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

produced much alarm in neighbouring places and caused Ashton to be avoided from fear of infection. Shortly after 1796, Ferriar made an inquiry into an epidemic of fever at a village within a mile of Manchester; the houses were many of them new, built for the convenience of a large cotton mill; but even the new houses were offensive, with cellars occupied by lodgers, and almost every house overcrowded. This was the first fever in the village, and it was traced to a family who had come from Manchester with infected clothes. Stockport about the same time erected a House of Recovery, having “the same general causes of fever which render the disease so common in Manchester”; and Ferriar adds: “I believe there is not a town in the kingdom containing four thousand inhabitants which would not be greatly benefited by similar establishments.” The bad harvest of 1794 raised the price of wheat to 55_s._ 7_d._ on 1 January, 1795, and the prospect of another short harvest to 77_s._ 2_d._ on 1 July. A famine being threatened, the Government caused neutral ships bound to French ports with corn to be seized, and brought into English ports, the owners receiving an ample profit. Agents were also sent to the Baltic to buy corn. By these means the price of wheat, which had risen in August to 108_s._ 4_d._, fell in October to 76_s._ 9_d._ Parliament met on the 29th October, and various measures were taken[287]. In the spring of 1796, the climax of distress was reached, wheat being at 100_s._ per quarter. The harvest of 1796 was abundant and wheat fell to 57_s._ 3_d._ The harvests of 1797 and 1798 were not equally good, but they were not altogether bad, and the price of wheat kept about 50_s._ for nearly three years, which were years of comparative comfort between the dearth of 1794-96 and the dearth of 1799-1802. Fevers in the Dearth of 1799-1802. Although Willan chooses the end of the year 1799 to enlarge upon the London fever, he does not connect it with the dearth that was already beginning to be felt (soup kitchens having been opened in various parts of London). The price of wheat, which had been steadily about 50_s._ in 1797 and 1798, rose in May, 1799 to 61_s._ 8_d._, after a hard winter which had probably injured the autumn-sown corn. The harvest turned out ill, and the price of wheat rose in December, 1799, to 94_s._ 2_d._ Bounties were offered on imported foreign grain, but in June, 1800, the price was 134_s._ 5_d._, falling in August to 96_s._ 2_d._ on the crops promising well. The latter end of harvest proved wet, much of the grain being lost, so that the price per quarter of wheat rose to 133_s._ in December. There was much suffering, and some rioting. Parliament met on the 11th November, 1800, on account of the dearth, the opinions of the members being much divided as to the causes of the high prices. In March, 1801, wheat was at 156_s._ 2_d._ per quarter, beef from 10_d._ to 10½_d._ per pound, mutton 11_d._ to 12_d._ per pound. It is to this year, when the quartern loaf was at one-and-eightpence, that a comparison by Arthur Young belongs, showing the great change in the purchasing power of wages[288]. By the end of summer, 1801, wheat rose to 180_s._, and the quartern loaf was for four weeks at 1_s._ 10½_d._ Whatever statistics were then kept of fever-cases, show a decided rise in the years 1800 and 1801: Manchester Glasgow London House of Royal Newcastle Bills of Recovery Infirmary Dispensary Mortality Year (fever-cases) (fever-cases) (fever-cases) (fever-deaths) 1796 371 43 201 1547 1797 339 83 65 1526 1798 398 45 67 1754 1799 364 128 -- 1784 1800 747 104 -- 2712 1801 1070 63 425 2908 1802 601 104 -- 2201 1803 256 85 352 2326 1804 184 97 255 1702 1805 268 99 74 1307 The London Fever Hospital was not opened until February, 1802, a small house in Gray’s Inn Lane containing sixteen beds. It came at the end of the epidemic, and was in small request during the next fifteen years. The same epidemic at Leeds was the occasion of opening a House of Recovery there in 1804, twenty-five years after Lucas had first called for it. The state of affairs in Leeds, which at length moved the richer classes to that step, is thus described by Whitaker[289]: “In the years 1801 and 1802 an alarming epidemic fever spread in Leeds and the neighbourhood. The contagion extended so rapidly and proved so fatal that some hundreds were affected at the same time, and two medical gentlemen, with several nurses, fell victims to the disease.... In 1802 whole streets were infected house by house; in one court, of crowded population, typhus raged for four months successively.” One of the Leeds physicians, Dr Thorp, seized the occasion to urge the need of a fever hospital, in a pamphlet written in 1802, in which he said: “In a visit made a few days ago to those abodes of misery, I saw in one particular district upwards of twenty-five families ill in contagious fever. In some houses two, in others six or seven [families] were confined, many of whom appeared to be in extreme danger.” The superintendent of the sick poor stated to Dr Thorp “that sixty families in epidemic fever are under his care at this time. New applications are making daily. In some families three, in others six or seven, are in the disease. Forty persons in fever have applied to him for medical aid within the present week[290].” The wonder is that, with the enormous prices of food, things were not worse. At the time when provisions were dearest, work was slack in several industries. A commercial report of 1 April, 1801, speaks of the trade of Birmingham as very distressed, a large proportion of the men being out of work; the ribbon trade of Coventry was deplorable, and the woollen trade of Yorkshire still worse. Evidence of epidemic typhus in various parts of England came out in connexion with the reports on influenza in 1803. Holywell, in Flintshire, with a large cotton-making industry, had not been free from a bad kind of typhus for two years previous to the influenza of 1803[291]. In Bristol there was a good deal of fever in 1802-3, which found its way, through domestic servants, into good houses in Clifton, “and proved fatal in some instances[292].” It is probable that these are only samples, the writings on epidemics being singularly defective at this period. The following, dated 10th April, 1802, by a surgeon at Earlsoham, near Framlingham, Suffolk, gives us a glimpse of malignant contagious fever in a farm-house: “The most prevailing epidemics for the last twelve months have been typhus maligna and mitior, scarlatina anginosa, measles, and mumps. Many of the former have proved alarmingly fatal in several of our villages, whilst those of the second class of typhoid fevers have put on the appearance of the low nervous kind attended with great prostration of strength, depression of spirits, loss of appetite, etc., which frequently continue many weeks before a compleat recovery ensues.” Five cases, of “the most malignant kind of typhus,” occurred in a farmer’s family: one of the sons, aged eighteen, died in a few days with delirium, and black sordes of the mouth, tongue and throat; then the father, two daughters, and another son, took the infection but all escaped with their lives. Of four persons who nursed them, one caught the fever, and died. Four persons in a neighbouring family, who visited them, took infection, of whom two died[293]. There was perhaps nothing very unusual in such instances of country fevers at the beginning of the century. The incident is exactly in the manner of one that figures prominently in a story of Scottish life and customs at the same period, which long passed current as a faithful picture and as enforcing a much-needed moral[294]. Comparative immunity from Fevers during the War and high prices of 1803-15. From 1803 to 1816 there was comparatively little fever in this country. This was notably the case in London, but it was also true of all the larger towns where fever-hospitals had been established, and it was as true of Ireland as of England. This was, indeed, a time of great prosperity, which reached to all classes, the permanent rise of wages having more than balanced the increased cost of the necessaries of life. The following prices of wheat will show that a dear loaf did not necessarily mean distress while the war-expenditure lasted: Prices of wheat (from Tooke). _s._ _d._ 1802 57 1 1803 52 3 1804 Lady Day 49 6 Dec. 86 2 1805 Aug. 98 4 Dec. 74 5 1806 73 5 1807 Nov. 66 1808 May 73 6 Dec. 92 1809 March 95 July 86 6 Dec. 102 6 1810 June 113 5 Dec. 94 7 1811 June 86 11 Nov. 101 6 1812 Aug. 155 Nov. 113 6 1813 Aug. 112 Dec. 73 6 1814 July 66 5 1815 Dec. 53 7 1816 May 74 Dec. 103 1817 June 111 6 1817 Sept. 77 7 1818 Dec. 78 10 1819 Aug. 75 1820 72 1821 July 51 Dec. 50 1822 42 1823 Feb. 40 8 June 62 5 Oct. 46 5 Dec. 50 8 1824 65 The only years in the period from 1803 to 1816 in which there was some slight increase of fever were about 1811-12. There was undoubtedly some distress in the manufacturing districts at that time, owing to the much talked-of Orders in Council, which had the effect of closing American markets to British manufactures[295]. The small amount of fever in London between the year 1803 and the beginning of the epidemic of 1817-19 rests on the testimony of Bateman[296], who in 1804 took up Willan’s task of keeping a systematic record of the cases at the Carey Street Dispensary. He has only two special entries relating to typhus: one in the autumn of 1811, when some cases occurred in the uncleanly parts of Clerkenwell and St Luke’s (“but I have not learned that it has existed in any other districts of London”); the other in October and November 1813, when there was more typhus among the Irish in some of the filthy courts of Saffron Hill, near Hatton Garden, than for several years past, the infection having spread rapidly and fatally in several houses. The best evidence of this lull in typhus in London is the almost empty state of the new fever-hospital: Year Admissions 1802 164 1803 176 1804 80 1805 66 1806 93 1807 63 1808 69 1809 29 1810 52 1811 43 1812 61 1813 85 1814 59 1815 80 1816 118 1817 760 Until it was removed to Pancras Road, in September, 1816, the London fever-hospital had only sixteen beds. But Bateman says that no one was refused admission, and that for several years the house was frequently empty three or four weeks together. Also at the Dispensary, in Carey Street, he had an opportunity during the period 1804-1816, “Of observing the entire freedom from fevers enjoyed by the inhabitants of the numerous crowded courts and alleys within the extensive district comprehended in our visits from that charity.” And again, writing in the winter of 1814-15, Bateman says: “To those who recollect the numerous cases of typhoid fevers [this term did not then mean enteric] which called for the relief of dispensaries twelve or fourteen years ago, and the contagion of which was often with great difficulty eradicated from the apartments where it raged, and even seized the same individuals again and again when they escaped its fatal influences, the great freedom from these fevers which now exists, even in the most close and filthy alleys in London, is the ground of some surprise.” And once more, in the summer of 1816, just as the new epidemic period was about to begin, he says: “The extraordinary disappearance of contagious fever from every part of this crowded metropolis during the long period comprehended by these Reports [since 1804], cannot fail to have attracted the attention of the reader.” Bateman concluded, not without reason, that this immunity of London from fever was due to the high degree of well-being among the poorer classes in times of plenty; and although he made out that the poor of Dublin, Cork and some Scotch towns did not profit by times of plenty so much as those in London, yet his reason for the abeyance of fever from 1804 to 1816 applied to England, Ireland and Scotland at large, and was doubtless the true reason. The following figures from Manchester[297], Leeds[298] and Glasgow[299] hospitals, as well as the Irish statistics elsewhere given, are closely parallel with those of London: _Manchester House of Recovery._ Year Cases Deaths 1796-7 371 40 1797-8 339 16 1798-9 398 27 1799-1800 364 41 1800-1 747 63 1801-2 1070 84 1802-3 601 53 1803-4 256 33 1804-5 184 34 1805-6 268 29 1806-7 311 33 1807-8 208 15 1808-9 260 21 1809-10 278 30 1810-11 172 15 1811-12 140 18 1812-13 126 13 1813-14 226 17 1814-15 379 29 1815-16 185 14 1816-17 172 6 _Leeds House of Recovery._ Year Cases Deaths 1804 (2 mo.) 10 0 1805 66 6 1806 75 2 1807 35 1 1808 80 3 1809 93 8 1810 75 14 1811 92 4 1812 80 12 1813 137 11 1814 79 4 1815 146 15 1816 121 13 1817 178 8 1818(10 mo.) 254 20 _Glasgow Royal Infirmary (Fever Wards)._ Year Cases 1795 18 1796 43 1797 83 1798 45 1799 128 1800 104 1801 63 1802 104 1803 85 1804 97 1805 99 1806 75 1807 25 1808 27 1809 76 1810 82 1811 45 1812 16 1813 35 1814 90 1815 230 1816 399 1817 714 1818 1371 Even such fever as there was in Britain from 1804 to 1817 was not all certainly typhus. The high death-rates at the Manchester fever-hospital in 1804 and 1805 (1 death in 7·5 cases and 1 death in 5·25 cases) may mean a certain proportion of enteric cases in those years. “From 1804 to 1805,” says Ferriar, “many cases were admitted of a most lingering and dangerous kind.... Many deaths took place from sudden changes in the state of the fever, contrary to the usual course of the disease, and only imputable to the peculiar character of the epidemic. Similar cases occurred at that time in private practice.” Next year, 1806, there was an epidemic among the troops at Deal, described under the name of “remittent fever,” which Murchison claims to have been enteric[300]. In September, 1808, says Bateman, several were admitted into the London House of Recovery, with malignant symptoms; “and some severe and even fatal instances occurred in individuals in respectable rank in life.” He still uses the name of typhus; but he is aware that the cases of continued fever, especially in the summer and autumn of 1810, had often symptoms pointing to a bowel-fever rather than to a head-fever[301]. The years 1807 and 1808 appear to have been the most generally unwholesome during this period of comparative immunity from fever; they were marked by the occurrence of dysenteries, agues, and infantile remittents, as well as of fevers of the “typhus” kind. The chief account comes from Nottingham[302]. The cases of “typhus” there were very tedious, but not violent, nor attended with any unfavourable symptoms, only one case having petechiae, and all having diarrhoea. The following table of admissions for various kinds of fever (as classified by Cullen) at the Nottingham General Hospital, 25 March, 1807, to 25 March, 1808, shows the preponderance of “synochus” and next to it, of infantile remittent: _Admitted to the Nottingham General Hospital, 1807._ Intermittent fever 7 Synocha 10 Typhus 27 Febris nervosa 26 Synochus 155 Febris infantum remittens 88 Dysentery 5 The state of war in the Peninsula was favourable to epidemic or spreading diseases, and there is a good deal to show that such diseases did exist among the British troops[303]. But there is only one good instance of England getting a taste of that experience of war-typhus which the Continent had to endure for many years. This was on the return of the remnant of the army after the defeat at Corunna on 16 January, 1809. The troops were crowded pell-mell on board transports, which had a very rough passage home. Dysentery broke out among them, and was the most urgent malady when they landed at Plymouth in a state of filth and rags. Typhus fever followed, but in the first three weeks at Plymouth, to the 18th of February, it was not of a malignant type, only 8 dying of it in the Old Cumberland Square Hospital; in the next three weeks, 28 died of it there. Up to the 27th of March, 1809, the sick at Plymouth from the Corunna army numbered 2432, of whom 241 died. Of 4 medical officers, 3 took the contagion, of 29 orderlies, 25 took it. The fever was in some cases followed by a relapse, which was more often fatal than the original attack[304]. This was a typical instance of typhus bred from dysentery or other incidents of campaigning, a contagion more dangerous to others than to those who had engendered it. “Within a few yards of the spot where I now write,” says Dr James Johnson, of Spring Gardens, London, “the greater part of a family fell sacrifices to the effects of fomites that lurked in a blanket purchased from one of these soldiers after their return from Corunna[305].” In August, 1813, an Irish regiment passing through Leyburn, a small market-town of the West Riding of Yorkshire, in an airy situation, was obliged to leave behind a soldier ill of typhus, who died of the fever after a few days. The infection appeared soon after in the cottages adjoining, and remained in that end of the town for several months, choosing the clean and respectable houses. In a farmer’s family, a son, aged twenty-nine, died of it, while another son and two daughters had a narrow escape. The disease appeared also in the village of Wensby, a mile distant, and in other villages. Few lives were lost[306]. These were, perhaps, not altogether solitary instances in Britain of typhus spread abroad by the movements of troops during the great French war. Let us multiply such instances by hundreds, and we shall vaguely realize the meaning of the statement that the period of the Napoleonic wars, and more particularly the period from the renewal of the war in 1803 until its close in 1815, was one of the worst times of epidemic typhus in the history of modern Europe. It was precisely in those years that England, Scotland and Ireland enjoyed a most remarkable degree of freedom from contagious fever. The Distress and Epidemic Fever (Relapsing) following the Peace of 1815 and the fall of wages. The long period of comparative immunity from typhus near the beginning of the 19th century was first broken, both in Great Britain and in Ireland, by the very severe winter of 1814-15; but it was not until the great depression of trade following the peace of 1815 (which made a difference of forty millions sterling a year in the public expenditure) and the bad harvest of 1816 that typhus fever and relapsing fever became truly epidemic, chiefly in Ireland but also in Scotland and England. The lesson of the history is unmistakable: with all the inducements to typhus from neglect of sanitation in the midst of rapidly increasing numbers, there was surprisingly little of the disease so long as trade was brisk and the means of subsistence abundant. The reckoning came in the thirty years following the Peace. In London, says Bateman[307], the epidemic began in the autumn of 1816, before the influence of scarcity was acutely felt, in the courts about Saffron Hill, the same locality in which he mentioned fever in the winter of 1813-14 among the poor Irish. But this means little more than that the Irish, whether in Ireland or out of it, are the first to feel the effects of scarcity in producing fever. At the very same time that it began among them in Saffron Hill, it began among some young people at a silk factory in Spitalfields. In March, 1817, there was a good deal more of it in Saffron Hill, as well as among the silk-weavers in Essex Street, Whitechapel, in Old Street, in Clerkenwell, and in Shadwell workhouse. Many poor-houses, and especially those of Whitechapel, St Luke’s, St Sepulchre’s and St George’s, Southwark, were getting crowded in 1817 with half-starved persons, among whom fever was rife in the summer and autumn. There was also much of it in the homes of working people in the eastern, north-eastern and Southwark parishes, with more occasional infected households in Shoe Lane, Clare Market, Somers Town and St Giles’s in the Fields (“in the filthy streets between Dyot Street and the end of Oxford Street”)[307]. The hospitals and dispensaries were fully occupied with fever, and the new House of Recovery in Pancras Road, with accommodation for seventy patients, was soon full. At the Guardian Asylum for young women, more than half of the forty inmates were seized with the fever in one week. The cases were on the whole milder than in ordinary years; of 678 admitted to the House of Recovery in 1817, fifty died or 1 in 13·5. In two-thirds of these patients the fever lasted two weeks or to the beginning of the third week; of the remaining third, a few lost the fever on the 7th, 8th or 9th day, a larger number on the 12th to the 14th day, while a considerable number kept it to the end of the third week or beginning of the fourth. Of the whole 678, only 75 had a free perspiration, and in only 19 of these was the perspiration critical so as to end the fever abruptly. The fever relapsed in 54 of the 678, a proportion of relapsing cases which seemed to Bateman to be “remarkably great[308].” In most the symptoms continued without break throughout the illness. Besides other febrile symptoms, there were pains in the limbs and back, aching of the bones, and soreness of the flesh, as if the patients had been beaten. There was a certain proportion of severe complicated cases of typhus. Bateman held that the differences in type depended on the differences of constitution, giving the following reason for and illustration of his opinion: “Thus, in the instance of a man and his wife who were brought to the House of Recovery together, the former was affected with the mildest symptoms of fever, which scarcely confined him to bed, and terminated in a speedy convalescence; while his wife was lying in a state of stupor, covered with _petechiae_ and _vibices_; in a word, exhibiting the most formidable symptoms of the worst form of typhus. Yet these extreme degrees of the disease manifestly originated from the same cause; and it would be equally unphilosophical to account them different kinds of fever and give them distinct generic appellations as in the case of the benign and confluent smallpox, which are generated in like manner from one contagion.” Besides this woman, only eight others had petechiae. The House of Commons Committee were unable to find out with numerical precision how much more prevalent the fever was in 1817-18 than in the years preceding[309]. To their surprise they found that in six of the general hospitals of London, which admitted cases of fever, “no register is kept in the hospital to distinguish the different varieties of disease.” The apothecary of St Luke’s Workhouse told them that he attended, on an average of common years, about 150 cases of fever; in the last year [1817] the number rose to 600; and they were assured by several besides Bateman, that the great decrease of the deaths from “fever” in the London bills of mortality during a space of fourteen years at the beginning of the century (1803-17), was not a mere apparent decrease, from the growing inadequacy of the bills, but was a real decrease. The epidemic which began in 1817 continued in London throughout the years 1818 and 1819, chiefly in the densely populated poorer quarters of the town. Two instances of the London slums of the time came to light before the House of Commons Committee on Mendicity and Vagrancy in 1815-16: firstly, Calmel’s Buildings, a small court near Portman Square, consisting of twenty-four houses, in which lived seven hundred Irish in distress and profligacy, neglected by the parish and shunned by everyone from dread of contagion; and, secondly, George Yard, Whitechapel, consisting of forty houses, in which lived two thousand persons in a similar state of wretchedness. The dwellings of the poorer classes in London at this period, before the alleys and courts began to disappear, were described thus generally by Dr Clutterbuck[310]: “The houses the poor occupy are often large, and every room has its family, from the cellar to the garret. Thirty or forty individuals are thus often collected under the same roof; the different apartments must be approached by a common stair, which is rarely washed or cleansed; there are often no windows or openings of any kind backwards; and the _privies_ are not unfrequently within the walls, and emit a loathsome stench that is diffused over the whole house. The houses are generally situated in long and narrow alleys, with lofty buildings on each side; or in a small and confined court, which has but a single opening, and that perhaps a low gateway: such a court is in fact little other than a well. These places are at the same time the receptacles of all kinds of filth, which is only removed by the scavenger at distant and uncertain intervals, and always so imperfectly as to leave the place highly offensive and disgusting.” In England, generally, this epidemic of 1817-19 is somewhat casually reported. One writes from Witney, Oxfordshire, “on the prevailing epidemic,” which began there in July, 1818, among poor persons, in crowded, filthy and ill-ventilated situations. At first it was like the ordinary contagious fever of this country, “a disease familiar to common observation”; but afterwards it showed choleraic and pneumonic complications. Sometimes the parotid and submaxillary glands were inflamed; petechiae were absent[311]. The type of fever at Ipswich in the spring of 1817 was contagious (e.g. six cases in one family) and sthenic, or of strong reaction, admitting of bloodletting, according to the teaching which Armstrong, Clutterbuck and others had been reviving for fevers[312]. Those instances, one from Oxfordshire the other from Suffolk, must stand for many. Hancock says that the fever of 1817-19 “visited almost every town and village of the United Kingdom[313].” Prichard says that it began in Ireland, “where the distress was most urgent, and afterwards prevailed through most parts of Britain,” some of the more opulent also being involved in the calamity. As to its prevalence in the manufacturing towns of Yorkshire we have ample testimony. The Leeds House of Recovery, which had not been fully occupied at any time since its opening in 1804, received 178 cases in 1817, and 254 in the first ten months of 1818. Of the latter, 66 came from low lodging-houses, of whom upwards of 50 were strangers. Of 50 admitted in January, 1818, 20 came from four or five lodging-houses in March Lane, and from another locality equally bad--Boot and Shoe Yard; while the rest of the 50 in that month came from houses and streets in the same vicinity. March Lane was one of the worst seats of the great Leeds plague in 1645. By the month of April, 1820, the epidemic had decreased a good deal in Leeds, the cases becoming at the same time more anomalous[314]. The following is one of the Rochdale cases: June 2, 1818, Alice Eccles, a delicate young woman living in a crowded and filthy court from which fever had not been absent for nearly a year, was bled to ten ounces, purged, and recovered. On September 20th the same woman returned, desiring to be bled again. She was labouring under her former complaint; “since her last illness she had been repeatedly exposed to contagion, or rather, she had been living in an atmosphere thoroughly saturated with infectious effluvia, the house in which she resided, and generally the room in which she slept, having had one or more cases of fever in them,” and the windows kept closed[315]. At Halifax in the summer of 1818, typhus (or relapsing fever) had increased so much that fever-wards were added to the Dispensary. It had been alarmingly fatal in a high-lying village near Settle. It was prevalent in Ripon, Huddersfield and Wakefield; and had been brought from Leeds to Atley. A Bradford physician visited 27 cases of fever in one day at a neighbouring village. Throughout Yorkshire, it was confined to the lower orders, and was not very fatal[316]. At Carlisle it began about July, 1817, and became somewhat frequent in the winter and spring following; of 457 cases treated from the Dispensary 46 died, or 1 in 10[317]. At Newcastle, a mild typhus (typhus mitior) broke out in the autumn of 1816, not in the poorer quarters, but mostly among the domestics of good houses in elevated situations. There was much privation at Newcastle, as elsewhere, at this time, among the poor. Murchison takes this fever of the autumn of 1816 at Newcastle to have been enteric or typhoid; but it is described as a simple continued fever, with vertigo, headache, and bloodshot eyes, lasting from five or six days to four or five weeks, ending usually without a marked crisis, and causing few deaths[318]. The epidemic continued in Newcastle for three years, the admissions to the Fever Hospital from 4 Sept. 1818, to 4 March, 1819, having been 160, with 12 deaths. Dr McWhirter wrote, in April, 1819, that he saw on his rounds as dispensary physician “too many of the obvious causes of fever,” including the filth and wretchedness of the poor inhabitants: “one rather wonders that so many escape it than that some are its victims[319].” Thus far there has been little besides Bateman’s essay to indicate the nature or type of the fever in England. In Ireland it was to a large extent relapsing fever, and, as we shall see, it was so also in Scotland. Bateman found less than a tenth part of the cases at the London Fever Hospital to have relapses, which was an unusually large proportion, in his experience. Elsewhere in England the tendency to relapse was either wanting or the relapses were described or accounted for in other ways; to understand this it has to be kept in mind that the epidemic was the occasion of a great revival of blood-letting, a practice which had fallen into disuse in fevers since the last half of the 18th century, and was something of a novelty in 1817. The fever of that year was undoubtedly abrupt in its onset, strong, “inflammatory,” with full bounding pulse, beating carotids, hot and dry skin, intense headache, suffused eyes, and the like symptoms, which seemed to call for depletion. The common practice was to bleed _ad deliquium_, which meant to ten, or fourteen, or twenty ounces, at the outset of the fever. There was hardly one of the writers upon the epidemic, unless it were Bateman, an advocate of the cordial and supporting regimen, who did not consider the stages or duration of the fever as artificially determined by the blood-letting, and not as belonging to the natural history. In order to show how much the treatment by blood-letting dominated the view of the fever itself, of its type, its stages, or duration, I shall take the Bristol essay of Prichard, who adopted phlebotomy, as he says, at first tentatively and with some fear and trembling, but at length practised it vigorously, having found it to answer well[320]. The epidemic of fever in Bristol began about June, 1817, and lasted fully two years. The first cases brought to St Peter’s Hospital, which was the general workhouse of the city, were of wretched vagrants found ill by the wayside or abandoned in hovels. About the same time forty-two felons in the Bristol Newgate, “one of the most loathsome dungeons in Britain, perhaps I might say in Europe,” were infected, of whom only one died, and he of a relapse. From June, 1817, to the end of 1819, there were 591 cases in the poor’s house, 647 in the General Infirmary, and 975 treated from the Dispensary, making 2213 cases, of which a record was kept. But there were also many cases in private practice among the domestics, children, and others in good houses, such as those on Redcliff Hill. The cases in the poor’s house were classified by Prichard as follows: 1817 1818 1819 Simple Fever 22 45 40 with cephalic symptoms 24 27 25 " pneumonic symptoms 7 10 16 " gastric symptoms 3 11 5 " enteric symptoms 3 4 5 " hepatic symptoms 5 3 3 exhausted and moribund 1 6 4 not characterised 30 44 2 --- --- -- 95 150 105 --------------- Of these there died 20 16 11 The “genuine form,” or ground-type, according to Prichard, was “simple fever,” of which the cases with cephalic symptoms were merely the more protracted or more serious. “The pneumonic, hepatic, gastric, enteric and rheumatic forms may be regarded as varieties”--the gastric and hepatic being cases mostly in summer with jaundice, the enteric in autumn and winter with diarrhoea and dysentery. Nearly all these patients were bled within four or five days from the commencement of the disease: “in a very large proportion of the cases the fever was immediately cut short”; when it did not end thus abruptly, its symptoms declined gradually, and the attack was over within eight or ten days. After the blooding “sleep very frequently followed, and a partial or sometimes a complete remission of the symptoms.” Only one case of relapse is mentioned, No. 118, of the year 1818, and that was a relapse in a very prolonged case: the patient was admitted on 6 October, had a relapse on 18 November, and was discharged on 23 December. Prichard has not one word in his text to suggest relapsing fever; the bulk of his cases were simple continued fever, with or without cephalic or other local symptoms, ending in four, six, eight or ten days, while some were cases of _typhus gravior_. The fever was undoubtedly contagious: it spread through whole families, and in St Peter’s Hospital itself it attacked seventy of the ordinary pauper inmates, including a good many lunatics. The Epidemic of 1817-19 in Scotland: Relapsing Fever. Let us now turn to the epidemic in Scotland, where the relapsing type was as marked as in Ireland, if not more so. The destitution in the Scots towns in the autumn of 1816, and following years, was fully as great as anywhere in the kingdom, although the peasantry of Scotland were not famine-stricken, as those of Ireland were. The state of the poorer classes in Edinburgh was graphically set forth in an essay by Dr Yule, in 1818[321], and in an article in _Blackwood’s Magazine_ the year after. Vigorous efforts to relieve the distress were made by the richer classes, and a special fever-hospital was opened at Queensbery House, the admissions to which, together with the fever-cases at the Royal Infirmary, were as follows:[322] Year Admitted Died Ratio of deaths 1817 511 33 1 in 15-16/33 1818 1572 75 1 in 21 1819 1027 30 1 in 34 (to 1 Dec.) Of this epidemic several accounts were published at the time, including one by Welsh, superintendent of the fever hospital, which is dominated, like the Bristol account of Prichard, by the idea that blood-letting cut short the fever[323]. Christison, who had experience of the relapsing form in his own person[324], describes also two other forms mixed with the cases of relapsing fever: a mild typhus, the _typhus mitior_ (_typhus gravior_ being exceedingly rare in that epidemic), and a form which began like the inflammatory relapsing _synocha_, and gradually after a week put on the characters of mild typhus. The admissions for fever to the Glasgow Infirmary, which was then the only charity that received fever cases, had been at a somewhat low level since the last epidemic in 1799-1801. They began to rise again with the distress of 1816:-- _Admissions for Fever, Glasgow Infirmary._ Year Cases 1814 90 1815 230 1816 399 1817 714 1818 1371 1819 630 1820 289 1821 234 1822 229 1823 269 At the height of the epidemic in 1818 an additional fever hospital was opened at Spring Gardens, to which 1929 cases were admitted in that and the following year. Great efforts were made in Glasgow to “stamp out” the contagion by disinfectants and removal to hospital[325]; but the course of the epidemic seemed to follow the economic conditions more than anything else. The outbreak at Aberdeen was later than in the south of Scotland, having begun in August, 1818. The infection was said to have been brought to the city by a woman who found a lodging in Sinclair’s Close. A group of houses in the close, covering an area of seventy by fifty feet and containing one hundred and three inmates, became the first centre of the fever. The scenes described are like those of the Irish epidemics: in one room, a man, his wife, and five children were lying ill on the floor; in another, a man, his wife and six children; in a third, a young girl, whose mother had just died of fever, was left with three infant brothers or sisters. More than three-fourths of the denizens of the close were “confined to bed in fever, and all the others crawling about during the intervals of their relapses.” The value of all the furniture and clothing belonging to 103 persons could little exceed £5. There was a horrible stench both within and without the houses (relapsing fever being remarkable for its odour). Yet this close was usually as healthy as any other part of the town. A House of Recovery, with sixty beds, was opened in the Gallowgate, and thirty beds were given up to fever-cases in the Infirmary of the city. Besides those ninety hospital cases at the date of 17 December, 1818, it was estimated that were three hundred more. Begging had been put down, so that the contagion had not spread to the richer classes. Despite these removals to hospital, the epidemic became more general about the New Year, 1819, and of a worse type; two physicians died of it, and some others had a narrow escape. At the outset, the fever had been of the relapsing kind--“subject to relapses for a third and fourth time, more especially when they return too early to their usual labour[326].” At a later period the epidemic seems to have become ordinary typhus, as it did also in Ireland and elsewhere; and it was called typhus in the essay upon it by Dr George Kerr[327]. The extent of this epidemic of 1818-19 over Scotland generally is not known; but the following notice of it in a country parish of Forfarshire was probably a sample of more that might have been given. Early in the summer of 1818 an epidemic of continued fever appeared in a manufacturing village seven miles from Lintrathen; it attacked at first young and plethoric subjects, and ran through whole families. In August it reached Lintrathen parish, in which one practitioner had forty cases, with no deaths. The fever was of an inflammatory nature; the bulk of the cases fell in October, and were nearly all of young women. They were bled to syncope, which then meant usually to 32 ounces. There was a prejudice against blooding among the old people, who said “they had had many fevers, and in their time no such thing was ever allowed.” But, according to the doctor, this withholding of the lancet had the effect of protracting their illnesses: “they toasted sick for six weeks, and were often confined to bed for months[328].” The epidemic of 1817-19 brought into prominence two questions, the one theoretical, the other practical. The theoretical question (not debated at the time) was touching the place or affinities of relapsing fever in the nosology. Christison maintained that it was the inflammatory fever, or _synocha_ of Cullen, showing a peculiar tendency to relapse. The fever of the same epidemic period in England was also undoubtedly a fever of strong or inflammatory reaction, corresponding to Cullen’s definition of _synocha_, but it relapsed much less frequently than in Ireland and Scotland in the same years. Even in Ireland and Scotland there were always many cases of “relapsing fever” which did not relapse. The law of its relapses was reduced to great simplicity by a physician learned in fevers, Dr John O’Brien, in the Dublin epidemic of 1827. The bulk of that epidemic was a fever of short periods--three, five, seven or nine days, most of the attacks ending on the fifth or seventh night of the fever. The attack being ended in a free perspiration, there might or might not happen, after an interval, a relapse, and again a relapse after that, or even a third. The five-days’ fever was more liable to relapse than the seven-days’ fever, the seven-days’ fever more liable than the nine-days’ fever, the fevers of the longest periods not liable at all. In other words, the sooner the patient “got the cool,” by a night’s sweating, the more liable he was to have one or more relapses[329]. The logical position of relapsing fever was completed by Dr Seaton Reid, of Belfast, when he proposed, in his account of the epidemic in 1846-7, to call it Relapsing Synocha[330]. Other fevers have shown a tendency to relapse in certain circumstances. Three fevers which have many points in common, the sweating sickness, dengue and influenza, are all subject to relapses. It was doubtless of the sweating sickness that Sir Thomas More was thinking when he wrote: “Considering there is, as physicians say, and as we also find, double the peril in the relapse that was in the first sickness.” Plague, also, might relapse, or recur in an individual once, twice, three times, or oftener in the same epidemic season. Enteric is an instance of a long-period fever which has at times a tendency to relapses[331]. None of these, however, can dispute the claim of relapsing synocha to be relapsing fever _par excellence_. For whatever reason, the short-period fever of times of distress and dearth or famine has shown a peculiar tendency to relapse, and has shown that tendency more in the 19th century than in the 18th, and more among the Irish and Scotch poor than among the English. The practical question that came to the front in the epidemic fever of 1817-19 was that of isolation hospitals for the sick. It was thus stated by Dr Millar, of Glasgow, in a letter of advice to the authorities of Aberdeen: “It is only by a universal, or nearly universal sweep of the sick into Fever Hospitals, joined to a universal or nearly universal purification of their dwellings, that anything is to be hoped for in the way of suppressing our epidemic. So far as this grand object is concerned, all the rest is folly: it is worse than folly[332].” This was the well-meant but somewhat fanatical application of a trite and commonplace notion. It was well understood by reflective persons at that time, who were quite sound on the contagiousness of fever, that the whole question of segregating the poor in fever hospitals was beset with difficulties, not merely of expense but also of expediency. A Select Committee of the House of Commons sat upon it in 1818, and published their report, with the minutes of evidence, on the 20th May. So much had been said in Parliament by Peel and others, and said so truly, of the spreading of fever all over Ireland by whole families turned adrift in beggary, that the Select Committee were full of ideas of contagion, and of the great opportunity of suppressing fever by destroying its germs or seeds. But they had soon occasion to learn that a fever may be potentially contagious, yet not contagious in all circumstances, and that segregation in fever hospitals had a rival in dispersion through general hospitals. Half-a-dozen London physicians of position, answering respectively for Guy’s, St Thomas’s, the London, St Bartholomew’s, St George’s, the Westminster and the Middlesex Hospitals, declared that they mixed their cases of contagious fever in the ordinary wards among the other patients; and when asked by the astonished Committee whether the fever did not spread, they answered one after another with singular unanimity, “Never,” which under cross-examination, became in one or two instances, “hardly ever,” as, for example, in the evidence for St Thomas’s Hospital, where a sister and a nurse had caught fever and died. The point of this London evidence was that the great safeguard against febrile contagion was free dilution with air, and that the great provocation of a contagious principle was to “concentrate” the cases of fever[333]. The Bristol experience in the same epidemic, although it did not come before the Select Committee, was wholly in agreement with medical opinion in London. The fever-cases there were received either into St Peter’s Hospital, which was the city poor-house, or into the General Infirmary. The former was an old irregular building, badly ventilated, in which the contagion spread freely to the ordinary inmates and became very virulent. Contrasting with the apartments of the old poor’s house, the wards of the Bristol General Infirmary were spacious, lofty, well-ventilated: “Here the patients labouring under fever were dispersed among invalids of almost every other description; so that, whatever effluvia emanated from infected bodies became immediately diluted in the mass of air free from such pollution. Here, accordingly, no instance occurred of the propagation of fever. None of the nurses were attacked, nor were patients lying in the adjacent beds in any instance infected, though cases of the worst description, some of them exhibiting all the symptoms of typhus gravior, were placed promiscuously among the other patients, scarcely two feet of space intervening between the beds[334].” The same practice was kept up in the Edinburgh Infirmary until 1858 or longer; Christison, who gives a diagram of an ordinary ward with four fever-beds in it, declared in 1850 that there had been no spread of fever for fifteen years before, except on one occasion, when the rules of the house were neglected[335]. The bold policy of dispersing fever-patients among the healthy was begun by Pringle and Donald Monro during the campaigns of 1742-48 and 1761-63 in the Netherlands and North Germany. They found that concentration raised the contagion to high degrees of virulence and that dispersion weakened it to the point of non-existence, Monro’s success at Paderborn in 1761 having been of the most signal kind[336]. The Select Committee of 1818 were more influenced by what they were told of the good effects of the earliest Houses of Recovery, at Waterford, Manchester and other places in the end of the last century. For several years after their opening they were little needed, the epidemic which gave the immediate impulse to their establishment having subsided in due time both in the towns provided with Houses of Recovery and in the innumerable places where no such provision had been made. The recommendations of the Committee do not appear to have been carried out; for the London Fever Hospital, in Pancras Road, which had been enlarged to seventy beds when the epidemic began in 1817, remained the only special fever hospital in London until the establishment of the hospitals of the Metropolitan Asylums Board in 1870[337]. * * * * * The confusion of commerce, depression of trade and lack of employment which followed the Peace of Paris, and gave occasion to the British and Irish epidemic fevers of 1817-19, gradually righted themselves. The price of wheat, which would have been still higher after the four-months drought of 1818, but for large imports, gradually fell, and was about 50_s._ in 1821, and 40_s._ in the winter of 1822-23. After that, it rose somewhat again, and the third decade of the century, in the middle of which occurred the great speculative crash of 1825, was on the whole a hard time for the working classes. The history of fever has few illustrations between the epidemic of 1817-19 and that of 1826-27, excepting the great famine-fever of Connemara and other parts of the West of Ireland in 1822, elsewhere described, which coincided with a somewhat prosperous time in England and called forth a princely charity[338]. The Relapsing Fever of 1827-28. The epidemic of relapsing fever which was at a height in Dublin in 1826, did not culminate in Edinburgh, Glasgow, and other towns of Scotland until