1709. The following shows the rise of the price of the quarter of wheat in

England: _s._ _d._ 1708 Lady-day 27 3 " Michaelmas 46 3 1709 Lady-day 57 6 " Michaelmas 81 9 1710 Lady-day 81 9 The export of corn was prohibited in 1709 and again in 1710. An epidemic of fever began in London in the autumn of 1709 and continued throughout 1710, in which year the fever-deaths reached the highest total since 1694. But it was not altogether a fever of starvation or distress among the poor, and perhaps not mainly so. There is always the dual question in connexion with fever following bad seasons and high prices: how much of it was due to the scarcity, and how much to those states of soil and atmosphere upon which the failure of the crop itself depended. An authentic case of the malignant fever which began to rage in London in the autumn of 1709 will both serve to show the remarkable type of at least a portion, if not the whole of the epidemic, and to prove its incidence upon the houses of the rich. The case is recorded by Sir David Hamilton[86]: “About the 5th of October, 1709, the son of that worthy gentleman, William Morison, esquire, was seized with a fever; at which time, and for some weeks before, a malignant fever raged in London.” He had a quick and weak pulse, great difficulty or hindrance of speech, and a stupidity; “whereto were added tremors, and startings of the tendons, a dry and blackish tongue, a high-coloured but transparent urine and coming away for the most part involuntarily, and a hot and dry skin.” Dr Grew was called in, and prescribed alexipharmac remedies (cordials, sudorifics, etc.) “A few days after the patient’s skin was stained or marked with red and purple spots, and especially upon his breast, legs and thighs. These symptoms, although a little milder now and then, prevailed for fourteen days; after that the spots vanished, and the convulsive motions so increased that the young gentleman seemed ready to sink under them for several days together.” He was treated with the application of blisters, and with doses of bark. His strength and flesh were so wasted that the hip whereon he lay was seized with a gangrene. For ten or twelve days before his death, “he breathed and perspired so offensive a smell that they were obliged to smoke his chamber with perfumes; and even myself, whilst I inclined my body a little too near him, was, by receiving his breath into my mouth, seized all on a sudden with such a sickness and faintness that I was obliged to take the air in the open fields, and returning thence to drink plentifully of _mountain_ wine at dinner.” The examination after death was made by the celebrated anatomist Dr Douglas. There was still a heap of brown-coloured spots visible on the breast; “there was nothing contained in the more conspicuous vessels of the abdomen but grumes or clots of blackish blood, without any serum in the interstices.” Hamilton adds: “We too seldom dissect the bodies of those dying in fevers.” The tremors, offensive sweats and offensive breath are distinctive of a form of typhus that became common towards the middle of the century, and was called putrid fever (not in the sense of Willis) or miliary fever from the watery vesicles of the skin that often attended it. But although Hamilton was writing on miliary fever (of the factitious variety) this case is not given as an example, but is appended to his sixteen cases of the latter, as an example of “a deadly fever with loss of speech from the beginning.” Among earlier cases, those belonging to the epidemic of 1661 as described by Willis correspond closely with this case, which we may take as representing part of the malignant fever that then raged in London. We have an anatomical record from each; but in neither was there sloughing of the lymph-follicles of the intestine, or of the mesenteric glands, as in the enteric fever of our own time; while in both there were red or purple spots on the breast or neck, and on the limbs. The “loss of speech from the beginning” suggests Sydenham’s “absolute aphonia” in the comatose fever of 1673-76, which resembled in other respects Willis’s fever of the brain and nervous stock (mostly of children) in 1661. One of the synonyms of “infantile remittent” was “an acute fever with dumbness[87].” This seems to have been a common type of fever in the latter part of the 17th century and early part of the 18th. Some likeness to enteric fever may be found in it, but there is no warrant for identifying it with that fever. Its main features may be said to have been its incidence upon the earlier years of life, but not to the exclusion of adult cases, its remarkable ataxic symptoms, which led Willis to refer it to “the brain and nervous stock” (spinal cord), its comatose character, its spots, occasional miliary eruption, ill-smelling sweats and other foetid evacuations, its protracted course, and its hectic sequelae. The weekly bills of mortality in London bear little evidence of unusual prevalence of fever in 1709, except in the weeks ending 13 and 20 September, when the fever-deaths were 96 and 75 (including “spotted fever”). But the unusual entry of “malignant fever” appears in three weekly bills, 19 July, 9 August and 23 August, one death being referred to it on each occasion. It was in the summer and autumn of 1710 that the fever reached a height in London, being attended with a very fatal smallpox. An essay on the London epidemic of 1710[88] is interesting chiefly for recording a probable case of relapsing fever, a form which was almost certainly part of the great febrile epidemic in London in 1727-29. Mrs Simon, aged 20, had a burning fever, stifling of her breath, frequent vomiting and looseness, foul tongue, loss of sleep, restlessness, intermitting, low and irregular pulse. This terrible fever disappeared on the fourth day, and she thought herself recovered. But on the seventh day from her being taken ill the fever returned, she was light-headed, did not know her relatives, and was fevered in the highest degree. It looked like a malignant fever, but there were no spots. The following table shows the very high mortality from fever (as well as from smallpox) in the epidemic to which the above case belonged. _London: Weekly deaths from fever, smallpox and all causes._ 1710. Week Dead of Dead of Dead of Dead of ending fever spotted fever smallpox all diseases May 2 103 [illegible] 99 571 9 90 6 60 517 16 84 7 71 502 23 93 15 71 503 30 106 11 83 550 June 6 93 2 98 508 13 79 8 84 509 20 106 12 99 574 27 105 15 86 503 July 4 106 7 99 482 11 107 13 97 467 18 126 16 89 509 25 109 13 105 562 Aug. 1 91 12 79 444 8 92 11 72 463 15 98 10 58 459 22 105 10 63 463 29 111 16 71 495 Sept. 5 76 4 63 414 12[89] 107 12 57 520 19 115 9 83 548 26 81 11 46 456 Oct. 3 98 9 45 469 10 79 10 49 480 17 90 5 41 477 24 107 5 45 470 31 106 14 51 421 Nov. 7 71 6 55 425 14 92 2 41 390 21 70 4 25 345 Throughout England, in country parishes and in towns, the first ten years of the 18th century were on the whole a period of good public health. In Short’s abstracts of the parish registers to show the excess of deaths over the births, those years are as little conspicuous as any in the long series. It was a time when there was a great lull in smallpox, and probably also in fevers. The figures for Sheffield may serve as an example[90]. It will be seen from the Table that the burials exceeded the baptisms in every decade from the Restoration to the end of the century; after that for twenty years the baptisms exceeded the burials, the marriages having increased greatly. _Vital Statistics of Sheffield._ Ten-year periods Marriages Baptisms Burials 1661-70 585 2086 2266 1671-80 537 2240 2387 1681-90 540 2595 2856 1691-1700 688 2221 2856 1701-10 942 3033 2613 1711-20 991 3304 2765 Of particular epidemics, we hear of a malignant fever at Harwich in 1709. Harwich was then an important naval station, and the fever may have arisen in connexion with the transport of troops to and from the seat of war, just as camp- and war-fevers appeared at various ports in the next war, 1742-48. There were rumours of a plague at Newcastle in 1710, which were contradicted by advertisement in the _London Gazette_[91]. But, as there was so much plague in the Baltic ports in 1710 it is possible that the Newcastle rumour may have been one of plague imported, and not a rumour suggested by the mortality from some other disease. To the same period of epidemic fever in London, about 1709-10, belongs also a curiously localized epidemic in an Oxford college, which reminds one somewhat of the circumstances of enteric fever in our time. It was told to Dr Rogers of Cork twenty-five or twenty-six years before the date of his writing (1734), by one who was a student at Oxford then: “There broke out amongst the scholars of Wadham College a fever very malignant, that swept away great numbers, whilst the rest of the colleges remained unvisited. All agreed that the contagious infection arose from the putrefaction of a vast quantity of cabbages thrown into a heap out of the several gardens near Wadham College[92].” The next epidemic of fever in London was in 1714. Like that of 1710, it followed a great rise in the price of wheat, or perhaps it followed the unseasonable weather which caused the deficient harvest. Before the Peace of Utrecht wheat in England was as low as 33_s._ 9_d._ per quarter, in 1712, the peace next year sending it no lower than 30_s._ But at Michaelmas, 1713, it rose with a bound to 56_s._ 11_d._, doubtless owing to a bad harvest. The fever-deaths in London began to rise in the spring of 1714, reaching a weekly total of 103 in the week ending 20 April. All through the summer and autumn they continued very high, the weekly totals exceeding, on an average, those of the year 1710, as in the foregoing table, and having corresponding large additions of “spotted fever.” The deaths from all causes in 1714 were a quarter more than those of the year before, the epidemic of fever being the chief contributor to the rise. This happened to be a very slack time in medical writing[93]; but, even in the absence of such testimony as we have for earlier and later epidemics of fever in London, we may safely conclude that the fever of 1714 was of the type of pestilential or malignant typhus, beginning in early summer and reaching a height in the old plague season of autumn. A singular instance of what may be considered war-typhus belongs to the winter of 1715-16. The political intrigues preceding and following the death of Queen Anne in 1714 culminated in the Jacobite rising in Scotland and the North of England in 1715. The Jacobites having been defeated at Preston on 13 November, prisoners to the number of 450 were brought to Chester Castle on the Sunday night before December 1st. A fortnight later (December 15th), Lady Otway writes of the 450 prisoners in the Castle: “They all lie upon straw, the better and the worse alike. The king’s allowance is a groat a day for each man for meat, but they are almost starved for want of some covering, though many persons are charitable to the sick.” The winter was unusually severe, the snow lying “a yard deep.” Many prisoners died in the Castle by “the severity of the season,” many were carried off by “a very malignant fever.” On February 16th Lady Otway writes again:--“So much sickness now in our Castle that they dye in droves like rotten sheep, and be 4 or 5 in a night throne into the Castle ditch ffor ther graves. The feavour and sickness increaseth dayly, is begun to spread much into the citty, and many of the guard solidyers is sick, it is thought by inffection. The Lord preserve us ffrom plague and pestilence[94]!” Prosperity of Britain, 1715-65. The fifty years from 1715 to 1765 were, with two or three exceptions, marked by abundant harvests, low prices and heavy exports of corn. This was undoubtedly a great time in the expansion of England, a time of fortune-making for the monied class, and of cheapness of the necessaries of life. The well-being and comfort of the middle class were undoubtedly great; also there was something peculiar to England in the prosperity of towns and villages throughout all classes. In the very worst year of the period, the year 1741, Horace Walpole landed at Dover on the 13th September, having completed the grand tour of Europe. Like many others, he was delighted with the pleasant county of Kent as he posted towards London; and on stopping for the night at Sittingbourne, he wrote as follows in a letter: “The country town delights me: the populousness, the ease, the gaiety, and well-dressed everybody, amaze me. Canterbury, which on my setting out I thought deplorable, is a paradise to Modena, Reggio, Parma, etc. I had before discovered that there was nowhere but in England the distinction of _middling people_. I perceive now that there is peculiar to us _middling houses_; how snug they are[95]!” Our history henceforth has little to record of malignant typhus fevers, or of smallpox, in these snug houses of the middle class, although not only the middle class, but also the highest class had a considerable share of those troubles all through the 17th century. But the 18th century, even the most prosperous part of it, from the accession of George I. to the beginning of the Industrial Revolution in the last quarter or third of it, was none the less a most unwholesome period in the history of England. The health of London was never worse than in those years, and the vital statistics of some other towns, such as Norwich, are little more satisfactory. This was the time which gave us the saying, that God made the country and man made the town. Praise of rural felicity was a common theme in the poetry of the time, as in Johnson’s _London_: “There every bush with nature’s music rings, There every breeze bears health upon its wings.” Both for the country and the town the history of the public health does not harmonize well with the optimist views of the 18th century. The historians are agreed that, under the two first Georges, during the ministries of Walpole, the Pelhams and Pitt, the prosperity of Britain was general. Adam Smith speaks of “the peculiarly happy circumstances of the country” during the reign of George II. (1727-60). Hallam characterizes the same reign as “the most prosperous that England had ever experienced.” The most recent historian of England in the 18th century is of the same opinion[96]. The novels of Fielding give us the concrete picture of the period with epic fidelity, and the picture is of abundance and prodigality. Agriculture and commerce with the Colonies, India and the continent of Europe, were the sources of the country’s wealth. Farming and stock-raising had been greatly improved by the introduction of roots and sown grasses. In some country parishes the baptisms were three times the burials. But the public health during this period will not appear in a favourable light from what follows. More particularly there were three occasions, about the years 1718, 1728 and 1741, when a single bad harvest in the midst of many abundant ones brought wide-spread distress, with epidemics of typhus and relapsing fever; from which fact it would appear that the common people had little in hand. Thorold Rogers, among economists, was of the opinion that the prosperity was all on the side of the governing and capitalist classes, that the labourers were in “irremediable poverty” and “without hope,” and that the law of parochial settlement, with the artificial fixing of wages by the Quarter Sessions and the bonuses out of the poor-rates, had the effect of keeping the mass of the people on the land “in a condition wherein existence could just be maintained[97].” I shall not attempt an independent judgment in economics, but proceed to those illustrations of national well-being which belong to my subject, leaving the latter to have their due weight on the one side of economical opinion or on the other. Besides the economical question there is of course also an ethical one. When the pinch came about 1766, there was the usual diversity of opinion expressed on the “condition of England” problem, one holding that the labourers were unfairly paid, another that the nation had been made “splendid and flourishing by keeping wages low,” and that the distress was due to “want of industry, want of frugality, want of sobriety, want of principle” among the common people at large. “If in a time of plenty,” wrote one austere moralist, “the labourers would abate of their drunkenness, sloth, and bad economy, and make a reserve against times of scarcity, they would have no reason to complain of want or distress at any time[98].” But there must have been something wrong in the economics and morals of their betters if it were the case that the working class as a whole, and not merely a certain number of individuals in it, was drunken, thriftless and slothful. The familiar proof of this is the apathy of the Church, broken by the Methodist revival of religion. The epidemic fevers of 1718-19. In the fifty years from 1715 to 1765, the three worst periods of epidemic fever in England and Scotland correspond closely to the three periods of actual famine and its attendant train of sicknesses in Ireland, namely, the years 1718-19, 1727-29, and 1740-42. The three divisions of the kingdom suffered in common, Ireland suffering most. The first period, 1718-19, was an extremely slack tide in medical writing, insomuch that hardly any accounts of the reigning maladies remain, except those by Wintringham, of York, and Rogers, of Cork. The whole of the Irish history of fevers and the allied maladies is dealt with in a chapter apart. Of the Scots history, little is known for the first of the three periods beyond a statement that there was a malignant fever and dysentery in Lorn, Argyllshire, in January and February, 1717[99]. Wintringham gives the following account of the _synochus_, afterwards called typhus, which attracted notice in the summer of 1718 and became more common in the warm season of 1719: in each year it began about May, reached its height in July and lasted all August, carrying off many of those who fell into it. It began with rigors, nausea and bilious vomiting, followed by alternate heats and chills, with great lassitude and a feeling of heaviness: then thirst and pungent heat, a dry and brown tongue, sometimes black. The patient slept little, did not sweat, and was mostly delirious, or anxious and restless, tossing continually in bed. About the 12th day it was not unusual for profuse and exhausting diarrhœa to come on. In a favourable case the fever ended in a crisis of sweating about the 16th day. Those who were of lax habit, unhealthy, hysteric, or cachectic, were apt to have tremors, spasms and delirium, while others were so prostrated as to have no control over their evacuations, lying in a stupor and raving when roused out of it. In these the fever would continue to the 20th day; in some few it ended without a manifest crisis, and with a slow convalescence[100]. This applies to the city of York, but in what special circumstances we are not told. However, it happens that a physician of York, two generations after, in giving an account of the great improvement that had taken place in its public health, throws some light on its old-world state: “The streets have been widened in many places by taking down a number of old houses built in such a manner as almost to meet in the upper stories, by which the sun and air were almost excluded in the streets and inferior apartments[101].” In London the fever-deaths, with the deaths from all causes, rose decidedly in 1718, and reached a very high figure in 1719, of which the summer was excessively hot. One cause, at least, was want of employment, especially among weavers in the East End[102]. But the epidemic fever of 1718-19 was not limited to the distressed classes; we have a glimpse of it, under the name of “spotted fever,” in the family of the archbishop of Canterbury: “On Friday night the archbishop of Canterbury’s sixth daughter was interred in our chancel, with four others preceding, she dying on Monday after three days of the spotted fever. The fourth and seventh are recovered, and hoped past danger[103].” The following table shows the fever-mortalities for London, from 1718 onwards, and, for comparison, the excessive mortalities in the epidemics of 1710 and 1714: _London Mortalities from Fever, &c._ Year Fevers Spotted fevers Smallpox All causes 1710 4397 343 3138 24620 1714 4631 150 2810 26569 1718 3475 132 1884 26523 1719 3803 124 3229 28347 1720 3910 46 1442 25454 1721 3331 84 2375 26142 1722 3088 22 2167 25750 1723 3321 51 3271 29197 1724 3262 84 1227 25952 1725 3277 59 3188 25523 1726 4666 84 1569 29647 1727 4728 102 2379 28418 1728 4716 94 2105 27810 1729 5235 [The entry 2849 29722 1730 4011 ends.] 1914 26761 1731 3225 2640 25262 1732 2939 1197 23358 1733 3831 1370 29233 1734 3116 2688 26062 1735 2544 1594 23538 1736 3361 3014 27581 1737 4580 2084 27823 1738 3890 1590 25825 1739 3334 1690 25432 1740 4003 2725 30811 In country parishes, according to Short’s abstracts of registers, there was no unusual sickness in 1718 and 1719. But in market towns the mortality rose greatly in 1719, which had an excessively hot summer; and that was the year when the _synochus_ or typhus described by Wintringham reached its worst at York. The mortality kept high for several years after 1719. _Market Towns._ Registers Registers with Deaths Births Year examined excess of deaths in same in same 1716 30 8 1060 845 1717 30 9 1485 1290 1718 30 3 249 169 1719 30 6 1737 1320 1720 30 10 2186 1461 1721 33 9 1294 952 1722 33 11 1664 1345 1723 33 14 2532 2176 The high mortalities in 1721-23 were mostly from smallpox, exact figures of many of the epidemics in Yorkshire and elsewhere being given in the chapter on that disease. The country parishes shared in its prevalence: _Country Parishes._ Registers Registers with Deaths Births Year examined excess of deaths in same in same 1721 174 35 793 586 1722 175 35 1015 775 1723 174 63 2021 1583 Besides smallpox, diarrhoeas and dysenteries in the autumn are given by Wintringham as the reigning maladies, fever not being mentioned. The Epidemic Fevers of 1726-29: evidence of Relapsing Fever. The four years 1726-29 were a great fever-period in London, the deaths having been as follows: Year Fever deaths All deaths 1726 4666 29,647 1727 4728 28,418 1728 4716 27,810 1729 5335 29,722 In the last of those years the entry in the annual bills becomes “fever, malignant fever, spotted fever and purples.” The following are the weekly maxima of fever deaths and deaths from all causes during the four years, 1726-29; in nearly all the weeks the deaths from “convulsions” (generic name for most of the maladies of infants) contribute from a fourth to a third, or even more, of the whole mortality. Week Fever All ending deaths deaths 1726 Jan. 18 71 633 March 15 81 678 May 31 103 611 June 7 106 607 Aug. 30 102 711 Sept. 6 116 680 13 109 643 20 109 648 1727 Aug. 8 103 577 15 123 698 22 132 730 29 130 789 Sept. 5 150 764 12 134 795 19 165 798 26 163 715 Oct. 3 150 684 1728 Feb. 6 112 748 13 131 889 20 121 850 27 145 927 March 5 93 733 Aug. 27 138 525 Sept. 3 131 562 Dec. 10 122 734 1729 Sept. 9 109 676 Nov. 4 213 908[104] 11 267 993[104] 18 166 783 Dec. 9 132 779 These are high mortalities, whatever were the types of fever that caused them. That the old pestilential fever of London was one of them we need have no doubt. Dr John Arbuthnot, writing two or three years after, said, “I believe one may safely affirm that there is hardly any year in which there are not in London fevers with buboes and carbuncles [the distinctive pestilential marks]; and that there are many petechial or spotted fevers is certain[105].” The essay of Strother also has a reference to “spotted fever” in its title, although the text throws very little light upon it[106]. But, for the rest, the “constitution” of 1727-29 is more than usually perplexing. There was an influenza at the end of 1729, which can be separated from the rest easily enough by the help of the London weekly bills of mortality; and it is probable, unless Arbuthnot, Huxham and Rutty have erred in their dates, that one or more epidemics of catarrhal fever had occurred before that, in the years 1727 and 1728. The greatest difficulty is with a certain “little fever,” or “hysteric fever,” or “febricula,” which gave rise to some writing and a good deal of talk. Strother does not specially treat of it, at least under that name, although he says that “many, especially women, have been subject to fits of vapours, cold sweats, apprehensions, and unaccountable fears of death; every small disappointment dejected them, tremblings and weakness attended them,” etc. (p. 116); and again, “never was a season when apoplexies, palsies and other obstructions of the nerves did prevail so much as they do at present, and have done for some time past” (p. 102); while he had frequently seen hysterical and hypochondriacal symptoms, dejection of spirits and the like remaining behind the fever (p. 109). For some years before this, much had been heard in London of the vapours, the “hypo,” the spleen, and the like, an essay by Dr Mandeville, better known by his ‘Fable of the Bees,’ having first made these maladies fashionable in the year 1711[107]. In due time it began to be noticed that symptoms which many physicians made light of as a “fit of vapours” were really the beginning of a fever. Dr Blackmore, in an essay on the Plague written in 1721, admitted the ambiguity: “For several days a malignant fever has so near a resemblance to one that is only hysterick, that many physicians and standers by, I am apt to believe, mistake the first for the last, and look upon a great and dangerous disease to be only the spleen, or a fit of the vapors, to the great hazard of the patient[108].” In 1730, Dr William Cockburn, in a polemic against the physicians whom he styles “the academical cabal” (because they objected to his secret electuary for dysentery), professes to give a history of the mistakes of the faculty in London over this “little fever,” or “hysteric fever,” which often became dangerous[109]: “The present fever, with a variation in some of its symptoms, has now subsisted twelve years [or since 1718] not in England only, but all over Europe [Manningham says it was peculiarly English]. Few or no physicians suspected the reigning and popular disease to be a fever. Vapours, a nervous disease, and such general appellations it had from sundry physicians. Others, who discovered the fever, knew it was the low or slow fever, first mentioned by Hippocrates.... The last were represented as ignorant for calling the distemper a fever, and affixing to it the name ‘low’ or ‘slow,’ a slow fever being, in their adversaries’ opinion, altogether unheard of among physicians and never recorded in their books. Nothing was more monstrous than calling this distemper a fever, or confining persons afflicted with it to their bed, and dieting them with broth, or other liquid food of good nourishment, and what is easily concocted.... ‘You are not hot, you are not dry; you are in good temper; and therefore you have no fever’ was the common language of the town.... They might have seen physicians practising for a destroying distemper, and yet, after seven years, they confess themselves ignorant of its very name.” At length, he continues, Blackmore admitted the ambiguity of diagnosis, while Mead, Freind and others, recognized that there was really such a thing as a slow, nervous fever, by no means free from danger to life. It is probably to this insidious fever that Strother refers: “Thus, having gone on for six or seven days in a train of indolence, they have been surprized on the seventh day, and have died on the eighth lethargick or delirious, whereas, if they had taken due care, the fever would have run its course in fifteen days or more.” It was the remissions, or intermissions, he explains, that often misled patients, by which he seems to mean the clear intervals between relapses. “Others, wearied out with relapses, have hoped their recovery would as certainly ensue as it had hitherto, and have deferred asking advice until it was too late.” These relapses, he thought, were brought on by venturing too soon into the air: “it is too well known that the fever has been cured, and patients have soon, after they have ventured into the air, relapsed and have again run the same circle of ill symptoms, if not worse than before.” Bark failed conspicuously in these “remittents:” “it is therefore incumbent on me to examine into the reason of this _new phenomenon_. I call it _new_,” he explains, because bark had hitherto succeeded. “Perhaps we may find reason to lay some blame on the air for the frequent relapses.... Periodical comas have of late been common; so soon as the fit was over, the drowsiness abated till the fit returned.” Elsewhere he speaks of the frequent relapses as belonging to a “quartan,” under which diagnosis bark had been tried. The fevers were less apt to “relapse” when treated by mild cathartics. Another symptom of this fever was jaundice: “If jaundice breaks forth on the fourth day of a fever, it is much better than if it comes at the conclusion of a fever.... Jaundices are now very common after the cure of these fevers.” These indications, dispersed throughout the rambling essay of Strother, point somewhat plainly to relapsing fever[110]. But his theoretical pathology comes in to obscure the whole matter. He explains everything by obstructions. The jaundice was due to obstruction of the liver by “styptics,” the hysteric symptoms to obstructions of the nerves; there were also theoretical obstructions of the mesentery, part of the matter being sometimes “thrown off into the mesenteric glands”; also “congestions” or phlegmons of the liver, spleen and pancreas. But it is when he comes to the bowels that his subjective morbid anatomy becomes truly misleading. There is nothing to show that Strother examined a single body dead of this fever. He says, however, in his _à priori_ way: “The crisis of these slow fevers is generally deposited on the bowels.... The lent fever is a symptomatical fever, arising from an inflammation, or an ulcer fixed on some of the bowels. A lent fever, depending on some fixed cause of the bowels, must be cured by having regard to those causes some of which I shall enumerate”:--the first supposition being that the fever depends on phlegmons by congestion of “the liver, spleen, pancreas, or the mesentery”; the second, if it depends on extravasations in an equally comprehensive range of viscera; the third, “if it depends on an ulcer, then all vulneraries must be administered internally; but to speak truth, when the viscera are ulcerated, there remains but small hope of life”; the fourth supposition is worms, the fifth corruption of the humours. All this is paper pathology. There is not a single precise fact relating to ulcerated Peyer’s patches, or to swollen mesenteric glands, or to enlarged spleen, which last would have been equally distinctive of relapsing as of enteric fever; it is “the viscera” that are ulcerated, or congested, or extravasated, or it is “some of the bowels,” or the pancreas and liver obstructed as well as the spleen, the obstruction of the liver being invoked to explain the highly significant jaundice. It is not quite clear whether Strother’s fever with relapses and jaundice corresponded exactly to the little fever, hysteric fever, or nervous fever of the same years; but it is worthy of note that relapsing fever in Ireland a century later was called febricula or the “short fever.” It was not until 1746 that the excellent essay upon it by Sir Richard Manningham was written. By that time a good deal was being said in various parts of Britain of a slow, nervous, or putrid fever, Huxham, in particular, identifying the nervous fever with Manningham’s febricula or little fever[111]. Some have supposed that the nervous fever of the 18th century included cases of enteric fever, if it did not stand for that disease exclusively. Murchison takes Manningham’s essay to be “an excellent description of enteric fever, under the title of febricula or little fever, etc.[112]” The following are brief extracts from his description, by which the reader will be able to form his own opinion on the question of identity[113]. At the beginning patients feel merely languid or uneasy, with flying pains, dryness of the lips and tongue but no thirst; in a day or two they find themselves often giddy, dispirited and anxious without apparent reason, and passing pale urine. They have transient fits of chilliness, a low, quick and unequal pulse, sometimes cold clammy sweats and risings in the throat. They go about until more violent symptoms come on, simulating those of quotidian, tertian or quartan fever; sometimes the malady simulates pleurisy. There may be attacks of dyspnoea, nausea and haemorrhage; the menses in women are checked. A loss of memory and a delirium occur at intervals for short periods. The malady is very difficult to cure and too often becomes fatal in the end. It will last thirty or forty days, unless it end fatally in stupor or syncope. A form of mania is a consequence of it, where it has been neglected or badly treated; “of late years this species of madness has been more than ordinarily frequent.” All sorts were liable to it, but mostly valetudinarians, delicate persons, and those in the decline of life; the fatalities were “especially among the opulent families of this great metropolis[114].” This fever-period in London corresponds on the whole closely with a series of unhealthy years in Short’s tables from the registers of market towns and country parishes, and with high mortalities in the Norwich register. It was not specially a smallpox period, as the last unhealthy year, 1723, was. On the other hand the epidemiographists in Yorkshire, Devonshire and Ireland dwell most upon fevers of the nature of typhus, some of which were due to famine or dearth, and upon “agues.” _Market Towns._ Registers No. with excess Deaths Births Year examined of deaths in same in same 1727 33 19 3606 2441 1728 34 23 4972 2355 1729 36 27 6673 3494 1730 36 16 3445 2529 _Norwich._ Year Buried Baptized 1728 1417 774 1729 1731 843 _Country Parishes._ Registers With excess Burials Baptisms Year examined of burials in same in same 1726 181 22 542 495 1727 180 55 1368 1091 1728 180 80 2429 1536 1729 178 62 2015 1442 1730 176 39 1302 1022 1731 175 24 700 614 The best epidemiologists of the time were not in London, but at York, Ripon, Plymouth, Cork and Dublin. Leaving the Irish history to a separate chapter, we shall find in the annals of Wintringham, Hillary and Huxham a somewhat detailed account of the fevers which caused the very high mortalities of the years 1727-29, with an occasional glimpse of the circumstances in which the fevers arose. Much of what follows relates to the same nervous, hysteric or “putrid” fever, with or without relapses, that has been described for London. Going back a little, Wintringham says[115] that the continued fevers of 1720 were milder than those of the year before (which were synochus or typhus) and were often languid or nervous, with giddiness, stupor and nervous tremblings, a quick pulse, a whitish tongue, no thirst, and sweats of the head, neck and chest: this fever lasted twenty days or more, and ended in a general sweat. He had mentioned the “languid nervous fevers” first in the years 1716 and 1717, and he mentions them again as mixed with or following the synochus or typhus of 1727-28. In April, 1727, there were fevers prevalent, remitting and intermitting, but with uncertain paroxysms; in May, a fever with pleuritic pains; in July, a putrid fever in some, but the chief diseases of that month were “remittents and intermittents,” which were often attended by cutaneous eruptions, sometimes of dusky colour and dry, at other times full of clear serum; which, “as they depended upon a scorbutic taint, tormented the sick with pruritus.” The sick persons in these remittents were for the most part drowsy and stupid, especially during the paroxysm; the fevers were followed by lassitude, debility, languor of spirits and hysteric symptoms. Hillary[116], who practised at Ripon, not far from Wintringham, at York, records in 1726 the prevalence of remittents and intermittents: “some had exanthematous eruptions towards the latter end of the disease, filled with a clear or yellowish water, which went or dried away without any other inconvenience to the sick but an uneasy itching for a few days”--just as Wintringham had described a miliary fever for 1727. It is also under 1726 that he describes the same drowsy and nervous symptoms of Wintringham’s summer fever of 1727: “Ancient and weak hysterical people had nervous twitchings and catchings, and were comatous and delirious; some were very languid, sick and faint, and had tremors; the young and robust, who had more full pulses, were generally delirious, unless it was prevented or taken off by proper evacuations and cooling medicines. I found blistering to be of very great service in this fever, and the sick were more relieved by it than ever I observed in any other fever whatever. People of lax, weak constitutions were very low and faint, and had frequent, profuse, partial sweatings, which most commonly were cold and clammy.” Huxham also, at the other end of England, says that in October and November, 1727, a slow nervous fever attacked not a few; and under the date of January, 1728, he confirms the Yorkshire experiences of the prevalence of angina. There can be little doubt that England in 1727 was already suffering in a measure from the distress that was acutely felt in Ireland; it was much aggravated by the hard winter of 1728-29[117], but it had begun before that and was doubtless the indirect cause of the great prevalence of sickness. The exports of corn under the bounty system used to bring two or three millions of money into the country in a year. But in 1727 there was a debt balance of 70,757 quarters of wheat imported, and in 1728 the import exceeded the export by 21,322 quarters, the price rising at the same time from 4_s._ to 8_s._ per bushel[118]. Under the year 1727 Hillary says: “Many of the labouring and poor people, who used a low diet, and were much exposed to the injuries and changes of the weather, died; many of whom probably wanted the necessary assistance of diet and medicines.” And after referring, under the winter of 1727-28, to the prevalence of a fatal suffocative angina, which fell, by a kind of metastasis, on the diaphragm or pleura, and sometimes on the peritoneum, he proceeds (p. 16):-- “Nor did any other method, which art could afford, relieve them: insomuch that many of the little country towns and villages were almost stripped of their poor people, not only in the country adjacent to Ripon, but all over the northern parts of the kingdom: indeed I had no certain account of what distempers those who were at a distance died of, but suppose they were the same as those which I have mentioned, which were nearer to us. Bleeding, pectorals with volatiles, and antiphlogistic diluters and blistering, were the most successful. I observed that very few of the richer people, who used a more generous way of living, and were not exposed to the inclemencies of the weather, were seized with any of these diseases at this time.... The quartans were very subject to turn into quotidians, and sometimes to continual, in which the sick were frequently delirious.” The Yorkshire accounts by Wintringham and Hillary for the second year of this epidemic period, the year 1728, are very full, as regards the symptoms or types of the fevers; but it would be tedious to cite them at length, and unnecessary to do so unless to answer the not inconceivable cavil that the fevers were not of the nature of typhus in one or other of its forms. The chief point is that the second year, towards Midsummer, brought a fever with the symptoms of _synochus_, and not rarely marked with small red spots like fleabites or with purple petechiae. In the autumn of 1729, Hillary noticed a fever of a slow type, which might go on as long as thirty days and end without a perfect crisis--the nearest approach to enteric fever in any of the descriptions. For the same years, 1727-29, Huxham, of Plymouth, describes languid fevers of the “putrid” type, with profuse sweating, followed by typhus of a more spotted type. Like the Yorkshire observer, Huxham mentions also “intermittents” as mixed with the continued fevers. The great prevalence of these fevers, “intermittents and other fevers,” in the west of England in 1728-29 was known to Dr Rutty of Dublin, who speaks especially of “the neighbourhoods of Gloucester and London, and very mortal in the country places, but less in the cities.” This is confirmed by Dover: “I happened to live in Gloucestershire in the years 1728 and 1729, when a very fatal epidemical fever raged to such a degree as to sweep off whole families, nay almost whole villages. I was called to several houses where eight or nine persons were down at a time; and yet did not so much as lose one patient where I was concerned[119].” Some of the cases of nervous or putrid fever in the epidemics of 1727-29 appear to have been marked by relapses in the country districts as well as in London. Huxham says under date of April, 1728, that those who had wholly got rid of the putrid fever were exceedingly apt to have relapses. Hillary does not mention relapses until March, 1733, when a fever, with many hysterical symptoms, which succeeded the influenza of that year, relapsed in several, “though seemingly perfectly recovered before.” But he seems really to be contrasting relapsing fever and typhus when he points out that, whereas the inflammatory type of fever in the first year of the epidemic (1727) was greatly benefited by enormous phlebotomies, the fever patients in the two seasons following, when the fever was more of the nature of spotted typhus, could not stand the loss of so much blood, or, it might be, the loss of any blood[120]. This was precisely the remark made by Christison and others a century later, when the inflammatory synocha, which often had the relapsing type very marked, changed to the spotted typhus. From the year 1731 we begin to have annual accounts (soon discontinued) of the reigning maladies in Edinburgh, on the same plan as Wintringham’s, Hillary’s and Huxham’s, with which, indeed, they are sometimes collated and compared[121]. The fevers of Edinburgh and the villages near were as various as those of Plymouth, according to Huxham, and singularly like the latter. Thus, in the winter of 1731-32, there was much worm fever, comatose fever, or convulsive fever among children, but not limited to children, marked by intense pain in the head, raving in some, stupor in others, tremulous movements, leaping of the tendons, and all the other symptoms described by Willis for the fever of 1661, a fatal case of October, 1732, in a boy of ten, recorded by St Clair one of the Edinburgh professors, reading exactly like the cases of Willis already given[122]. St Clair’s case, which was soon fatal, had no worms; but in the general accounts, both for the winter of 1731-32 and the autumn of 1732, it is said that many of the younger sort passed worms, both _teretes_ and _ascarides_, and recovered, the fatalities among children being, as usual, few. In March and April, 1735, there were again “very irregular fevers of children.” Huxham records exactly the same “worm-fever” of children at Plymouth in the spring of 1734--a fever with pains in the head, languor, anxiety, oppression of the breast, vomiting, diarrhoea, and a comatose state (_affectus soporosus_), which attacked the young mostly, and was often attended by the passage of worms. He gives the same account of the seasons as Gilchrist--the years 1734 and 1735 marked by almost continual rains, the country more squalid than had been known for some years[123]. But it is the nervous fever that chiefly engrosses attention both in Scotland and in England. In 1735, Dr Gilchrist, of Dumfries, made it the subject of an essay, returning to the subject a few years after[124]. “As _our_ fever,” he says, “seems to be peculiar to this age, it is not a little surprising that much more has not been said upon it.” He is not sure whether its frequency of late years may not be owing to the manner of living (it was the time of the great drink-craze, which Huxham also connects with the reigning maladies) and to a long course of warm, rainy seasons; the winters for some years had been warm and open, and the summers and harvests rainy. It was only the poorer sort and those a degree above them who were subject to this fever; he knew but few instances of it amongst those who lived well, and none amongst wine-drinkers. It was in some insidious in its approach; those who seemed to be in no danger the first days for the most part died. In others the onset was violent, with nausea, heat, thirst and delirium. Among the symptoms were looseness, pains in the belly, local sweating, tickling cough, leaping of the tendons. Sometimes they were in continual cold clammy sweats; at other times profuse sweats ran from them, as if water were sprinkled upon them, the skin feeling death cold. At Edinburgh, from October, 1735, to February, 1736, the fever became very common, and was often a relapsing fever. “The sick had generally a low pulse on the first two or three days, with great anxiety and uneasiness, and thin, crude urine. Delirium began about the fourth day, and continued until the fever went off on the seventh day. Sometimes the disease was lengthened to the fourteenth day. The approach of the delirium could always be foretold by the urine becoming more limpid, and without sediment.... A large plentiful sweat was the crisis in some. Others were exposed to relapses, which were very frequent, and rather more dangerous than the former fever[125].” These evidences, beginning with Strother’s for London in 1728 and extending to the Edinburgh record of 1735, must suffice to identify true relapsing fever. In the chapter on Irish fevers we shall find clear evidence of relapsing fever in Dublin in 1739, before the great famine had begun. Huxham’s account of the fevers at Plymouth, in Devonshire generally, and in Cornwall about the years 1734-36 is of the first importance. It is highly complex, owing to the prevalence of an affection of the throat, so that one part of the constitution is “anginose fever.” This has been dealt with in the chapter on Scarlatina and Diphtheria. Another part was true typhus. In his account of the nervous fever we are introduced, as in the Yorkshire annals, 1726-27, to a phenomenon that was almost distinctive of the low, nervous or putrid fever from about 1750 to 1760 or longer, namely, the eruption of red, or purple, or white watery vesicles, from which it got the name of miliary fever. Huxham’s annals are full of this phenomenon about the years 1734-36[126]. The red pustules, or white pustules, with attendant ill-smelling sweats, are mentioned over and over again. He thought them critical or relieving: “Happy was then the patient who broke out in sweats or in red pustules.” These fevers are said to have extended to the country parts of Devonshire, after they had ceased in Plymouth, and to Cornwall in August, 1736. In Plymouth itself the type of fever changed after a time to malignant spotted fever, synochus, or true typhus. The malignant epidemic seemed to have been brought in by the fleet; it had raged for a long time among the sailors of the fleet lying at Portsmouth, and had destroyed many of them. In March, 1735, it was raging among the lower classes of Plymouth. About the 10th day of the fever, previously marked by various head symptoms, there appeared petechiae, red or purple, or livid or black, up to the size of vibices or blotches, or the eruption might be more minute, like fleabites. A profuse, clammy, stinking sweat, or a most foetid diarrhoea wasted the miserable patients. A black tongue, spasms, hiccup, and livid hands presaged death about the 11th to 14th day. So extensive and rapid was the putrefaction of the bodies that they had to be buried at once or within twenty-four hours. It was fortunate for many to have had a mild sweat and a red miliary eruption about the 4th or 5th day; but for others the course of the disease was attended with great risk. In April the type became worse, and the disease more general. There was rarely now any constriction of the throat. Few pustules broke out; but in place of them there were dusky or purple and black petechiae, and too often livid blotches, with which symptoms very many died both in April and May. In July this contagious fever had decreased much in Plymouth, and in September it was only sporadic there. With a mere reference to Hillary’s account of somewhat similar fevers at Ripon in 1734-5 (with profuse sweats, sometimes foetid, great fainting and sinking of spirits, starting of the limbs and beating of the tendons, hiccup for days, etc.[127]) we may pass to a more signal historical event, the great epidemic of fever in 1741-42, of which the Irish part alone has hitherto received sufficient notice[128]. The epidemic fever of 1741-42. The harvest of 1739 had been an abundant one, and the export of grain had been large. At Lady-day the price of wheat had been 31_s._ 6_d._ per quarter, and it rose 10_s._ before Lady-day, 1740. An extremely severe winter had intervened, one of the three memorable winters of the 18th century. The autumn-sown wheat was destroyed by the prolonged and intense frost, and the price at Michaelmas, 1740, rose to 56_s._ per quarter, the exportation being at the same time prohibited, but not until every available bushel had been sold to the foreigners. The long cold of the winter of 1739-40 had produced much distress and want in London, Norwich, Edinburgh and other towns. In London the mortality for 1740 rose to a very high figure, 30,811, of which 4003 deaths were from fever and 2725 from smallpox. In mid-winter, 1739-40, coals rose to £3. 10_s._ per chaldron, owing to the navigation of the Thames being closed by ice; the streets were impassable by snow, there was a “frost-fair” on the Thames, and in other respects a repetition of the events preceding the London typhus of 1685-86. The _Gentleman’s Magazine_ of January, 1740, tells in verse how the poor were “unable to sustain oppressive want and hunger’s urgent pain,” and reproaches the rich,--“colder their hearts than snow, and harder than the frost”; while in its prose columns it announces that “the hearts of the rich have been opened in consideration of the hard fate of the poor[129].” The long, hard winter was followed by the dry spring and hot summer of 1740, during which the sickness (in Ireland at least) was of the dysenteric type. In the autumn of 1740 the epidemic is said to have taken origin both at Plymouth and Bristol from ships arriving with infection among the men--at the former port the king’s ships ‘Panther’ and ‘Canterbury,’ at the latter a merchant ship. At Plymouth it was certainly raging enormously from June to the end of the year--“febris nautica pestilentialis jam saevit maxime,” says Huxham; it continued there all through the first half of 1741, “when it seemed to become lost in a fever of the bilious kind.” It was in the dry spring and very hot summer of 1741 that the fever became general over England. Wall says that it appeared at Worcester at the Spring Assizes among a few; at Exeter also it was traced to the gaol delivery; and it was commonly said that the turmoil of the General Election (which resulted in driving Walpole from his long term of power) helped its diffusion. But undoubtedly the great occasion of its universality was a widely felt scarcity. The rise in the price of wheat was small beside the enormous leaps that prices used to take in the medieval period, having been at no time double the average low price of that generation. It was rather the want of employment that made the pinch so sharp in 1741. The weaving towns of the west of England were losing their trade; of “most trades,” also, it was said that they were in apparent decay, “except those which supply luxury[130].” Dr Barker, of Sarum, the best medical writer upon the epidemic, says: “The general poverty which has of late prevailed over a great part of this nation, and particularly amongst the woollen manufacturers in the west, where the fever has raged and still continues to rage with the greatest violence, affords but too great reason to believe that this has been one principal source of the disease[131].” He explains that the price of wheat had driven the poor to live on bad bread. This is borne out by a letter from Wolverhampton, 27 November, 1741[132]. The writer speaks of the extraordinary havoc made among the poorer sort by the terrible fever that has for some time raged in most parts of England and Ireland. At first it seldom fixed on any but the poor people, and especially such as lived in large towns, workhouses, or prisons. Country people and farmers seemed for the most part exempt from it, “though we have observed it frequently in villages near market towns”; whereas, says the writer, the epidemic fevers of 1727, 1728 and 1729 were first observed to begin among the country people, and to be some time in advancing to large towns. This writer’s theory was that the fever was caused by bad bread, and he alleges that horse-beans, pease and coarse unsound barley were almost the only food of the poor. To this a Birmingham surgeon took exception[133]. Great numbers of the poor had, to his knowledge, lived almost entirely upon bean-bread, but had been very little afflicted with the fever. Besides, every practitioner knew that the fever was not confined to the poor. He pointed out that in Wolverhampton, whence the bad-bread theory emanated, the proportion of poor to those in easier circumstances was as six to one, poverty having increased so much by decay of trade that many wanted even the necessaries of life. The Birmingham surgeon was on the whole inclined to the theory of “the ingenious Sydenham, that the disease may be ascribed to a contagious quality in the air, arising from some secret and hidden alterations in the bowels of the earth, passing through the whole atmosphere, or to some malign influence in the heavenly bodies”--these being Sydenham’s words as applied to the fever of 1685-6. Barker, also, draws a parallel between the epidemic of 1741 and that of 1685-86: the Thames was frozen in each of the two winters preceding the respective epidemics, and the spring and summer of 1740 and 1741 were as remarkable for drought and heat as those of 1684 and 1685. In London the deaths from fever in 1741 reached the enormous figure of 7528, the highest total in the bills of mortality from first to last, while the deaths from all causes were 32,119, in a population of some 700,000, also the highest total from the year of the great plague until the new registration of the whole metropolitan area in 1838. It will be seen from the following table (on p. 81) of the weekly mortalities that the fever-deaths rose greatly in the autumn, but, unlike the old plague, reached a maximum in the winter. The effects of the epidemic of typhus upon the weaving towns of the west of England, in which the fever lasted, as in London, into the spring of 1742, were seen at their worst in the instance of Tiverton. It was then a town of about 8000 inhabitants, having increased little during the last hundred years. Judged by the burials and baptisms in the parish register it was a more unhealthy place since the extinction of plague than it had been before that. It was mostly a community of weavers, who had not been in prosperous circumstances for sometime past. In 1735 the town had been burned down, and in 1738 it was the scene of riots. The hard winter of 1739-40 brought acute distress, and in 1741 spotted fever was so prevalent that 636 persons were buried in that year, being 1 in 12 of the inhabitants. At the height of the epidemic ten or eleven funerals were seen at one time in St Peter’s churchyard. Its population twenty years after is estimated to have declined by two thousand, and at the end of the 18th century it was a less populous place than at the beginning[134]. _Mortality by Fever in London, 1741-42._ Week All ending Fever causes 1741 March 10 123 660 17 103 564 24 112 624 31 105 573 April 7 123 670 14 128 687 21 89 580 28 123 622 May 5 104 495 12 141 587 19 129 573 26 153 600 June 2 138 512 9 138 483 16 115 536 23 127 494 30 154 513 July 7 149 523 14 162 551 21 130 485 28 151 621 Aug. 4 128 512 11 142 541 18 172 636 25 192 665 Sept. 1 171 675 8 190 691 15 182 760 22 199 748 29 189 733 Oct. 6 207 784 13 192 787 20 232 793 27 234 850 Nov. 3 250 835 10 228 772 17 182 670 24 214 806 Dec. 1 224 768 8 203 748 15 191 761 22 179 775 29 180 702 1742 Jan. 5 221 893 12 184 760 19 151 724 Feb. 2 132 675 9 103 533 16 108 675 25 103 641 _Effects of the Epidemic of 1741-42 on Provincial Towns. (Short’s Abstracts of Parish Registers.)_ With burials Registers more than Baptisms in Burials in Year examined baptisms the same the same 1740 27 6 1409 1940 1741 27 14 3787 6205 1742 26 6 1721 3345 Other parts of the kingdom may be represented by Norwich, Newcastle and Edinburgh. The record of baptisms in Norwich is almost certainly defective; in only two years from 1719 to 1741, is a small excess of baptisms over burials recorded, namely, in 1722 and 1726, while in a third year, 1736, the figures are exactly equal. In 1740 there are 916 baptisms to 1173 burials, and in 1741, 851 baptisms to 1456 burials; while in 1742, owing to an epidemic of smallpox, the deaths rose to 1953, or to more than double the recorded births[135]. The distress was felt most in East Anglia in 1740. Blomefield, who ends his history in that year, says there was much rioting throughout the kingdom, “on the pretence of the scarcity and dearness of grain.” At Wisbech Assizes fourteen were found guilty, but were not all executed. In Norfolk two were convicted and executed accordingly. At Norwich the military fired upon the mob and killed seven persons, of whom only one was truly a rioter[136]. It was also in the severe winter of 1739-40 that the distress began in Edinburgh. The mills were stopped by ice and snow, causing a scarcity of meal; the harvest of 1740 was bad, riots took place in October, and granaries were plundered[137]. The deaths from fever were many in 1740, but were nearly doubled in 1741, with a significant accompaniment of fatal dysentery[138]: _Edinburgh Mortalities, 1740-41._ (Population in 1732, estimated at 32,000.)[139] 1740 1741 All causes 1237 1611 ---- ---- Consumption 278 349 Fever 161 304 Flux 3 36 Smallpox 274 206 Measles 100 112 Chincough 26 101 Convulsions 22 16 The last four items are of children’s maladies, for which Edinburgh was worse reputed even than London. At Newcastle the deaths in the register in 1741 were 320 more than in 1740, in which year they were doubtless excessive, as elsewhere. But there is a significant addition: “There have also been buried upwards of 400 upon the Ballast Hills near this town[140].” The symptoms of the epidemic fever of 1741-42 are described by Barker, of Salisbury, and Wall, of Worcester[141]. It began like a common cold, as was remarked also in Ireland. On the seventh day spots appeared like fleabites on the breast and arms; in some there were broad purple spots like those of scurvy. Miliary eruptions were apt to come out about the eleventh day, especially in women. In most, after the first six or seven days, there was a wonderful propensity to diarrhoea, which might end in dysentery. The cough, which had appeared at the outset, went off about the ninth day, when stupor and delirium came on. Gilchrist, of Dumfries, describes the fever there in November, 1741, as more malignant than the “nervous fever” which he had described in 1735. It came to an end about the fourteenth day; the sick were almost constantly under a coma or raving, and they died of an absolute oppression of the brain; a profuse sweat about the seventh day was followed by an aggravation of all the symptoms[142]. An anonymous writer, dating from Sherborne, uses the occasion to make an onslaught upon blood-letting[143]. Sanitary Condition of London under George II. The great epidemic of fever in 1741-42 was the climax of a series of years in London all marked by high fever mortalities. If there had not been something peculiarly favourable to contagious fever in the then state of the capital, it is not likely that a temporary distress caused by a hard winter and a deficient harvest following should have had such effects. This was the time when the population is supposed to have stood still or even declined in London. Drunkenness was so prevalent that the College of Physicians on 19 January, 1726, made a representation on it to the House of Commons through Dr Freind, one of their fellows and member for Launceston: “We have with concern observed for some years past the fatal effects of the frequent use of several sorts of distilled spirituous liquor upon great numbers of both sexes, rendering them diseased, not fit for business, poor, a burthen to themselves and neighbours, and too often the cause of weak, feeble and distempered children, who must be, instead of an advantage and strength, a charge to their country[144].” “This state of things,” said the College, “doth every year increase.” Fielding guessed that a hundred thousand in London lived upon drink alone; six gallons per head of the population per annum is an estimate for this period, against one gallon at present. The enormous duty of 20_s._ per gallon served only to develope the trade in smuggled Hollands gin and Nantes brandy. In the harvest of 1733 farmers in several parts of Kent were obliged to offer higher wages, although the price of grain was low, and could hardly get hands on any terms, “which is attributed to the great numbers who employ themselves in smuggling along the coast[145].” The mean annual deaths were never higher in London, not even in plague times over a series of years, the fever deaths keeping pace with the mortality from all causes, and, in the great epidemic of typhus in 1741, making about a fourth part of the whole. The populace lived in a bad atmosphere, physical and moral. As Arbuthnot said in 1733, they “breathed their own steams”; and he works out the following curious sum: “The perspiration of a man is about 1/34 of an inch in 24 hours, consequently one inch in 34 days. The surface of the skin of a middle-sized man is about 15 square feet; consequently the surface of the skin of 2904 such men would cover an acre of ground, and the perspir’d matter would cover an acre of ground 1 inch deep in 34 days, which, rarefi’d into air, would make over that acre an atmosphere of the steams of their bodies near 71 foot high.” This, he explains, would turn pestiferous unless carried away by the wind; “from whence it may be inferred that the very first consideration in building of cities is to make them open, airy, and well perflated[146].” In the growth of London from a medieval walled city of some forty or sixty thousand inhabitants to the “great wen” of Cobbett’s time, these considerations had been little attended to so far as concerned the quarters of the populace. The Liberties of the City and the out-parishes were covered with aggregates of houses all on the same plan, or rather want of plan. In the medieval period the extramural population built rude shelters against the town walls or in the fosse, if it were dry, or along the side of the ditch. The same process of squatting at length extended farther afield, with more regular building along the sides of the great highways leading from the gates. Queen Elizabeth’s proclamation of 1580 was designed to check the growth of London after this irregular fashion; but as neither the original edict nor the numerous copies of it, reissued for near a hundred years, made any provision for an orderly expansion of the capital, these prohibitions had merely the effect of adding to the hugger-mugger of building, “in odd corners and over stables.” The outparishes were covered with houses and tenements of all kinds, to which access was got by an endless maze of narrow passages or alleys; regular streets were few in them, and it would appear from the account given by John Stow in 1598 of the parish of Whitechapel that even the old country highway, one of the great roads into Essex and the eastern counties, had been “pestered[147].” The “pestering” of the field lanes in the suburban parishes with poor cottages is Stow’s frequent theme[148]. The borough of Southwark, as part of the City, may have been better than most: “Then from the Bridge straight towards the south a continual street called Long Southwark, built on both sides with divers lanes and alleys up to St George’s Church, and beyond it through Blackman Street towards New Town or Newington”--the mazes of courts and alleys on either side of the Borough Road which may be traced in the maps long after Stow’s time. So again in St Olave’s parish along the river bank eastwards from London Bridge--“continual building on both sides, with lanes and alleys, up to Battle Bridge, to Horsedown, and towards Rotherhithe.” In the Western Liberty, the lanes that had been laid out in Henry VIII.’s time, Shoe Lane, Fetter Lane and Chancery Lane, served as three main arteries to the densely populated area between Fleet Street and Holborn, but for the rest it was reached by a plexus or _rete mirabile_ of alleys and courts, notorious even in the 19th century. In like manner Drury Lane and St Martin’s Lane were the main arteries between High Holborn and the Strand. One piazza of Covent Garden was a new centre of regular streets, to which the haberdashers and other trades were beginning to remove from the City, for greater room, about 1662. The Seven Dials were a wonder when they were new, about 1694, and had the same intention of openness and regularity as in Wren’s unused design for the City after the fire. The great speculative builder of the Restoration was Nicholas Barbone, son of Praise-God Barbones. He built over Red Lion Fields, much to the annoyance of the gentlemen of Gray’s Inn[149], and his manner of building may be inferred from the following: “He was the inventor of this new method of building by casting of ground into streets and small houses, and to augment their number with as little front as possible, and selling the ground to workmen by so much per foot front, and what he could not sell build himself. This has made ground-rents high for the sake of mortgaging; and others, following his steps, have refined and improved upon it, and made a superfoetation of houses about London[150].” In these mazes of alleys, courts, or “rents” the people were for the most part closely packed. Overcrowding had been the rule since the Elizabethan proclamation of 1580, and it seems to have become worse under the Stuarts. On February 24, 1623, certain householders of Chancery Lane were indicted at the Middlesex Sessions for subletting, “to the great danger of infectious disease, with plague and other diseases.” In May, 1637, one house was found to contain eleven married couples and fifteen single persons; another house harboured eighteen lodgers. In the most crowded parishes the houses had no sufficient curtilage, standing as they did in alleys and courts. When we begin to have some sanitary information long after, it appears that their vaults, or privies, were indoors, at the foot of the common stair[151]. In 1710, Swift’s lodging in Bury Street, St James’s, for which he paid eight shillings a week (“plaguy deep” he thought), had a “thousand stinks in it,” so that he left it after three months. The House of Commons appears to have been ill reputed for smells, which were specially remembered in connexion with the hot summer of the great fever-year 1685[152]. The newer parts of London were built over cesspools, which were probably more dangerous than the visible nuisances of the streets satirized by Swift and Gay. There were also the “intramural” graveyards; of one of these, the Green Ground, Portugal Street, it was said by Walker, as late as 1839; “The effluvia from this ground are so offensive that persons living in the back of Clement’s Lane are compelled to keep their windows closed.” But that which helped most of all to make a foul atmosphere in the houses of the working class, an atmosphere in which the contagion of fever could thrive, was the window-tax. It is hardly possible that those who devised it can have foreseen how detrimental it would be to the public health; it took nearly a century to realize the simple truth that it was in effect a tax upon light and air. The Window-Tax. Willan, writing of fever in London in 1799, mentions that even the passages of tenement houses were “kept dark in order to lessen the window-tax,” and the air therefore kept foul[153]. Ferriar, writing of Manchester in the last years of the 18th century, mentions, among other fever-dens, a large house in an airy situation which had been built for a poor’s-house, but abandoned: having been let to poor families for a very trifling rent, many of the windows and the principal entrance were built up, and the fever then became universal in it[154]. The Carlisle typhus described by Heysham for 1781 began in a house near one of the gates, tenanted by five or six very poor families; they had “blocked up every window to lessen the burden of the window-tax[155].” John Howard’s interest having been excited in the question of gaol-fever, he noted the effects of the window-tax not only in prisons but in other houses. The magistrates of Kent appear to have paid the tax for the gaols in that county from the county funds; but in most cases the burden fell on the keepers of the gaols. “The gaolers,” says Howard, “have to pay it; this tempts them to stop the windows and stifle their prisoners;” and he appends the following note: “This is also the case in many work-houses and farm-houses, where the poor and the labourers are lodged in rooms that have no light nor fresh air; which may be a cause of our peasants not having the healthy ruddy complexions one used to see so common twenty or thirty years ago. The difference has often struck me in my various journeys[156].” Such impressions are known to be often fallacious; but in the history of the window-tax, which we shall now follow, it will appear that there was a new law, with increased stringency, in the years 1746-1748, corresponding to the “twenty or thirty years ago” of Howard’s recollection. The window-tax was originally a device of the statesmen of the Revolution “for making good the deficiency of the clipped money.” By the Act of 7 and 8 William and Mary, cap. 18, taking effect from the 25th March, 1696, every inhabited house owed duty of two shillings per annum, and, over and above such duty on all inhabited houses, every dwelling-house with ten windows owed four shillings per annum, and every house with twenty windows eight shillings. In 1710 houses with from twenty to thirty windows were made to pay ten shillings, and those with more than thirty windows twenty shillings. Various devices were resorted to to check the evasions of bachelors, widows and others. A farmer had to pay for his servants, recouping himself from their wages. A house subdivided into tenements was to count as one; which would have made the tax difficult to gather except from the landlord. The machinery of collection was a board of commissioners, receivers-general and collectors. But in the 20th of George II. (1746) the basis of the law was changed. The tax was levied upon the several windows of a house, so much per window, so that it fell more decisively than before upon the tenants of tenement-houses, and not on the landlords. The two-shillings house duty was continued; but the window-tax became sixpence per annum for every window of a house with ten, eleven, twelve, thirteen or fourteen windows, or lights, ninepence for every window of a house with fifteen, sixteen, seventeen, eighteen or nineteen windows, and one shilling for every window of a house with twenty or more windows. An exemption in the Act in favour of those receiving parochial relief was decided by the law officers of the Crown not to apply to houses with ten or more windows or lights, which would have included most tenement-houses; on the other hand they ruled that hospitals, poor-houses, workhouses, and infirmaries were not chargeable with the window duty. To remove doubts and check evasions another Act was made in 21 George II. cap. 10. All skylights, and lights of staircases, garrets, cellars and passages were to count for the purpose of the tax; also certain outhouses, but not others, were to count as part of the main dwelling whether they were contiguous or not. The 11th paragraph of the Amendment Act shows how the law had been working in the course of its first year: “No window or light shall be deemed to be stopped up unless such window or light shall be stopped up effectually with stone or brick or plaister upon lath,” etc. This remained the law down to 1803, when a change was made back to the original basis of rating houses as a whole, according to the number of their windows, the rate being considerably raised and fixed according to a schedule. The tax for tenement houses was at the same time made recoverable from the landlord. The window-tax thus became a form of the modern house-tax, rated upon windows instead of upon rental, and so lost a great part of its obnoxious character. The law of 1747-48, which taxed each window separately, and was enforced by a galling and corrupt machinery of commissioners, receivers-general and collectors paid by results, could not fail to work injuriously; for light and air, two of the primary necessaries of life, were in effect taxed. Even rich men appear to have taken pleasure in circumventing the collectors[157]. But it was among the poor, and especially the inhabitants of tenement houses, that the effect was truly disastrous; a tax on the skylights of garrets and on the lights of cellars, staircases and passages, taught the people to dispense with them altogether. Towards the end of the 18th century the grievance became now and then the subject of a pamphlet or a sermon. Gaol-Fever. Besides these ordinary things favouring contagious epidemic fever both in town and country, there were two special sources of contagion, the gaols and the fleets and armies. I shall take first the state of the gaols, which has been already indicated in speaking of the window-tax. In the opinion of Lind, a great part of the fever, which was a constant trouble in ships of the navy, came direct from the gaols through the pressing of newly discharged convicts. The state of the prisons in the first half of the 18th century was certainly not better than Howard found it to be a generation after; it was probably worse, for the administration of justice was more savage. About the beginning of the century, many petitions were made to Parliament by imprisoned debtors, complaining of their treatment, and a Bill was introduced in 1702. Sixty thousand were said to be in prison for debt[158]. On 25 February, 1729, the House of Commons appointed a committee “to inquire into the state of the gaols of this Kingdom”; but only two prisons were reported on, the Fleet and the Marshalsea, in London, the inquiries upon these being due to the energy of Oglethorpe, then at the beginning of his useful career. The committee found a disgraceful state of things:--wardens, tip-staffs and turnkeys making their offices so lucrative by extortion that the reversion of them was worth large sums, prisoners abused or neglected if they could not pay, some prisoners kept for years after their term was expired, the penniless crowded three in a bed, or forty in one small room, while some rooms stood empty to await the arrival of a prisoner with a well-filled purse. On the common side of the Fleet Prison, ninety-three prisoners were confined in three wards, having to find their own bedding, or pay a shilling a week, or else sleep on the floor. The “Lyons Den” and women’s ward, which contained about eighteen, were very noisome and in very ill repair. Those who were well had to lie on the floor beside the sick. A Portuguese debtor had been kept two months in a damp stinking dungeon over the common sewer and adjoining to the sink and dunghill; he was taken elsewhere on payment of five guineas. In the Marshalsea there were 330 prisoners on the common side, crowded in small rooms. George’s ward, sixteen feet by fourteen and about eight feet high, had never less than thirty-two in it “all last year,” and sometimes forty; there was no room for them all to lie down, about one-half of the number sleeping over the others in hammocks; they were locked in from 9 p.m. to 5 a.m. in summer (longer hours in winter), and as they were forced to ease nature within the room, the stench was noisome beyond expression, and it seemed surprising that it had not caused a contagion; several in the heat of summer perished for want of air. Meanwhile the room above was let to a tailor to work in, and no one allowed to lie in it. Unless the prisoners were relieved by their friends, they perished by famine. There was an allowance of pease from a casual donor who concealed his name, and 30 lbs. of beef three times a week from another charitable source. The starving person falls into a kind of hectic, lingers for a month or two and then dies, the right of his corpse to a coroner’s inquest being often scandalously refused[159]. The prison scenes in Fielding’s _Amelia_ are obviously faithful and correct. Oglethorpe’s committee had done some good since they first met at the Marshalsea on 25th March, 1729, not above nine having died from that date to the 14th May; whereas before that a day seldom passed without a death, “and upon the advancing of the spring not less than eight or ten usually died every twenty-four hours.” Two of the chief personages concerned were found by a unanimous vote of the House of Commons to have committed high crimes and misdemeanours; but when they were tried before a jury on a charge of felony they were found not guilty. About a year after these reports to the Commons there was a tragic occurrence among the Judges and the Bar of the Western Circuit during the Lent Assizes of 1730. The Bridewell at Taunton was filled for the occasion of the Assizes with drafts of prisoners from other gaols in Somerset, among whom several from Ilchester were said to have been more than ordinarily noisome. Over a hundred prisoners were tried, of whom eight were sentenced to death (six executed), and seventeen to transportation. As the Assize Court continued its circuit through Devon and Dorset several of its members sickened of the gaol fever and died: Piggot, the high-sheriff, on the 11th April, Sir James Sheppard, serjeant-at-law, on 13th April at Honiton, the crier of the court and two of the Judge’s servants at Exeter, the Judge himself, chief baron Pengelly, at Blandford, and serjeant-at-law Rous, on his return to London, whither he had posted from Exeter as soon as he felt ill[160]. It is said that the infection afterwards spread within the town of Taunton, where it arose, “and carried off some hundreds”; but the local histories make no mention of such an epidemic in 1730, and no authority is cited for it[161]. Something of the same kind is believed to have happened at a gaol delivery at Launceston in 1742, but the circumstances are vaguely related, and it does not appear that any prominent personage in the Assize Court died on the occasion[162]. The great instance of a Black Assize in the 18th century, comparable to those of Cambridge, Oxford and Exeter in the 16th[163], was that of the Old Bailey Sessions in London in April, 1750. It has been fully related by Sir Michael Foster, one of the justices of the King’s Bench, who had himself been on the bench at the January sessions preceding, and was the intimate friend of Sir Thomas Abney, the presiding judge who lost his life from the contagion of the April sessions[164]. “At the Old Bailey sessions in April, 1750, one Mr Clarke was brought to his trial; and it being a case of great expectation, the court and all the passages to it were extremely crowded; the weather too was hotter than is usual at that time of the year[165]. Many people who were in court at this time were sensibly affected with a very noisome smell; and it appeared soon afterwards, upon an enquiry ordered by the court of aldermen, that the whole prison of Newgate and all the passages leading thence into the court were in a very filthy condition, and had long been so. What made these circumstances to be at all attended to was, that within a week or ten days at most, after the session, many people who were present at Mr Clarke’s trial were seized with a fever of the malignant kind; and few who were seized recovered. The symptoms were much alike in all the patients, and in less than six weeks time the distemper entirely ceased. It was remarked by some, and I mention it because the same remark hath formerly been made on a like occasion [Oxford, 1577], that women were very little affected: I did not hear of more than one woman who took the fever in court, though doubtless many women were there. “It ought to be remembered that at the time this disaster happened there was no sickness in the gaol more than is common in such places. This circumstance, which distinguisheth this from most of the cases of the like kind which we have heard of, suggesteth a very proper caution: not to presume too far upon the health of the gaol, barely because the gaol-fever is not among the prisoners. For without doubt, if the points of cleanliness and free air have been greatly neglected, the putrid effluvia which the prisoners bring with them in their clothes etc., especially where too many are brought into a crowded court together, may have fatal effects on people who are accustomed to breathe better air; though the poor wretches, who are in some measure habituated to the fumes of a prison, may not always be sensible of any great inconvenience from them. “The persons of chief note who were in court at this time and died of the fever were Sir Samuel Pennant, lord mayor for that year, Sir Thomas Abney, one of the justices of the Common Pleas, Charles Clarke, esquire, one of the barons of the exchequer, and Sir Daniel Lambert, one of the aldermen of London. Of less note, a gentleman of the bar, two or three students, one of the under-sheriffs, an officer of Lord Chief Justice Lee, who attended his lordship in court at that time, several of the jury on the Middlesex side, and about forty other persons whom business or curiosity had brought thither.” The same thing was remarked here as at Exeter in 1586 that those who sat on the side of the Court nearest to the dock were most attacked by the infection[166]. When the cases of fever began to occur, after the usual incubation of “a week or ten days,” there was much fear of the infection spreading, so that many families, it is said, retired into the country[167]. But Pringle wrote on 24 May, “However fatal it has been since the Sessions, it is highly probable that the calamity will be in a great measure confined to those who were present at the tryal[168];” and Justice Foster gives no hint of anyone having taken the fever who was not present in court. The tragedy of gaol-fever at the Old Bailey in 1750 secured increased attention to the subject of scientific ventilation. The great bar to fresh air indoors throughout the 18th century was the window-tax. It bore particularly hard on prisoners, for the gaolers had to pay the window-tax out of their profits, and they naturally preferred to build up the windows. Scientific ventilation of gaols was something of a mockery in these circumstances; but it is the business of science to find out cunning contrivances, and ingenious ventilators were devised for Newgate, the leading spirit in this work being the Rev. Dr Hales, rector of a parish near London, and an amateur in physiology at the meetings of the Royal Society. A ventilating apparatus had been erected at Newgate about a year before the fatal sessions of 1650, but it does not seem to have answered. It consisted of tubes from the various wards meeting in a great trunk which opened on the roof. A committee of the Court of Aldermen in October 1750 resolved, after consulting Pringle and Hales, to add a windmill on the leads over the vent, and that was done about two years after. Pringle, who inspected the ventilator on 11 July, 1752, says that a considerable stream of air of a most offensive smell issued from the vent; and it appeared that no fewer than seven of the eleven carpenters who were working at the alterations on the old ventilator caught gaol-fever (of the petechial kind), which spread among the families of some of them[169]. Pringle and Hales were of opinion that the wards furnished with tubes were less foul than the others; and they claimed, on the evidence of the man who took care of the apparatus, that only one person had died in the gaol in two months, whereas, before the windmill was used, there died six or seven in a week[170]. But Oglethorpe had claimed an improvement of the same kind at the Marshalsea in 1729 merely from having the prisoners saved from hunger; and Lind, who was a most matter-of-fact person, did not think that the ingenious contrivances for ventilation had answered their end[171]. Howard’s visitations of the prisons, which began in 1773 and were continued or repeated during several years following, brought to light many instances of epidemic sickness therein, which was nearly always of the nature of gaol-typhus. The following is a list compiled from his various reports, the two or three instances of smallpox infection being given elsewhere. _Wood Street Compter, London._ About 100 in it, chiefly debtors. Eleven died in beginning of 1773; since then it has been visited by Dr Lettsom at the request of the aldermen. _Savoy, London._ On 15 March, 1776, 119 prisoners. Many sick and dying. Between that date and next visit, 25 May, 1776, the gaol-fever has been caught by many. _Hertford._ Inmates range from 20 to 30. In the interval of two visits, the gaol-fever prevailed and carried off seven or eight prisoners and two turnkeys. (The interval probably corresponded to the admission of an unusual number of debtors.) _Chelmsford._ Number of inmates varies from 20 to 60, about one-half debtors. A close prison frequently infected with the gaol-distemper. _Dartford, County Bridewell._ A small prison. About two years before visit of 1774 there was a bad fever, which affected the keeper and his family and every fresh prisoner. Two died of it. _Horsham, Bridewell._ The keeper a widow: her husband dead of the gaol-fever. _Petworth, Bridewell._ Allowance per diem a penny loaf (7½ oz.). Th. Draper and Wm. Godfrey committed 6 Jan., 1776: the former died on 11 Jan., the other on 16th. Wm. Cox, committed 13 Jan., died 23rd. “None of these had the gaol-fever. I do not affirm that these men were famished to death; it was extreme cold weather.” After this the allowance of bread was doubled, thanks to the Duke of Richmond. _Southwark, the new gaol._ Holds up to 90 debtors and felons. “In so close a prison I did not wonder to see, in March, 1776, several felons sick on the floors.” No bedding, nor straw. The Act for preserving the health of prisoners is on a painted board. _Aylesbury._ About 20 prisoners. First visit Nov., 1773, second Nov., 1774: in the interval six or seven died of the gaol-distemper. _Bedford._ About twenty years ago the gaol-fever was in this prison; some died there, and many in the town, among whom was Mr Daniel, the surgeon who attended the prisoners. The new surgeon changed the medicines from sudorifics to bark and cordials; and a sail-ventilator being put up the gaol has been free from the fever almost ever since. (This was the gaol which is often said to have started Howard on his inquiries when he was High Sheriff.) _Warwick._ Holds up to fifty-seven. The late gaoler died in 1772 of the gaol-distemper, and so did some of his prisoners. No water then; plenty now. _Southwell, Bridewell._ A small prison. A few years ago seven died here of the gaol-fever within two years. _Worcester._ Has a ventilator. Mr Hallward the surgeon caught the gaol-fever some years ago, and has ever since been fearful of going into the dungeon; when any felon is sick, he orders him to be brought out. _Shrewsbury._ Gaol-fever has prevailed here more than once of late years. _Monmouth._ At first visit in 1774, they had the gaol-fever, of which died the gaoler, several of his prisoners, and some of their friends. _Usk (Monmouth) Bridewell._ The keeper’s wife said that many years ago the prison was crowded, and that herself, her father who was then keeper, and many others of the family had the gaol-fever, three of whom, and several of the prisoners, died of it. _Gloucester, the Castle._ Many prisoners died here in 1773; and always except at Howard’s last visit, he saw some sick in this gaol. A large dunghill near the stone steps. The prisoners miserable objects: Mr Raikes and others took pity on them. _Winchester._ The former destructive dungeon was down eleven steps, and darker than the present. Mr Lipscomb said that more than twenty prisoners had died in it of the gaol-fever in one year, and that the surgeon before him had died of it. _Liverpool._ Holds about sixty, offensive, crowded. Howard in March, 1774, told the keeper his prisoners were in danger of the gaol-fever. Between that date and Nov., 1775, twenty-eight had been ill of it at one time. _Chester, the Castle._ Dungeon used to imprison military deserters. Two of them brought by a sergeant and two men to Worcester, of which party three died a few days after they came to their quarters. (For fever in this prison in 1716 see the text, p. 60.) _Cowbridge._ The keeper said, on 19 August, 1774, that many had died of the gaol-fever, among them a man and a woman a year before, at which time himself and daughter were ill of it. _Cambridge, the Town Bridewell._ In the spring of 1779, seventeen women were confined in the daytime, and some of them at night, in the workroom, which has no fireplace or sewer. This made it extremely offensive, and occasioned a fever or sickness among them, which so alarmed the Vice-Chancellor that he ordered all of them to be discharged. Two or three of them died within a few days. _Exeter, the County Bridewell._ Between first visit in 1775 and next on 5 Feb., 1779, the surgeon and two or three prisoners have died of the gaol-fever. In 1755 a prisoner discharged from the gaol went home to Axminster, and infected his family, of whom two died, and many others in that town afterwards. _Exeter, the High Gaol for felons._ Mr Bull, the surgeon, stated that he was by contract excused from attending in the dungeons any prisoners that should have the gaol-fever. _Winchester, Bridewell._ Close and small. Receives many prisoners from other gaols at Quarter Sessions. It has been fatal to vast numbers. The misery of the prisoners induced the Duke of Chandos to send them for some years 30 lbs. of beef and 2 gallon loaves a week. _Devizes, Bridewell._ Two or three years ago the gaol-fever carried off many. An infirmary added since then. _Marlborough._ The rooms offensive. Saw one dying on the floor of the gaol-fever. One had died just before, and another soon after his discharge. _Launceston._ Small, with offensive dungeons. No windows, chimneys, or drains. No water. Damp earthen floor. Those who serve there often catch the gaol-fever. At first visit, found the keeper, his assistant and all the prisoners but one sick of it (on 19 Feb., 1774, eleven felons in it). Heard that, a few years before, many prisoners had died of it, and the keeper and his wife in one night. A woman confined three years by the Ecclesiastical Court had three children born in the gaol. _Bodmin, Bridewell._ Much out of repair. The night rooms are two garrets with small close-glazed skylight 17 in. × 12 in. A few years ago the gaol-fever was very fatal, not only in the prison but also in the town. _Taunton, Bridewell._ Six years ago, when there was no infirmary provided, the gaol-fever spread over the whole prison, so that eight died out of nineteen prisoners. _Shepton Mallet._ Men’s night room close, with small window. So unhealthy some years ago that the keeper buried three or four in a week. _Thirsk._ Prisoners had the gaol-fever not long ago. _Carlisle._ During the gaol-fever which some years ago carried off many of the prisoners, Mr Farish, the chaplain, visited the sick every day. I shall add some medical experiences of gaol-fever in London from the notes of Lettsom[172]:-- May, 1773. A person released from Newgate “in a malignant or jail-fever” was brought into a house in a court off Long Lane, Aldersgate Street; soon after which fourteen persons in the same confined court were attacked with a similar fever: one died before Lettsom was called in, one was sent to hospital, eleven attended by him all recovered, though with difficulty. Two deaths in Wood Street Compter: 1. Rowell, an industrious, sober workman, who had supported for many years a wife and three children; some of these having been lately sick, he fell behind with his rent, a little over three guineas; he offered all he had (more than enough) to the landlord, but the latter preferred to throw the man and his family into the Compter, where Rowell died of fever. 2. Russell, once a reputable tradesman on Ludgate Hill, fell into a debt of under three guineas, sent to the Compter with his wife and five children, took fever and died; attended in his sickness in a bare room by his eldest daughter, elegant and refined, aged seventeen; his son, aged fourteen, took the fever and recovered. There was one Black Assize at this period, at Dublin in April 1776. A criminal, brought into the Court of Sessions without cleansing, infected the court and alarmed the whole city. Among others who died of the contagion were Fielding Ould, High Sheriff, the counsellors Derby, Palmer, Spring and Ridge, Mr Caldwell, Messrs Bolton and Eriven, and several attorneys and others whose business it was to attend the court[173]. There were two notorious outbreaks of malignant fever among foreign prisoners of war, one in 1761[174] and another in 1780[175], the first among French and Spaniards at Winchester and Portchester, the second among Spaniards at Winchester. Howard found so little typhus in the gaols in his later visits that it seemed as if banished for good. But it was heard of frequently about 1780-85--at Maidstone, at Aylesbury, at Worcester, costing the lives of some of the visiting physicians. Circumstances of severe and mild Typhus. The circumstances of the gaol distemper bring out one grand character of typhus which will have to be stated formally before we go farther. Ordinary domestic typhus was not a very fatal disease. Haygarth says that of 285 attacked by it in the poorer quarters of Chester in the autumn of 1774, only twenty-eight died. Ferriar, in Manchester, had sometimes an even more favourable experience than that: “The mortality of the epidemic was not great, ... out of the first ninety patients whom I attended, only two died.” This was before the House of Recovery was opened; so that the low mortality was of typhus in the homes of the people. The fever was often an insidious languishing, without great heat, and marked most by tossing and wakefulness, which might pass into delirium; when it went through the members of a family or the inmates of a house, there would be some cases concerning which it was hard to say whether they were cases of typhus or not. Misery and starvation brought it on, and often it was itself but a degree of misery and starvation. “I have found,” says Ferriar, “that for three or four days before the appearance of typhus in a family consisting of several children, they had subsisted on little more than cold water.” “It has been observed,” says Langrish, “that those who have died of hunger and thirst, as at sieges and at sea, etc., have always died delirious and feverish.” The fever was on the whole a distinct episode, but in many cases it had no marked crisis. “Those women who recovered,” says Ferriar, “were commonly affected with hysterical symptoms after the fever disappeared;” and again: “Fevers often terminate in hysterical disorders, especially in women; men, too, are sometimes hysterically inclined upon recovering from typhus, for they experience a capricious disposition to laugh or cry, and a degree of the globus hystericus.” These were probably the more case-hardened people, inured to their circumstances, their healthy appetite dulled by the practice of fasting or “clemming,” or by opium, and their blood accustomed to be renovated by foul air. If the limit of subsistence be approached gradually, life may be sustained thereat without any sharp crisis of fever, or with only such an interlude of fever as differs but little from a habit of body unnamed in the nosology. The worst kind of typhus, often attended with delirium, crying and raving, intolerable pains in the head, and livid spots on the skin, ending fatally perhaps in two or three days, or after a longer respite of stupor or waking insensibility, was commonly the typhus of those not accustomed to the minimum of well-being--the typhus of hardy felons newly thrown into gaol, of soldiers in a campaign crowded into a hospital after a season in the open air, of sailors on board ship mixing with newly pressed men having the prison atmosphere clinging to them, of judges, counsel, officials of the court and gentlemen of the grand jury brought into the same atmosphere with prisoners at a gaol-delivery, of the wife and children of a discharged prisoner returned to his home, of the gaol-keeper, gaol-chaplain, or gaol-doctor, of the religious and charitable who visited in poor localities even where no fever was known to be, and most of all of country people who crowded to the towns in search of work or of higher wages or of a more exciting life. It was in these circumstances that the most fatal infections of typhus took place. Such extraordinary malignancy of typhus happened often when the type of sickness (if indeed there was definite disease at all) among the originally ailing failed to account for it; it was the great disparity of condition that accounted for it. There were, however, more special occasions when a higher degree of malignancy than ordinary was bred or cultivated among the classes at large who were habitually liable to typhus. But even the old pestilential spotted fever which used to precede, accompany, and follow the plague itself, was fatal to a comparatively small proportion of all who had it. Thus, towards the end of the great London plague of 1625, on 18th October, Sir John Coke writes to Lord Brooke: “In London now the tenth person dieth not of those that are sick, and generally the plague seems changed into an ague[176].” One in ten is probably too small a fatality for the old pestilential fever; but that is the usually accepted proportion of deaths to attacks in the typhus fever of later times. The rate of fatality is got, naturally, by striking an average. But in truth an aggregate of typhus cases, however homogeneous in conventional symptoms or type-characters, was not always really homogeneous. We have seen that ninety cases of typhus could occur in the slums of Manchester with only two deaths. On the other hand there were outbreaks of gaol-fever in which half or more of all that were attacked died; and I suspect that the average fatality in typhus of one in ten was often brought up by an admixture of cases of healthy and well-conditioned people who caught a much more malignant type of fever from their contact with those inured to misery. To strike an average is in many instances a convenience and a help to the apprehension of a truth; but for the average to be instructive, the members of the aggregate must be more or less comparable in their circumstances. It has been truly said that there is no common measure between Lazarus and Dives as regards their subjective views of things; it is not a little strange to find that they are just as incommensurable in their risk of dying from the infection of typhus fever. The rule seems to be that the degree of acuteness or violence of an attack of typhus was inversely as the habitual poor condition of the victim. In adducing evidence of the tragic nature of typhus infection conveyed across the gulf of misery to the other side, I shall endeavour to keep strictly to the scientific facts, leaving the moral, if there be a moral (and it is not always obvious), to point itself. Let us take first the common case of country-bred people migrating to the towns. Any lodging in a crowded centre of industry and trade would be high-rented compared with the country cottage which they had left, and they would naturally gravitate to the slums of the city. “Great numbers of the labouring poor,” says Ferriar of Manchester, “who are tempted by the prospect of large wages to flock into the principal manufacturing towns, become diseased by getting into dirty infected houses on their arrival. Others waste their small stock of money without procuring employment, and sink under the pressure of want and despair.... The number of such victims sacrificed to the present abuses is incredible.” And again: “It must be observed that persons newly arrived from the country are most liable to suffer from these causes, and as they are often taken ill within a few days after entering an infected house, there arises a double injury to the town, from the loss of their labour, and the expense of supporting them in their illness. A great number of the home-patients of the Infirmary are of this description. The horror of these houses cannot easily be described; a lodger fresh from the country often lies down in a bed filled with infection by its last tenant, or from which the corpse of a victim to fever has only been removed a few hours before[177].” Two instances from the same author will show the severe type of the fever. The tenant of a house in Manchester, who was herself ill of typhus along with her three children, took in a lodger, a girl named Jane Jones, fresh from the country. The lodger fell ill, but the fact was kept concealed from the visiting physician until her screams discovered her: “She was found delirious, with a black fur on the lips and teeth, her cheeks extremely flushed, and her pulse low, creeping, and scarcely to be counted.” Treatment was of no use; she “passed whole nights in shrieking,” and in her extremity, she was saved, as Ferriar believed, by affusions of cold water. Another case, exactly parallel, proved fatal in three days: “In 1792 I had two patients ill of typhus in an infected lodging-house. I desired that they might be washed with cold water; and a healthy, ruddy young woman of the neighbourhood undertook the office. Though apparently in perfect health before she went into the sick chamber, she complained of the intolerable smell of the patients, and said she felt a head-ache when she came down stairs. She sickened, and died of the fever in three days[178].” These are instances of country-bred people, plunging abruptly into the fever-dens of cities and catching a typhus severe in the direct ratio of their ruddy, healthy condition. Another class of cases is that of persons carrying the atmosphere of a gaol into the company of healthy and otherwise favourably situated people. Howard gives a case: at Axminster a prisoner discharged from Exeter gaol in 1755 infected his family with the gaol-distemper, of which two of them died, and many others in that town. The best illustrations of the greater severity and fatality of typhus among the well-to-do come from Ireland, in times of famine, and will be found in another chapter. But it may be said here, so that this point in the natural history of typhus fever may not be suspected of exaggeration, that the enormously greater fatality of typhus (of course, in a smaller number of cases) among the richer classes in the Irish famines, who had exposed themselves in the work of administration, of justice, or of charity, rests upon the unimpeachable authority of such men as Graves, and upon the concurrent evidence of many. Ship-Fever. The prevalence of fevers in ships of war and transports from the Restoration onwards can be learned but imperfectly, and learned at all only with much trouble. Sir Gilbert Blane, who was not wanting in aptitude and had the archives of the Navy Office at his service, goes no farther back than 1779, from which date an account was kept of the causes of death in the naval hospitals. But the deaths on board ships of the fleet were not systematically recorded until 1811, when the Board of Admiralty instructed all commanders of ships of war to send to the Naval Office an annual account of all the deaths of men on board[179]. The sources of information for earlier periods are more casual. The war with France, which dated from the accession of William III. and continued until the Peace of Ryswick in 1697, led to numerous conflicts with French and Spaniards in the West Indies, and to naval expeditions year after year. The loss of life from sickness in the British ships for a few years at the end of the century was such as can hardly be realized by us. Some part of it happened on the outward voyages, but by far the greater part of it was from the poison of yellow fever which had entered the ships in the anchorages of West Indian colonies. It was probably to that cause that the enormous mortality in the fleet under Sir Francis Wheeler was owing. After some ineffective operations against the French in the Windward Islands in the winter of 1693-4, he sailed for North America with the intention of attacking Quebec. This he failed to do, having sailed from Boston for home on the 3rd of August without entering the St Lawrence. The reason of the failure was probably the extraordinary fatality which Cotton Mather, of Boston, professes to have heard from the admiral himself, namely, that he lost by a malignant fever on the passage from Barbados to Boston 1300 sailors out of 2100, and 1800 soldiers out of 2400[180]. Another instance comes from Carlisle Bay, Barbados. The slave ship ‘Hannibal’ arrived there in November, 1694, during a disastrous epidemic of yellow fever. Phillips, the captain, whose journal of the voyage is published[181], had great difficulty in saving his crew from being pressed into the king’s ships, which were short of men owing to the yellow fever. Captain Sherman, of the ‘Tiger,’ who convoyed the ‘Hannibal’ and other merchantmen back to England in April, 1695, told Phillips that he buried six hundred men out of his ship during the two years that he lay at Barbados, though his complement was but 220, “still pressing men out of the merchant ships that came in, to recruit his number in the room of those that died daily.” These and other similar experiences of yellow fever in the West Indies, which might be collected from the naval history, do not come properly into this chapter; and I pass from them to ship-fever proper, having indicated how much of the loss of life abroad was due to yellow fever. Some light is thrown upon the state of health on board ships of war on the home station by Dr William Cockburn, physician to the fleet, afterwards the friend of Swift, who calls him “honest Dr Cockburn.” He had a secret remedy for dysentery, which he succeeded in getting adopted by the Admiralty, greatly to his own emolument for many years after. Dining on board one of the ships at Portsmouth, in 1696, with Lord Berkeley of Stratton, he brought up the subject of his electuary, and arranged for a public trial of it next day on board the ‘Sandwich.’ An uncertain number, which looks to have been about seven in Cockburn’s own account, but became seventy in the pamphlet which advertised the electuary after his death, were available for the trial and were speedily cured. Cockburn’s three essays on the health of seamen[182] leave no doubt as to the extensive prevalence of scurvy and the causes thereof; while his references to “malignant fever,” although they are, as usual, brought in to illustrate some doctrinal or theoretical point, give colour to the belief that ship-typhus may have been as common then as we know it to have been in the ships at Portsmouth and Plymouth, on the more direct testimony of Huxham in 1736, and of Lind twenty years later. A naval surgeon of the time of William III. and Anne, was induced by his enthusiasm for blood-letting in fevers to record some of his experiences on board ship[183]. It was usually the lustiest, both of the young, strong and healthy people, and likewise of the elder sort, that died of fevers, the symptoms which proved so mortal having been delirium, phrenitis, coma or stupor, whether they occurred in the συνόχοι (of Sydenham) or in the συνεχεῖς (of the same author): “I had observed in a ship of war whose complement was near 500, in a Mediterranean voyage in the year 1694, where we lost about 90 or 100 men, mostly by fevers, that those who died were commonly the young, but almost always the strongest, lustiest, handsomest persons, and that two or three escaped by means of such [natural] haemorrhagies, which were five or six pounds of blood”--the point being that the amount of blood drawn by phlebotomy should be in proportion to the robustness and body-weight of the patient. In 1703 and 1704 he was surgeon to two of Her Majesty’s ships “where a delirium, stupor and phrenitis” were found as symptoms of the fevers. In the summer of 1704, cruising in the latitudes of Portugal and Spain, the men brought on board from Lisbon unripe lemons with which they made great quantities of punch. This was the evident cause of a cholera morbus and dysentery: “after this we had a pretty many taken with the _synochus putris_, and some with the _causus_” [malignant fever]. Most of these fevers went off by a crisis in sweating, “which was so large I had good reason to believe it judicatory.” In several the fevers left on the 9th, 10th or 11th day, and in almost all by the 14th. “About the latter end of July, and in August, there were many taken with a delirium and stupor or coma, and some with the phrenitis in their fever.” Among the symptoms was one which we find described for fevers on board ship on the West Coast of Africa at the same time--“soreness all over as if from blows with a cane,” a symptom afterwards associated with dengue. “Sometimes the bones (as they term it) don’t pain them much.” In some cases there were petechial spots as well as a stupor. In the month of August “the fevers with a stupor and phrenitis” came on apace. The treatment was to take ten ounces of blood every day from the second to the eighth day of the fever, to give tartar emetic in five-grain doses at the outset, and to administer cathartic glysters in the second half of the fever. “Seeing the lustiest men now ran no more hazard of their lives than any other who were usually taken with this fever, nor indeed so much, in the beginning of September I resolved, after all the phlebotomy was done in these fevers, to try the cathartic sooner.” Many of these who had accustomed themselves to the liberal use of spirituous liquors miscarried in the phrenitis. White left the navy in 1704 and settled in practice at Lisbon, where he saw much fever. He had seen epidemics break out in British ships of war at anchor in the Tagus, crowded with men and prisoners. One case he mentions in a Lisbon woman, with continual synochus, stupor, and petechiae on the fifth day: “This was contagious, for she got it by going often to assist a gunner of a man-of-war, who came to her house with this distemper upon him: for many at the same time on board that ship were sick of that disease.” Among the causes of fever on board ship he mentions the effluvia of the bilge-water. Exposed to these emanations were “a multitude of people breathing and constantly perspiring in a close place, such as a ship’s _allop_ or lower deck next the hould, where is the entry to a certain vacant space near the ship’s center, which leadeth to the bottom, for gathering all the water together which the ship draweth by leakage, and is called the well. Several times there is occasion for some people to go down to examine the quantity of the water, and in some ships to bore an augur hole to let in as much as will preserve a good air. I have often known two or three men killed at a time, as it is said; and the reason may be understood from what I said of the general effects of that fluid in ordinary fever [he is now writing on heat apoplexy], where there is not above two or three inches, but just as much as may make a surface, almost equal to the square of the well, of stagnant salt water which had been a long while in gathering; and the air over the whole _allop_ extremely rarified, and here not at all ventilated[184].” We owe it to the accident of the celebrated Dr Freind having accompanied Lord Peterborough’s expedition to Spain in 1705 that some account has been preserved of the sickness among the troops ashore and afloat[185]. The expedition of some 8000 men being then in its second year, fever and dysentery were by far the most common diseases, so common that “we can hardly turn, whether at sea or in camp, without finding them as if our inseparable companions and as if domesticated among us.” In the summer of the previous year there had been much fever both in the ships of the fleet and in the camp before Barcelona: “It was of the continual kind, though it usually remitted in the day time, and seemed to approach nearly to the stationary one which Sydenham has described in the years 1685 and 1686.” He then gives symptoms, which were on the whole those of the hospital fever to be afterwards described from Pringle’s medical account of the campaigns in 1743-48. Persons of a robust habit were affected more than others, and more severely, and carried off sooner. The others were generally taken away by a lingering death. “Some, when the fever seemed to have been wholly gone off lay four or five days without pain or sickness, though weak; afterwards being suddenly seized with convulsions of the nerves they in a short time expired”--perhaps the phenomenon of relapse, which Lind recorded for ship-fever fifty years after and was seen among the troops landed from Corunna in 1809. In some few the parotids, or abscesses formed about the groin, carried off the disease. He then gives the case of a lieutenant on board the ‘Barfleur.’ At first he was restless and delirious; on the 7th and 8th days he had _subsultus tendinum_; on the 8th day his tongue was sometimes fixed, and his eyes sparkled; on the 9th day, he was wholly deprived of his understanding; he pulled off the fringe of the bed and plucked the flocks; when he had before faultered in his speech, he was sometimes seized with hiccough. But on the 10th day, after 12 oz. of blood had been drawn from the jugular vein, his delirium went off on a sudden, and he began to mend, making a perfect recovery. Until the middle of the 18th century there are few other notices of ship-fever, but it is probable that Huxham’s accounts of a very malignant typhus among the crews of ships of war at Plymouth in 1735 (as well as at Portsmouth according to report), and again in 1741, are to be taken as samples of what might have been recorded on many occasions[186]. Fever and Dysentery of Campaigns: War Typhus, 1742-63. The war in Ireland after the accession of William III. produced two remarkable instances of war-sickness, which are fully given in another chapter. The campaigns of Marlborough against the armies of Louis XIV., from 1704 to the Treaty of Utrecht in 1713, appear to have found no historian from the medical side, nor does the duke refer to these matters in his dispatches or letters, beyond a remark in a letter to his wife from near Munich, 30 July, 1704, a fortnight before the battle of Blenheim: “There having been no war in this country for above sixty years, these towns and villages are so clean that you would be pleased with them[187].” The war of 1742-48, in which George II. joined Austria against France, produced the first good accounts of war typhus, on land and on board ship, in the writings of Pringle[188]. After the battle of Dettingen, 27 June, 1743, the men were exposed all night in the wet fields; during the next eight days five hundred of them were attacked with dysentery, and in a few weeks near half the army were either ill of it or had recovered from it. The dysentery continued all July and part of August, while the army lay at Hanau. The village of Feckenheim, a league from the camp, was used as a hospital, some 1500 being quartered in it, most of them ill at first of dysentery. The latrines appear to have been ill designed and badly kept. “A malignant fever began among the men, from which few escaped: for however mild or bad soever the flux was for which the person was sent to hospital, this fever almost surely supervened. The petechial spots, blotches, parotids, frequent mortifications, and the great mortality, characterized a pestilential malignity: in this it was worse than the true plague.... Of 14 mates employed about the hospital five died; and, excepting one or two, all the rest had been ill and in danger. The hospital lost nearly half of the patients; but the inhabitants of the village of Feckenheim, where the sick were, having first received the bloody flux, and afterwards the fever by contagion, were almost utterly destroyed[189].” The survivors from the sick troops in Feckenheim were removed to Neuwied, where they were relieved; “but the rest, who were mixed with them, caught the infection.” The mixed troops were sent still down the Rhine in bilanders, during which voyage “the fever became so virulent that above half the number died in the boats, and many of the remnant soon after their arrival.” A parcel of tents sent in these bilanders to the Low Countries were given to a Ghent tradesman to refit; he employed twenty-three journeymen upon them, “but these unhappy men were quickly seized with this fever, whereof seventeen died.” They had no other communication with the infected but through the tents. “These,” says Pringle, “are instances of high malignity. The common course of the infection is slow, and only catching to those constantly confined to the bad air. Sometimes one will have this fever about him for several days before it confines him to his bed; others I have known complain for weeks of the same symptoms without any regular fever at all; and some, after leaving the infectious place, have afterwards fallen ill of it[190].” After the battle of Fontenoy on 11 May, 1745, the army was in good health: “the smallpox was the only new disease; it came with the recruits from England, but did not spread; and indeed we have never known it of any consequence in the field.” On the Jacobite rebellion breaking out in Scotland later in the same year, some of the returning troops were ordered to disembark at Newcastle, Holy Island and Berwick. They had a long voyage, so that a kind of remitting fever which some of them had acquired in the autumn in the Low Countries was “by the crowds and the foul air of the hold soon converted into the jail distemper and became infectious.” At Newcastle most of the nurses and medical attendants of the extemporized hospital were seized with it, of whom three apothecaries, four apprentices and two journeymen died. But the most remarkable experience was on Holy Island. Of ninety-seven men taken out of the ships there, ill of the gaol-fever, forty died, “and the people of the place receiving the infection, in a few weeks buried fifty, the sixth part of the inhabitants of that island.” At Nairn and Inverness there was a singular experience in the spring of 1746. The ships which brought Houghton’s brigade to Nairn carried also thirty-six deserters to be tried by court-martial at the headquarters at Inverness: these men had deserted to the French in Flanders, had been found on board of a captured French transport carrying men to aid the Pretender, and had been thrown into gaol in England till an opportunity arose of sending them to their trial. Three days after the landing at Nairn of the force with which these deserters sailed, six of the officers were seized with fever and many of the men, of whom eighty were left sick at Nairn; in the ten days that the regiment remained at Inverness it sent one hundred and twenty more to hospital, ill of the same fever, which became frequent also among the inhabitants of the town. “Though the virulence of the distemper diminished afterwards in their march to Fort Augustus and Fort William, yet the corps continued sickly for some time.” From the middle of February, 1746, when the army crossed the Forth, to the end of the campaign, there were two thousand sick in hospital, including wounded, of which number near three hundred died, mostly of the contagious fever[191]. After the Peace of Aix-la-Chapelle in 1748, the English troops embarked at Willemstad for home; “but the wind being contrary, several of the ships lay above a month at anchor, and, after all, meeting with a tedious and stormy passage, during which the men kept mostly below deck, the air was corrupted and produced the jail or hospital fever.” The ships that came to Ipswich were in the worst state, about four hundred men having been landed sick there, most of them ill of this contagious fever. The infection was at first as active and the mortality as great on shore as on board; but the virulence of the fever was at length subdued by dispersing the sick and convalescents as much as possible[192]. Monro gives a similar account of the camp sickness among the British troops during the campaigns in North Germany in 1760-63. In the autumn of 1760, before he joined the forces, there had been much malignant fever and dysentery: the camp at Warburg was near the battlefield (31 July, 1760), where many of the dead were scarce covered with earth; there were also many dead horses, and in a time of heavy rains, the camp, with the neighbouring villages and fields, was filled with the excrements of a numerous army. Not only the soldiers, but the inhabitants of the country, who were reduced to the greatest misery and want, were infected, and whole villages almost laid waste. When Monro joined at Paderborn in January, 1761, he found the hospitals overcrowded, and the malignancy of the fever thereby much increased, so that a great many died. “The 1st and 3rd regiments suffered most, owing to all the sick of each regiment being put into a particular hospital by themselves, which kept up the infection, so that they lost one-third of those left ill of this fever, and many of the nurses and people who attended them were seized with it.” He distributed the sick men of the Coldstreams among the houses in the town, and lost few in comparison with the 1st and 3rd regiments. The contagion, under this bold policy, did not spread. Two points in the symptoms are noteworthy: first the occurrence of suppurating buboes of the groins and armpits in several; and, secondly, the frequency of round worms. “In this fever it was common for patients to vomit worms, or to pass them by stool, or, what was more frequent, to have them come up into the throat or mouth, and sometimes into their nostrils, while they were asleep in bed, and to pull them out with their fingers. The same thing happened to most of the British soldiers brought to the hospitals for other feverish disorders as well as this.” He cannot explain the commonness of round worms in the sick, unless it was from the great quantity of crude vegetables and fruits eaten, and the bad water. Patients in convalescence often suffered from deafness, and from suppurating parotids. Some had frequent relapses into the fever, “which seemed to be owing to the irritation of these insects,” namely the worms. Most of those who fell into profuse, kindly, warm sweats recovered, the sweats lasting from twelve to forty-eight hours, and carrying off the fever. He never saw any miliary eruptions, and only sometimes petechiae, or small spots, or marbling as in measles[193]. Ship-Fever in the Seven Years’ War and American War. Ship-fever would appear to have been at its worst after the middle of the 18th century. Dr James Lind joined Haslar Hospital in 1758, and brought to the naval medical service the same high qualities which Pringle and Monro brought to that of the army[194]. The smaller ships, such as the ‘Saltash’ sloop, the ‘Richmond’ frigate, and the ‘Infernal’ bomb were full of fever of the most malignant kind; of 120 men in the ‘Saltash,’ 80 were infected with a contagion much more virulent and dangerous than that in the guard-ships. The explanation was that the smaller ships were receiving vessels for the larger ships, and were manned from the gaols; drafts from them carried the infection to the guard-ships and to the ships fitting out for foreign service. Malignant fever also arose on the voyage home from America[195]. In September and October 1758, after the reduction of Louisburg, several of the ships arriving at Spithead were infected with a malignant fever; three hundred men were received from them at Haslar Hospital (some with scurvy), of whom twenty-eight died. The ‘Edgar,’ having been manned at the Nore from gaols, sailed for the Mediterranean, and lost sixty men from fever and scurvy. The ‘Loestoffe,’ having lain in the St Lawrence for eight months in perfect health, took on board six convalescent men from Point Levi Hospital before sailing for home; in forty-eight hours, fifty out of her two hundred men were seized with fevers and fluxes, and six died on the voyage home. The ‘Dublin’ on the homeward voyage from Quebec buried nineteen, and on her arrival reported ninety men sick of fever, fluxes and scurvy. The ‘Neptune’ was said to have lost one hundred and sixty men in a few months, and reported 136 sick. The ‘Cambridge,’ with 650 men in health, sent three of her crew to the ‘Neptune’ laid up, to prepare her for the dock; of these three, one on the fifth day became spotted and died, and another narrowly escaped with life. The ‘Diana’ developed fever during a rough passage home from America. The ‘St George,’ having sailed from Spithead in 1760, met with rough weather and had to return on account of sickness. On the other hand, Hawke’s fleet of twenty ships of the line with fourteen thousand men, which defeated the French in November 1759, kept the Bay of Biscay for four months in the most perfect health. From 1 July, 1758, to 1 July, 1760, there were 5743 admissions to Haslar Hospital, the chief diseases being as follows: Fevers 2174 Scurvy 1146 Consumption 360 Rheumatism 350 Fluxes 245 Of the fevers some were of an intermittent type, but by far the most were continued ship-typhus. Relapses were common, even to the sixth or seventh time. The fever varied a good deal in malignity, but never produced buboes, livid blotches or mortifications, and seldom parotids. Twenty-four men received from January to March 1760 out of the ‘Garland’ had most of them petechial spots accompanied with other symptoms of malignity, and of these, five died or 20 per cent. But of 105 received during the same months from the ‘Postilion’ and ‘Liverpool’ only eight died, and those mostly of a flux. The infection had little tendency to spread among the attendants at Haslar. In the first six months only one nurse died; in 1759, two labourers and two nurses died, one of the nurses by infection, having concealed some infected shirts under her bed, the other by decay of nature. Of more than a hundred persons employed in various offices about the sick there died only those five in the course of eighteen months. Although Lind’s account of ship-fever in the British navy is bad enough, he has collected some far worse particulars of foreign ships. Febrile contagion destroyed two-thirds of the men in the Duc d’Anville’s fleet at Chebucto (now Halifax), in 1746, the complete destruction of which was afterwards accomplished by the scurvy. It was ship-fever which ravaged the Marquis d’Antin’s squadron in 1741, the Count de Roquesevel’s in 1744, and the Toulon squadron in 1747. He takes the following from Poissonnier’s _Traité de Maladies des Gens de Mer_: The fleet commanded by M. Dubois de la Mothe sailed in 1757 from Rochefort for Louisburg, Canada, having some men sickly. The ships touched at Brest, and sent 400 ashore sick. They sailed from Brest on 3 May, and arrived at Louisburg on 28 June. There was then sickness in only two ships, but in a short time it appeared in all the fleet. On 14 October the fleet sailed from Louisburg for home, embarking one thousand sick, and leaving four hundred supposed dying. In less than six days from sailing most of the thousand sick were dead. When the fleet arrived at Brest on 22 November there were few seamen well enough to navigate the ships; 4000 men were ill, the holds and decks being crowded with the sick. The hospitals at Brest were already occupied, two ships from Quebec shortly before having sent a thousand men to them. Fifteen hospitals were soon filled, attended by five physicians and one hundred and fifty surgeons. Two hundred almoners and nurses fell victims. The infection passed to the lower class of the citizens, the havoc became general, and houses everywhere were filled with the dying and the dead. At length it got among the prisoners in the hulks. This dreadful infection began to abate in March, 1758, and ceased in April, having carried off in less than five months upwards of 10,000 people in the hospitals alone, besides a great number of the Brest townspeople. The stench was intolerable. No person could enter the hospitals without being immediately seized with headache; and every kind of indisposition quickly turned to fatal fever, as in the old plague times. The state of the bodies showed the degree of malignity that had been engendered: the lungs were engorged with blood, and looked gangrenous; the intestines often contained a green offensive liquor, and sometimes worms. Lind’s other instances are chiefly of the Dutch East Indiamen that anchored at Spithead with fever on board. In Nov., 1770, the ‘Yselmonde’ bound to Batavia, came to anchor at Spithead, and buried a number of men every day; two custom-house officers caught the fever and died. He gives two other instances of Dutch ships bound to Batavia, which came in to Portsmouth with fever[196]. The Dutch were said to send annually 2000 soldiers to Batavia, and to lose three-fourths of them by the ship-fever before they arrived. In 1769 Lind saw ship-fever in the Russian fleet at Spithead. Brownrigg, of Whitehaven, gives a good instance of the diffusion of typhus in a newly-commissioned ship of war, and thence to the civil population, which bears out Lind’s favourite notion that the gaols and the press-gang had far-reaching effects. In the year 1757 a sloop of war had been hastily manned at the Nore to protect the shipping between the Irish and Cumberland ports. She reached Whitehaven in May, with fever on board. The men were landed and lodged in small houses. Brownrigg found about forty lying on the floor of three small rooms, very close together, many of them in a dying state; seven days after he was himself seized with fever, and had a narrow escape with life. The ship’s surgeon died of it, his mate recovered with difficulty, two surgeons of the town died of it, and two more in Cockermouth. The contagion spread widely among the inhabitants of Whitehaven, Cockermouth and Workington[197]. Lind showed to Howard in one of the wards of Haslar Hospital a number of sailors ill of the gaol fever; it had been brought on board their ship by a man who had been discharged from a prison in London, and it spread so much that the ship had to be laid up[198]. With the outbreak of the American War we begin to hear of still more disastrous epidemics of fever in the English fleets. Some instances from Robertson’s full collection must suffice[199]. The ‘Nonsuch’ left England in March, 1777, and fifty of her men were carried off by fever before December; in that month, the ‘Nonsuch,’ ‘Raisonable’ and ‘Somerset’ had each from 130 to 150 men on the sick list, chiefly fever in the ‘Somerset,’ and scurvy in the other two. In April, 1778, the ‘Venus,’ with a crew of 240, was at Rhode Island very sickly; the surgeon told Robertson that they had lost about fifty men of fever, which still continued to rage on board: they became sickly from being crowded with prisoners and cruising with them on board in bad weather. The ‘Somerset’ had buried 90 men of the fever since she left England, 70 of them being of the best seamen. On arriving at Spithead in October, 1779, Robertson found much fever in the Channel Fleet which had lately come in, especially in the ‘Canada,’ ‘Intrepid,’ ‘Shrewsbury,’ ‘London’ and ‘Namur,’ three or four of which were put past service, so much were they disabled by sickness. At Gibraltar Hospital from 12 January to 31 March, 1780, there were admitted 570 men from twenty-seven ships, of whom 57 died; of 110 sick from the ‘Ajax,’ 18 died; of 437 Spanish prisoners, 37 died. Next year, in May, 1781, at Gibraltar, the ‘Bellona’ had buried 27 men since she left England, and had 108 on the sick list. The ‘Cumberland’ had buried 15; of the ‘Marlborough’s’ men, 40 had died at the hospital. Robertson had to purchase at his own expense vegetable acids, fruit and vegetables for the sick. Some statistics remain of the loss of men in the navy by sickness in the Seven Years’ War (1756-62) and in the American War[200]. The House of Commons had ordered a return of the number of seamen and marines raised and lost in the former; but the return was too general to be of much use, the number “lost” having included all those men who had been sent to hospital and never returned to their ships, all those who had been discharged as unserviceable, and all deserters. The number raised was 184,899, and the number “lost” 133,708, besides 1512 killed. The Return by the Navy Board for the period of the American War was more specific, showing only the number of the dead and killed. _Seamen and Marines raised, dead or killed, during the American War, 29 Sept., 1774, to 29 Sept., 1780_: Year Raised Dead Killed 1774 345 -- -- 1775 4,735 -- -- 1776 21,565 1679 105 1777 37,457 3247 40 1778 31,847 4801 254 1779 41,831 4726 551 1780 28,210 4092 293 ------- ------ ---- 175,990 18,545 1243 Fully a tenth part of the men raised were lost by sickness. Fever was the chief sickness, and as it happened rarely that more than one in ten cases of fever died, it will be easy to form an approximate estimate of the proportion of all the men raised for the ships that were on the sick list at one time or another with fever--nearly the whole, one might guess. During the three last years of the period Haslar Hospital was constantly full of typhus fever. Admiral Keppel’s fleet arrived at Spithead on 26 October, 1778, and soon began to be infected with contagious fever; before the end of December, 3600 men had been sent to Haslar, which could make up at a pinch 1800 beds. But the great epidemic at Portsmouth was the next year, 1779, when the very large Channel Fleet under Sir Charles Hardy came in. During the month of September, 2500 men were received into hospital, and more than 1000 ill of fevers remained on board for want of room in the hospitals. In the last four months of 1779, 6064 sick were sent to Haslar, which had 2443 patients on 1 January, 1780. There was an additional hospital at Foston, holding 200, as well as two hospital ships holding