Chapter I: Typhus and Other Continued Fevers (4)

The high mortalities in 1721-23 were mostly from smallpox, exact figures of many of the epidemics in Yorkshire and elsewhere being given in the chapter on that disease. The country parishes shared in its prevalence:

_Country Parishes._

Registers Registers with Deaths Births
Year examined excess of deaths in same in same

1721 174 35 793 586
1722 175 35 1015 775
1723 174 63 2021 1583

Besides smallpox, diarrhoeas and dysenteries in the autumn are given by Wintringham as the reigning maladies, fever not being mentioned.

The Epidemic Fevers of 1726-29: evidence of Relapsing Fever.

The four years 1726-29 were a great fever-period in London, the deaths having been as follows:

Year Fever deaths All deaths

1726 4666 29,647
1727 4728 28,418
1728 4716 27,810
1729 5335 29,722

In the last of those years the entry in the annual bills becomes “fever, malignant fever, spotted fever and purples.”

The following are the weekly maxima of fever deaths and deaths from all causes during the four years, 1726-29; in nearly all the weeks the deaths from “convulsions” (generic name for most of the maladies of infants) contribute from a fourth to a third, or even more, of the whole mortality.

Week Fever All
ending deaths deaths
1726
Jan. 18 71 633
March 15 81 678
May 31 103 611
June 7 106 607
Aug. 30 102 711
Sept. 6 116 680
13 109 643
20 109 648
1727
Aug. 8 103 577
15 123 698
22 132 730
29 130 789
Sept. 5 150 764
12 134 795
19 165 798
26 163 715
Oct. 3 150 684
1728
Feb. 6 112 748
13 131 889
20 121 850
27 145 927
March 5 93 733
Aug. 27 138 525
Sept. 3 131 562
Dec. 10 122 734
1729
Sept. 9 109 676
Nov. 4 213 908[104]
11 267 993[104]
18 166 783
Dec. 9 132 779

These are high mortalities, whatever were the types of fever that caused them. That the old pestilential fever of London was one of them we need have no doubt. Dr John Arbuthnot, writing two or three years after, said, “I believe one may safely affirm that there is hardly any year in which there are not in London fevers with buboes and carbuncles [the distinctive pestilential marks]; and that there are many petechial or spotted fevers is certain[105].”

The essay of Strother also has a reference to “spotted fever” in its title, although the text throws very little light upon it[106]. But, for the rest, the “constitution” of 1727-29 is more than usually perplexing. There was an influenza at the end of 1729, which can be separated from the rest easily enough by the help of the London weekly bills of mortality; and it is probable, unless Arbuthnot, Huxham and Rutty have erred in their dates, that one or more epidemics of catarrhal fever had occurred before that, in the years 1727 and 1728. The greatest difficulty is with a certain “little fever,” or “hysteric fever,” or “febricula,” which gave rise to some writing and a good deal of talk. Strother does not specially treat of it, at least under that name, although he says that “many, especially women, have been subject to fits of vapours, cold sweats, apprehensions, and unaccountable fears of death; every small disappointment dejected them, tremblings and weakness attended them,” etc. (p. 116); and again, “never was a season when apoplexies, palsies and other obstructions of the nerves did prevail so much as they do at present, and have done for some time past” (p. 102); while he had frequently seen hysterical and hypochondriacal symptoms, dejection of spirits and the like remaining behind the fever (p. 109). For some years before this, much had been heard in London of the vapours, the “hypo,” the spleen, and the like, an essay by Dr Mandeville, better known by his ‘Fable of the Bees,’ having first made these maladies fashionable in the year 1711[107].

In due time it began to be noticed that symptoms which many physicians made light of as a “fit of vapours” were really the beginning of a fever. Dr Blackmore, in an essay on the Plague written in 1721, admitted the ambiguity:

“For several days a malignant fever has so near a resemblance to one
that is only hysterick, that many physicians and standers by, I am apt
to believe, mistake the first for the last, and look upon a great and
dangerous disease to be only the spleen, or a fit of the vapors, to
the great hazard of the patient[108].”

In 1730, Dr William Cockburn, in a polemic against the physicians whom he styles “the academical cabal” (because they objected to his secret electuary for dysentery), professes to give a history of the mistakes of the faculty in London over this “little fever,” or “hysteric fever,” which often became dangerous[109]:

“The present fever, with a variation in some of its symptoms, has now
subsisted twelve years [or since 1718] not in England only, but all
over Europe [Manningham says it was peculiarly English]. Few or no
physicians suspected the reigning and popular disease to be a fever.
Vapours, a nervous disease, and such general appellations it had from
sundry physicians. Others, who discovered the fever, knew it was the
low or slow fever, first mentioned by Hippocrates.... The last were
represented as ignorant for calling the distemper a fever, and
affixing to it the name ‘low’ or ‘slow,’ a slow fever being, in their
adversaries’ opinion, altogether unheard of among physicians and never
recorded in their books. Nothing was more monstrous than calling this
distemper a fever, or confining persons afflicted with it to their
bed, and dieting them with broth, or other liquid food of good
nourishment, and what is easily concocted.... ‘You are not hot, you
are not dry; you are in good temper; and therefore you have no fever’
was the common language of the town.... They might have seen
physicians practising for a destroying distemper, and yet, after seven
years, they confess themselves ignorant of its very name.”

At length, he continues, Blackmore admitted the ambiguity of diagnosis, while Mead, Freind and others, recognized that there was really such a thing as a slow, nervous fever, by no means free from danger to life. It is probably to this insidious fever that Strother refers:

“Thus, having gone on for six or seven days in a train of indolence,
they have been surprized on the seventh day, and have died on the
eighth lethargick or delirious, whereas, if they had taken due care,
the fever would have run its course in fifteen days or more.” It was
the remissions, or intermissions, he explains, that often misled
patients, by which he seems to mean the clear intervals between
relapses. “Others, wearied out with relapses, have hoped their
recovery would as certainly ensue as it had hitherto, and have
deferred asking advice until it was too late.” These relapses, he
thought, were brought on by venturing too soon into the air: “it is
too well known that the fever has been cured, and patients have soon,
after they have ventured into the air, relapsed and have again run the
same circle of ill symptoms, if not worse than before.” Bark failed
conspicuously in these “remittents:” “it is therefore incumbent on me
to examine into the reason of this _new phenomenon_. I call it _new_,”
he explains, because bark had hitherto succeeded. “Perhaps we may find
reason to lay some blame on the air for the frequent relapses....
Periodical comas have of late been common; so soon as the fit was
over, the drowsiness abated till the fit returned.”

Elsewhere he speaks of the frequent relapses as belonging to a
“quartan,” under which diagnosis bark had been tried. The fevers were
less apt to “relapse” when treated by mild cathartics. Another symptom
of this fever was jaundice: “If jaundice breaks forth on the fourth
day of a fever, it is much better than if it comes at the conclusion
of a fever.... Jaundices are now very common after the cure of these
fevers.”

These indications, dispersed throughout the rambling essay of Strother, point somewhat plainly to relapsing fever[110]. But his theoretical pathology comes in to obscure the whole matter. He explains everything by obstructions. The jaundice was due to obstruction of the liver by “styptics,” the hysteric symptoms to obstructions of the nerves; there were also theoretical obstructions of the mesentery, part of the matter being sometimes “thrown off into the mesenteric glands”; also “congestions” or phlegmons of the liver, spleen and pancreas. But it is when he comes to the bowels that his subjective morbid anatomy becomes truly misleading. There is nothing to show that Strother examined a single body dead of this fever. He says, however, in his _à priori_ way: “The crisis of these slow fevers is generally deposited on the bowels.... The lent fever is a symptomatical fever, arising from an inflammation, or an ulcer fixed on some of the bowels. A lent fever, depending on some fixed cause of the bowels, must be cured by having regard to those causes some of which I shall enumerate”:--the first supposition being that the fever depends on phlegmons by congestion of “the liver, spleen, pancreas, or the mesentery”; the second, if it depends on extravasations in an equally comprehensive range of viscera; the third, “if it depends on an ulcer, then all vulneraries must be administered internally; but to speak truth, when the viscera are ulcerated, there remains but small hope of life”; the fourth supposition is worms, the fifth corruption of the humours. All this is paper pathology. There is not a single precise fact relating to ulcerated Peyer’s patches, or to swollen mesenteric glands, or to enlarged spleen, which last would have been equally distinctive of relapsing as of enteric fever; it is “the viscera” that are ulcerated, or congested, or extravasated, or it is “some of the bowels,” or the pancreas and liver obstructed as well as the spleen, the obstruction of the liver being invoked to explain the highly significant jaundice.

It is not quite clear whether Strother’s fever with relapses and jaundice corresponded exactly to the little fever, hysteric fever, or nervous fever of the same years; but it is worthy of note that relapsing fever in Ireland a century later was called febricula or the “short fever.” It was not until 1746 that the excellent essay upon it by Sir Richard Manningham was written. By that time a good deal was being said in various parts of Britain of a slow, nervous, or putrid fever, Huxham, in particular, identifying the nervous fever with Manningham’s febricula or little fever[111]. Some have supposed that the nervous fever of the 18th century included cases of enteric fever, if it did not stand for that disease exclusively. Murchison takes Manningham’s essay to be “an excellent description of enteric fever, under the title of febricula or little fever, etc.[112]” The following are brief extracts from his description, by which the reader will be able to form his own opinion on the question of identity[113].

At the beginning patients feel merely languid or uneasy, with flying
pains, dryness of the lips and tongue but no thirst; in a day or two
they find themselves often giddy, dispirited and anxious without
apparent reason, and passing pale urine. They have transient fits of
chilliness, a low, quick and unequal pulse, sometimes cold clammy
sweats and risings in the throat. They go about until more violent
symptoms come on, simulating those of quotidian, tertian or quartan
fever; sometimes the malady simulates pleurisy. There may be attacks
of dyspnoea, nausea and haemorrhage; the menses in women are checked.
A loss of memory and a delirium occur at intervals for short periods.
The malady is very difficult to cure and too often becomes fatal in
the end. It will last thirty or forty days, unless it end fatally in
stupor or syncope. A form of mania is a consequence of it, where it
has been neglected or badly treated; “of late years this species of
madness has been more than ordinarily frequent.” All sorts were liable
to it, but mostly valetudinarians, delicate persons, and those in the
decline of life; the fatalities were “especially among the opulent
families of this great metropolis[114].”

This fever-period in London corresponds on the whole closely with a series of unhealthy years in Short’s tables from the registers of market towns and country parishes, and with high mortalities in the Norwich register. It was not specially a smallpox period, as the last unhealthy year, 1723, was. On the other hand the epidemiographists in Yorkshire, Devonshire and Ireland dwell most upon fevers of the nature of typhus, some of which were due to famine or dearth, and upon “agues.”

_Market Towns._

Registers No. with excess Deaths Births
Year examined of deaths in same in same

1727 33 19 3606 2441
1728 34 23 4972 2355
1729 36 27 6673 3494
1730 36 16 3445 2529

_Norwich._

Year Buried Baptized

1728 1417 774
1729 1731 843

_Country Parishes._

Registers With excess Burials Baptisms
Year examined of burials in same in same

1726 181 22 542 495
1727 180 55 1368 1091
1728 180 80 2429 1536
1729 178 62 2015 1442
1730 176 39 1302 1022
1731 175 24 700 614

The best epidemiologists of the time were not in London, but at York, Ripon, Plymouth, Cork and Dublin. Leaving the Irish history to a separate chapter, we shall find in the annals of Wintringham, Hillary and Huxham a somewhat detailed account of the fevers which caused the very high mortalities of the years 1727-29, with an occasional glimpse of the circumstances in which the fevers arose. Much of what follows relates to the same nervous, hysteric or “putrid” fever, with or without relapses, that has been described for London. Going back a little, Wintringham says[115] that the continued fevers of 1720 were milder than those of the year before (which were synochus or typhus) and were often languid or nervous, with giddiness, stupor and nervous tremblings, a quick pulse, a whitish tongue, no thirst, and sweats of the head, neck and chest: this fever lasted twenty days or more, and ended in a general sweat. He had mentioned the “languid nervous fevers” first in the years 1716 and 1717, and he mentions them again as mixed with or following the synochus or typhus of 1727-28.

In April, 1727, there were fevers prevalent, remitting and intermitting, but with uncertain paroxysms; in May, a fever with pleuritic pains; in July, a putrid fever in some, but the chief diseases of that month were “remittents and intermittents,” which were often attended by cutaneous eruptions, sometimes of dusky colour and dry, at other times full of clear serum; which, “as they depended upon a scorbutic taint, tormented the sick with pruritus.” The sick persons in these remittents were for the most part drowsy and stupid, especially during the paroxysm; the fevers were followed by lassitude, debility, languor of spirits and hysteric symptoms.

Hillary[116], who practised at Ripon, not far from Wintringham, at York, records in 1726 the prevalence of remittents and intermittents: “some had exanthematous eruptions towards the latter end of the disease, filled with a clear or yellowish water, which went or dried away without any other inconvenience to the sick but an uneasy itching for a few days”--just as Wintringham had described a miliary fever for 1727. It is also under 1726 that he describes the same drowsy and nervous symptoms of Wintringham’s summer fever of 1727:

“Ancient and weak hysterical people had nervous twitchings and
catchings, and were comatous and delirious; some were very languid,
sick and faint, and had tremors; the young and robust, who had more
full pulses, were generally delirious, unless it was prevented or
taken off by proper evacuations and cooling medicines. I found
blistering to be of very great service in this fever, and the sick
were more relieved by it than ever I observed in any other fever
whatever. People of lax, weak constitutions were very low and faint,
and had frequent, profuse, partial sweatings, which most commonly were
cold and clammy.” Huxham also, at the other end of England, says that
in October and November, 1727, a slow nervous fever attacked not a
few; and under the date of January, 1728, he confirms the Yorkshire
experiences of the prevalence of angina.

There can be little doubt that England in 1727 was already suffering in a measure from the distress that was acutely felt in Ireland; it was much aggravated by the hard winter of 1728-29[117], but it had begun before that and was doubtless the indirect cause of the great prevalence of sickness. The exports of corn under the bounty system used to bring two or three millions of money into the country in a year. But in 1727 there was a debt balance of 70,757 quarters of wheat imported, and in 1728 the import exceeded the export by 21,322 quarters, the price rising at the same time from 4_s._ to 8_s._ per bushel[118]. Under the year 1727 Hillary says:

“Many of the labouring and poor people, who used a low diet, and were
much exposed to the injuries and changes of the weather, died; many of
whom probably wanted the necessary assistance of diet and medicines.”
And after referring, under the winter of 1727-28, to the prevalence of
a fatal suffocative angina, which fell, by a kind of metastasis, on
the diaphragm or pleura, and sometimes on the peritoneum, he proceeds
(p. 16):--

“Nor did any other method, which art could afford, relieve them:
insomuch that many of the little country towns and villages were
almost stripped of their poor people, not only in the country adjacent
to Ripon, but all over the northern parts of the kingdom: indeed I had
no certain account of what distempers those who were at a distance
died of, but suppose they were the same as those which I have
mentioned, which were nearer to us. Bleeding, pectorals with
volatiles, and antiphlogistic diluters and blistering, were the most
successful. I observed that very few of the richer people, who used a
more generous way of living, and were not exposed to the inclemencies
of the weather, were seized with any of these diseases at this
time.... The quartans were very subject to turn into quotidians, and
sometimes to continual, in which the sick were frequently delirious.”

The Yorkshire accounts by Wintringham and Hillary for the second year of this epidemic period, the year 1728, are very full, as regards the symptoms or types of the fevers; but it would be tedious to cite them at length, and unnecessary to do so unless to answer the not inconceivable cavil that the fevers were not of the nature of typhus in one or other of its forms. The chief point is that the second year, towards Midsummer, brought a fever with the symptoms of _synochus_, and not rarely marked with small red spots like fleabites or with purple petechiae. In the autumn of 1729, Hillary noticed a fever of a slow type, which might go on as long as thirty days and end without a perfect crisis--the nearest approach to enteric fever in any of the descriptions. For the same years, 1727-29, Huxham, of Plymouth, describes languid fevers of the “putrid” type, with profuse sweating, followed by typhus of a more spotted type. Like the Yorkshire observer, Huxham mentions also “intermittents” as mixed with the continued fevers.

The great prevalence of these fevers, “intermittents and other fevers,” in the west of England in 1728-29 was known to Dr Rutty of Dublin, who speaks especially of “the neighbourhoods of Gloucester and London, and very mortal in the country places, but less in the cities.” This is confirmed by Dover:

“I happened to live in Gloucestershire in the years 1728 and 1729,
when a very fatal epidemical fever raged to such a degree as to sweep
off whole families, nay almost whole villages. I was called to several
houses where eight or nine persons were down at a time; and yet did
not so much as lose one patient where I was concerned[119].”

Some of the cases of nervous or putrid fever in the epidemics of 1727-29 appear to have been marked by relapses in the country districts as well as in London. Huxham says under date of April, 1728, that those who had wholly got rid of the putrid fever were exceedingly apt to have relapses. Hillary does not mention relapses until March, 1733, when a fever, with many hysterical symptoms, which succeeded the influenza of that year, relapsed in several, “though seemingly perfectly recovered before.” But he seems really to be contrasting relapsing fever and typhus when he points out that, whereas the inflammatory type of fever in the first year of the epidemic (1727) was greatly benefited by enormous phlebotomies, the fever patients in the two seasons following, when the fever was more of the nature of spotted typhus, could not stand the loss of so much blood, or, it might be, the loss of any blood[120]. This was precisely the remark made by Christison and others a century later, when the inflammatory synocha, which often had the relapsing type very marked, changed to the spotted typhus.

From the year 1731 we begin to have annual accounts (soon discontinued) of the reigning maladies in Edinburgh, on the same plan as Wintringham’s, Hillary’s and Huxham’s, with which, indeed, they are sometimes collated and compared[121]. The fevers of Edinburgh and the villages near were as various as those of Plymouth, according to Huxham, and singularly like the latter. Thus, in the winter of 1731-32, there was much worm fever, comatose fever, or convulsive fever among children, but not limited to children, marked by intense pain in the head, raving in some, stupor in others, tremulous movements, leaping of the tendons, and all the other symptoms described by Willis for the fever of 1661, a fatal case of October, 1732, in a boy of ten, recorded by St Clair one of the Edinburgh professors, reading exactly like the cases of Willis already given[122]. St Clair’s case, which was soon fatal, had no worms; but in the general accounts, both for the winter of 1731-32 and the autumn of 1732, it is said that many of the younger sort passed worms, both _teretes_ and _ascarides_, and recovered, the fatalities among children being, as usual, few. In March and April, 1735, there were again “very irregular fevers of children.” Huxham records exactly the same “worm-fever” of children at Plymouth in the spring of 1734--a fever with pains in the head, languor, anxiety, oppression of the breast, vomiting, diarrhoea, and a comatose state (_affectus soporosus_), which attacked the young mostly, and was often attended by the passage of worms. He gives the same account of the seasons as Gilchrist--the years 1734 and 1735 marked by almost continual rains, the country more squalid than had been known for some years[123].

But it is the nervous fever that chiefly engrosses attention both in Scotland and in England. In 1735, Dr Gilchrist, of Dumfries, made it the subject of an essay, returning to the subject a few years after[124]. “As _our_ fever,” he says, “seems to be peculiar to this age, it is not a little surprising that much more has not been said upon it.” He is not sure whether its frequency of late years may not be owing to the manner of living (it was the time of the great drink-craze, which Huxham also connects with the reigning maladies) and to a long course of warm, rainy seasons; the winters for some years had been warm and open, and the summers and harvests rainy. It was only the poorer sort and those a degree above them who were subject to this fever; he knew but few instances of it amongst those who lived well, and none amongst wine-drinkers. It was in some insidious in its approach; those who seemed to be in no danger the first days for the most part died. In others the onset was violent, with nausea, heat, thirst and delirium. Among the symptoms were looseness, pains in the belly, local sweating, tickling cough, leaping of the tendons. Sometimes they were in continual cold clammy sweats; at other times profuse sweats ran from them, as if water were sprinkled upon them, the skin feeling death cold.

At Edinburgh, from October, 1735, to February, 1736, the fever became very common, and was often a relapsing fever.

“The sick had generally a low pulse on the first two or three days,
with great anxiety and uneasiness, and thin, crude urine. Delirium
began about the fourth day, and continued until the fever went off on
the seventh day. Sometimes the disease was lengthened to the
fourteenth day. The approach of the delirium could always be foretold
by the urine becoming more limpid, and without sediment.... A large
plentiful sweat was the crisis in some. Others were exposed to
relapses, which were very frequent, and rather more dangerous than the
former fever[125].”

These evidences, beginning with Strother’s for London in 1728 and extending to the Edinburgh record of 1735, must suffice to identify true relapsing fever. In the chapter on Irish fevers we shall find clear evidence of relapsing fever in Dublin in 1739, before the great famine had begun.

Huxham’s account of the fevers at Plymouth, in Devonshire generally, and in Cornwall about the years 1734-36 is of the first importance. It is highly complex, owing to the prevalence of an affection of the throat, so that one part of the constitution is “anginose fever.” This has been dealt with in the chapter on Scarlatina and Diphtheria. Another part was true typhus. In his account of the nervous fever we are introduced, as in the Yorkshire annals, 1726-27, to a phenomenon that was almost distinctive of the low, nervous or putrid fever from about 1750 to 1760 or longer, namely, the eruption of red, or purple, or white watery vesicles, from which it got the name of miliary fever. Huxham’s annals are full of this phenomenon about the years 1734-36[126]. The red pustules, or white pustules, with attendant ill-smelling sweats, are mentioned over and over again. He thought them critical or relieving: “Happy was then the patient who broke out in sweats or in red pustules.” These fevers are said to have extended to the country parts of Devonshire, after they had ceased in Plymouth, and to Cornwall in August, 1736. In Plymouth itself the type of fever changed after a time to malignant spotted fever, synochus, or true typhus.

The malignant epidemic seemed to have been brought in by the fleet; it had raged for a long time among the sailors of the fleet lying at Portsmouth, and had destroyed many of them. In March, 1735, it was raging among the lower classes of Plymouth. About the 10th day of the fever, previously marked by various head symptoms, there appeared petechiae, red or purple, or livid or black, up to the size of vibices or blotches, or the eruption might be more minute, like fleabites. A profuse, clammy, stinking sweat, or a most foetid diarrhoea wasted the miserable patients. A black tongue, spasms, hiccup, and livid hands presaged death about the 11th to 14th day. So extensive and rapid was the putrefaction of the bodies that they had to be buried at once or within twenty-four hours. It was fortunate for many to have had a mild sweat and a red miliary eruption about the 4th or 5th day; but for others the course of the disease was attended with great risk. In April the type became worse, and the disease more general. There was rarely now any constriction of the throat. Few pustules broke out; but in place of them there were dusky or purple and black petechiae, and too often livid blotches, with which symptoms very many died both in April and May. In July this contagious fever had decreased much in Plymouth, and in September it was only sporadic there. With a mere reference to Hillary’s account of somewhat similar fevers at Ripon in 1734-5 (with profuse sweats, sometimes foetid, great fainting and sinking of spirits, starting of the limbs and beating of the tendons, hiccup for days, etc.[127]) we may pass to a more signal historical event, the great epidemic of fever in 1741-42, of which the Irish part alone has hitherto received sufficient notice[128].

The epidemic fever of 1741-42.

The harvest of 1739 had been an abundant one, and the export of grain had been large. At Lady-day the price of wheat had been 31_s._ 6_d._ per quarter, and it rose 10_s._ before Lady-day, 1740. An extremely severe winter had intervened, one of the three memorable winters of the 18th century. The autumn-sown wheat was destroyed by the prolonged and intense frost, and the price at Michaelmas, 1740, rose to 56_s._ per quarter, the exportation being at the same time prohibited, but not until every available bushel had been sold to the foreigners. The long cold of the winter of 1739-40 had produced much distress and want in London, Norwich, Edinburgh and other towns. In London the mortality for 1740 rose to a very high figure, 30,811, of which 4003 deaths were from fever and 2725 from smallpox. In mid-winter, 1739-40, coals rose to £3. 10_s._ per chaldron, owing to the navigation of the Thames being closed by ice; the streets were impassable by snow, there was a “frost-fair” on the Thames, and in other respects a repetition of the events preceding the London typhus of 1685-86. The _Gentleman’s Magazine_ of January, 1740, tells in verse how the poor were “unable to sustain oppressive want and hunger’s urgent pain,” and reproaches the rich,--“colder their hearts than snow, and harder than the frost”; while in its prose columns it announces that “the hearts of the rich have been opened in consideration of the hard fate of the poor[129].” The long, hard winter was followed by the dry spring and hot summer of 1740, during which the sickness (in Ireland at least) was of the dysenteric type. In the autumn of 1740 the epidemic is said to have taken origin both at Plymouth and Bristol from ships arriving with infection among the men--at the former port the king’s ships ‘Panther’ and ‘Canterbury,’ at the latter a merchant ship. At Plymouth it was certainly raging enormously from June to the end of the year--“febris nautica pestilentialis jam saevit maxime,” says Huxham; it continued there all through the first half of 1741, “when it seemed to become lost in a fever of the bilious kind.” It was in the dry spring and very hot summer of 1741 that the fever became general over England. Wall says that it appeared at Worcester at the Spring Assizes among a few; at Exeter also it was traced to the gaol delivery; and it was commonly said that the turmoil of the General Election (which resulted in driving Walpole from his long term of power) helped its diffusion. But undoubtedly the great occasion of its universality was a widely felt scarcity. The rise in the price of wheat was small beside the enormous leaps that prices used to take in the medieval period, having been at no time double the average low price of that generation. It was rather the want of employment that made the pinch so sharp in 1741. The weaving towns of the west of England were losing their trade; of “most trades,” also, it was said that they were in apparent decay, “except those which supply luxury[130].” Dr Barker, of Sarum, the best medical writer upon the epidemic, says:

“The general poverty which has of late prevailed over a great part of
this nation, and particularly amongst the woollen manufacturers in the
west, where the fever has raged and still continues to rage with the
greatest violence, affords but too great reason to believe that this
has been one principal source of the disease[131].”

He explains that the price of wheat had driven the poor to live on bad bread. This is borne out by a letter from Wolverhampton, 27 November, 1741[132]. The writer speaks of the extraordinary havoc made among the poorer sort by the terrible fever that has for some time raged in most parts of England and Ireland. At first it seldom fixed on any but the poor people, and especially such as lived in large towns, workhouses, or prisons. Country people and farmers seemed for the most part exempt from it, “though we have observed it frequently in villages near market towns”; whereas, says the writer, the epidemic fevers of 1727, 1728 and 1729 were first observed to begin among the country people, and to be some time in advancing to large towns. This writer’s theory was that the fever was caused by bad bread, and he alleges that horse-beans, pease and coarse unsound barley were almost the only food of the poor. To this a Birmingham surgeon took exception[133]. Great numbers of the poor had, to his knowledge, lived almost entirely upon bean-bread, but had been very little afflicted with the fever. Besides, every practitioner knew that the fever was not confined to the poor. He pointed out that in Wolverhampton, whence the bad-bread theory emanated, the proportion of poor to those in easier circumstances was as six to one, poverty having increased so much by decay of trade that many wanted even the necessaries of life. The Birmingham surgeon was on the whole inclined to the theory of “the ingenious Sydenham, that the disease may be ascribed to a contagious quality in the air, arising from some secret and hidden alterations in the bowels of the earth, passing through the whole atmosphere, or to some malign influence in the heavenly bodies”--these being Sydenham’s words as applied to the fever of 1685-6.

Barker, also, draws a parallel between the epidemic of 1741 and that of 1685-86: the Thames was frozen in each of the two winters preceding the respective epidemics, and the spring and summer of 1740 and 1741 were as remarkable for drought and heat as those of 1684 and 1685.

In London the deaths from fever in 1741 reached the enormous figure of 7528, the highest total in the bills of mortality from first to last, while the deaths from all causes were 32,119, in a population of some 700,000, also the highest total from the year of the great plague until the new registration of the whole metropolitan area in 1838. It will be seen from the following table (on p. 81) of the weekly mortalities that the fever-deaths rose greatly in the autumn, but, unlike the old plague, reached a maximum in the winter.

The effects of the epidemic of typhus upon the weaving towns of the west of England, in which the fever lasted, as in London, into the spring of 1742, were seen at their worst in the instance of Tiverton. It was then a town of about 8000 inhabitants, having increased little during the last hundred years. Judged by the burials and baptisms in the parish register it was a more unhealthy place since the extinction of plague than it had been before that. It was mostly a community of weavers, who had not been in prosperous circumstances for sometime past. In 1735 the town had been burned down, and in 1738 it was the scene of riots. The hard winter of 1739-40 brought acute distress, and in 1741 spotted fever was so prevalent that 636 persons were buried in that year, being 1 in 12 of the inhabitants. At the height of the epidemic ten or eleven funerals were seen at one time in St Peter’s churchyard. Its population twenty years after is estimated to have declined by two thousand, and at the end of the 18th century it was a less populous place than at the beginning[134].

_Mortality by Fever in London, 1741-42._

Week All
ending Fever causes
1741
March 10 123 660
17 103 564
24 112 624
31 105 573
April 7 123 670
14 128 687
21 89 580
28 123 622
May 5 104 495
12 141 587
19 129 573
26 153 600
June 2 138 512
9 138 483
16 115 536
23 127 494
30 154 513
July 7 149 523
14 162 551
21 130 485
28 151 621
Aug. 4 128 512
11 142 541
18 172 636
25 192 665
Sept. 1 171 675
8 190 691
15 182 760
22 199 748
29 189 733
Oct. 6 207 784
13 192 787
20 232 793
27 234 850
Nov. 3 250 835
10 228 772
17 182 670
24 214 806
Dec. 1 224 768
8 203 748
15 191 761
22 179 775
29 180 702
1742
Jan. 5 221 893
12 184 760
19 151 724
Feb. 2 132 675
9 103 533
16 108 675
25 103 641

_Effects of the Epidemic of 1741-42 on Provincial Towns. (Short’s Abstracts of Parish Registers.)_

With burials
Registers more than Baptisms in Burials in
Year examined baptisms the same the same

1740 27 6 1409 1940
1741 27 14 3787 6205
1742 26 6 1721 3345

Other parts of the kingdom may be represented by Norwich, Newcastle and Edinburgh. The record of baptisms in Norwich is almost certainly defective; in only two years from 1719 to 1741, is a small excess of baptisms over burials recorded, namely, in 1722 and 1726, while in a third year, 1736, the figures are exactly equal. In 1740 there are 916 baptisms to 1173 burials, and in 1741, 851 baptisms to 1456 burials; while in 1742, owing to an epidemic of smallpox, the deaths rose to 1953, or to more than double the recorded births[135]. The distress was felt most in East Anglia in 1740. Blomefield, who ends his history in that year, says there was much rioting throughout the kingdom, “on the pretence of the scarcity and dearness of grain.” At Wisbech Assizes fourteen were found guilty, but were not all executed. In Norfolk two were convicted and executed accordingly. At Norwich the military fired upon the mob and killed seven persons, of whom only one was truly a rioter[136]. It was also in the severe winter of 1739-40 that the distress began in Edinburgh. The mills were stopped by ice and snow, causing a scarcity of meal; the harvest of 1740 was bad, riots took place in October, and granaries were plundered[137]. The deaths from fever were many in 1740, but were nearly doubled in 1741, with a significant accompaniment of fatal dysentery[138]:

_Edinburgh Mortalities, 1740-41._

(Population in 1732, estimated at 32,000.)[139]

1740 1741
All causes 1237 1611
---- ----
Consumption 278 349
Fever 161 304
Flux 3 36
Smallpox 274 206
Measles 100 112
Chincough 26 101
Convulsions 22 16

The last four items are of children’s maladies, for which Edinburgh was worse reputed even than London.

At Newcastle the deaths in the register in 1741 were 320 more than in 1740, in which year they were doubtless excessive, as elsewhere. But there is a significant addition: “There have also been buried upwards of 400 upon the Ballast Hills near this town[140].”

The symptoms of the epidemic fever of 1741-42 are described by Barker, of Salisbury, and Wall, of Worcester[141]. It began like a common cold, as was remarked also in Ireland. On the seventh day spots appeared like fleabites on the breast and arms; in some there were broad purple spots like those of scurvy. Miliary eruptions were apt to come out about the eleventh day, especially in women. In most, after the first six or seven days, there was a wonderful propensity to diarrhoea, which might end in dysentery. The cough, which had appeared at the outset, went off about the ninth day, when stupor and delirium came on. Gilchrist, of Dumfries, describes the fever there in November, 1741, as more malignant than the “nervous fever” which he had described in 1735. It came to an end about the fourteenth day; the sick were almost constantly under a coma or raving, and they died of an absolute oppression of the brain; a profuse sweat about the seventh day was followed by an aggravation of all the symptoms[142]. An anonymous writer, dating from Sherborne, uses the occasion to make an onslaught upon blood-letting[143].

Sanitary Condition of London under George II.

The great epidemic of fever in 1741-42 was the climax of a series of years in London all marked by high fever mortalities. If there had not been something peculiarly favourable to contagious fever in the then state of the capital, it is not likely that a temporary distress caused by a hard winter and a deficient harvest following should have had such effects. This was the time when the population is supposed to have stood still or even declined in London. Drunkenness was so prevalent that the College of Physicians on 19 January, 1726, made a representation on it to the House of Commons through Dr Freind, one of their fellows and member for Launceston:

“We have with concern observed for some years past the fatal effects
of the frequent use of several sorts of distilled spirituous liquor
upon great numbers of both sexes, rendering them diseased, not fit for
business, poor, a burthen to themselves and neighbours, and too often
the cause of weak, feeble and distempered children, who must be,
instead of an advantage and strength, a charge to their country[144].”

“This state of things,” said the College, “doth every year increase.” Fielding guessed that a hundred thousand in London lived upon drink alone; six gallons per head of the population per annum is an estimate for this period, against one gallon at present. The enormous duty of 20_s._ per gallon served only to develope the trade in smuggled Hollands gin and Nantes brandy. In the harvest of 1733 farmers in several parts of Kent were obliged to offer higher wages, although the price of grain was low, and could hardly get hands on any terms, “which is attributed to the great numbers who employ themselves in smuggling along the coast[145].”

The mean annual deaths were never higher in London, not even in plague times over a series of years, the fever deaths keeping pace with the mortality from all causes, and, in the great epidemic of typhus in 1741, making about a fourth part of the whole. The populace lived in a bad atmosphere, physical and moral. As Arbuthnot said in 1733, they “breathed their own steams”; and he works out the following curious sum:

“The perspiration of a man is about 1/34 of an inch in 24 hours,
consequently one inch in 34 days. The surface of the skin of a
middle-sized man is about 15 square feet; consequently the surface of
the skin of 2904 such men would cover an acre of ground, and the
perspir’d matter would cover an acre of ground 1 inch deep in 34 days,
which, rarefi’d into air, would make over that acre an atmosphere of
the steams of their bodies near 71 foot high.” This, he explains,
would turn pestiferous unless carried away by the wind; “from whence
it may be inferred that the very first consideration in building of
cities is to make them open, airy, and well perflated[146].”

In the growth of London from a medieval walled city of some forty or sixty thousand inhabitants to the “great wen” of Cobbett’s time, these considerations had been little attended to so far as concerned the quarters of the populace. The Liberties of the City and the out-parishes were covered with aggregates of houses all on the same plan, or rather want of plan. In the medieval period the extramural population built rude shelters against the town walls or in the fosse, if it were dry, or along the side of the ditch. The same process of squatting at length extended farther afield, with more regular building along the sides of the great highways leading from the gates. Queen Elizabeth’s proclamation of 1580 was designed to check the growth of London after this irregular fashion; but as neither the original edict nor the numerous copies of it, reissued for near a hundred years, made any provision for an orderly expansion of the capital, these prohibitions had merely the effect of adding to the hugger-mugger of building, “in odd corners and over stables.” The outparishes were covered with houses and tenements of all kinds, to which access was got by an endless maze of narrow passages or alleys; regular streets were few in them, and it would appear from the account given by John Stow in 1598 of the parish of Whitechapel that even the old country highway, one of the great roads into Essex and the eastern counties, had been “pestered[147].” The “pestering” of the field lanes in the suburban parishes with poor cottages is Stow’s frequent theme[148]. The borough of Southwark, as part of the City, may have been better than most: “Then from the Bridge straight towards the south a continual street called Long Southwark, built on both sides with divers lanes and alleys up to St George’s Church, and beyond it through Blackman Street towards New Town or Newington”--the mazes of courts and alleys on either side of the Borough Road which may be traced in the maps long after Stow’s time. So again in St Olave’s parish along the river bank eastwards from London Bridge--“continual building on both sides, with lanes and alleys, up to Battle Bridge, to Horsedown, and towards Rotherhithe.” In the Western Liberty, the lanes that had been laid out in Henry VIII.’s time, Shoe Lane, Fetter Lane and Chancery Lane, served as three main arteries to the densely populated area between Fleet Street and Holborn, but for the rest it was reached by a plexus or _rete mirabile_ of alleys and courts, notorious even in the 19th century. In like manner Drury Lane and St Martin’s Lane were the main arteries between High Holborn and the Strand. One piazza of Covent Garden was a new centre of regular streets, to which the haberdashers and other trades were beginning to remove from the City, for greater room, about 1662. The Seven Dials were a wonder when they were new, about 1694, and had the same intention of openness and regularity as in Wren’s unused design for the City after the fire. The great speculative builder of the Restoration was Nicholas Barbone, son of Praise-God Barbones. He built over Red Lion Fields, much to the annoyance of the gentlemen of Gray’s Inn[149], and his manner of building may be inferred from the following:

“He was the inventor of this new method of building by casting of
ground into streets and small houses, and to augment their number with
as little front as possible, and selling the ground to workmen by so
much per foot front, and what he could not sell build himself. This
has made ground-rents high for the sake of mortgaging; and others,
following his steps, have refined and improved upon it, and made a
superfoetation of houses about London[150].”

In these mazes of alleys, courts, or “rents” the people were for the most part closely packed. Overcrowding had been the rule since the Elizabethan proclamation of 1580, and it seems to have become worse under the Stuarts. On February 24, 1623, certain householders of Chancery Lane were indicted at the Middlesex Sessions for subletting, “to the great danger of infectious disease, with plague and other diseases.” In May, 1637, one house was found to contain eleven married couples and fifteen single persons; another house harboured eighteen lodgers. In the most crowded parishes the houses had no sufficient curtilage, standing as they did in alleys and courts. When we begin to have some sanitary information long after, it appears that their vaults, or privies, were indoors, at the foot of the common stair[151]. In 1710, Swift’s lodging in Bury Street, St James’s, for which he paid eight shillings a week (“plaguy deep” he thought), had a “thousand stinks in it,” so that he left it after three months. The House of Commons appears to have been ill reputed for smells, which were specially remembered in connexion with the hot summer of the great fever-year 1685[152].

The newer parts of London were built over cesspools, which were probably more dangerous than the visible nuisances of the streets satirized by Swift and Gay. There were also the “intramural” graveyards; of one of these, the Green Ground, Portugal Street, it was said by Walker, as late as 1839; “The effluvia from this ground are so offensive that persons living in the back of Clement’s Lane are compelled to keep their windows closed.” But that which helped most of all to make a foul atmosphere in the houses of the working class, an atmosphere in which the contagion of fever could thrive, was the window-tax. It is hardly possible that those who devised it can have foreseen how detrimental it would be to the public health; it took nearly a century to realize the simple truth that it was in effect a tax upon light and air.

The Window-Tax.

Willan, writing of fever in London in 1799, mentions that even the passages of tenement houses were “kept dark in order to lessen the window-tax,” and the air therefore kept foul[153]. Ferriar, writing of Manchester in the last years of the 18th century, mentions, among other fever-dens, a large house in an airy situation which had been built for a poor’s-house, but abandoned: having been let to poor families for a very trifling rent, many of the windows and the principal entrance were built up, and the fever then became universal in it[154]. The Carlisle typhus described by Heysham for 1781 began in a house near one of the gates, tenanted by five or six very poor families; they had “blocked up every window to lessen the burden of the window-tax[155].” John Howard’s interest having been excited in the question of gaol-fever, he noted the effects of the window-tax not only in prisons but in other houses. The magistrates of Kent appear to have paid the tax for the gaols in that county from the county funds; but in most cases the burden fell on the keepers of the gaols.

“The gaolers,” says Howard, “have to pay it; this tempts them to stop
the windows and stifle their prisoners;” and he appends the following
note: “This is also the case in many work-houses and farm-houses,
where the poor and the labourers are lodged in rooms that have no
light nor fresh air; which may be a cause of our peasants not having
the healthy ruddy complexions one used to see so common twenty or
thirty years ago. The difference has often struck me in my various
journeys[156].”

Such impressions are known to be often fallacious; but in the history of the window-tax, which we shall now follow, it will appear that there was a new law, with increased stringency, in the years 1746-1748, corresponding to the “twenty or thirty years ago” of Howard’s recollection.

The window-tax was originally a device of the statesmen of the Revolution “for making good the deficiency of the clipped money.” By the Act of 7 and 8 William and Mary, cap. 18, taking effect from the 25th March, 1696, every inhabited house owed duty of two shillings per annum, and, over and above such duty on all inhabited houses, every dwelling-house with ten windows owed four shillings per annum, and every house with twenty windows eight shillings. In 1710 houses with from twenty to thirty windows were made to pay ten shillings, and those with more than thirty windows twenty shillings. Various devices were resorted to to check the evasions of bachelors, widows and others. A farmer had to pay for his servants, recouping himself from their wages. A house subdivided into tenements was to count as one; which would have made the tax difficult to gather except from the landlord. The machinery of collection was a board of commissioners, receivers-general and collectors.