CHAPTER V.

MEASLES. In the earliest English writings on medicine, measles is the inseparable companion of smallpox; so closely are they joined in pathology and treatment that even the statements as to the pustules and scars of the eruption are in some compends made to apply to both without distinction. This singular conjunction of two diseases came originally from the Arabian teaching, which was everywhere authoritative in the medieval period, and especially authoritative in all that related to smallpox. In the Latin compends based upon Avicenna or other Arabic writers, the two names were _variolae_ and _morbilli_, the former being as it were the _morbus_ proper and the latter its diminutive. It can hardly be doubted that we owe the English name of measles as the equivalent of _morbilli_ to John of Gaddesden. Originally the English word meant the leprous, first in the Latin form _miselli_ and _misellae_ (diminutive of _miser_), as in the histories of Matthew Paris, and later in the Norman-French form of _mesles_, as in the Acts of Parliament of Edward I. and in the ‘Vision of Piers the Ploughman.’ In the 15th century the leper-houses in the suburbs of London were called the “lazarcotes” or “meselcotes.” Gaddesden, by some unaccountable stretch of similarity, coupled the sores or tubercular nodules on the legs of “pauperes vel consumptivi,” who were called “_anglicé_ mesles,” with the spotted rash of the Arabian “morbilli”; and it was doubtless this haphazard bracketting of two unlike diseases that led in course of time to the name of mesles being disjoined from its original sense of the leprous and restricted to the second member of Gaddesden’s strangely assorted couple. In the time of Henry VIII. smallpox and mezils are familiarly named together just as _variolae et morbilli_ are an inseparable pair in the treatises of the Arabistic writers. A still more singular usurpation by “mezils” or “maysilles” or “measles” is met with in the Elizabethan period. In the vocabulary of Levins, a schoolmaster who was also a medical graduate of Oxford, the word _variolae_ is rendered by “ye maysilles,” while _morbilli_ is omitted altogether among the Latin names and smallpox among the English; and in the English translation of Latin aphorisms appended to one of the works of William Clowes, surgeon to St Bartholomew’s Hospital, _variolae_ is in like manner translated “measles” on every occasion. In the English dictionary by Baret, belonging to the same period, measles is defined as “a disease with many reddish spottes or speckles in the face and bodie, much like freckles in colour”--which seems to exclude the possibility of a pustular disease having been part of the Elizabethan notion of measles. Notwithstanding this singular usage of the vocabularies and dictionaries, the name of smallpox occurs by itself in letters or other memorials of the Elizabethan period, having been doubtless correctly applied to the true pustular _variola_. In the short essay on smallpox by Kellwaye, appended to his book on the plague (1593), measles and smallpox are distinguished on the whole clearly, according to the definitions of Fracastori or other foreign writers of the 16th century. The association between measles and smallpox that survived longest was a peculiar and somewhat uncommon one; certain cases of smallpox, in which the pustules were wholly or partially represented by, or changed into, broad spots level with the skin, red or livid in colour, and in which haemorrhages occurred from the nose, lungs, bowels or kidneys, that is to say, cases of haemorrhagic smallpox, were apt to be called, from the time of James I. until as late as the case of Queen Mary in 1694, by the name of “smallpox and measles mingled.” From the date of the annual bills of mortality by the Parish Clerks of London, the year 1629, it is improbable that there was any real confusion between smallpox and measles; there was certainly some ambiguity in the entry of measles long after, but that later confusion, especially in the second half of the 18th century, was with scarlatina[1184]. The entry of measles is in the bills from the first, apart from that of “flox and smallpox:” Measles Smallpox Year deaths deaths 1629 42 72 1630 2 40 1631 3 58 1632 80 531 1633 21 72 1634 33 1354 1635 27 293 1636 12 127 1647 5 139 1648 92 401 1649 3 1190 1650 33 184 1651 33 525 1652 62 1279 1653 8 139 1654 52 832 1655 11 1294 1656 153 823 1657 15 835 1658 80 409 1659 6 1523 1660 74 354 In the great epidemic of smallpox in 1628, the year before the bills begin, Thomas Alured wrote to Sir John Coke that his house in London had been visited “once with the measles and twice with the smallpox, though I thank God we are now free; and I know not how many households have run the same hazard[1185].” In the year 1656, which has the highest total in the above table, two cases of measles are mentioned in a letter of 31st May: “Young Sir Charles Sedley is at this time very sick of a feaver and the meazells, of which Sir William dyed”--Charles Sedley being then in his seventeenth year[1186]. An instance parallel to that of 1628, of measles and smallpox co-existing in the same household, occurred in the royal palace at Whitehall in December, 1660. The princess of Orange, sister of the king, died of smallpox on the 23rd; on that day, or a day or two before, her sister the princess Henrietta, who had come from France on a visit with the queen-mother, Henrietta Maria, removed from Whitehall to St James’s, “for fear of infection.” After a few days she embarked on board the ‘London’ at Portsmouth to return to France, but the ship had to come to anchor again owing to the princess being attacked with “the measles.” Her illness, which delayed the sailing of the vessel until the 24th of January, 1661, is uniformly spoken of as the measles in the various letters which make mention of it[1187]. In that year, and in several of the next ten years, the measles deaths in London reached a considerable total: Measles Year deaths 1661 188 1662 20 1663 42 1664 311 1665 7 1666 3 1667 83 1668 200 1669 15 1670 295 The epidemic of 1670 is the subject of a description by Sydenham, the diagnostic points of which were doubtless those current at the time. Sydenham’s description of Measles in London, 1670 and 1674. Sydenham’s account of the epidemic of 1670 is full enough to leave no doubt that it was measles of the ordinary kind; the details, indeed, are as minute for all essential points as they would be in a modern text-book[1188]: Measles, he says, is a disease mainly of young children (_infantes_), and is apt to run through all that are under one roof. It begins with a rigor, followed by heats and chills during the first day. On the second day there is fever, with intense malaise, thirst, loss of appetite, white tongue (not actually dry), slight cough, heaviness of the head and eyes, and constant drowsiness. In most cases a humour distils from the nose and eyes, the effusion or suffusion of tears being the most certain sign of sickening for measles, more certain indeed than the exanthem. The child sneezes as if it had taken cold, the eyelids swell, there may be vomiting, more usually there are loose green stools (especially during dentition), and there is excessive fretfulness. On the fourth or fifth day small red maculae, like fleabites, begin to appear on the forehead and the rest of the face, which coalesce, as they continue to come out in increasing numbers, so as to form racemose clusters. These maculae will be found by the touch to be slightly elevated, although they seem level to the eye. On the trunk and limbs, to which they gradually extend, they are not elevated. About the sixth day the maculae begin to roughen and scale, from the face downwards, and by the eighth day are scarcely discernible anywhere. On the ninth day the whole body is as if dusted with bran. The common people say that the spots had “turned inwards,” by which they mean that, if it had been smallpox, they would have remained out longer, and have proceeded to suppuration or maturation. The rash having thus “gone in,” there is an access of fever, attended with laboured breathing and cough, the latter being so incessant as to keep the children from sleep day or night. If they had been treated by the heating regimen, they are apt to have the chest troubles pass into peripneumonia, by which complication measles becomes more destructive than smallpox itself, although there is no danger in it if it be rightly treated. When peripneumonia threatens, the patient should be bled, even if it be a tender infant. Diarrhoea, which sometimes continues for weeks after an attack of measles, may be cut short by blood-letting, and so also may whooping-cough. This epidemic, says Sydenham, began in January, and was almost ended in July, which agrees exactly with the rise and decline of measles deaths in the weekly bills of the Parish Clerks. His account of the epidemic of 1674 is still more important to be set beside the figures in the bills; for the type, according to Sydenham, was anomalous, and the total of deaths entered by the Parish Clerks (795) is exceptionally large. Like the epidemic four years before, it began in January, came to a height about the vernal equinox, and was nearly over at the summer solstice[1189]. _Weekly Deaths in London in the first six months of 1674. (Epidemic of Measles.)_ 1674 Week Griping in Convulsions Consumption All ending Fever Smallpox the guts Measles Teeth causes Jan. 6 35 13 35 0 37 15 78 332 13 35 19 32 1 32 22 65 369 20 37 12 29 0 39 18 65 327 27 34 15 38 0 38 17 68 354 Feb. 3 32 23 39 7 45 26 75 418 10 47 18 35 4 48 35 86 430 17 55 21 46 15 70 38 98 537 24 62 17 45 28 54 44 97 510 March 3 58 31 28 59 48 49 87 547 10 55 22 31 87 85 58 122 688 17 63 15 46 95 79 57 113 695 24 59 23 44 65 57 39 96 568 31 51 19 49 60 77 51 105 622 April 7 44 13 40 43 65 48 118 547 14 53 20 32 31 60 50 98 535 21 40 17 43 38 55 42 106 517 28 50 17 44 53 67 34 87 520 May 5 51 31 28 30 56 24 75 452 12 38 26 47 30 54 37 79 479 19 50 35 33 26 47 28 82 461 26 67 27 33 13 45 28 63 415 June 2 48 24 28 14 41 26 77 365 9 35 26 38 15 48 27 66 369 16 64 34 38 19 38 22 70 419 23 34 33 34 9 52 15 71 368 30 37 39 30 9 30 21 59 343 It will be seen that the highest weekly mortality from measles is only 95, in the week ending 17th May. But in that week the deaths from all causes reached the enormous total of 695, which was nearly three hundred above the weekly average of the time. This appears to have been the epidemic of measles which Morton declares to have destroyed three hundred in a week, a mode of reckoning which would claim for measles, directly or indirectly, the excess of mortality from all causes during the height of the epidemic[1190]. These high weekly mortalities in February, March, April and May are remarkable for the season of the year. Usually when the weekly figures reach six or seven hundred, it is in a hot autumn, and the cause is infantile diarrhoea, represented in the bills by the excessive number of deaths from “griping in the guts” and “convulsions;” more rarely, and then only for three or four weeks, correspondingly high figures are reached in a season of influenza. But in this case the epidemic measles is the only relevant thing. The measles deaths by themselves do by no means account for the enormous weekly totals; but two of the three columns of figures which help them, and indeed keep pace with the rise of the measles deaths, namely, “convulsions” and “teeth,” are infantile deaths obviously related to the prevailing epidemic; while the third column, “consumption,” which contributes most of all, did not in the London bills mean pulmonary consumption exclusively, but also the wasting or marasmus which followed or attended acute fevers in general, and was specially apt to follow or attend measles[1191]. Sydenham gives no indication that the spring of 1674 was unusually productive of pneumonia or pleurisy among adults; the winter, he says, was unusually warm, the weather in spring turning colder. But, as to the measles, he does say that the epidemic was anomalous or irregular; while both he and Morton refer the fatalities more especially to the sequelae of measles,--to the “suffocation” of infants and children by the bronchitis or peripneumonia, or to “angina,” as Morton says, meaning perhaps the same as in Scotland was understood by “closing” in infants. Measles itself was a milder disease than smallpox, according to the experience of all times; and yet, by its sequelae (bronchitis, capillary bronchitis and pneumonia, including what Morton calls “angina,” and excluding, for the present, whooping-cough), it raised the weekly mortalities of February, March, April and May, 1674, to far above the average. Sydenham said, with reference to the much milder epidemic of 1670, that these after-effects of measles “destroyed more than even smallpox itself” (_quae_ [_peripneumonia_] _plures jugulat quam aut variolae ipsae_). We shall not correctly understand the part played by measles among the infective maladies of children unless we keep that grand character of it in mind--that its effects upon the mortality of infancy and childhood are only in part expressed by the deaths actually appearing under its name. The London bills for 1674 afford us the opportunity of testing Sydenham’s paradox that measles, by its after-effects, destroyed more than smallpox itself. The epidemic of measles was nearly over in June; and immediately thereafter an epidemic of smallpox began (not of course from zero but from the usual level of the disease), which reached a maximum of 122 deaths in the week ending 20th October. The second half of the year was thus marked by a sharp outburst of smallpox, as the first half was marked by a sharp outburst of measles; and those two diseases were the only epidemic maladies that gave character to the respective seasons, each being in its proper season, according to Sydenham--measles in the spring, smallpox in the autumn. Although the measles deaths were only 795 for the whole year, the smallpox deaths being 2507, yet the former epidemic was attended by so great an excess of deaths under various other heads that the half of the year in which it fell was far more unhealthy than the succeeding half in which the smallpox mainly fell, the weekly average of the first six months having been 468 deaths, and of the second six months 349 deaths. The following table shows the weekly mortalities for the second half of the year; it will be observed that no column of figures keeps pace with the rise of the smallpox deaths, as three columns had kept pace with the rise of the measles deaths in the first six months of the year. _Weekly Deaths in London in the last six months of 1674. (Epidemic of Smallpox.)_ 1674 Week Griping in Convulsions Consumption All ending Fever Smallpox the guts Measles Teeth causes July 7 31 44 35 9 44 24 69 351 14 38 55 34 5 37 17 54 353 21 40 71 47 6 42 25 56 395 28 43 71 37 3 49 18 48 367 Aug. 4 38 68 39 6 31 23 47 347 11 33 66 48 -- 18 8 45 324 18 49 86 41 1 26 20 48 374 25 35 85 23 3 32 10 46 328 Sept. 1 60 96 41 -- 32 18 57 414 8 32 99 48 3 22 16 32 374 15 28 102 38 2 30 19 55 362 22 27 72 32 3 29 11 57 327 29 39 81 34 2 41 9 53 358 Oct. 6 37 98 29 -- 34 10 63 391 13 36 75 25 -- 35 17 49 311 20 42 122 35 1 34 10 68 402 27 24 75 36 -- 38 15 45 294 Nov. 3 34 83 21 -- 30 11 41 322 10 30 81 15 -- 31 12 49 321 17 31 70 16 -- 24 10 58 304 24 35 70 28 -- 38 14 57 344 Dec. 1 33 85 29 -- 32 14 68 378 8 33 66 28 -- 36 11 53 327 15 29 61 26 -- 39 16 49 339 22 34 68 21 -- 32 11 52 335 29 41 41 19 -- 33 7 74 337 The total of deaths by smallpox for the year, 2507 was the highest since the bills began, and remained the highest until 1681. It is open to us to suppose that it would not have been so high but for the epidemic of measles preceding. The measles not only made the first half of the year far more deadly than the second, within which most of the smallpox fell, but its effects may have aided the high mortality of smallpox itself, according to the experience of later times that infants and young children recovering from measles in a greatly weakened condition fell an easier prey to smallpox coming after[1192]. Morton passes from the fatal epidemic of 1674 (or, as he says, 1672), with the remark that the malady had not been epidemic again in London from that time until the date of his writing, 1692-94, a period of nearly twenty years; and that is on the whole borne out by the London bills and by Sydenham’s records so far as they extend. From 1687 to 1700, inclusive, the London bills grouped the measles deaths along with the deaths from smallpox, under the heading, “Flox, Smallpox and Measles”; in 1701 the total of measles, 4 deaths, is given as a separate item in the same bracket with smallpox; and in 1702 the heading of “Measles,” is restored to the place in the alphabetical list which it had held, except for that unaccountable break, from the beginning of the published bills in 1629. The following are the annual totals from and including the great epidemic of 1674: Death from Year measles 1674 795 1675 1 1676 83 1677 87 1678 93 1679 117 1680 49 1681 121 1682 50 1683 39 1684 6 1685 197 1686 25 Thus for a good many years after the general prevalence of measles in 1674 the deaths from it in London averaged only about one and a half in the week, while in no year until 1705-6 is there an epidemic comparable to that of 1674. It is clear that the severe epidemics of measles came at first at very long intervals, and that the years between had a very moderate mortality from that disease. Measles in the 18th century. There is hardly a reference to be found to measles in medical or other writings until the annual accounts of the public health at Ripon, York, Plymouth, etc. in the third decade of the 18th century. The annual deaths from it in London, according to the bills, were as follows, from 1701, when the disease was restored to its separate place in the classification: Year Measles deaths 1701 4 1702 27 1703 51 1704 12 1705 319 1706 361 1707 37 1708 126 1709 89 1710 181 1711 97 1712 77 1713 61 1714 139 1715 30 1716 270 1717 35 1718 492 1719 243 1720 213 1721 238 1722 114 1723 231 1724 118 1725 70 1726 256 1727 72 1728 82 1729 41 1730 311 1731 102 1732 30 1733 605 1734 20 1735 10 1736 169 1737 127 1738 216 1739 326 1740 46 The high mortalities of 1705 and 1706 belonged to one continuous epidemic from October, 1705, to April, 1706 (Sir David Hamilton says that smallpox was common in London in July, 1705, but the deaths in the bills are not excessive). The epidemic followed a great prevalence of the autumnal diarrhoea of infants, so that it is probable the high mortality was due as much to a greater fatality of cases from the antecedent weakening, as to an unusual number of cases[1193]. The following were the weekly deaths in a population about one-sixth that of London now: 1705-1706 Week Measles ending deaths Oct. 16 9 23 9 30 12 Nov. 6 10 13 30 20 34 27 29 Dec. 4 37 11 46 18 44 25 22 Jan. 1 35 8 33 15 28 22 20 29 18 Feb. 5 27 12 11 19 26 26 28 Mar. 5 10 12 10 19 9 26 13 Apr. 2 9 9 9 The unusually large mortalities from measles in 1718-19 and in 1733 were again associated with a “constitution” otherwise sickly. The epidemic in the latter year, from the middle of March to the end of July, which had a maximum of 47 deaths in each of the two middle weeks of May, followed close upon a severe influenza. Like the epidemic of 1674, it was attended by a high mortality from other causes, especially “convulsions” and “consumption”; and, as the bills had now begun to give the ages at death, it is no longer doubtful, or merely conjectural, that the great excess of deaths under these and other heads was really among infants, or that a rise in “consumption” at that time of the year meant an increase in the wasting diseases of infancy. This was a period when any epidemic malady among London children was sure to go hard with many of them, the period, namely, when spirit drinking, besides ruining the health of the parents, rendered them, in the opinion of the College of Physicians, “too often the cause of weak, feeble and distempered children[1194].” The intervals between epidemics of measles in London having been so considerable as the table shows, it is not surprising to find but casual mention of the disease in the chronicles of Wintringham, Hillary, and Huxham for England, of Rogers, O’Connell and Rutty for Ireland, and of the Edinburgh annalists. Wintringham, of York, whose annals extend from 1715 to 1730, records an epidemic of measles in 1721, which began in April and lasted all the summer, being for the most part of a bad type, attended with continual cough and inflammation of the lungs. Hillary, of Ripon, enters measles in 1726, “very common but mild,” autumn and winter being the season of it. Wintringham briefly mentions the same epidemic. Huxham of Plymouth has an entry of measles in the first year of his annals, 1727, in the month of July, followed by whooping-cough in December. Wintringham again enters measles at York in 1730 in the company of smallpox. In the annual accounts of the disease at Edinburgh, for a series of years beginning with 1731, measles is first mentioned in 1735[1195]. The epidemic began in June and became universal in December: “The progress of these measles along the west road of England towards Edinburgh was very remarkable, for they could be traced from village to village; and it was singular that the first person in Edinburgh who was seized with them was a lady in childbed, who saw nobody but her nurse and a friend who lived in the house with her”--an argument, apparently, for the doctrine of an epidemic “morbillous” constitution of the air. Five years after, we obtain the mortality statistics of Edinburgh, in the two great years of scarcity, typhus fever and sicknesses of all kinds, the years 1740 and 1741: in those two years measles must have been as general as smallpox if it were half as mortal, for the deaths set down to it in each year are 110 and 112, as compared with 274 and 206 from the more usual infantile infection. In like manner the second year of the disastrous epidemic of typhus in 1741-42, had the highest total of measles deaths in London until the great epidemic of 1808. While the high mortality of that year was due to special causes, it is at the same time clear from the following table that measles had not yet become a steady or perennial cause of death to the infancy of the capital: Year Measles deaths 1741 42 1742 981 1743 17 1744 5 1745 14 1746 250 1747 81 1748 10 1749 106 1750 321 1751 21 1752 111 1753 253 1754 12 1755 423 1756 156 1757 24 1758 696 1759 316 1760 175 1761 394 1762 122 1763 610 1764 65 1765 54 1766 482 1767 80 1768 409 1769 90 1770 325 1771 115 1772 211 1773 199 1774 121 1775 283 1776 153 1777 145 1778 388 1779 99 1780 272 1781 201 1782 170 1783 185 1784 29 1785 20 1786 793[1196] 1787 84 1788 55 1789 534 1790 119 1791 156 1792 450 1793 248 1794 172 1795 328 1796 307 1797 222 1798 196 1799 223 1800 395 The considerable epidemic of 1755 is thus referred to by Fothergill in his monthly notes: _May_: the measles more common than for some years, adults, who had not before had it, rarely escaping. _June_: measles common, smallpox rare. _September and October_: no epidemic disease but measles; few perished in proportion to all who took it[1197]. The epidemic of 1758 was more fatal, but Fothergill’s notes are not continued to that year. The elder Heberden says that measles was remarkably epidemical (in London) in 1753, which year has only 253 deaths in the bills, whereas the year 1755 has 423 deaths and the year 1758 has 696; but, as he implies that the type was mild, there would have been a multitude of cases to produce that number of deaths. It was a peculiarity of that epidemic, he says, that the cough preceded the outbreak of measles by seven or eight days, whereas it was usually but two or three days in advance of the eruption[1198]. At that period there would have been an epidemic of measles in London every other year, or once in three years, with a fatality from the direct effects seldom more than a sixth part that of an epidemic of smallpox. A London writer some twenty years after said that few escaped measles in infancy or childhood, while the deaths put down to it were only a tenth part of those due to smallpox on an average of years[1199]. The proportion of measles deaths to smallpox deaths was nearly the same in Manchester for twenty years from 1754 to 1774, according to Percival’s table of the burials in the register of the Collegiate Church where most of the poorer class were buried[1200]: _Annual averages of Burials from Measles etc. at the Collegiate Church, Manchester._ All deaths Deaths at Period Measles Smallpox under two all ages Baptisms 1754-58 21 64 209 651 678 1759-63[1201] 10·6 95 213 639 731 1764-69 9·6 98 229 659 827 1770-74 21·6 102 242 651 1062 The ages of those who died of measles “in six years from 1768 to 1774,” to the number of 91, were as follows: Total 3 mo. -6 mo. -12 mo. -2 years -3 -4 -5 -10 -20 -30 91 2 3 10 31 25 7 9 2 1 1 Fifty were males, forty-one females--a preponderance of males which is according to rule. Of the whole ninety-one, no fewer than fifty-one died in June of the several years. In the smaller and more healthy towns, such as Northampton, the epidemics of measles came at long intervals and caused but few deaths: _Infantile Causes of Death, All Saints, Northampton_[1202]. Year Measles Whooping-cough Convulsions Teething 1742 3 1 10 8 1743 -- -- 21 2 1744 -- 3 14 4 1745 -- -- 22 7 1746 -- 3 19 3 1747 7 -- 29 -- 1748 -- -- 24 4 1749 -- 6 15 4 1750 1 -- 17 1 1751 -- -- 14 6 1752 -- 1 13 6 1753} not published 1754} 1755 -- 1 8 1 1756 -- 2 10 2 1757 1 1 28 4 In the parish of Holy Cross, a suburb of Shrewsbury, there were 4 deaths from measles in the ten years 1750-60, and 15 in the ten years 1760-70, the smallpox deaths having been respectively 33 and 46. Ackworth, in Yorkshire, may represent the country parishes. It had no deaths from measles from 1747 to 1757, two deaths from 1757 to 1767. At Kilmarnock during thirty-six years from 1728 to 1764, there were 93 deaths from measles, 52 of them in the period 1747-52, and only 11 in the next twelve years. Sims, of Tyrone, having described an epidemic of smallpox which desolated the close of 1766 and spring of 1767 with unheard of havoc (it had been out of the country for some years), mentions farther that an epidemic of measles followed immediately: “Before the close of the summer solstice the measles sprang up with a most luxuriant growth,” and was followed in harvest by whooping-cough. Wherever we have the means of comparison by figures, it appears that measles caused by its direct fatality not more than a sixth part of the deaths by smallpox in Britain generally. But in the colonies, where an epidemic of smallpox was a rare event of the great seaports, and as much an affair of adults as of children, measles seems to have been more fatal, dividing with diphtheria or scarlatina the great bulk of the infectious mortality of childhood. Thus Webster enters under 1772: “In this year the measles appeared in all parts of America with unusual mortality. In Charleston died 800 or 900 children”; and under 1773: “In America the measles finished its course and was followed by disorders in the throat”--especially in 1775[1203]. It is only among the children of public institutions in England that we find in the corresponding period a similar predominance of measles and scarlatina over smallpox. In the Infirmary Books of the Foundling Hospital the more general outbreaks of smallpox cease after 1765, while epidemics of measles, extending to perhaps a third or more of the inmates, as well as great epidemics of scarlatina, begin after that date to be common[1204]. In the Infirmary Book from which the following extracts are taken, the number of deaths is not stated. The number of children in the Hospital was 312 in 1763, 368 in 1766 and 438 in 1768.