of

the reader.”

Bateman concluded, not without reason, that this immunity of London from

fever was due to the high degree of well-being among the poorer classes in

times of plenty; and although he made out that the poor of Dublin, Cork

and some Scotch towns did not profit by times of plenty so much as those

in London, yet his reason for the abeyance of fever from 1804 to 1816

applied to England, Ireland and Scotland at large, and was doubtless the

true reason.

The following figures from Manchester[297], Leeds[298] and Glasgow[299]

hospitals, as well as the Irish statistics elsewhere given, are closely

parallel with those of London:

_Manchester House of Recovery._

Year Cases Deaths

1796-7 371 40

1797-8 339 16

1798-9 398 27

1799-1800 364 41

1800-1 747 63

1801-2 1070 84

1802-3 601 53

1803-4 256 33

1804-5 184 34

1805-6 268 29

1806-7 311 33

1807-8 208 15

1808-9 260 21

1809-10 278 30

1810-11 172 15

1811-12 140 18

1812-13 126 13

1813-14 226 17

1814-15 379 29

1815-16 185 14

1816-17 172 6

_Leeds House of Recovery._

Year Cases Deaths

1804 (2 mo.) 10 0

1805 66 6

1806 75 2

1807 35 1

1808 80 3

1809 93 8

1810 75 14

1811 92 4

1812 80 12

1813 137 11

1814 79 4

1815 146 15

1816 121 13

1817 178 8

1818(10 mo.) 254 20

_Glasgow Royal Infirmary (Fever Wards)._

Year Cases

1795 18

1796 43

1797 83

1798 45

1799 128

1800 104

1801 63

1802 104

1803 85

1804 97

1805 99

1806 75

1807 25

1808 27

1809 76

1810 82

1811 45

1812 16

1813 35

1814 90

1815 230

1816 399

1817 714

1818 1371

Even such fever as there was in Britain from 1804 to 1817 was not all

certainly typhus. The high death-rates at the Manchester fever-hospital in

1804 and 1805 (1 death in 7·5 cases and 1 death in 5·25 cases) may mean a

certain proportion of enteric cases in those years. “From 1804 to 1805,”

says Ferriar, “many cases were admitted of a most lingering and dangerous

kind.... Many deaths took place from sudden changes in the state of the

fever, contrary to the usual course of the disease, and only imputable to

the peculiar character of the epidemic. Similar cases occurred at that

time in private practice.” Next year, 1806, there was an epidemic among

the troops at Deal, described under the name of “remittent fever,” which

Murchison claims to have been enteric[300]. In September, 1808, says

Bateman, several were admitted into the London House of Recovery, with

malignant symptoms; “and some severe and even fatal instances occurred in

individuals in respectable rank in life.” He still uses the name of

typhus; but he is aware that the cases of continued fever, especially in

the summer and autumn of 1810, had often symptoms pointing to a

bowel-fever rather than to a head-fever[301].

The years 1807 and 1808 appear to have been the most generally unwholesome

during this period of comparative immunity from fever; they were marked by

the occurrence of dysenteries, agues, and infantile remittents, as well as

of fevers of the “typhus” kind. The chief account comes from

Nottingham[302]. The cases of “typhus” there were very tedious, but not

violent, nor attended with any unfavourable symptoms, only one case having

petechiae, and all having diarrhoea. The following table of admissions

for various kinds of fever (as classified by Cullen) at the Nottingham

General Hospital, 25 March, 1807, to 25 March, 1808, shows the

preponderance of “synochus” and next to it, of infantile remittent:

_Admitted to the Nottingham General Hospital, 1807._

Intermittent fever 7

Synocha 10

Typhus 27

Febris nervosa 26

Synochus 155

Febris infantum remittens 88

Dysentery 5

The state of war in the Peninsula was favourable to epidemic or spreading

diseases, and there is a good deal to show that such diseases did exist

among the British troops[303]. But there is only one good instance of

England getting a taste of that experience of war-typhus which the

Continent had to endure for many years. This was on the return of the

remnant of the army after the defeat at Corunna on 16 January, 1809. The

troops were crowded pell-mell on board transports, which had a very rough

passage home. Dysentery broke out among them, and was the most urgent

malady when they landed at Plymouth in a state of filth and rags. Typhus

fever followed, but in the first three weeks at Plymouth, to the 18th of

February, it was not of a malignant type, only 8 dying of it in the Old

Cumberland Square Hospital; in the next three weeks, 28 died of it there.

Up to the 27th of March, 1809, the sick at Plymouth from the Corunna army

numbered 2432, of whom 241 died. Of 4 medical officers, 3 took the

contagion, of 29 orderlies, 25 took it. The fever was in some cases

followed by a relapse, which was more often fatal than the original

attack[304]. This was a typical instance of typhus bred from dysentery or

other incidents of campaigning, a contagion more dangerous to others than

to those who had engendered it. “Within a few yards of the spot where I

now write,” says Dr James Johnson, of Spring Gardens, London, “the greater

part of a family fell sacrifices to the effects of fomites that lurked in

a blanket purchased from one of these soldiers after their return from

Corunna[305].” In August, 1813, an Irish regiment passing through

Leyburn, a small market-town of the West Riding of Yorkshire, in an airy

situation, was obliged to leave behind a soldier ill of typhus, who died

of the fever after a few days. The infection appeared soon after in the

cottages adjoining, and remained in that end of the town for several

months, choosing the clean and respectable houses. In a farmer’s family, a

son, aged twenty-nine, died of it, while another son and two daughters had

a narrow escape. The disease appeared also in the village of Wensby, a

mile distant, and in other villages. Few lives were lost[306].

These were, perhaps, not altogether solitary instances in Britain of

typhus spread abroad by the movements of troops during the great French

war. Let us multiply such instances by hundreds, and we shall vaguely

realize the meaning of the statement that the period of the Napoleonic

wars, and more particularly the period from the renewal of the war in 1803

until its close in 1815, was one of the worst times of epidemic typhus in

the history of modern Europe. It was precisely in those years that

England, Scotland and Ireland enjoyed a most remarkable degree of freedom

from contagious fever.

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

and the fall of wages.

The long period of comparative immunity from typhus near the beginning of

the 19th century was first broken, both in Great Britain and in Ireland,

by the very severe winter of 1814-15; but it was not until the great

depression of trade following the peace of 1815 (which made a difference

of forty millions sterling a year in the public expenditure) and the bad

harvest of 1816 that typhus fever and relapsing fever became truly

epidemic, chiefly in Ireland but also in Scotland and England. The lesson

of the history is unmistakable: with all the inducements to typhus from

neglect of sanitation in the midst of rapidly increasing numbers, there

was surprisingly little of the disease so long as trade was brisk and the

means of subsistence abundant. The reckoning came in the thirty years

following the Peace.

In London, says Bateman[307], the epidemic began in the autumn of 1816,

before the influence of scarcity was acutely felt, in the courts about

Saffron Hill, the same locality in which he mentioned fever in the winter

of 1813-14 among the poor Irish. But this means little more than that the

Irish, whether in Ireland or out of it, are the first to feel the effects

of scarcity in producing fever. At the very same time that it began among

them in Saffron Hill, it began among some young people at a silk factory

in Spitalfields. In March, 1817, there was a good deal more of it in

Saffron Hill, as well as among the silk-weavers in Essex Street,

Whitechapel, in Old Street, in Clerkenwell, and in Shadwell workhouse.

Many poor-houses, and especially those of Whitechapel, St Luke’s, St

Sepulchre’s and St George’s, Southwark, were getting crowded in 1817 with

half-starved persons, among whom fever was rife in the summer and autumn.

There was also much of it in the homes of working people in the eastern,

north-eastern and Southwark parishes, with more occasional infected

households in Shoe Lane, Clare Market, Somers Town and St Giles’s in the

Fields (“in the filthy streets between Dyot Street and the end of Oxford

Street”)[307]. The hospitals and dispensaries were fully occupied with

fever, and the new House of Recovery in Pancras Road, with accommodation

for seventy patients, was soon full. At the Guardian Asylum for young

women, more than half of the forty inmates were seized with the fever in

one week. The cases were on the whole milder than in ordinary years; of

678 admitted to the House of Recovery in 1817, fifty died or 1 in 13·5. In

two-thirds of these patients the fever lasted two weeks or to the

beginning of the third week; of the remaining third, a few lost the fever

on the 7th, 8th or 9th day, a larger number on the 12th to the 14th day,

while a considerable number kept it to the end of the third week or

beginning of the fourth. Of the whole 678, only 75 had a free

perspiration, and in only 19 of these was the perspiration critical so as

to end the fever abruptly. The fever relapsed in 54 of the 678, a

proportion of relapsing cases which seemed to Bateman to be “remarkably

great[308].” In most the symptoms continued without break throughout the

illness. Besides other febrile symptoms, there were pains in the limbs and

back, aching of the bones, and soreness of the flesh, as if the patients

had been beaten. There was a certain proportion of severe complicated

cases of typhus. Bateman held that the differences in type depended on the

differences of constitution, giving the following reason for and

illustration of his opinion:

“Thus, in the instance of a man and his wife who were brought to the

House of Recovery together, the former was affected with the mildest

symptoms of fever, which scarcely confined him to bed, and terminated

in a speedy convalescence; while his wife was lying in a state of

stupor, covered with _petechiae_ and _vibices_; in a word, exhibiting

the most formidable symptoms of the worst form of typhus. Yet these

extreme degrees of the disease manifestly originated from the same

cause; and it would be equally unphilosophical to account them

different kinds of fever and give them distinct generic appellations

as in the case of the benign and confluent smallpox, which are

generated in like manner from one contagion.” Besides this woman, only

eight others had petechiae.

The House of Commons Committee were unable to find out with numerical

precision how much more prevalent the fever was in 1817-18 than in the

years preceding[309]. To their surprise they found that in six of the

general hospitals of London, which admitted cases of fever, “no register

is kept in the hospital to distinguish the different varieties of

disease.” The apothecary of St Luke’s Workhouse told them that he

attended, on an average of common years, about 150 cases of fever; in the

last year [1817] the number rose to 600; and they were assured by several

besides Bateman, that the great decrease of the deaths from “fever” in the

London bills of mortality during a space of fourteen years at the

beginning of the century (1803-17), was not a mere apparent decrease, from

the growing inadequacy of the bills, but was a real decrease.

The epidemic which began in 1817 continued in London throughout the years

1818 and 1819, chiefly in the densely populated poorer quarters of the

town. Two instances of the London slums of the time came to light before

the House of Commons Committee on Mendicity and Vagrancy in 1815-16:

firstly, Calmel’s Buildings, a small court near Portman Square, consisting

of twenty-four houses, in which lived seven hundred Irish in distress and

profligacy, neglected by the parish and shunned by everyone from dread of

contagion; and, secondly, George Yard, Whitechapel, consisting of forty

houses, in which lived two thousand persons in a similar state of

wretchedness. The dwellings of the poorer classes in London at this

period, before the alleys and courts began to disappear, were described

thus generally by Dr Clutterbuck[310]:

“The houses the poor occupy are often large, and every room has its

family, from the cellar to the garret. Thirty or forty individuals are

thus often collected under the same roof; the different apartments

must be approached by a common stair, which is rarely washed or

cleansed; there are often no windows or openings of any kind

backwards; and the _privies_ are not unfrequently within the walls,

and emit a loathsome stench that is diffused over the whole house. The

houses are generally situated in long and narrow alleys, with lofty

buildings on each side; or in a small and confined court, which has

but a single opening, and that perhaps a low gateway: such a court is

in fact little other than a well. These places are at the same time

the receptacles of all kinds of filth, which is only removed by the

scavenger at distant and uncertain intervals, and always so

imperfectly as to leave the place highly offensive and disgusting.”

In England, generally, this epidemic of 1817-19 is somewhat casually

reported. One writes from Witney, Oxfordshire, “on the prevailing

epidemic,” which began there in July, 1818, among poor persons, in

crowded, filthy and ill-ventilated situations. At first it was like the

ordinary contagious fever of this country, “a disease familiar to common

observation”; but afterwards it showed choleraic and pneumonic

complications. Sometimes the parotid and submaxillary glands were

inflamed; petechiae were absent[311]. The type of fever at Ipswich in the

spring of 1817 was contagious (e.g. six cases in one family) and sthenic,

or of strong reaction, admitting of bloodletting, according to the

teaching which Armstrong, Clutterbuck and others had been reviving for

fevers[312]. Those instances, one from Oxfordshire the other from Suffolk,

must stand for many. Hancock says that the fever of 1817-19 “visited

almost every town and village of the United Kingdom[313].” Prichard says

that it began in Ireland, “where the distress was most urgent, and

afterwards prevailed through most parts of Britain,” some of the more

opulent also being involved in the calamity. As to its prevalence in the

manufacturing towns of Yorkshire we have ample testimony. The Leeds House

of Recovery, which had not been fully occupied at any time since its

opening in 1804, received 178 cases in 1817, and 254 in the first ten

months of 1818. Of the latter, 66 came from low lodging-houses, of whom

upwards of 50 were strangers. Of 50 admitted in January, 1818, 20 came

from four or five lodging-houses in March Lane, and from another locality

equally bad--Boot and Shoe Yard; while the rest of the 50 in that month

came from houses and streets in the same vicinity. March Lane was one of

the worst seats of the great Leeds plague in 1645. By the month of April,

1820, the epidemic had decreased a good deal in Leeds, the cases becoming

at the same time more anomalous[314].

The following is one of the Rochdale cases:

June 2, 1818, Alice Eccles, a delicate young woman living in a crowded

and filthy court from which fever had not been absent for nearly a

year, was bled to ten ounces, purged, and recovered. On September 20th

the same woman returned, desiring to be bled again. She was labouring

under her former complaint; “since her last illness she had been

repeatedly exposed to contagion, or rather, she had been living in an

atmosphere thoroughly saturated with infectious effluvia, the house in

which she resided, and generally the room in which she slept, having

had one or more cases of fever in them,” and the windows kept

closed[315].

At Halifax in the summer of 1818, typhus (or relapsing fever) had

increased so much that fever-wards were added to the Dispensary. It had

been alarmingly fatal in a high-lying village near Settle. It was

prevalent in Ripon, Huddersfield and Wakefield; and had been brought from

Leeds to Atley. A Bradford physician visited 27 cases of fever in one day

at a neighbouring village. Throughout Yorkshire, it was confined to the

lower orders, and was not very fatal[316]. At Carlisle it began about

July, 1817, and became somewhat frequent in the winter and spring

following; of 457 cases treated from the Dispensary 46 died, or 1 in

10[317]. At Newcastle, a mild typhus (typhus mitior) broke out in the

autumn of 1816, not in the poorer quarters, but mostly among the domestics

of good houses in elevated situations. There was much privation at

Newcastle, as elsewhere, at this time, among the poor. Murchison takes

this fever of the autumn of 1816 at Newcastle to have been enteric or

typhoid; but it is described as a simple continued fever, with vertigo,

headache, and bloodshot eyes, lasting from five or six days to four or

five weeks, ending usually without a marked crisis, and causing few

deaths[318]. The epidemic continued in Newcastle for three years, the

admissions to the Fever Hospital from 4 Sept. 1818, to 4 March, 1819,

having been 160, with 12 deaths. Dr McWhirter wrote, in April, 1819, that

he saw on his rounds as dispensary physician “too many of the obvious

causes of fever,” including the filth and wretchedness of the poor

inhabitants: “one rather wonders that so many escape it than that some are

its victims[319].”

Thus far there has been little besides Bateman’s essay to indicate the

nature or type of the fever in England. In Ireland it was to a large

extent relapsing fever, and, as we shall see, it was so also in Scotland.

Bateman found less than a tenth part of the cases at the London Fever

Hospital to have relapses, which was an unusually large proportion, in his

experience. Elsewhere in England the tendency to relapse was either

wanting or the relapses were described or accounted for in other ways; to

understand this it has to be kept in mind that the epidemic was the

occasion of a great revival of blood-letting, a practice which had fallen

into disuse in fevers since the last half of the 18th century, and was

something of a novelty in 1817. The fever of that year was undoubtedly

abrupt in its onset, strong, “inflammatory,” with full bounding pulse,

beating carotids, hot and dry skin, intense headache, suffused eyes, and

the like symptoms, which seemed to call for depletion. The common practice

was to bleed _ad deliquium_, which meant to ten, or fourteen, or twenty

ounces, at the outset of the fever. There was hardly one of the writers

upon the epidemic, unless it were Bateman, an advocate of the cordial and

supporting regimen, who did not consider the stages or duration of the

fever as artificially determined by the blood-letting, and not as

belonging to the natural history.

In order to show how much the treatment by blood-letting dominated the

view of the fever itself, of its type, its stages, or duration, I shall

take the Bristol essay of Prichard, who adopted phlebotomy, as he says, at

first tentatively and with some fear and trembling, but at length

practised it vigorously, having found it to answer well[320]. The epidemic

of fever in Bristol began about June, 1817, and lasted fully two years.

The first cases brought to St Peter’s Hospital, which was the general

workhouse of the city, were of wretched vagrants found ill by the wayside

or abandoned in hovels. About the same time forty-two felons in the

Bristol Newgate, “one of the most loathsome dungeons in Britain, perhaps I

might say in Europe,” were infected, of whom only one died, and he of a

relapse. From June, 1817, to the end of 1819, there were 591 cases in the

poor’s house, 647 in the General Infirmary, and 975 treated from the

Dispensary, making 2213 cases, of which a record was kept. But there were

also many cases in private practice among the domestics, children, and

others in good houses, such as those on Redcliff Hill. The cases in the

poor’s house were classified by Prichard as follows:

1817 1818 1819

Simple Fever 22 45 40

with cephalic symptoms 24 27 25

" pneumonic symptoms 7 10 16

" gastric symptoms 3 11 5

" enteric symptoms 3 4 5

" hepatic symptoms 5 3 3

exhausted and moribund 1 6 4

not characterised 30 44 2

--- --- --

95 150 105

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

Of these there died 20 16 11

The “genuine form,” or ground-type, according to Prichard, was “simple

fever,” of which the cases with cephalic symptoms were merely the more

protracted or more serious. “The pneumonic, hepatic, gastric, enteric and

rheumatic forms may be regarded as varieties”--the gastric and hepatic

being cases mostly in summer with jaundice, the enteric in autumn and

winter with diarrhoea and dysentery. Nearly all these patients were bled

within four or five days from the commencement of the disease: “in a very

large proportion of the cases the fever was immediately cut short”; when

it did not end thus abruptly, its symptoms declined gradually, and the

attack was over within eight or ten days. After the blooding “sleep very

frequently followed, and a partial or sometimes a complete remission of

the symptoms.” Only one case of relapse is mentioned, No. 118, of the year

1818, and that was a relapse in a very prolonged case: the patient was

admitted on 6 October, had a relapse on 18 November, and was discharged on

23 December. Prichard has not one word in his text to suggest relapsing

fever; the bulk of his cases were simple continued fever, with or without

cephalic or other local symptoms, ending in four, six, eight or ten days,

while some were cases of _typhus gravior_. The fever was undoubtedly

contagious: it spread through whole families, and in St Peter’s Hospital

itself it attacked seventy of the ordinary pauper inmates, including a

good many lunatics.

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

Let us now turn to the epidemic in Scotland, where the relapsing type was

as marked as in Ireland, if not more so. The destitution in the Scots

towns in the autumn of 1816, and following years, was fully as great as

anywhere in the kingdom, although the peasantry of Scotland were not

famine-stricken, as those of Ireland were. The state of the poorer classes

in Edinburgh was graphically set forth in an essay by Dr Yule, in

1818[321], and in an article in _Blackwood’s Magazine_ the year after.

Vigorous efforts to relieve the distress were made by the richer classes,

and a special fever-hospital was opened at Queensbery House, the

admissions to which, together with the fever-cases at the Royal Infirmary,

were as follows:[322]

Year Admitted Died Ratio of deaths

1817 511 33 1 in 15-16/33

1818 1572 75 1 in 21

1819 1027 30 1 in 34

(to 1 Dec.)

Of this epidemic several accounts were published at the time, including

one by Welsh, superintendent of the fever hospital, which is dominated,

like the Bristol account of Prichard, by the idea that blood-letting cut

short the fever[323]. Christison, who had experience of the relapsing

form in his own person[324], describes also two other forms mixed with the

cases of relapsing fever: a mild typhus, the _typhus mitior_ (_typhus

gravior_ being exceedingly rare in that epidemic), and a form which began

like the inflammatory relapsing _synocha_, and gradually after a week put

on the characters of mild typhus.

The admissions for fever to the Glasgow Infirmary, which was then the only

charity that received fever cases, had been at a somewhat low level since

the last epidemic in 1799-1801. They began to rise again with the distress

of 1816:--

_Admissions for Fever, Glasgow Infirmary._

Year Cases

1814 90

1815 230

1816 399

1817 714

1818 1371

1819 630

1820 289

1821 234

1822 229

1823 269

At the height of the epidemic in 1818 an additional fever hospital was

opened at Spring Gardens, to which 1929 cases were admitted in that and

the following year. Great efforts were made in Glasgow to “stamp out” the

contagion by disinfectants and removal to hospital[325]; but the course of

the epidemic seemed to follow the economic conditions more than anything

else.

The outbreak at Aberdeen was later than in the south of Scotland, having

begun in August, 1818. The infection was said to have been brought to the

city by a woman who found a lodging in Sinclair’s Close. A group of houses

in the close, covering an area of seventy by fifty feet and containing

one hundred and three inmates, became the first centre of the fever. The

scenes described are like those of the Irish epidemics: in one room, a

man, his wife, and five children were lying ill on the floor; in another,

a man, his wife and six children; in a third, a young girl, whose mother

had just died of fever, was left with three infant brothers or sisters.

More than three-fourths of the denizens of the close were “confined to bed

in fever, and all the others crawling about during the intervals of their

relapses.” The value of all the furniture and clothing belonging to 103

persons could little exceed £5. There was a horrible stench both within

and without the houses (relapsing fever being remarkable for its odour).

Yet this close was usually as healthy as any other part of the town. A

House of Recovery, with sixty beds, was opened in the Gallowgate, and

thirty beds were given up to fever-cases in the Infirmary of the city.

Besides those ninety hospital cases at the date of 17 December, 1818, it

was estimated that were three hundred more. Begging had been put down, so

that the contagion had not spread to the richer classes. Despite these

removals to hospital, the epidemic became more general about the New Year,

1819, and of a worse type; two physicians died of it, and some others had

a narrow escape. At the outset, the fever had been of the relapsing

kind--“subject to relapses for a third and fourth time, more especially

when they return too early to their usual labour[326].” At a later period

the epidemic seems to have become ordinary typhus, as it did also in

Ireland and elsewhere; and it was called typhus in the essay upon it by Dr

George Kerr[327].

The extent of this epidemic of 1818-19 over Scotland generally is not

known; but the following notice of it in a country parish of Forfarshire

was probably a sample of more that might have been given.

Early in the summer of 1818 an epidemic of continued fever appeared in

a manufacturing village seven miles from Lintrathen; it attacked at

first young and plethoric subjects, and ran through whole families. In

August it reached Lintrathen parish, in which one practitioner had

forty cases, with no deaths. The fever was of an inflammatory nature;

the bulk of the cases fell in October, and were nearly all of young

women. They were bled to syncope, which then meant usually to 32

ounces. There was a prejudice against blooding among the old people,

who said “they had had many fevers, and in their time no such thing

was ever allowed.” But, according to the doctor, this withholding of

the lancet had the effect of protracting their illnesses: “they

toasted sick for six weeks, and were often confined to bed for

months[328].”

The epidemic of 1817-19 brought into prominence two questions, the one

theoretical, the other practical. The theoretical question (not debated at

the time) was touching the place or affinities of relapsing fever in the

nosology. Christison maintained that it was the inflammatory fever, or

_synocha_ of Cullen, showing a peculiar tendency to relapse. The fever of

the same epidemic period in England was also undoubtedly a fever of strong

or inflammatory reaction, corresponding to Cullen’s definition of

_synocha_, but it relapsed much less frequently than in Ireland and

Scotland in the same years. Even in Ireland and Scotland there were always

many cases of “relapsing fever” which did not relapse. The law of its

relapses was reduced to great simplicity by a physician learned in fevers,

Dr John O’Brien, in the Dublin epidemic of 1827. The bulk of that epidemic

was a fever of short periods--three, five, seven or nine days, most of the

attacks ending on the fifth or seventh night of the fever. The attack

being ended in a free perspiration, there might or might not happen, after

an interval, a relapse, and again a relapse after that, or even a third.

The five-days’ fever was more liable to relapse than the seven-days’

fever, the seven-days’ fever more liable than the nine-days’ fever, the

fevers of the longest periods not liable at all. In other words, the

sooner the patient “got the cool,” by a night’s sweating, the more liable

he was to have one or more relapses[329].

The logical position of relapsing fever was completed by Dr Seaton Reid,

of Belfast, when he proposed, in his account of the epidemic in 1846-7, to

call it Relapsing Synocha[330]. Other fevers have shown a tendency to

relapse in certain circumstances. Three fevers which have many points in

common, the sweating sickness, dengue and influenza, are all subject to

relapses. It was doubtless of the sweating sickness that Sir Thomas More

was thinking when he wrote: “Considering there is, as physicians say, and

as we also find, double the peril in the relapse that was in the first

sickness.” Plague, also, might relapse, or recur in an individual once,

twice, three times, or oftener in the same epidemic season. Enteric is an

instance of a long-period fever which has at times a tendency to

relapses[331]. None of these, however, can dispute the claim of relapsing

synocha to be relapsing fever _par excellence_. For whatever reason, the

short-period fever of times of distress and dearth or famine has shown a

peculiar tendency to relapse, and has shown that tendency more in the 19th

century than in the 18th, and more among the Irish and Scotch poor than

among the English.

The practical question that came to the front in the epidemic fever of

1817-19 was that of isolation hospitals for the sick. It was thus stated

by Dr Millar, of Glasgow, in a letter of advice to the authorities of

Aberdeen: