Chapter I: Typhus and Other Continued Fevers (3)

An easy explanation of plague ceasing in London has long been current, and just because it is an easy explanation it will probably hold the field for many years to come. It is that the fire of 1666 burnt out the seeds of plague. Defoe, writing in 1723, ascribed this opinion to certain “quacking philosophers,” but he would hardly have said so if he could have foreseen the respectable authority for it in after times. The plague had ceased in most of its provincial centres after the Civil Wars, and in some of them, such as York, from as early a date as 1604. It ceased in all the principal cities of Western Europe within a few years of its cessation in London. In London itself it ceased after 1666, not only in the City which was the part burned down in September of that year, but in St Giles’s, where the Great Plague began, in Cripplegate, Whitechapel and Stepney, where it was always worst, in Southwark, Bermondsey and Newington, in Lambeth and Westminster. Nor can it be said that the City was the source from which the infection used to spread to the Liberties and out-parishes. All the later plagues of London, perhaps even that of 1563, began in the Liberties or out-parishes and at length invaded the City. The part of London that was rebuilt after 1666 contained many finer dwelling-houses than before, built of stone, with substantial carpentry, and elegantly finished in fine and rare woods. The fronts of the new houses did not overhang so as to obstruct the ventilation of the streets and lanes; but the streets, lanes, alleys and courts were somewhat closely reproduced on the old foundations. A side walk in some streets was secured for foot-passengers by means of massive posts, which, with the projecting signs of houses and shops, were at length removed in 1766. The improvements in the City after the fire were mostly in the houses of the richer citizens. The City was the place of residence of the rich, with perhaps as many poorer purlieus in close proximity as the residential districts of London now have. But four-fifths of London at the time of the fire were beyond the walls of the City. It is in these extramural regions that the interest mostly lies for epidemical diseases. They remain, says Defoe in 1723, “still in the same condition they were in before.” Unfortunately we know little of their condition, whether in the 17th century or in the 18th. But there must have been something in it most unfavourable to health; for we find from the Bills of Mortality that the cessation of plague made hardly any difference to the annual average of deaths, the increase of population being allowed for. This fact makes the disappearance of plague all the more remarkable.

Fevers to the end of the 17th century.

The epidemical seasons of 1685-86 were the last that Sydenham recorded; he was shortly after laid aside from active work by gout, and died in 1689. Morton, who made notes of fevers and smallpox until 1694, is more a clinical observer than a student of “epidemic constitutions”; and although his writings are of value to the epidemiologist, he does not help us to understand the circumstances in which epidemic diseases prevailed more at one time than another. To the end of the century there is no other medical source of information, and little besides generalities to be collected from any source. It is known that the years from 1693 to 1699 were years of scarcity all over the kingdom, that the fever-deaths in London reached the high figure of 5036 in 1694, and that there was a high mortality in many country parishes and market towns during the scarcity. But there are few particular illustrations of the type of epidemic sickness. There is, therefore, little left to do but to give the figures, and to add some remarks.

_Fever Deaths in the London Bills, 1687-1700._

Spotted Deaths
Fever fever from all
Year deaths deaths causes

1687 2847 144 21460
1688 3196 139 22921
1689 3313 129 23502
1690 3350 203 21461
1691 3490 193 22691
1692 3205 161 20874
1693 3211 199 20959
1694 5036 423 24109
1695 3019 105 19047
1696 2775 102 18638
1697 3111 137 20292
1698 3343 274 20183
1699 3505 306 20795
1700 3675 189 19443

_Tables from Short’s Abstracts of Parish Registers._

Registers Registers with Deaths Births
Year examined excess of death in them in them

_Country Parishes._

1689 144 27 828 692
1690 146 17 532 324
1691 147 16 336 180
1692 147 10 207 146
1693 146 27 650 426
1694 148 18 465 348
1695 149 23 649 492
1696 150 19 503 344
1697 150 21 559 409
1698 152 12 397 289
1699 151 20 433 318
1700 160 29 890 739

_Market Towns._

1689 25 12 1965 1415
1693 25 5 417 338
1694 25 6 1307 681
1695 25 3 309 246
1696 26 4 1020 708
1697 26 2 109 80
1698 26 4 575 423
1699 26 7 1181 867
1700 27 4 726 587

In the London figures the year 1694 stands out conspicuous by its deaths from all causes, and by its high total of fevers. The fever-deaths began to rise from their steady weekly level a little before Christmas, 1693, and remained high all through the year 1694, with a good many deaths from “spotted fever” in the worst weeks. Among the victims in London in February was Sir William Phipps, Governor of New England: his illness appeared at first to be a cold, which obliged him to keep his chamber; but it proved “a sort of malignant fever, whereof many about this time died in the city[65].” Pepys, writing to Evelyn on 10 August, 1694, calls it “the fever of the season,” three being down with it at his house, but well advanced in their recovery. In that week and in the week following, the deaths in London from all causes touched the highest points of the year, the deaths from fever and spotted fever being a full quarter of them. Fever at its worst in London never made more than a quarter of the annual deaths from all causes; so that, if we take it to have been the successor of the plague, it operated in a very different way--with a greatly lessened fatality of all that were attacked, with only a reminder of the old special incidence upon the summer and autumn seasons, but with a steadiness from year to year, and throughout each year, that made the fever-deaths of a generation little short of one of those enormous totals of plague-deaths that were rapidly piled up during a few months, perhaps once or twice in a generation.

The following table from the London weekly Bills shows the progress of the fever from the end of April, 1694, with the number of deaths specially assigned to “spotted fever”:--

_London: Weekly Mortalities from fever and all causes, epidemic of 1694._

Week Spotted All
ending Fever fever deaths

April 24 90 15 427
May 1 77 10 369
8 89 9 413
15 80 5 395
22 101 3 428
29 72 8 430
June 5 112 12 469
12 113 12 434
19 113 11 430
26 99 14 396
July 3 94 11 423
17 86 10 445
24 115 13 507
31 84 13 484
Aug. 7 99 10 462
14 110 20 530
21 135 19 583
28 111 20 510
Sept. 5 115 16 505
12 112 12 462
18 98 9 504
25 106 4 490
Oct. 2 124 8 533
9 125 10 553
16 114 9 552
23 104 3 511
30 118 3 528
Nov. 6 70 3 439
10 89 7 453
13 106 2 471
20 117 13 538
27 79 6 456
Dec. 4 87 6 475
11 87 3 407
18 78 4 445
25 66 3 394

The year 1694, to which the epidemic of malignant fever (as well as malignant smallpox) belongs, was one of the series of “seven ill years” at the end of the 17th century (1693-99). They were long noted, says Thorold Rogers, “for the distress of the people and for the exalted profits of the farmer.” The price of wheat in the autumn and winter of 1693 was the highest since the famine of 1661. In 1697-8 corn was again dear and much of it was spoilt. At Norwich in 1698 wheat was sold at 44_s._ a comb.

Harvests spoiled by wet weather or unseasonable cold appear to have been the most general cause of the high prices of food. In London there was no unusual sickness except in 1694; indeed the other years to the end of the century show a somewhat low mortality, the year 1696, which Macaulay marks as a time of severe distress among the common people owing to the calling in of the debased coinage[66], had the smallest number of deaths from all causes (18,638) since many years before, and for a century after allowing for the increase of population. But the deaths from “fever” were some three thousand every year, and the births, so far as registered, were, as usual, far below the deaths.

It was in the country at large that the effects of the “seven ill years” were chiefly felt. According to Short’s abstracts of parish registers, there was unusual mortality at the beginning of the period and at the end of it; in his Chronology he mentions spotted fever, bloody flux and agues in 1693 (besides an influenza or universal slight fever recorded by Molyneux of Dublin), and again in 1697 and 1698 “purples, quinsies, Hungarian and spotted fever, universal pestilential spotted fever,” from famine and bad food.

When we look for the evidence of this in England we shall have difficulty in finding it. Short’s own abstracts give almost no colour to it; but there are other figures from the parish registers, scattered through the county histories and statistical works, which prove that the seven ill years must have checked population. Thus at Sheffield in the ten years 1691-1700 there was the greatest excess of burials over baptisms in the whole history of the town from 1561--namely, 2856 burials to 2221 baptisms (688 marriages). At Minehead, Somerset, a parish of some 1200 people occupied in weaving, the deaths and births were as follows in four years of the decennium:

Baptised. Buried.

1691 57 75
1694 34 55
1695 47 48
1697 35 65

A glimpse of spotted or pestilential fever in Bristol during the years of distress at the end of the 17th century comes from Dr Dover, a man of no academical repute, but at all events an articulate voice. Passing from an account of the spotted pestilential fever at Guayaquil, “when I took it by storm,” he goes on[67]:

“About thirty-seven years since [written in 1732], this fever raged
much in Bristol, so that I visited from twenty-five to thirty patients
a day for a considerable time, besides their poor children taken into
their workhouse, where I engaged myself, for the encouragement of so
good and charitable an undertaking, to find them physick and give them
advice at my own expense and trouble for the two first years. All
these poor children in general had this fever, yet no more than one of
them died of it of the whole number, which was near two hundred.”

--an experience of typhus in children which was strictly according to rule. This had clearly been the occasion of a memorial addressed to the Mayor and Aldermen of Bristol, in 1696, praying that a capacious workhouse should be erected for children and the aged, which “will prevent children from being smothered or starved by the neglect of the parish officers and poverty of their parents, which is now a great loss to the nation[68].”

The year 1698 was the climax of the seven ill years. The spring was the most backward for forty-seven years, the first wheat in the ear being seen near London on 16th June. For four months to the end of August the days were almost all rainy, except from the 18th to the 26th July. Whole fields of corn were spoilt. In Kent there was barley standing uncut on 29th September, and some lay in the swathe until December. Much of the corn in the north of England was not got in until Christmas, and in Scotland they were reaping the green empty corn in January[69].

Fevers of the seven ill years in Scotland.

It is from Scotland that we hear most of the effects of the seven ill years in the way of famine and fever. Scotland was then in a backward state compared with England; and its northern climate, making the harvest always a few weeks later than in England, told especially against it in the ill years. Fynes Morryson, in the beginning of the 17th century, contrasts the Scotch manner of life unfavourably with the English, and Sir Robert Sibbald’s account towards the end of that century is little better. Morryson says, “the excesse of drinking was then farre greater in generall among the Scots than the English.” Sibbald remarks[70] on the drinking habits of the Scots common people: their potations of ale or spirits on an empty stomach, especially in the morning, relaxed the fibres and induced “erratic fevers of a bad type, bastard pleurisies, ... dropsies, stupors, lethargies and apoplexies.” Morryson says: “Their bedsteads were then like cubbards in the wall, with doores to be opened and shut at pleasure, so as we climbed up to our beds. They used but one sheete, open at the sides and top, but close at the feete, and so doubled[71].” Sibbald says the peasantry had poor food and hard work, and were subject to many diseases--“heartburn, sleeplessness, ravings, hypochondriac affections, mania, dysentery, scrophula, cancer, and a dire troop of diseases which everywhere now invades the husbandmen that were formerly free from diseases.” _Causa a victu est._ Therefore consumption was common enough. He has much to say of fevers,--of intermittents, especially in spring and autumn, catarrhal fevers, nervous fevers, comatose fevers, with delirium, spasms and the like symptoms, malignant, spotted, pestilential, hectic, &c. The continued fevers ranged in duration from fifteen to thirty-one days, recovery being ushered in with sweats, alvine flux and salivation. Purple fevers had sometimes livid or black spots mixed with the purple (mottling); in a case given, there were suppurations which appear to have been bubonic. There had been no plague in Scotland since 1647-48; but fevers, unless Sibbald has given undue prominence to them, would appear to have filled its place among the adults.

Another writer of this period, from whom some information is got as to fevers, was Dr Andrew Brown of Edinburgh. He is mainly a controversialist, and is on the whole of little use save for the history of the treatment of fevers. He came to London on a visit in 1687, attracted by the fame of Sydenham’s method of curing fevers by antimonial emetics and by purgation: “Returning home as much overjoyed as I had gotten a treasure, I presently set myself to that practice”--of which he gave an account in his ‘Vindicatory Schedule concerning the New Cure of Fever[72].’ Continual fever, he says, takes up, with its pendicles, the half of all the diseases that men are afflicted with; and some part of what he calls continual fever must have been spotted: “As concerning the eruption of spots in fevers, these altogether resemble the marks made by stroaks on the skin, and these marks are also made by the stagnation and coagulation of the blood in the small channels [according to the doctrine of obstructions].... They tinge the skin with blewness or redness.”

The bitter controversy as to the treatment of fevers led Brown into another writing in 1699[73].

“The fevers that reign at this time [it was towards the end of the
seven ill years] are for the most part quick and peracute, and cut off
in a few days persons of impure bodies. And as I have used this method
by vomiting and purging in many, and most successfully at this time,
so I have had lately considerable experience thereof in my own family:
wherein four of my children and ten servants had the fever, and
blessed be God, are all recovered, by repeated vomiting with
antimonial vomits and frequent purgings, except two servants, the one
having gotten a great stress at work, who bragging of his strength did
contend with his neighbour at the mowing of hay, and presently
sickened and died the sixth day, and whom I saw not till the day
before he died, and found him in such a condition that I could not
give him either vomit or purge: and the other was his neighbour who
strove with him, being a man of most impure and emaciate body, who had
endured want and stress before he came to my service, and who got not
all was necessary because he had not the occasion of due attendance,
all my servants being sick at the time[74].”

This account of the experience which Dr Andrew Brown had lately had among his children and domestics in or near Edinburgh was written in 1699, and may be taken as relating to part of the wide-spread sickliness of the seven ill years in Scotland. Fletcher of Saltoun gives us a general view of the deplorable state of Scotland at the end of the 17th century, which was intensified by the succession of bad harvests[75]. The rents of cultivated farms were paid, not in money, but in corn, which gave occasion to many inequalities, to the traditional fraudulent practices of millers and to usury. The pasture lands for sheep and black cattle had no shelters from the weather, and no winter provision of hay or straw (roots were unheard of until long after), “so that the beasts are in a dying condition.” The country swarmed with vagrants (a hundred thousand, he estimates, in ordinary times, but doubled in the dear years), who lived and multiplied in incest, rioted in swarms in the nearest hills in times of plenty, and in times of distress fell upon farmhouses in gangs of forty or more, demanding food. Besides these there were a great many poor families very meanly provided for by the Church boxes, who lived wholly upon bad food and fell into various diseases. He had been credibly informed that some families in the years of mere scarcity preceding the climax of 1698-99 had eaten grains, for want of bread. “In the worst time, from unwholesome food diseases are so multiplied among poor people that, if some course be not taken, the famine may very probably be followed by a plague[76].”

We owe some details of these calamities in Scotland to Patrick Walker, the Covenanter, who records them to show how the prophecies of Divine vengeance on the land, uttered during the Stuart persecutions by Cargill and Peden, had been in due time fulfilled[77]:

“In the year 1694, in the month of August, that crop got such a stroke
in one night by east mist or fog standing like mountains (and where it
remained longest and thickest the badder were the effects, which all
our old men, that had seen frost, blasting and mildewing, had never
seen the like) that it got little more good of the ground. In November
that winter many were smitten with wasting sore fluxes and strange
fevers (which carried many off the stage) of such a nature and manner
that all our old physicians had never seen the like and could make no
help; for all things that used to be proper remedies proved
destructive. And this was not to be imputed to bad unwholesome
victual; for severals who had plenty of old victual did send to
Glasgow for Irish meal, and yet were smitten with fluxes and fevers in
a more violent and infectious nature and manner than the poorest in
the land, whose names and places where they dwelt I could instance.

“These unheard-of manifold judgments continued seven years, not always
alike, but the seasons, summer and winter, so cold and barren, and the
wonted heat of the sun so much withholden, that it was discernible
upon the cattle, flying fowls and insects decaying, that seldom a fly
or gleg was to be seen. Our harvests not in the ordinary months, many
shearing in November and December, yea some in January and February;
the names of the places I can instruct. Many contracting their deaths,
and losing the use of their feet and hands, shearing and working
amongst it in frost and snow; and after all some of it standing still,
and rotting upon the ground, and much of it for little use either to
man or beast, and which had no taste or colour of meal. Meal became so
scarce that it was at two shillings a peck, and many could not get it.

“Through the long continuance of these manifold judgments deaths and
burials were so many and common that the living were wearied with
burying of the dead. I have seen corpses drawn in sleds. Many got
neither coffins nor winding-sheet.

“I was one of four who carried the corpse of a young woman a mile of
way; and when we came to the grave, an honest poor man came and said,
‘You must go and help me to bury my son, he is lien dead this two
days; otherwise I will be obliged to bury him in my own yard.’ We
went, and there were eight of us had two miles to carry the corpse of
that young man, many neighbours looking on us, but none to help us. I
was credibly informed, that in the North, two sisters on a Monday’s
morning were found carrying the corpse of their brother on a barrow
with bearing-ropes, resting themselves many times, and none offering
to help them.

“I have seen some walking about at sunsetting, and next day at six
o’clock in the summer morning found dead in their houses, without
making any stir at their death, their head lying upon their hand, with
as great a smell as if they had been four days dead; the mice or rats
having eaten a great part of their hands and arms.

“The nearer and sorer these plagues seized, the sadder were their
effects, that took away all natural and relative affections, so that
husbands had no sympathy with their wives, nor wives with their
husbands, parents with their children, nor children with their
parents. These and other things have made me to doubt if ever any of
Adam’s race were in a more deplorable condition, their bodies and
spirits more low, than many were in these years.”

In the parish of West Calder, 300 out of 900 “examinable” persons
wasted away.

Some facts and traditions of the Seven Ill Years were recorded nearly
a century after in the Statistical Account of Scotland. From the Kirk
Session records of the parish of Fordyce, Banffshire, it did not
appear “that any public measures were pursued for the supply of the
poor, nor anything uncommon done by the Session except towards the
end. The common distribution of the collections of the church amounted
only to about 1_s._ 2_d._ or 1_s._ 4_d._ weekly.” The Kirk Session
records bore witness to the numerous cases of immorality in the years
before the famine that had been dealt with ecclesiastically, and to
the entire and speedy cessation of such cases thereafter[78].

The account for the parish of Keithhall and Kinkell, Aberdeenshire,
says that “many died of want, in particular ten Highlanders in a
neighbouring parish, that of Kemnay; so that the Session got a bier
made to carry them to the grave, not being able to afford coffins for
such a number[79].” In the upland parish of Montquhitter, in the same
county, the dear years reduced the population by one half or more.
Until 1709 many farms were waste. Of sixteen families that resided on
the estate of Lettertie, thirteen were extinguished. The account of
this parish contains several stories of the distress, with the names
of individuals[80]. It is clear, however, that all the parishes of
Scotland were not equally distressed. The county of Moray and “some of
the best land along the east coast of Buchan and Formartine
[Aberdeenshire] abounded with seed and bread;” but transport to the
upland parishes was difficult[81].

We may take it that these experiences in the reign of William III. were peculiar to Scotland; even Ireland, which had troubles enough of the same kind in the 18th and 19th centuries, was at that time resorted to as a place of refuge by the distressed Scots. Among the special and temporary causes in Scotland were antiquated agricultural usage, an almost incredible proportion of the people in a state of lawless vagrancy, such as Henry VIII. and Elizabeth had to deal with a century and a half before, a low state of morals, both commercial and private, a tyrannical disposition of the employers, a sullen attitude of the labourers, and a total decay of the spirit of charity. An ancient elder of the parish of Fordyce, who kept some traditions of the dear years, remarked to the minister: “If the same precautions had been taken at that time which he had seen taken more lately in times of scarcity, the famine would not have done so much hurt, nor would so many have perished.”

The evil of vagrancy, for which Fletcher of Saltoun saw no remedy but a state of slavery not unlike that which Protector Somerset had actually made the law of England for a couple of years, 1547-49, in somewhat similar circumstances, gradually cured itself without a resort to the practices of antiquity or of barbarism.

The union with England in 1707, by removing the customs duties and opening the Colonial trade to Scots shipping (they had a share in the East India trade already) gave a remarkable impulse to the manufacture of linen and to commerce. Such was the demand for Scots linen that, it seemed to De Foe, “the poor could want no employment”; and it may certainly be taken as a fact that the establishment on a free basis of industries and foreign markets gave Scotland relief from the pauperism and vagrancy, like those of Ireland in the 18th and 19th centuries, that threatened for a time, and especially in the Seven Ill Years, to retard the developement of the nation.

* * * * *

For several years after the period of scarcity or famine from 1693 to 1699, the history of fever in Britain presents little for special remark.

A book of the time was Dr George Cheyne’s _New Theory of Continual Fever_, London, 1701. His theory is that of Bellini and Borelli, which accounted for everything in fevers on mechanical principles, and ignored the infective element in them. Cheyne does not even describe what the fevers were; but in showing how the theory applies, he mentions incidentally the symptoms--quick pulse, pain in the head, burning heat, want of sleep, raving, clear or flame-coloured urine, and morbid strength. Equally theoretical is the handling of the subject by Pitcairn. Freind, in his essays on fevers[82], is mainly occupied with controversial matters of treatment, except in connexion with Lord Peterborough’s expedition to Spain in 1705, as we shall see in a section on sickness of camps and fleets.

In the absence of clinical details from the medical profession, the following from letters of the time will serve a purpose:

On 18 September, 1700, Thomas Bennett writes to Thomas Coke from Paris giving an account of the fever of Coke’s brother: His fever is very violent upon him, and he has a hickup and twitchings in his face; he is especially ill in the night, and has now and then violent sweats. He raved for eight days together and in all that time did not get an hour’s sleep. He was attended by Dr Helvetius and other physicians. Lady Eastes, her son, and most of her servants are sick, but they are all on the mending hand; her steward is dead of a high fever, having been sick but five days[83]. These are Paris fevers, the symptoms suggesting typhus, especially the prolonged vigil in one of the cases. It is to be remarked that they occurred among the upper classes; and it appears that the universal fevers “of a bad type” in France in 1712 did not spare noble houses nor even the palace of Louis the Great[84].

The following from the London Bills will show the prevalence of fever from year to year[85].

Dead of Dead of Dead of
Year Fever Spotted Fever all diseases

1701 2902 68 20,471
1702 2682 53 19,481
1703 3162 74 20,720
1704 3243 61 22,684
1705 3290 41 22,097
1706 2662 54 19,847
1707 2947 42 21,600
1708 2738 62 21,291
1709 3140 118 21,800
1710 4397 343 24,620
1711 3461 142 19,833
1712 3131 96 21,198
1713 3039 102 21,057
1714 4631 150 26,569
1715 3588 161 22,232
1716 3078 100 24,436
1717 2940 137 23,446
1718 3475 132 26,523
1719 3803 124 28,347
1720 3910 66 25,454

The London fever of 1709-10.

The “seven ill years” were followed by the fine summer and abundant harvest (although hardly more than half the breadth was sown) of 1699. Scarcity was not a cause of excessive sickness again until 1709-10; although the harvest of 1703 was unfavourable. The price of wheat in 1702 was 25_s._ 6_d._ per quarter, and continued low for a number of years, notwithstanding the war with France. In Marlborough’s wars there were no war-prices for farmers, as in the corresponding circumstances a century after; on the contrary, corn and produce of all kinds were so cheap that farmers had difficulty in paying their rents. The bounty of five shillings per quarter on exported wheat had given a great impulse to corn-growing, so that the acreage of wheat sown was much more than the country in an ordinary year required, partly, no doubt, because the bread of the poorer classes was largely made from the coarser cereals. The period of abundance was broken by the excessively severe winter of 1708-9, one of three memorable winters in the 18th century. The frost lasted all over Europe from October to March, and was followed by a greatly deficient crop in 1709. The following shows the rise of the price of the quarter of wheat in England:

_s._ _d._

1708 Lady-day 27 3
" Michaelmas 46 3
1709 Lady-day 57 6
" Michaelmas 81 9
1710 Lady-day 81 9

The export of corn was prohibited in 1709 and again in 1710.

An epidemic of fever began in London in the autumn of 1709 and continued throughout 1710, in which year the fever-deaths reached the highest total since 1694. But it was not altogether a fever of starvation or distress among the poor, and perhaps not mainly so. There is always the dual question in connexion with fever following bad seasons and high prices: how much of it was due to the scarcity, and how much to those states of soil and atmosphere upon which the failure of the crop itself depended. An authentic case of the malignant fever which began to rage in London in the autumn of 1709 will both serve to show the remarkable type of at least a portion, if not the whole of the epidemic, and to prove its incidence upon the houses of the rich.

The case is recorded by Sir David Hamilton[86]:

“About the 5th of October, 1709, the son of that worthy gentleman,
William Morison, esquire, was seized with a fever; at which time, and
for some weeks before, a malignant fever raged in London.” He had a
quick and weak pulse, great difficulty or hindrance of speech, and a
stupidity; “whereto were added tremors, and startings of the tendons,
a dry and blackish tongue, a high-coloured but transparent urine and
coming away for the most part involuntarily, and a hot and dry skin.”
Dr Grew was called in, and prescribed alexipharmac remedies (cordials,
sudorifics, etc.) “A few days after the patient’s skin was stained or
marked with red and purple spots, and especially upon his breast, legs
and thighs. These symptoms, although a little milder now and then,
prevailed for fourteen days; after that the spots vanished, and the
convulsive motions so increased that the young gentleman seemed ready
to sink under them for several days together.” He was treated with the
application of blisters, and with doses of bark. His strength and
flesh were so wasted that the hip whereon he lay was seized with a
gangrene. For ten or twelve days before his death, “he breathed and
perspired so offensive a smell that they were obliged to smoke his
chamber with perfumes; and even myself, whilst I inclined my body a
little too near him, was, by receiving his breath into my mouth,
seized all on a sudden with such a sickness and faintness that I was
obliged to take the air in the open fields, and returning thence to
drink plentifully of _mountain_ wine at dinner.” The examination after
death was made by the celebrated anatomist Dr Douglas. There was still
a heap of brown-coloured spots visible on the breast; “there was
nothing contained in the more conspicuous vessels of the abdomen but
grumes or clots of blackish blood, without any serum in the
interstices.” Hamilton adds: “We too seldom dissect the bodies of
those dying in fevers.”

The tremors, offensive sweats and offensive breath are distinctive of a form of typhus that became common towards the middle of the century, and was called putrid fever (not in the sense of Willis) or miliary fever from the watery vesicles of the skin that often attended it. But although Hamilton was writing on miliary fever (of the factitious variety) this case is not given as an example, but is appended to his sixteen cases of the latter, as an example of “a deadly fever with loss of speech from the beginning.” Among earlier cases, those belonging to the epidemic of 1661 as described by Willis correspond closely with this case, which we may take as representing part of the malignant fever that then raged in London. We have an anatomical record from each; but in neither was there sloughing of the lymph-follicles of the intestine, or of the mesenteric glands, as in the enteric fever of our own time; while in both there were red or purple spots on the breast or neck, and on the limbs. The “loss of speech from the beginning” suggests Sydenham’s “absolute aphonia” in the comatose fever of 1673-76, which resembled in other respects Willis’s fever of the brain and nervous stock (mostly of children) in 1661. One of the synonyms of “infantile remittent” was “an acute fever with dumbness[87].” This seems to have been a common type of fever in the latter part of the 17th century and early part of the 18th. Some likeness to enteric fever may be found in it, but there is no warrant for identifying it with that fever. Its main features may be said to have been its incidence upon the earlier years of life, but not to the exclusion of adult cases, its remarkable ataxic symptoms, which led Willis to refer it to “the brain and nervous stock” (spinal cord), its comatose character, its spots, occasional miliary eruption, ill-smelling sweats and other foetid evacuations, its protracted course, and its hectic sequelae.

The weekly bills of mortality in London bear little evidence of unusual prevalence of fever in 1709, except in the weeks ending 13 and 20 September, when the fever-deaths were 96 and 75 (including “spotted fever”). But the unusual entry of “malignant fever” appears in three weekly bills, 19 July, 9 August and 23 August, one death being referred to it on each occasion. It was in the summer and autumn of 1710 that the fever reached a height in London, being attended with a very fatal smallpox. An essay on the London epidemic of 1710[88] is interesting chiefly for recording a probable case of relapsing fever, a form which was almost certainly part of the great febrile epidemic in London in 1727-29.

Mrs Simon, aged 20, had a burning fever, stifling of her breath,
frequent vomiting and looseness, foul tongue, loss of sleep,
restlessness, intermitting, low and irregular pulse. This terrible
fever disappeared on the fourth day, and she thought herself
recovered. But on the seventh day from her being taken ill the fever
returned, she was light-headed, did not know her relatives, and was
fevered in the highest degree. It looked like a malignant fever, but
there were no spots.

The following table shows the very high mortality from fever (as well as from smallpox) in the epidemic to which the above case belonged.

_London: Weekly deaths from fever, smallpox and all causes._

1710.

Week Dead of Dead of Dead of Dead of
ending fever spotted fever smallpox all diseases

May 2 103 [illegible] 99 571
9 90 6 60 517
16 84 7 71 502
23 93 15 71 503
30 106 11 83 550
June 6 93 2 98 508
13 79 8 84 509
20 106 12 99 574
27 105 15 86 503
July 4 106 7 99 482
11 107 13 97 467
18 126 16 89 509
25 109 13 105 562
Aug. 1 91 12 79 444
8 92 11 72 463
15 98 10 58 459
22 105 10 63 463
29 111 16 71 495
Sept. 5 76 4 63 414
12[89] 107 12 57 520
19 115 9 83 548
26 81 11 46 456
Oct. 3 98 9 45 469
10 79 10 49 480
17 90 5 41 477
24 107 5 45 470
31 106 14 51 421
Nov. 7 71 6 55 425
14 92 2 41 390
21 70 4 25 345

Throughout England, in country parishes and in towns, the first ten years of the 18th century were on the whole a period of good public health. In Short’s abstracts of the parish registers to show the excess of deaths over the births, those years are as little conspicuous as any in the long series. It was a time when there was a great lull in smallpox, and probably also in fevers. The figures for Sheffield may serve as an example[90]. It will be seen from the Table that the burials exceeded the baptisms in every decade from the Restoration to the end of the century; after that for twenty years the baptisms exceeded the burials, the marriages having increased greatly.

_Vital Statistics of Sheffield._

Ten-year
periods Marriages Baptisms Burials

1661-70 585 2086 2266
1671-80 537 2240 2387
1681-90 540 2595 2856
1691-1700 688 2221 2856
1701-10 942 3033 2613
1711-20 991 3304 2765

Of particular epidemics, we hear of a malignant fever at Harwich in 1709. Harwich was then an important naval station, and the fever may have arisen in connexion with the transport of troops to and from the seat of war, just as camp- and war-fevers appeared at various ports in the next war, 1742-48.

There were rumours of a plague at Newcastle in 1710, which were contradicted by advertisement in the _London Gazette_[91]. But, as there was so much plague in the Baltic ports in 1710 it is possible that the Newcastle rumour may have been one of plague imported, and not a rumour suggested by the mortality from some other disease.

To the same period of epidemic fever in London, about 1709-10, belongs also a curiously localized epidemic in an Oxford college, which reminds one somewhat of the circumstances of enteric fever in our time. It was told to Dr Rogers of Cork twenty-five or twenty-six years before the date of his writing (1734), by one who was a student at Oxford then: “There broke out amongst the scholars of Wadham College a fever very malignant, that swept away great numbers, whilst the rest of the colleges remained unvisited. All agreed that the contagious infection arose from the putrefaction of a vast quantity of cabbages thrown into a heap out of the several gardens near Wadham College[92].”

The next epidemic of fever in London was in 1714. Like that of 1710, it followed a great rise in the price of wheat, or perhaps it followed the unseasonable weather which caused the deficient harvest. Before the Peace of Utrecht wheat in England was as low as 33_s._ 9_d._ per quarter, in 1712, the peace next year sending it no lower than 30_s._ But at Michaelmas, 1713, it rose with a bound to 56_s._ 11_d._, doubtless owing to a bad harvest. The fever-deaths in London began to rise in the spring of 1714, reaching a weekly total of 103 in the week ending 20 April. All through the summer and autumn they continued very high, the weekly totals exceeding, on an average, those of the year 1710, as in the foregoing table, and having corresponding large additions of “spotted fever.” The deaths from all causes in 1714 were a quarter more than those of the year before, the epidemic of fever being the chief contributor to the rise. This happened to be a very slack time in medical writing[93]; but, even in the absence of such testimony as we have for earlier and later epidemics of fever in London, we may safely conclude that the fever of 1714 was of the type of pestilential or malignant typhus, beginning in early summer and reaching a height in the old plague season of autumn.

A singular instance of what may be considered war-typhus belongs to the winter of 1715-16. The political intrigues preceding and following the death of Queen Anne in 1714 culminated in the Jacobite rising in Scotland and the North of England in 1715. The Jacobites having been defeated at Preston on 13 November, prisoners to the number of 450 were brought to Chester Castle on the Sunday night before December 1st. A fortnight later (December 15th), Lady Otway writes of the 450 prisoners in the Castle:

“They all lie upon straw, the better and the worse alike. The king’s
allowance is a groat a day for each man for meat, but they are almost
starved for want of some covering, though many persons are charitable
to the sick.” The winter was unusually severe, the snow lying “a yard
deep.” Many prisoners died in the Castle by “the severity of the
season,” many were carried off by “a very malignant fever.” On
February 16th Lady Otway writes again:--“So much sickness now in our
Castle that they dye in droves like rotten sheep, and be 4 or 5 in a
night throne into the Castle ditch ffor ther graves. The feavour and
sickness increaseth dayly, is begun to spread much into the citty, and
many of the guard solidyers is sick, it is thought by inffection. The
Lord preserve us ffrom plague and pestilence[94]!”

Prosperity of Britain, 1715-65.

The fifty years from 1715 to 1765 were, with two or three exceptions, marked by abundant harvests, low prices and heavy exports of corn. This was undoubtedly a great time in the expansion of England, a time of fortune-making for the monied class, and of cheapness of the necessaries of life.

The well-being and comfort of the middle class were undoubtedly great; also there was something peculiar to England in the prosperity of towns and villages throughout all classes. In the very worst year of the period, the year 1741, Horace Walpole landed at Dover on the 13th September, having completed the grand tour of Europe. Like many others, he was delighted with the pleasant county of Kent as he posted towards London; and on stopping for the night at Sittingbourne, he wrote as follows in a letter:

“The country town delights me: the populousness, the ease, the gaiety,
and well-dressed everybody, amaze me. Canterbury, which on my setting
out I thought deplorable, is a paradise to Modena, Reggio, Parma, etc.
I had before discovered that there was nowhere but in England the
distinction of _middling people_. I perceive now that there is
peculiar to us _middling houses_; how snug they are[95]!”

Our history henceforth has little to record of malignant typhus fevers, or of smallpox, in these snug houses of the middle class, although not only the middle class, but also the highest class had a considerable share of those troubles all through the 17th century. But the 18th century, even the most prosperous part of it, from the accession of George I. to the beginning of the Industrial Revolution in the last quarter or third of it, was none the less a most unwholesome period in the history of England. The health of London was never worse than in those years, and the vital statistics of some other towns, such as Norwich, are little more satisfactory. This was the time which gave us the saying, that God made the country and man made the town. Praise of rural felicity was a common theme in the poetry of the time, as in Johnson’s _London_:

“There every bush with nature’s music rings,
There every breeze bears health upon its wings.”

Both for the country and the town the history of the public health does not harmonize well with the optimist views of the 18th century. The historians are agreed that, under the two first Georges, during the ministries of Walpole, the Pelhams and Pitt, the prosperity of Britain was general. Adam Smith speaks of “the peculiarly happy circumstances of the country” during the reign of George II. (1727-60). Hallam characterizes the same reign as “the most prosperous that England had ever experienced.” The most recent historian of England in the 18th century is of the same opinion[96]. The novels of Fielding give us the concrete picture of the period with epic fidelity, and the picture is of abundance and prodigality. Agriculture and commerce with the Colonies, India and the continent of Europe, were the sources of the country’s wealth. Farming and stock-raising had been greatly improved by the introduction of roots and sown grasses. In some country parishes the baptisms were three times the burials. But the public health during this period will not appear in a favourable light from what follows. More particularly there were three occasions, about the years 1718, 1728 and 1741, when a single bad harvest in the midst of many abundant ones brought wide-spread distress, with epidemics of typhus and relapsing fever; from which fact it would appear that the common people had little in hand. Thorold Rogers, among economists, was of the opinion that the prosperity was all on the side of the governing and capitalist classes, that the labourers were in “irremediable poverty” and “without hope,” and that the law of parochial settlement, with the artificial fixing of wages by the Quarter Sessions and the bonuses out of the poor-rates, had the effect of keeping the mass of the people on the land “in a condition wherein existence could just be maintained[97].” I shall not attempt an independent judgment in economics, but proceed to those illustrations of national well-being which belong to my subject, leaving the latter to have their due weight on the one side of economical opinion or on the other. Besides the economical question there is of course also an ethical one. When the pinch came about 1766, there was the usual diversity of opinion expressed on the “condition of England” problem, one holding that the labourers were unfairly paid, another that the nation had been made “splendid and flourishing by keeping wages low,” and that the distress was due to “want of industry, want of frugality, want of sobriety, want of principle” among the common people at large. “If in a time of plenty,” wrote one austere moralist, “the labourers would abate of their drunkenness, sloth, and bad economy, and make a reserve against times of scarcity, they would have no reason to complain of want or distress at any time[98].” But there must have been something wrong in the economics and morals of their betters if it were the case that the working class as a whole, and not merely a certain number of individuals in it, was drunken, thriftless and slothful. The familiar proof of this is the apathy of the Church, broken by the Methodist revival of religion.

The epidemic fevers of 1718-19.

In the fifty years from 1715 to 1765, the three worst periods of epidemic fever in England and Scotland correspond closely to the three periods of actual famine and its attendant train of sicknesses in Ireland, namely, the years 1718-19, 1727-29, and 1740-42. The three divisions of the kingdom suffered in common, Ireland suffering most. The first period, 1718-19, was an extremely slack tide in medical writing, insomuch that hardly any accounts of the reigning maladies remain, except those by Wintringham, of York, and Rogers, of Cork. The whole of the Irish history of fevers and the allied maladies is dealt with in a chapter apart. Of the Scots history, little is known for the first of the three periods beyond a statement that there was a malignant fever and dysentery in Lorn, Argyllshire, in January and February, 1717[99].

Wintringham gives the following account of the _synochus_, afterwards called typhus, which attracted notice in the summer of 1718 and became more common in the warm season of 1719: in each year it began about May, reached its height in July and lasted all August, carrying off many of those who fell into it.

It began with rigors, nausea and bilious vomiting, followed by
alternate heats and chills, with great lassitude and a feeling of
heaviness: then thirst and pungent heat, a dry and brown tongue,
sometimes black. The patient slept little, did not sweat, and was
mostly delirious, or anxious and restless, tossing continually in bed.
About the 12th day it was not unusual for profuse and exhausting
diarrhœa to come on. In a favourable case the fever ended in a crisis
of sweating about the 16th day. Those who were of lax habit,
unhealthy, hysteric, or cachectic, were apt to have tremors, spasms
and delirium, while others were so prostrated as to have no control
over their evacuations, lying in a stupor and raving when roused out
of it. In these the fever would continue to the 20th day; in some few
it ended without a manifest crisis, and with a slow
convalescence[100].

This applies to the city of York, but in what special circumstances we are not told. However, it happens that a physician of York, two generations after, in giving an account of the great improvement that had taken place in its public health, throws some light on its old-world state: “The streets have been widened in many places by taking down a number of old houses built in such a manner as almost to meet in the upper stories, by which the sun and air were almost excluded in the streets and inferior apartments[101].”

In London the fever-deaths, with the deaths from all causes, rose decidedly in 1718, and reached a very high figure in 1719, of which the summer was excessively hot. One cause, at least, was want of employment, especially among weavers in the East End[102]. But the epidemic fever of 1718-19 was not limited to the distressed classes; we have a glimpse of it, under the name of “spotted fever,” in the family of the archbishop of Canterbury:

“On Friday night the archbishop of Canterbury’s sixth daughter was interred in our chancel, with four others preceding, she dying on Monday after three days of the spotted fever. The fourth and seventh are recovered, and hoped past danger[103].”

The following table shows the fever-mortalities for London, from 1718 onwards, and, for comparison, the excessive mortalities in the epidemics of 1710 and 1714:

_London Mortalities from Fever, &c._

Year Fevers Spotted fevers Smallpox All causes

1710 4397 343 3138 24620
1714 4631 150 2810 26569
1718 3475 132 1884 26523
1719 3803 124 3229 28347
1720 3910 46 1442 25454
1721 3331 84 2375 26142
1722 3088 22 2167 25750
1723 3321 51 3271 29197
1724 3262 84 1227 25952
1725 3277 59 3188 25523
1726 4666 84 1569 29647
1727 4728 102 2379 28418
1728 4716 94 2105 27810
1729 5235 [The entry 2849 29722
1730 4011 ends.] 1914 26761
1731 3225 2640 25262
1732 2939 1197 23358
1733 3831 1370 29233
1734 3116 2688 26062
1735 2544 1594 23538
1736 3361 3014 27581
1737 4580 2084 27823
1738 3890 1590 25825
1739 3334 1690 25432
1740 4003 2725 30811

In country parishes, according to Short’s abstracts of registers, there was no unusual sickness in 1718 and 1719. But in market towns the mortality rose greatly in 1719, which had an excessively hot summer; and that was the year when the _synochus_ or typhus described by Wintringham reached its worst at York. The mortality kept high for several years after 1719.

_Market Towns._

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

1716 30 8 1060 845
1717 30 9 1485 1290
1718 30 3 249 169
1719 30 6 1737 1320
1720 30 10 2186 1461
1721 33 9 1294 952
1722 33 11 1664 1345
1723 33 14 2532 2176