1710. Engl. transl. of the latter, Lond. 1737.

[226] Ormerod, _Clin. Obs. on Continued Fever_. London, 1848. [227] _Historia Febris Miliaris, et de Hemicrania Dissertatio._ Auctore Joanne Fordyce, M.D., Londini, 1758. Symptoms at p. 16. In an Appendix Dr Balguy makes the following curious division of the miliary vesicles: the white in malignant continued fever, the dull red in remittent fever, the “almost efflorescent” in intermittent. Fordyce makes them to appear as early as the third day, and to begin to disappear in four or six days in favourable cases. [228] London, 1773, p. 9. See also Sir W. Fordyce’s essay of the same year. [229] John Moore, M.D., _Medical Sketches_, Lond. 1786. Part II. “On Fevers.” Referring to the “putrid” fever in particular, he says that certain unbelievers, of whom he was probably one, “assert that mankind are tenacious of opinions, when once adopted, in proportion as they are extraordinary, disagreeable and incredible.” Dr Moore is best known as the author of _Zeluco_. [230] Haygarth, _Phil. Trans._ LXIV. 73. [231] Percival, _ibid._ LXIV. 59. [232] Hutchinson, u. s. [233] _Annual Register_, 1766, p. 220. The King’s Speech on 11 Nov. was chiefly occupied with the dearth. The use of wheat for distilling was prohibited by an order of Council of 16 Sept. 1766. _Gent. Magaz._ p. 399. To show the hardships of the rural population at this time, Mr Gladstone, in a speech at Hawarden in 1891, read the following words copied from a stone set up in the park of Hawarden to commemorate the rebuilding of a mill: “Trust in God for bread, and to the king for protection and justice. This mill was built in the year 1767. Wheat was within this year at 9_s._, and barley at 5_s._ 6_d._ a bushel. Luxury was at a great height, and charity extensive, but the poor were starved, riotous, and hanged.” [234] Lecky, III. 115. [235] _Gent. Magaz._, series of letters by various hands in 1766. See also a long essay in the _Annual Register_ for 1767 (then edited by Edmund Burke), “On the Causes and Consequences of the present High Price of Provisions,” p. 165. The evidence of a rise in the standard of living, in the matter of dress and luxuries as well as of food, is equally clear from Scotland in the articles written by the parish ministers for the ‘Statistical Account.’ [236] For a judicious estimate of the value of the Parish Clerks’ bills of mortality see the elaborate paper by Dr William Ogle, _Journ. Statist. Soc._ LV. (1892), 437. [237] _Diseases of the Army._ New ed. 1775, pp. 334-5. Pringle admitted, however, that “in some of the lowest, moistest and closest parts of the town, and among the poorer people, spotted fevers and dysenteries are still to be seen, which are seldom heard of among those of better rank living in more airy situations.” [238] _Medical Sketches_, Lond. 1786, p. 464. [239] Lecky, _History of England in the Eighteenth Century_, II. 636, generalizes the facts as follows: “The wealthy employer ceased to live among his people; the quarters of the rich and of the poor became more distant, and every great city soon presented those sharp divisions of classes and districts in which the political observer discovers one of the most dangerous symptoms of revolution.” [240] “This disease, as it appears in jails and hospitals, has been well described by Sir John Pringle; and other authors have given accounts of it on board of ships, especially crowded transports and prison-ships, but I do not find that its originating in the families of the poor in great cities during the winter has been taken notice of.” _Med. Trans. Coll. Phys._ III. 345. [241] He has been immortalised by Johnson’s verses: “Well tried through many a varying year See Levett to the grave descend, Officious, innocent, sincere, Of every friendless name the friend. In misery’s darkest cavern known His ready help was ever nigh;” etc. [242] John Coakley Lettsom, M.D., _Medical Memoirs of the General Dispensary in London, April 1773 to March 1774_. London, 1774. [243] Nothing could be clearer than Dr John Arbuthnot’s reasoning and advice on this matter half a century before. [244] London, 1775. [245] _Med. Trans. of the Coll. Phys. Lond._ III. (1785), 345: “Observations on the Disease commonly called the Jail or Hospital Fever.” By John Hunter, M.D., physician to the army. [246] James Sims, M.D., “Scarlatina anginosa as it appeared in London in 1786,” _Mem. Med. Soc. Lond._ I. 414. Willan, who saw the same epidemic of scarlatinal sore-throat in London in 1786, believed that the angina was also “connected with a different species of contagion, namely, that of the typhus or malignant fever originating in the habitations of the poor, where no attention is paid to cleanliness and ventilation.” _Cutaneous Diseases_, 1808, p. 333. [247] The rumour of London fevers seems to have reached Barker, who kept an epidemiological record at Coleshill. Referring to the winter of 1788-89, he says: “At this time there were dreadful fevers in London, fatal to many, and a very infectious one in Coventry, of which many among the poor died, most of them being delirious, and many phrenetical.” [248] Robert Willan, M.D., _Reports on the Diseases of London, particularly during the years 1796-97-98-99 and 1800_. London, 1801. [249] He names specially some streets of St Giles’s parish, the courts and alleys adjoining Liquorpond Street, Hog-Island, Turnmill Street, Saffron Hill, Old Street, Whitecross Street, Golden Lane, the two Bricklanes, Rosemary Lane, Petticoat Lane, Lower East Smithfield, some parts of Upper Westminster, and several streets of Southwark, Rotherhithe, etc. “I recollect a house in Wood’s Close, Clerkenwell, wherein the fomites of fever were thus preserved for a series of years; at length an accidental fire cleared away the nuisance. A house, notorious for dirt and infection, near Clare-market, afforded a farther proof of negligence: it was obstinately tenanted till the wall and floors, giving way in the night, crushed to death the miserable inhabitants.” [250] _Medical Reports on the Effects of Water, Cold and Warm, as a Remedy in Fever and other Diseases._ 2nd ed., 1798. It need hardly be explained that Dr Currie was competent on fevers, his use of the clinical thermometer marking him as a man of precision. He is best known to the laity as the biographer of Robert Burns and the generous helper of the poet’s widow and family. [251] “If it be supposed,” says Currie, “that some cases may be denominated typhus by mistake, let it be considered how many cases of this disease do not appear in the books of the Dispensary, though occurring among the poor, being attended by the surgeons and apothecaries of the Benefit Clubs to which they belong.” [252] Moss (_A Familiar Medical Survey of Liverpool_, 1784), who had not the same means of knowing the prevalence of typhus in Liverpool as Currie, declares that “there has been but one instance of a _truly_ malignant fever happening in the town for many years; it was in the autumn of 1781, and appeared in Chorley Street, which is one of the narrowest and most populous streets in the town, and nine died of it in one week; it was only of short duration, and did not spread in any other part of the town.” He admits that the habitations of the poorer class were confined, being chiefly in cellars; yet the diet of the _sober_ and _industrious_ is wholesome and sufficient, the comfortable artizans being ship-carpenters, coopers, ropers and the like. [253] John Clark, M.D., _Observations on the Diseases which prevail in Long Voyages_, &c. 2nd ed., Lond. 1792; _Account of the Newcastle Dispensary from its Commencement in 1777 to March 1789_, Newcastle, 1789; and subsequent Annual Reports. [254] Haygarth, _Phil. Trans._ LXIV. 67; Hemingway, _History of Chester_, I. 344 _seq._ [255] Arnold Toynbee, _Lectures on the Industrial Revolution of the 18th Century, etc._ London, 1884. [256] Toynbee (u. s.) says of the time before the mills were built: “The manufacturing population still lived to a very great extent in the country. The artisan often had his small piece of land, which supplied him with wholesome food and healthy recreation. His wages and employments too were more regular. He was not subject to the uncertainties and knew nothing of the fearful sufferings which his descendants were to endure from commercial fluctuations, especially before the introduction of free trade.” [257] Percival, “Population of Manchester.” _Phil. Trans._ LXIV. 54. [258] James Lucas, “Remarks on Febrile Contagion.” _London Medical Journal_, X. 260. [259] In Appendix to Hutchinson’s _Cumberland_, 1794. Reprinted in Appendix to Joshua Milne’s _Valuation of Annuities_, Lond. 1815. [260] John Heysham, M.D., _Account of the Jail Fever, or Typhus Carcerum, as it appeared at Carlisle in 1781_. London, 1782. [261] Aikin, _Phil. Trans._ LXIV. 473. [262] John Aikin, M.D., _The Country from 30 to 40 miles round Manchester_. Lond. 1795, p. 584. [263] John Ferriar, M.D., _Medical Histories and Reflections_. 4 vols., 1810-13, I. 172. [264] Ferriar, I. 261. [265] _Ibid._ I. 234. [266] _Ibid._ II. 213-20. [267] _Ibid._ I. 153-6; and II. 57. [268] Ferriar, I. 166-8. [269] This is perhaps the first numerical evidence of the slight fatality of typhus in children. A more elaborate proof of the same was given long after by Geary for Limerick. An early age-table for Whitehaven is given under Smallpox, _infra_. [270] David Campbell, M.D., _Observations on the Typhus or Low Contagious Fever_. Lancaster, 1785. [271] Joshua Dixon, M.D., _Annual Reports of the Whitehaven Dispensary, 1795 to 1805_. Details for 1773-4 in his note in _Memoirs of Lettsom_, III. 353. [272] Dixon, _Literary Life of Dr Brownrigg_, pp. 238-9. [273] Aikin, _Country round Manchester_. Lond. 1795, p. 616. [274] _Nature and Origin of the Contagion of Fevers._ Hull, 1788. [275] _Account of a Contagious Fever at Aylesbury._ Aylesbury, 1785. [276] Thomas Day, _Some Considerations ... on the Contagion in Maidstone Jail_, 1785. [277] See Barnes, in _Mem. Lit. Phil. Soc. Manchester_, II. 85. Dr Samuel Parr wrote his epitaph in the Cathedral. Also Johnstone sen. to Lettsom, _Memoirs_, III. 241. [278] Martin Wall, M.D., _Clin. Obs. on the Use of Opium in Low Fevers and in the Synochus_. Oxford, 1786. [279] J. C. Jenner, in _Lond. Med. Journal_, VII. 163. [280] _Gent. Magaz._ 1785, I. 231, March 1. [281] This is the period and the district to which Robert Burns refers, under date of 21 June, 1783, in a letter to his cousin, James Burness, of Montrose: “I shall only trouble you with a few particulars relative to the wretched state of this country. Our markets are exceedingly high, oatmeal 17_d._ and 18_d._ per boll, and not to be got even at that price. We have, indeed, been pretty well supplied with quantities of white peas from England and elsewhere; but that resource is likely to fail us, and what will become of us then, particularly the very poorest sort, heaven only knows.” The lately flourishing silk and carpet weaving had declined during the American War, and the seasons had been adverse to farmers. The lines in Burns’ poem, “Death and Dr Hornbook”: ‘This while ye hae been mony a gate At mony a house.’ ‘Ay, Ay,’ quoth he, and shook his head.-- are explained by a note, “An epidemical fever was then raging in the country.” [282] Account by Rev. Geo. Skene Keith, _Statist. Act._ II. 544. [283] Also Banff, _ibid._ XX. 347. [284] “Not twenty years ago, but you I think Can scarcely bear it now in mind, there came Two blighting seasons, when the fields were left With half a harvest. It pleased heaven to add A worse affliction in the plague of war, &c.” Trotter, _Medicina Nautica_, I. 182, 1797, gives these real cases:--“During the short time that I attended the dispensary at Newcastle, just at the beginning of the [French] war, I was sent for to a poor man in a miserable and low part of the town called Sandgate. He was ill with what is called a spotted fever.” Six children were standing round his bed, the oldest not more than nine. They had been ill first, then his wife, who was recovered and had gone out to pawn the last article they had to buy meal for the children. The man worked on the quay at 1_s._ 2_d._ per diem. Again, “When I practised as a surgeon and apothecary at the end of the late [American] war in a small town in Northumberland, with an extensive country business, some similar scenes came under my view. Two servants of two opulent farmers applied to me for relief. The first had seven children, who took the fever one by one till the whole became sick. His wages were 1_s._ per diem. His master, a rich man, thought himself charitable by allowing them to pull turnips from his field for food. The other servant was a shepherd; but his herding, as the saying is, was a poor one. The first and second of six children were able to work a little, till they got a fever in a severe winter, and down they fell, one after another, the father and mother at last.” They wanted to sell the cow; but some charitable ladies raised a small subscription, by which means the comforts of wine and diet came within their reach; their master, for his part, sent them the carcase of a sheep, which had been found dead in a furrow, with a request that the skin should be returned. [285] Jenner to Shrapnell, Baron’s _Life of Jenner_, I. 106-7. [286] John Barker, _Epidemicks_, pp. 201-6. [287] The dearth of 1794-95 called forth one notable piece, the ‘Thoughts and Details on Scarcity,’ drawn up by Mr Burke, from his experience in Buckinghamshire, originally for the use of Mr Pitt, in November, 1795. Burke takes an optimist line, and preaches the economic doctrine of _laissez faire_: “After all,” he asks, “have we not reason to be thankful to the Giver of all good? In our history, and when ‘the labourer of England is said to have been once happy,’ we find constantly, after certain intervals, a period of real famine; by which a melancholy havock was made among the human race. The price of provisions fluctuated dreadfully, demonstrating a deficiency very different from the worst failures of the present moment. Never, since I have known England, have I known more than a comparative scarcity. The price of wheat, taking a number of years together, has had no very considerable fluctuation, nor has it risen exceedingly within this twelvemonth. Even now, I do not know of one man, woman, or child, that has perished from famine; fewer, if any, I believe, than in years of plenty, when such a thing may happen by accident. This is owing to a care and superintendence of the poor, far greater than any I remember.... Not only very few (I have observed that I know of none though I live in a place [Beaconsfield] as poor as most) have actually died of want, but we have seen no traces of those dreadful exterminating epidemicks, which, in consequence of scanty and unwholesome food, in former times not unfrequently wasted whole nations. Let us be saved from too much wisdom of our own, and we shall do tolerably well.” The last sentence is his favourite principle of “a wise and salutary neglect” on the part of Government. [288] A labourer at Bury St Edmunds, receiving a weekly wage of five shillings, was able to buy therewith at the old prices: Cost of same in 1801 £ _s._ _d._ {A bushel of wheat 0 16 0 {A bushel of malt 0 9 0 5_s._{A pound of butter 0 1 0 {A pound of cheese 0 0 4 {Tobacco, one penny 0 0 1 ----------- £1 6 5 {Weekly wage in 1801, 9_s._ {Parish bonus 6_s._ 15 0 ---------- 0 11 5 deficiency [289] _Loidis and Elmete_, 1816, p. 85. [290] Thorp, Tract of 1802, cited by Hunter, _Ed. Med. Surg. Journ._ April, 1819, p. 239. [291] Currie, _Med. Phys. Journ._ X. 213. [292] Beddoes. [293] Goodwin, _Med. Phys. Journ._ IX. 509. Cf. Gervis, _Med. Chir. Trans._ II. 236. [294] Elizabeth Hamilton, _The Cottagers of Glenburnie_, Edin. 1808: “The only precaution which the good people, who came to see him [the farmer] appeared now to think necessary, was carefully to shut the door, which usually stood open.... The prejudice against fresh air appeared to be universal.... The doctor did not think it probable that he would live above three days; but said, the only chance he had was in removing him from that close box in which he was shut up, and admitting as much air as possible into the apartment.... While the farmer yet hovered on the brink of death, his wife and Robert, his second son, were both taken ill.... Peter MacGlashan had taken to his bed on going home and was now dangerously ill of the fever.... All the village indeed offered their services; and Mrs Mason, though she blamed the thoughtless custom of crowding into a sick room, could not but admire the kindness and good nature with which all the neighbours seemed to participate in the distress of this afflicted family.” [295] Charlotte Brontë’s story of _Shirley_ falls in this period and turns upon the industrial crisis in Yorkshire; but it is on the whole a happy idyllic picture. Harriet Martineau wrote in _Household Words_, vol. I. 1850, Nos. 9-12, a story entitled “The Sickness and Health of the People of Bleaburn,” a Yorkshire village supposed to have been Osmotherly. It is, in substance, an account of a terrible epidemic of fever in the year 1811, the story opening with the news of the victory of Albuera and the rejoicings thereon. It appears to have been constructed very closely from the real events of the plague of 1665-66 in the village of Eyam, in the North Peak of Derbyshire, and had probably a very slender foundation in any facts of fever in Yorkshire or elsewhere in the year 1811. “Ten or eleven corpses,” says the novelist, “were actually lying unburied, infecting half-a-dozen cottages from this cause.” Cf. infra, Leyburn, p. 167. [296] T. Bateman, M.D., _Reports on the Diseases of London ... from 1804 to 1816_. Lond. 1819. [297] Parl. Committee’s Report on Contag. Fev. 1818, p. 33. Table by P. M. Roget. [298] Adam Hunter, _Ed. Med. Surg. Journ._, April, 1819. [299] Cleland, _Glasgow and Clydesdale Statist. Soc. Transactions_, Pt. I. Nov. 2, 1836. [300] Sutton, _Account of a Remittent Fever among the Troops in this Climate_. Canterbury, 1806. [301] In the first three months of 1811 a singular fever occurred among working people in part of a suburb of Paisley, one practitioner having 32 cases in 13 families. It was marked by rigors at the onset, pain in the back, headache, dry skin, loaded very red tongue, quick fluttering pulse, watchfulness, delirium-like fatuity, abdominal pain in many, foetid stools, great prostration, gradual recovery after fifteen or sixteen days without manifest crisis, and relapses in some. In this fever Murchison discovers enteric or typhoid. Its limitation to a part of one of the suburbs of Paisley is, of course, in the manner of enteric fever; on the other hand, only one of those 32 cases died, which is a rate of fatality perhaps not unparalleled in typhoid but much more often matched in typhus or relapsing fever of young and old together; while the length of the fever, fifteen or sixteen days or sometimes more, is too great for the abortive kind of enteric and too little for enteric fever completing both its first and second stages. James Muir, _Edin. Med. and Surg. Journ._ VIII. 134. Murchison, _Continued Fevers_, p. 428. [302] James Clarke, M.D., “Medical Report for Nottingham from March 1807 to March 1808,” _Edin. Med. and Surg. Journ._ IV. 422. His account of the unwholesome state of the weavers’ houses is as bad as any of those already given. [303] McGrigor, “Med. Hist. of British Armies in Peninsula,” _Med. Chir. Trans._ VI. 381. [304] Richard Hooper, “Account of the Sick landed from Corunna,” _Edin. Med. and Surg. Journ._ V. (1809), p. 398. See also Sir James McGrigor, _ibid._ VI. 19. [305] James Johnson, _Influence of Tropical Climates_, p. 20. [306] J. Terry, in _Ed. Med. and Surg. Journ._, Jan. 1820, p. 247. [307] Bateman, _Account of the Contagious Fever of this Country_. Lond. 1818. [308] The following from the “Observations on Prevailing Diseases,” Oct.-Nov., 1818 (perhaps by Dr Copland), in the _London Medical Repository_, X. 525, shows that the relapses in the earlier part of this epidemic had been commonly remarked in London: “Fevers are still prevalent.... Relapses have been noticed as of frequent occurrence in the instances of the late epidemic. To what are these to be attributed? Are we to ascribe them to the influence of the atmosphere, to anything in the nature of the disorders themselves, or to the vigorous plans of treatment which are adopted for their removal? These relapses are more common in hospital than in private practice.... It has recently become the fashion to consider the state of recovery from fever as one which will do better without than with the interposition of the cinchona bark. Has the prevalence of this negative practice anything to do with the admitted fact of frequent relapse?” [309] _Report of the Select Committee of the House of Commons on Contagious Fever_, Parl. Papers, 1818. [310] _On the Epidemic Fever at present prevailing._ Lond. 1819, p. 40. [311] J. B. Sheppard, “Remarks on the prevailing Epidemic.” _Edin. Med. Surg. Journ._, July 1819, p. 346. Also for Taplow, Roberts, _Lond. Med. Repos._ XIV. 186. [312] W. Hamilton, M.D., _Med. and Phys. Journ._, June 1817, p. 451. [313] _Laws and Phenomena of Pestilence_, Lond. 1821, p. 39. Christison says: “All great towns, with the exception it is said of Birmingham.” [314] Adam Hunter, _Edin. Med. Surg. Journ._, Apr. 1819, p. 234, and Apr. 1820. [315] Wood, “Cases of Typhus.” _Edin. Med. Surg. Journ._, April, 1819. [316] Adam Hunter, u. s. [317] T. Barnes, _Edin. Med. Surg. Journ._, April, 1819. [318] H. Edmonston, _ibid._ XIV. (1818), p. 71. [319] T. McWhirter, _ibid._ April, 1819, p. 317. [320] J. C. Prichard, M.D., _History of the Epidemic Fever which prevailed in Bristol, 1817-19_. Lond. 1820. [321] _Obs. on the Cure and Prevention of the Contagious Fever now in Edinburgh._ Edin. 1818. [322] _Edin. Med. Surg. Journ._ XVI. 146. [323] Benj. Welsh, _Efficacy of Bloodletting in the Epidemic Fever of Edinburgh_. Edin. 1819. [324] _Life of Sir Robert Christison_, Edin. 1885, I. 142:--“I had been scarcely three weeks at my post in the fever hospital when I was attacked suddenly--so suddenly, that in half-an-hour I was utterly helpless from prostration. I had nearly six days of the primary attack, then a week of comfort, repose and feebleness, and next the secondary attack, or relapse, for three days more. My pulse rose to 160, and continued hard and incompressible even at that rate. My temperature under the tongue was 107° &c.” He was bled to 30 oz. and next day to 20 oz. more. Before the end of the epidemic, in August, 1819, he had another attack of relapsing fever, for which he was bled to 24 oz. and a third, after exposure to chill, the same autumn, which last was a simple five-days’ fever without relapse, also treated by the abstraction of 24 oz. of blood. In 1832 he had two attacks of the same _synocha_ without relapses, and throughout the rest of his life many more: e.g. 16 June, 1861, “I have had something like the relapsing fever of my youth”--a five-days’ fever with a relapse on the 18th day; and again, on 19 March, 1868, “Incomprehensible return of mine ancient enemy.” These experiences coloured Christison’s view of relapsing fever, the so-called relapses being, in his opinion, comparable to the returning paroxysms of ague. [325] Cleland. [326] Report signed A. Brebner, provost, printed in Harty, _Historic Sketch of the Contagious Fever in Ireland, 1817-19_. Dublin, 1820, Appendix, p. 110. [327] _Memoir concerning the Typhus Fever in Aberdeen, 1818-19._ By George Kerr, Aberdeen, 1820. [328] William Gourlay, “History of the Epidemic Fever as it appeared in a Country Parish in the North of Scotland.” _Edin. Med. and Surg. Journ._, July, 1819, p. 329, dated 20 Nov. 1818. [329] _Trans. K. and Q. Cal. Phys. Ireland_, V. 527. [330] _Dub. Q. J. Med. Sc._ VIII. 297. [331] A succession of thirty-one cases of relapsing typhoid at Charing Cross Hospital in 1877-78 were made the subject of an able essay by J. Pearson Irvine, M.D., _Relapse of Typhoid Fever_, London, 1880. [332] Cited in Aberdeen Report, 17 Dec. 1818, in Harty, App. p. 110. [333] _Report of Select Committee_, u. s. p. 6, and minutes of evidence. [334] Prichard, pp. 74, 88. [335] Christison, _Month. J. Med. Sc._ X.; Bennett, _Princip. and Pract. of Med._ 944-5. [336] See above, p. 110-11. [337] A complementary measure, namely, notification of contagious sickness to the authorities, was put in practice at Leeds in 1804 on the opening of the House of Recovery there. The Leeds House of Recovery, with fifty beds, was opened on 1 November, 1804, the epidemic of fever being then about over. One of its officers was an inspector, whose duty was “to detect the first appearance of infection, to cause the removal of the patient to the House of Recovery, and to superintend the fumigating and whitewashing of the apartment from which he is removed. So great is the solicitude of the physicians to promote early removal that rewards are offered to such as shall first give information of an infectious fever in their neighbourhoods.” It was claimed that this had been a great success, Leeds having been for twelve years previous to the epidemic of 1817 nearly exempted from two of the most infectious and fatal diseases, namely, typhus and scarlet fever. (It happened, however, that the whole of England, Scotland and even Ireland were exempted to the same remarkable, and of course gratifying degree.) Whitaker, _Loidis and Elmete_, 1816, p. 85. [338] A strange epidemic of the early summer of 1824 in a semi-charitable girls’ school at Cowan Bridge, between Leeds and Kendal, which is the subject of a moving chapter in ‘Jane Eyre,’ was inquired into by Mrs Gaskell, the biographer of Charlotte Brontë. Forty girls were attacked with fever. A woman who was sent to nurse the sick, saw when she entered the school-room from twelve to fifteen girls lying about, some resting their heads on the table, others on the ground; all heavy-eyed and flushed, indifferent and weary, with pains in every limb, the atmosphere of the room having a peculiar odour. The symptoms, so far as known, and the circumstances of the school, point more to relapsing fever than to typhus, which is the name given to it by Charlotte Brontë. None died of the fever (it is otherwise in the tale), but one girl died at home of its after-effects. Dr Batty, of Kirby, who was called in, did not consider the type of fever to be alarming or dangerous. The dietary of the school had undoubtedly been most meagre for growing girls, and its discipline severe. The house was old and unsuited for the purposes of a boarding-school. [339] Cowan, _Journ. Statist. Soc._ III. (1840) p. 271; _Glas. Med. Journ._ III. 437. [340] Some of these were treated at the extra fever-hospital in Spring Gardens. [341] From the table by Christison, _Edin. Med. Journ._, Jan. 1858, p. 581. [342] _Life of Christison_, “Autobiography.” [343] John Burne, M.D., _Pract. Treatise on the Typhus or Adynamic Fever_. London, 1828. [344] To show the effect of emotion in causing a relapse, he gives an instance, almost the only concrete illustration in all his book: An Irishwoman, Ann McCarthy, aged 26, was admitted to Guy’s Hospital on 20 June, 1827, with “adynamic fever of the second degree,” having been already ill for two weeks: the course of her fever was favourable and she was “soon convalescent.” While still in the ward mending her strength, she lent her bonnet to another female patient to go out with; finding that her kindness had been abused by the woman forgetting to return the bonnet, she became exceedingly angry, relapsed into the fever on the 10th of July, was wildly delirious for several days, and died on the 19th of July. At this time it was the practice at Guy’s to examine the bodies after death; but permission was refused in the case in question, so that Burne was unable to say “whether the bowels were affected.” The case, therefore, may have been one of relapsing enteric fever. A similar ambiguity is discussed by Hughes Bennett in his _Principles and Practice of Physic_ (p. 923), and decided in favour of relapsing fever proper, or relapsing synocha. [345] Sir William Jenner, M.D., _Lectures and Essays on Fevers and Diphtheria_, 1849 to 1879. London, 1893. [346] Christison, _Life_, u. s. I. 341. [347] “Cases showing the frequency of the occurrence of Follicular Ulceration in the Mucous Membrane of the Intestine during the progress of Idiopathic Fever, with Dissections, and Observations on its Pathology.” _Lond. Med. and Physical Journ._, Aug. 1826, p. 97. [348] _Ibid._ p. 351. [349] Burne, u. s. [350] Richard Bright, M.D., _Reports of Medical Cases_. Part I., 1827. [351] _Life of Sir Robert Christison_, I. 144. Also in _Trans. Soc. Sc. Assn._ 1863, p. 104. [352] _Edin. Med. Journ._, Jan. 1858, p. 588. Cf. _infra_, under Dysentery, 1828. [353] Reid, _Trans. K. and Q. Coll. of Phys. in Ireland_, V.; O’Brien, _ibid._ [354] Writing in 1839, Dr Stokes, of Dublin, made the following remarkable assertion (_Dub. Journ. Med. and Chem. Sc._ XV. p. 3, note): “In the epidemic of 1826 and 1827 we observed the follicular ulceration (dothienenteritis of the French) in the greater number of cases.” As the epidemic of 1826-27 was almost wholly one of relapsing fever, the statement is at least puzzling. It was made twelve years after the epidemic, at a time when the discrepancies between British and French observers, as to the occurrence of ulceration of the ileum in continued fever, were much discussed. Dr Lombard, of Geneva, having visited Glasgow, Dublin and other places, and confirmed the fact that the characteristic lesion of enteric fever was at that time only occasional, went on to say that Irish typhus was a species of disease by itself, a _morbus miseriae_. Whereupon the editor of the ‘Dublin Journal of Medical Science’ (XII. 503, in a review of Cowan’s Glasgow Statistics) gave the following truly Irish reply: “Had Dr Lombard made more inquiries, he would have found that Ireland is not so sunk in misery and debasement but that she can produce occasionally a fever which, in abdominal ulcerations, can compete with the sporadic diseases of her wealthier and more enlightened neighbours.” It may have been in the same patriotic spirit that Stokes declared “the greater number of cases” in the epidemic of 1826 and 1827 to have had follicular ulceration. [355] G. L. Roupell, M.D., _Some Account of a Fever prevalent in 1831_. Lond. 1837. [356] In addition to what has been said on this point already, for particular epidemics, I shall give a statement for ordinary years by Dr Carrick, of Bristol, in his ‘Medical Topography’ of that city: _Trans. Prov. Med. Assocn._ II. (1834), p. 176. “Continued fever is common enough, but nine-tenths of the cases are of a simple character, terminating for the most part within seven days, and unaccompanied with anything more serious than slight catarrhal or rheumatic disorder. Typhus gravior is rare--much more so than might be expected.” [357] Charles West, M.D., “Historical Notices designed to illustrate the question whether Typhus ought to be classed among the Exanthematous Fevers.” _Edin. Med. and Surg. Journ._ 1840, April, p. 279. [358] Alexander Kilgour, M.D., _ibid._ Oct. 1841, p. 381. [359] Cowan, “Vital Statistics of Glasgow,” _Journ. Statist. Soc._ III. [360] Cases at Mile-End Fever Hospital. [361] Including 906 male fever-patients at Albion Street temporary hospital. [362] _Blackwood’s Magazine_, March, 1838, p. 289. [363] In 1819 the Irish in Glasgow had been estimated at 1 in 9·67: in 1831 the Irish part of the population had risen to 1 in 5·69. Dr Cowan, however, said of them: “From ample opportunities of observation, they appear to me to exhibit much less of that squalid misery and habitual addiction to the use of ardent spirits than the Scotch of the same grade.” [364] Robert Cowan, M.D., “Statistics of Fever in Glasgow for 1837.” _Lancet_, April 10, 1839. [365] James Arrott, M.D., _Edin. Med. and Surg. Journ._, Jan. 1839, p. 121. [366] Craigie _ibid._ April, 1837. [367] Christison, _Monthly Journ. Med. Sc._ X. 1850, p. 262. [368] Kilgour, u. s. [369] Cowan, _Journ. Statist. Soc._ III. 1841. [370] Arrott, u. s. [371] Craigie, u. s. [372] _Edin. Med. and Surg. Journ._ July, 1838. [373] _Principles and Practice of Physic_, 3rd ed. 1848, II. 742, 732. [374] _First Report of the Registrar-General_, London, 1839. [375] The district registrars had hardly organised their work in the first two or three years of registration. Some gave much more complete returns than others. There was a reluctance to register births, and the marriages were not all registered. But the totals of deaths came out very nearly as the actuaries had expected. [376] The Third Report of the Registrar-General gives the mortality in all parts of England from typhus in 1839 (as well as from scarlatina) in an elaborate table of the registration districts and sub-districts. [377] W. Budd, M.D., _Lancet_, 27 Dec. 1856, and 2 July, 1859. Dr Budd, who had been studying in Paris and seeing much typhoid fever, but little or no typhus, in the service of Louis at La Pitié hospital, took the whole of these cases for enteric or typhoid, and insisted, in his later life, on the ground of his North Tawton experiences in 1839, that typhoid fever spread by contagion. He published numerous papers on this theme (_Lancet_, 27 Dec. 1856, another series in the same journal from 2 July to Nov. 1859, _Brit. Med. Journ._ Nov.-Dec. 1861, and, finally, a volume of reprints with additions, _Typhoid Fever, its Nature, Mode of Spreading and Prevention_, London, 1873). But he published no clinical cases nor post-mortem notes, to make good his 1839 diagnosis, on which the whole matter turned, contenting himself with an assurance that he knew typhoid well from studying it under Louis (who, at that time, believed that the typhus of armies, gaols, &c. and of the British writers, was the same as the fever which he, and others after him, named typhoid). He also made the following six statements, as if he were making affidavit: (1) that the great majority of the cases had early diarrhoea, (2) that three had profuse intestinal haemorrhage, (3) that more or less of tympanitis was almost universal in the epidemic, (4) that in nearly every case he found the rose-coloured lenticular spots, (5) that one case, which was the only one examined post-mortem, had the characteristic ulceration of the intestine, and (6) that one fatal case had the symptoms of perforation of the gut. This summary manner, asking in effect to be taken on trust, is not usually accepted from innovators, none of the great discoverers having resorted to it. Hitherto, however, no one has thought proper to question Budd’s diagnosis of the epidemic fever in his North Tawton practice, nor even to remark upon his strange error of treating the epidemic of 1838-39 all over Britain as purely one of typhoid (_Lancet_, 27 Dec. 1856). But everyone knew that typhoid fever did not spread in the way that he described (doubtless correctly for the above cases). After the publication of his book in 1873 an attempt was made by an influential layman in the _Times_ (9 Nov. 1874) to popularize Budd’s fallacies or paradoxes on the contagiousness of typhoid. “How,” it was asked, after a summary of the North Tawton epidemic in 1839, “could a disease whose characters are so severely demonstrable, have ever been imagined to be non-contagious? How could such a doctrine be followed, as it has been, to the destruction of human life?” [378] “For three years past trade had been getting worse and worse, and the price of provisions higher and higher. This disparity between the amount of the earnings of the working classes and the price of their food occasioned, in more cases than could well be imagined, disease and death. Whole families went through a gradual starvation. They only wanted a Dante to record their sufferings. And yet even his words would fall short of the awful truth; they could only present an outline of the tremendous facts of the destitution that surrounded thousands upon thousands in the terrible years 1839, 1840, and 1841. Even philanthropists who had studied the subject were forced to own themselves perplexed in their endeavour to ascertain the real causes of the misery; the whole matter was of so complicated a nature that it became next to impossible to understand it thoroughly.... The most deplorable and enduring evil that arose out of the period of commercial depression to which I refer, was this feeling of alienation between the different classes of society. It is so impossible to describe, or even faintly to picture, the state of distress which prevailed in the town [Manchester] at that time, that I will not attempt it; and yet I think again that surely, in a Christian land, it was not known even so feebly as words could tell it, or the more happy and fortunate would have thronged with their sympathy and their aid. In many instances the sufferers wept first, and then they cursed. Their vindictive feelings exhibited themselves in rabid politics. And when I hear, as I have heard, of the sufferings and privations of the poor, of provision shops, where ha’porths of tea, sugar, butter, and even flour, were sold to accommodate the indigent--of parents sitting in their clothes by the fireside during the whole night for seven weeks together, in order that their only bed and bedding might be reserved for the use of their large family--of others sleeping upon the cold hearthstone for weeks in succession, without adequate means of providing themselves with food or fuel--and this in the depth of winter--of others being compelled to fast for days together, uncheered by any hope of better fortune, living, moreover, or rather starving, in a crowded garret, or damp cellar, and gradually sinking under the pressure of want and despair into a premature grave; and when this has been confirmed by the evidence of their careworn looks, their excited feelings, and their desolate homes--can I wonder that many of them, in such times of misery and destitution, spoke and acted with ferocious precipitation?” Mrs Gaskell, _Mary Barton_. [379] John Goodsir, “On a Diseased Condition of the Intestinal Glands,” _Lond. and Edin. Monthly Journ. of Med. Science_, April, 1842. He does not enter on the question “as to whether the subject of the present paper constitutes a distinct species of disease, or be merely a form of the ordinary continued fever”; but he appears to recognize that a certain district may have a form of fever special to it, as Reid had probably told him. [380] John Reid, M.D., “Analysis and Details of Forty-seven Inspections after Death,” _Edin. Med. and Surg. Journ._, Oct. 1839, p. 456. [381] Reid, u. s., from Home’s records. [382] Murchison, _Continued Fevers_, 2nd ed. 1873, p. 444. [383] Lombard, in _Dublin Journal of Med. Sc._ X. (1836), p. 17. He bore witness, also, to the rarity of the bowel-lesion in the Glasgow fevers. This was confirmed by Dr Perry, of that city, _Ibid._ X. 381. See also Julius Staberoh, M.D., “Researches on the Occurrence of Typhus in the Manufacturing Cities of Great Britain,” _Ibid._ XIII. 426. [384] _Trans. Prov. Med. Assoc._ II. (1834), p. 176. [385] _Continued Fevers_, 2nd ed. 1873, p. 443. [386] Christison, “On the Changes which have taken place in the Constitution of Fevers and Inflammations in Edinburgh during the last forty years.” Paper read at Med. Chir. Soc. Edin. 4 March, 1857. _Edin. Med. Journ._ Jan. 1858, p. 577. [387] _Continued Fevers_, under the head of “Typhus,” p. 47. [388] See especially John Rose Cormack, M.D., _Natural History, Pathology and Treatment of the Epidemic Fever at present prevailing in Edinburgh and other towns_. Lond. 1843; and the papers by Wardell, _Lond. Med. Gaz._ N. S. II-V. [389] Dr Betty, of Lowtherstown, Fermanagh, _Dubl. Quart. Journ. Med. Sc._ VII. 125. [390] Murchison says that the enteric fever of the end of 1846 was prevalent at many places in England where the epidemic of typhus never made its appearance, and that in Edinburgh (according to an unpublished essay by Waters) most of the enteric cases not only occurred prior to the outbreak of the epidemic of Irish fever, but came from localities in the neighbouring country and from the best houses of the New Town--not from the crowded courts of the Old Town, to which the later epidemic of typhus and relapsing fever was restricted. Murchison, u. s. p. 49. The following papers relate to the autumnal typhoid of 1846 in England: Sibson, “Fever at Nottingham and neighbourhood in Summer and Autumn of 1846,” _Med. Gaz._ XXXIX.; Taylor, “Fever at Old and New Lenton in 1846,” _Med. Times_, XV. 159 and _Med. Gaz._ XXXVIII. 127; Turner, “Fever at Minchinhampton in Autumn 1846,” _Med. Gaz._ XLII. 157; Brenchley, “Fever in Berkshire in 1846,” _Med. Gaz._ XXXVIII. 1082; Bree, “Epidemic Fever at Great Finborough in Autumn of 1846,” _Prov. Med. and Surg. Journ._ 1847, p. 676. [391] In the _Report of the Registrar-General for the year 1847_. [392] This was the occasion which furnished Father Newman with a famous argument for the _bona fides_ of his co-religionists: “The Irish fever cut off between Liverpool and Leeds thirty priests and more young men in the flower of their days, old men who seemed entitled to some quiet time after their long toil. There was a bishop cut off in the North; but what had a man of his ecclesiastical rank to do with the drudgery and danger of sick calls, except that Christian faith and charity constrained him?” John Henry Newman, D.D., _History of My Religious Opinions_, London, 1865, p. 272. [393] Leigh, in _Report Reg.-Gen. for 1847_, X. p. xx. [394] H. M. Hughes, “On the Continued Fever at present existing in the southern districts of the metropolis,” _Lond. Med. Gaz._ Nov. 1847; Laycock, “Unusual prevalence of Fever at York,” _Lond. Med. Gaz._ Nov. 1847; Bottomley, “Notes on the Famine Fever at Croydon in 1847,” _Prov. Med. and Surg. Journ._ 1847; Ormerod, _Clinical Observations on Continued Fever at Bartholomew’s Hospital_, Lond. 1848; Art. in _Brit. and For. Med. Chir. Rev. 1848_, I. 285; Duncan, _Journ. Pub. Health_, I. 200 (Liverpool); Paxton, _Prov. Med. Journ._ 1847, pp. 533, 596 (Rugby). [395] The following papers relate to the epidemic in Scotland in 1847: Orr, “Historical and Statistical Sketch of the progress of Epidemic Fever in Glasgow during 1847,” _Edin. Med. and Surg. Journ._ LXIX.; Stark, “On the Mortality of Edinburgh and Leith for 1847,” _Ibid._ and LXXI.; R. Paterson, “Account of the Epidemic Fever of 1847-8” in Edinburgh, _Ibid._ LXX.; W. Robertson, “Notes on the Epidemic Fever of 1847-8,” _Month. Journ. of Med. Sc._ IX. 368; J. C. Steele, “View of the Sickness and Mortality in the Glasgow Royal Infirmary during 1847,” _Edin. Med. and Surg. Journ._ LXX.; J. C. Steele, “Statistics of the Glasgow Infirmary for 1848,” _Ibid._ LXXII. 241; J. Paterson, “Statistics of the Barony Parish Fever Hospital of Glasgow in 1847-8,” _Ibid._ LXX. 357. [396] Buchanan, _Report Med. Officer Privy Council for 1864_, and _Trans. Epid. Soc._ 1865, II. 17; Hamilton, _Lancet_, II. 1867, p. 608 (Liverpool); Martyn, _Brit. Med. Journ._ July, 1863; Davies, _Med. Times and Gaz._ II. 1867, p. 427 (Bristol); Thompson, _St George’s Hosp. Reports_, I. (1866), p. 47 (London); Allbutt, _ibid._ p. 61 (Leeds). [397] Buchanan, _Report Med. Off. Privy Council for 1865_, p. 210. [398] James Stark, M.D., “Remarks on the Epidemic Fever of Scotland during 1863-64-65” etc., _Trans. Epidem. Soc._ N. S. II. 312. See also Russell, _Glasg. Med. Journ._ July, 1864, and R. Beveridge (for Aberdeen), _Lancet_, I. 1868, p. 630. [399] Weber, _Lancet_, I. 1869, pp. 221, 255; Murchison, _ibid._ II. 1869, pp. 503, 647; Gee (Liverpool), _Brit. Med. Journ._ II. 1870, p. 246; Robinson (Leeds), _Lancet_, I. 1871, p. 644; Muirhead (Edinburgh), _Edin. Med. Journ._ July, 1870, p. 1; Rabagliati (Bradford), _ibid._ Dec. 1873; Tennant (Glasgow), _Glasgow Med. Journ._ May, 1871, p. 354; Armstrong (Newcastle), _Lancet_, I. 1873, p. 48. [400] Muirhead (l. c.) says: “In no single instance which came under my observation could starvation be said to be the immediate cause of the disease. Not one of those individuals could be said to be emaciated.... On strict and repeated inquiry, not one of them would confess to having been in destitute circumstances.” During the winter of 1870-71 I attended from the Edinburgh New Dispensary several relapsing-fever patients at their homes, and can clearly remember having been surprised at the condition of decency and comfort in which I found them. The appearance of comfort was certainly due in part to the district visitors, who were numerous and active during the epidemic. [401] Spear, “Typhus Fever in various parts of England, 1886-87.” _Rep. Med. Off. Loc. Gov. Bd._ N. S. XVI. p. 169. [402] 2303 of these fever deaths in 1864 occurred in the eight principal towns of Scotland, classified as follows: typhus, 1450, relapsing fever, 371, gastric, enteric, or typhoid, 382. [403] G. B. Longstaff, M.D., _Trans. Epid. Soc._ 1884-5, p. 72, reprinted in his _Studies in Statistics_, Lond. 1891, p. 402. The seasonal curve for the typhoid admissions to the London Fever Hospital over a longer period is nearly the same, as well as that of the registered deaths by typhoid in all London, 1869-84. [404] The following large registration districts besides those in the Table, had enteric-fever death rates of ·5 and upwards per 1000 persons living, in the ten years 1871-80; in nearly all of them there has been a marked decline in the ten years 1881-90:--Durham, Hartlepool, Easington, Houghton-le-Spring, Darlington, Gateshead (county Durham); Morpeth (Northumberland); Aysgarth, Todmorden, Dewsbury, Pontefract, Barnsley, Rotherham (Yorkshire); Dudley, Leigh, Ormskirk (Lancashire); Crickhowell (Wales); Worksop, Radford (Nottingham); Shrewsbury; Peterborough; Portsea Island (Hants). Of the London districts, Hackney had the highest enteric fever, 0·46 per 1000 in a general death-rate of 20·78. The high rate of a decennium is not unfrequently brought up by one great explosion. In many of the Lancashire, Yorkshire and Midland towns, with rates about ·4 per 1000 persons, the rate has been somewhat steady from year to year. In the decennium 1871-80, many special outbreaks, some of them in villages, were reported on by the inspectors of the Medical Department, and traced for the most part to water-supplies tainted by the percolation of excrement. [405] The Registration District of Middlesborough was carved out of Stockton and Guisborough in 1875. [406] Registration District containing a population of 72,707 on a mean between the census of 1871 and that of 1881. In 1891 the population was 146,812. [407] F. W. Barry, M.D., in _Rep. Med. Off. Loc. Gov. Board for 1882_, p.