A History of Epidemics in Britain Volume II of 2 by Charles Creighton

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Title: A History of Epidemics in Britain, Volume II (of 2)

From the Extinction of Plague to the Present Time

Author: Charles Creighton

Release Date: September 8, 2013 [eBook #43671]

Language: English

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A HISTORY

OF

EPIDEMICS IN BRITAIN.

London: C. J. CLAY and SONS,

CAMBRIDGE UNIVERSITY PRESS WAREHOUSE,

AND

H. K. LEWIS,

136, GOWER STREET, W.C.

Cambridge: DEIGHTON, BELL AND CO.

Leipzig: F. A. BROCKHAUS.

New York: MACMILLAN AND CO.

A HISTORY

OF

EPIDEMICS IN BRITAIN

BY

CHARLES CREIGHTON, M.A., M.D.,

FORMERLY DEMONSTRATOR OF ANATOMY IN THE UNIVERSITY OF CAMBRIDGE.

VOLUME II.

From the Extinction of Plague to the present time.

CAMBRIDGE:

AT THE UNIVERSITY PRESS.

1894

[All rights reserved.]

Cambridge:

PRINTED BY C. J. CLAY, M.A. AND SONS,

AT THE UNIVERSITY PRESS.

PREFACE.

This volume is the continuation of ‘A History of Epidemics in Britain from a.d. 664 to the Extinction of Plague’
(which was published three years ago), and is the completion of the history to the present time. The two volumes
may be referred to conveniently as the first and second of a ‘History of Epidemics in Britain.’ In adhering to the
plan of a systematic history instead of annals I have encountered more difficulties in the second volume than in the
first. In the earlier period the predominant infection was Plague, which was not only of so uniform a type as to
give no trouble, in the nosological sense, but was often so dramatic in its occasions and so enormous in its effects
as to make a fitting historical theme. With its disappearance after 1666, the field is seen after a time to be
occupied by a numerous brood of fevers, anginas and other infections, which are not always easy to identify
according to modern definitions, and were recorded by writers of the time, for example Wintringham, in so dry or
abstract a manner and with so little of human interest as to make but tedious reading in an almost obsolete
phraseology. Descriptions of the fevers of those times, under the various names of synochus, synocha, nervous,
putrid, miliary, remittent, comatose, and the like, have been introduced into the chapter on Continued Fevers so
as to show their generic as well as their differential character; but a not less important purpose of the chapter has
been to illustrate the condition of the working classes, the unwholesomeness of towns, London in particular, the
state of the gaols and of the navy, the seasons of dearth, the times of war-prices or of depressed trade, and all

[Pg v]

[Pg vi]

other vicissitudes of well-being, of which the amount of Typhus and Relapsing Fever has always been a curiously
correct index. It is in this chapter that the epidemiology comes into closest contact with social and economic
history. In the special chapter for Ireland the association is so close, and so uniform over a long period, that the
history may seem at times to lose its distinctively medical character.

As the two first chapters are pervaded by social and economic history, so each of the others will be found to have
one or more points of distinctive interest besides the strictly professional. Smallpox is perhaps the most suitable of
all the subjects in this volume to be exhibited in a continuous view, from the epidemics of it in London in the first
Stuart reigns to the statistics of last year. While it shares with Plague the merit, from a historical point of view, of
being always the same definite item in the bills of mortality, it can be shown to have experienced, in the course of
two centuries and a half, changes in its incidence upon the classes in the community, upon the several age-periods
and upon town and country, as well as a very marked change relatively to measles and scarlatina among the
infective scourges of infancy and childhood. For certain reasons Smallpox has been the most favoured infectious
disease, having claimed an altogether disproportionate share of interest at one time with Inoculation, at another
time with Vaccination. The history of the former practice, which is the precedent for, or source of, a whole new
ambitious scheme of prophylaxis in the infectious diseases of men and brutes, has been given minutely. The latter
practice, which is a radical innovation inasmuch as it affects to prevent one disease by the inoculation of another,
has been assigned as much space in the chapter on Smallpox as it seems to me to deserve. Measles and
Whooping-cough are historically interesting, in that they seem to have become relatively more prominent among
the infantile causes of death in proportion as the public health has improved. Whooping-cough is now left to head
the list of its class by the shrinkage of the others. It is in the statistics of Measles and Whooping-cough that the
principle of population comes most into view. The scientific interest of Scarlatina and Diphtheria is mainly that of
new, or at least very intermittent, species. Towards the middle of the 18th century there emerges an epidemic
sickness new to that age, in which were probably contained the two modern types of Scarlet Fever and
Diphtheria more or less clearly differentiated. The subsequent history of each has been remarkable: for a whole
generation Scarlatina could prove itself a mild infection causing relatively few deaths, to become in the generation
next following the greatest scourge of childhood; for two whole generations Diphtheria had disappeared from the
observation of all but a few medical men, to emerge suddenly in its modern form about the years 1856-59.

The history of Dysentery, as told by the younger Heberden, has been a favourite instance of the steady decrease
of a disease in London during the 18th century. I have shown the error in this, and at the same time have proved
from the London bills of mortality of the 17th and 18th centuries that Infantile Diarrhoea, which is now one of the
most important causes of death in some of the great manufacturing and shipping towns, was formerly still more
deadly to the infancy of the capital in a hot summer or autumn. Asiatic Cholera brings us back, at the end of the
history, to the same great problem which the Black Death of the 14th century raised near the beginning of it,
namely, the importation of the seeds of pestilence from some remote country, and their dependence for vitality or
effectiveness in the new soil upon certain favouring conditions, which sanitary science has now happily in its
power to withhold. I have left Influenza to be mentioned last. Its place is indeed unique among epidemic diseases;
it is the oldest and most obdurate of all the problems in epidemiology. The only piece of speculation in this volume
will be found in the five-and-twenty pages which follow the narrative of the various historical Influenzas; it is
purely tentative, exhibiting rather the disjecta membra of a theory than a compact and finished hypothesis. If
there is any new light thrown upon the subject, or new point of view opened, it is in bringing forward in the same
context the strangely neglected history of Epidemic Agues.

Other subjects than those which occupy the nine chapters of this volume might have been brought into a history of
epidemics, such as Mumps, Chickenpox and German Measles, Sibbens and Button Scurvy, together with certain
ordinary maladies which become epidemical at times, such as Pneumonia, Erysipelas, Quinsy, Jaundice, Boils and
some skin-diseases. While none of these are without pathological interest, they do not lend themselves readily to
the plan of this book; they could hardly have been included except in an appendix of miscellanea curiosa, and I
have preferred to leave them out altogether. It has been found necessary, also, to discontinue the history of
Yellow Fever in the West Indian and North American colonies, which was begun in the former volume.

I have, unfortunately for my own labour, very few acknowledgements to make of help from the writings of earlier
workers in the same field. My chief obligation is to the late Dr Murchison’s historical introduction to his
‘Continued Fevers of Great Britain.’ I ought also to mention Dr Robert Willan’s summary of the throat-
distempers of the 18th century, in his ‘Cutaneous Diseases’ of 1808, and the miscellaneous extracts relating to
Irish epidemics which are appended in a chronological table to Sir W. R. Wilde’s report as Census
Commissioner for Ireland. For the more recent history, much use has naturally been made of the medical reports
compiled for the public service, especially the statistical.

September, 1894.

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[Pg viii]

CONTENTS.

PAGE

CHAPTER I.

TYPHUS AND OTHER CONTINUED FEVERS.

The Epidemic Fever of 1661, according to Willis
4

Sydenham’s epidemic Constitutions
9

Typhus Fever perennial in London
13

The Epidemic Constitutions following the Great Plague
17

The Epidemic Fever of 1685-86
22

Retrospect of the great Fever of 1623-25
30

The extinction of Plague in Britain
34

Fevers to the end of the 17th Century
43

Fevers of the seven ill years in Scotland
47

The London Fever of 1709-10
54

Prosperity of Britain, 1715-65
60

The Epidemic Fevers of 1718-19
63

The Epidemic Fevers of 1726-29: evidence of Relapsing Fever
66

The Epidemic Fever of 1741-42
78

Sanitary Condition of London under George II.
84

The Window-Tax
88

Gaol-Fever
90

Circumstances of severe and mild Typhus
98

Ship-Fever
102

Fever and Dysentery of Campaigns: War Typhus, 1742-63
107

Ship-Fever in the Seven Years’ War and American War
111

The “Putrid Constitution” of Fevers in the middle third of the 18th Century
120

Miliary Fever
128

Typhus Fever in London, 1770-1800
133

Typhus in Liverpool, Newcastle and Chester in the last quarter of the 18th century
140

Fever in the Northern Manufacturing Towns, 1770-1800
144

Typhus in England and Scotland generally, in the end of the 18th century
151

Fevers in the Dearth of 1799-1802
159

Comparative immunity from Fevers during the War and high prices of 1803-15
162

The Distress and Epidemic Fever (Relapsing) following the Peace of 1815 and the fall of wages 167
The Epidemic of 1817-19 in Scotland: Relapsing Fever
174

The Relapsing Fever of 1827-28
181

Typhoid or Enteric Fever in London, 1826
183

Return of Spotted Typhus after 1831: “Change of Type.” Distress of the Working Class
188

Enteric Fever mixed with the prevailing Typhus, 1831-42
198

Relapsing Fever in Scotland, 1842-44
203

The “Irish Fever” of 1847 in England and Scotland
205

Subsequent Epidemics of Typhus and Relapsing Fevers
208

Relative prevalence of Typhus and Enteric Fevers since 1869
211

Circumstances of Enteric Fever
216

CHAPTER II.

FEVER AND DYSENTERY IN IRELAND.

Dysentery and Fever at Londonderry and Dundalk, 1689
229

A generation of Fevers in Cork
234

Famine and Fevers in Ireland in 1718 and 1728
236

The Famine and Fever of 1740-41
240

[Pg ix]

[Pg x]

The Epidemic Fevers of 1799-1801
248

The Growth of Population in Ireland
250

The Famine and Fevers of 1817-18
256

Famine and Fever in the West of Ireland, 1821-22
268

Dysentery and Relapsing Fever, 1826-27
271

Perennial Distress and Fever
274

The Great Famine and Epidemic Sicknesses of 1846-49
279

Decrease of Typhus and Dysentery after 1849
295

CHAPTER III.

INFLUENZAS AND EPIDEMIC AGUES.

Retrospect of Influenzas and Epidemic Agues in the 16th and 17th centuries
306

The Ague-Curers of the 17th Century
315

The Peruvian Bark Controversy
320

The Influenza of 1675
326

The Influenza of 1679
328

The Epidemic Agues of 1678-80
329

The Influenza of 1688
335

The Influenza of 1693
337

The Influenza of 1712
339

Epidemic Agues and Influenzas, 1727-29
341

The Influenza of 1733
346

The Influenza of 1737
348

The Influenza of 1743
349

Some Localized Influenzas and Horse-colds
352

The Influenza of 1762
356

The Influenza of 1767
358

The Influenza of 1775
359

The Influenza of 1782
362

The Epidemic Agues of 1780-85
366

The Influenza of 1788
370

The Influenza of 1803
374

The Influenza of 1831
379

The Influenza of 1833
380

The Influenza of 1837
383

The Influenza of 1847-48
389

The Influenzas of 1889-94
393

The Theory of Influenza
398

Influenza at Sea
425

The Influenzas of Remote Islands
431

CHAPTER IV.
SMALLPOX.

Retrospect of earlier epidemics
434

Smallpox after the Restoration
437

Sydenham’s Practice in Smallpox
445

Causes of Mild or Severe Smallpox
450

Pockmarked Faces in the 17th Century
453

The Epidemiology continued to the end of the 17th century
456

Smallpox in London in 1694: the death of the Queen
458

Circumstances of the great Epidemic in 1710
461

[Pg xi]

Inoculation brought into England
463

The popular Origins of Inoculation
471

Results of the first Inoculations; the Controversy in England
477

Revival of Inoculation in 1740: a New Method
489

The Suttonian Inoculation
495

Extent of Inoculation in Britain to the end of the 18th Century
504

The Epidemiology continued from 1721
517

Smallpox in London in the middle of the 18th century
529

The Epidemiology continued to the end of the 18th century
535

The range of severity in Smallpox, and its circumstances
544

Cowpox
557

Chronology of epidemics resumed from 1801
567

The Smallpox Epidemic of 1817-19
571

Extent of Inoculation with Cowpox or Smallpox, 1801-1825
582

The Smallpox Epidemic of 1825-26
593

A generation of Smallpox in Glasgow
597

Smallpox in Ireland, 1830-40
601

The Epidemic of 1837-40 in England
604

Legislation for Smallpox after the Epidemic of 1837-40
606

Other effects of the epidemic of 1837-40 on medical opinion
610

The age-incidence of Smallpox in various periods of history
622

CHAPTER V.
MEASLES.

Derivation and early uses of the name
632

Sydenham’s description of Measles in London, 1670 and 1674
635

Measles in the 18th century
641

Increasing mortality from Measles at the end of the 18th century
647

Measles in Glasgow in 1808 and 1811-12: Researches of Watt
652

Measles in the Period of Statistics
660

CHAPTER VI.

WHOOPING-COUGH.

Earliest references to whooping-cough
666

Whooping-cough in Modern Times
671

Whooping-cough as a Sequel of other Maladies
674

CHAPTER VII.

SCARLATINA AND DIPHTHERIA.

Nosological difficulties in the earlier history
678

The Throat-distemper of New England, 1735-36
685

Angina maligna in England from 1739
691

An epidemic of Throat-disease in Ireland, 1743
693

Malignant Sore-throat in Cornwall, 1748
694

Fothergill’s Sore-throat with Ulcers, 1746-48
696

“Scarlet Fever” at St Albans, 1748
698

Epidemics of Sore-throat with Scarlet rash in the period between Fothergill and Withering
699

Scarlatina anginosa in its modern form, 1777-78
708

History of Scarlatina after the Epidemic of 1778
713

Scarlatina (1788) and Diphtheria (1793-94) described by the same observer
715

Scarlatinal Epidemics, 1796-1805
719

Scarlatina since the beginning of Registration, 1837
726

[Pg xii]

Reappearance of Diphtheria in 1856-59
736

Conditions favouring Diphtheria
744

CHAPTER VIII.

INFANTILE DIARRHOEA, CHOLERA NOSTRAS, AND DYSENTERY.

Summer Diarrhoea of Infants in London, 17th century
748

Summer Diarrhoea of Infants, 18th century
754

Modern Statistics of Infantile Diarrhoea
758

Causes of the high Death-rates from Infantile Diarrhoea
763

Cholera Nostras
768

Dysentery in the 17th and 18th centuries
774

Dysentery in the 19th century
785

CHAPTER IX.

ASIATIC CHOLERA.

Asiatic Cholera at Sunderland in October, 1831
796

Extension of Cholera to the Tyne, December, 1831
802

The Cholera of 1832 in Scotland
805

The Cholera of 1832 in Ireland
816

The Cholera of 1832 in England
820

The Cholera of 1848-49 in Scotland
835

The Cholera of 1849 Ireland
839

The Cholera of 1849 in England
840

The Cholera of 1853 at Newcastle and Gateshead
849

The Cholera of 1854 in England
851

The Cholera of 1853-54 in Scotland and Ireland
855

The Cholera of 1865-66
856

The Antecedents of Epidemic Cholera in India
860

Note on Cerebro-Spinal Fever
863

CHAPTER I.

TYPHUS AND OTHER CONTINUED FEVERS.

It was remarked by Dr James Lind, in 1761, that a judicious synopsis of the writings on fevers, in a chronological
sense, would be a valuable book: it would bring to light, he was fain to expect, treasures of knowledge; “and
perhaps the influence of a favourite opinion, or of a preconceived fancy, on the writings of some even of our best
instructors, such as Sydenham and Morton, would more clearly be perceived[1].” Lind himself was the person to
have delivered such a history and criticism. He was near enough to the 17th century writers on fevers to have
entered correctly into their points of view; while so far as concerned the detection of theoretical bias or
preconceived fancies, he had shown himself a master of the art in his famous satire upon the “scorbutic
constitution,” a verbal or mythical construction which had been in great vogue for a century and a half, and was
still current, at the moment when Lind destroyed it, in the writings of Boerhaave and Haller. A judicious historical
view of the English writings on fevers, such as this 18th century critic desired to see, may now be thought
superfluous. The theories, the indications for treatment, the medical terms, have passed away and become the
mere objects of a learned curiosity. But the actual history of the old fevers, of their kinds, their epidemic
prevalence, their incidence upon rich or poor, upon children or adults, their fatality, their contagiousness, their
connexion with the seasons and other vicissitudes of the people—all this is something more than curious.

Unfortunately for the historian of diseases, he has to look for the realities amidst the “favourite opinions” or the
“preconceived fancies” of contemporary medical writers. Statements which at first sight appear to be
observations of matters of fact are found to be merely the necessary truths or verbal constructions of some

[Pg 1]

[Pg 2]

doctrine. One great doctrine of the 17th and 18th centuries was that of obstructions: in this doctrine, as applied to
fevers, obstructions of the mesentery were made of central importance; the obstructions of the mesentery
extended to its lymphatic glands; so that we come at length, in a mere theoretical inference, to something not
unlike the real morbid anatomy of enteric fever. Another great doctrine of the time, specially applied by Willis to
fevers, was that of fermentations and acrimonies. “This ferment,” says a Lyons disciple of Willis in 1682, “has its
seat in the glandules of the velvet coat of the stomach and intestines described by Monsieur Payer[2].” But the
Lyons physician is writing all the while of the fevers that have always been common in the Dombes and Bresse,
namely intermittents; the tertian, double tertian, quotidian, quartan, or double quartan paroxysm arises, he says,
from the coagulation of the humours by the ferment which has its seat in the glandules described by M. Payer,
even as acids cause a coagulation in milk, the paroxysm of ague continuing, “until this sharp chyle be dissipated
and driven out by the sweat or insensible perspiration.” The lymphatic follicles of the intestine known by the name
of Payer, or Peyer, were then the latest anatomical and physiological novelty, and were chosen, on theoretical
grounds, as the seat of fermentation or febrile action in agues. On the ground of actual observation they were
found about a century and a half after to be the seat of morbid action in typhoid fever.

While there are such pitfalls for the historian in identifying the several species of fevers in former times, there are
other difficulties of interpretation which concern the varieties of a continued fever, or its changes of type from
generation to generation. Is change of type a reality or a fiction? And, if a reality, did it depend at all upon the use
or abuse of a certain regimen or treatment, such as blooding and lowering, or heating and corroborating? A pupil
of Cullen, who wrote his thesis in 1782 upon the interesting topic of the change in fevers since the time of
Sydenham[3], inferred that the great physician of the Restoration could not have had to treat the low, putrid or
nervous fevers of the middle and latter part of the 18th century, otherwise he would not have resorted so regularly
to blood-letting, a practice which was out of vogue in continued fevers at the time when the thesis was written, as
well as for a good many years before and after. Fevers, it was argued, had undergone a radical change since the
time of Sydenham, in correspondence with many changes in diet, beverages and creature comforts, such as the
greatly increased use of tea, coffee and tobacco, and of potatoes or other vegetables in the diet, changes also in
the proportion of urban to rural population, in the use of carriages, and in many other things incident to the
progressive softening of manners. In due time the low, putrid, nervous type of typhus fever, which is so much in
evidence in the second half of the 18th century, ceased to be recorded, an inflammatory type, or a fever of strong
reaction, taking its place; so that Bateman, of London, writing in 1818, said: “The putrid pestilential fevers of the
preceding age have been succeeded by the milder forms of infectious fever which we now witness”; while
Armstrong, Clutterbuck, and others, who had revived the practice of blood-letting in fevers shortly before the
epidemic of 1817-18, claimed the comparatively slight fatality and short duration of the common fever of the time
as an effect of the treatment. After 1831, typhus again became low, depressed, spotted, not admitting of the
lancet; on which occasion the doctrine of “change of type” was debated in the form that the older generation of
practitioners still remember.

Thus the task of the historian, whose first duty is to ascertain, if he can, the actual matters of fact, or the realities,
in their sequence or chronological order, is made especially difficult, in the chapter on continued fevers, by the
contemporary influence of theoretical pathology or “a preconceived fancy,” by the ascription of modifying effects
to treatment, whether cooling or heating, lowering or supporting, and, most of all, by the absence of that more
exact method which distinguishes the records of fever in our own time. Nor can it be said that the work of
historical research has been made easier in all respects, by the exact discrimination and perfected diagnosis to
which we are accustomed in present-day fevers. In the years between 1840 and 1850, the three grand types of
fever then existing in Britain, namely, spotted typhus, enteric, and relapsing fever, were at length so clearly
distinguished, defined and described that no one remained in doubt or confusion. Thereupon arose the
presumption that these had always been the forms of continued fever in Britain, and that the same fevers,
presumably in the same relative proportions to each other, might have been left on record by the physicians of
former generations, if they had used the modern exactness and minuteness in observing both clinical history and
anatomical state, which were seen at their best in Sir William Jenner. It would simplify history, indeed it would
make history superfluous, if that were really the case. There are many reasons for believing that it was not the
case. As Sydenham looked forward to his successors having experiences that he never had, so we may credit
Sydenham with having really seen things which we never see, not even those of us who saw the last epidemics of
relapsing fever and typhus. It is due to him, and to his contemporaries and nearest successors, to reciprocate the
spirit in which he concludes the general chapter on epidemics prefatory to his annual constitutions from 1661 to
1676:

“I am far from taking upon myself the credit of exhausting my subject in the present observations.
It is highly probable that I may fail even in the full enumeration of the epidemics. Still less do I
warrant that the diseases which during the years in question have succeeded each other in the
sequence about to be exhibited shall remain the same in all future years. One thing most
especially do I aim at. It is my wish to state how things have gone lately; how they have been in
this country, and how they have been in this the city which we live in. The observations of some
years form my ground-work. It is thus that I would add my mite, such as it is, towards the
foundation of a work that, in my humble judgment, shall be beneficial to the human race.
Posterity will complete it, since to them it shall be given to take the full view of the whole cycle of

[Pg 3]

[Pg 4]

epidemics in their mutual sequences for years yet to come[4].”

The epidemic fever of 1661, according to Willis.

On the very threshold of the period at which the history is resumed in this volume, we find a minute account by
Willis of an epidemic in the year 1661, which at once raises the question whether a certain species of infectious
fever did really exist at that time which exists no longer, or whether Willis described as “a fever of the brain and
nervous stock” what we now call enteric fever. Willis’s fever corresponds in every respect to the worm fever, the
comatose fever, the remittent fever of children, the acute fever with dumbness, the convulsive fever, which was
often recorded by the medical annalists and other systematic observers as late as the beginning of the 19th
century[5]. It ceased at length to be recorded or described, and it has been supposed that it was really the infantile
or children’s part of enteric fever, which had occurred in former times as now[6]. The epidemic fever which Willis
saw in the summer of 1661, after a clear interval of two years from the great epidemics of agues, with influenzas,
in 1657-59, is called by him “a certain irregular and unaccustomed fever[7].” It was not, however, new to him
altogether; for he had seen the same type, and kept notes of the cases, in a particular household at Oxford in
1655, as well as on other occasions. It was an epidemical fever “chiefly infestous to the brain and nervous stock.”
It raged mostly among children and youths, and was wont to affect them with a long and, as it were, a chronical
sickness. When it attacked the old or middle-aged, which was more rarely, it did sooner and more certainly kill. It
ran through whole families, not only in Oxford and the neighbouring parts, “but in the countries at a great distance,
as I heard from physicians dwelling in other places.” Among those other witnesses, we shall call Sydenham; but
meanwhile let us hear Willis, whose account is the fullest and least warped by theory.

Its approach was insidious and scarce perceived, with no immoderate heat or sharp thirst, but
producing at length great debility and languishing, loss of appetite and loathing. Within eight days
there were brain symptoms—heavy vertigo, tingling of the ears, often great tumult and
perturbation of the brain. Instead of phrensy, there might be deep stupidity or insensibility;
children lay sometimes a whole month without taking any notice of the bystanders, and with an
involuntary flux of their excrements; or there might be frequent delirium, and constantly absurd
and incongruous chimaeras in their sleep. But in men a fury, and often-times deadly phrensy, did
succeed. If, however, neither stupidity nor great distraction did fall upon them, swimmings in the
head, convulsive movements, with convulsions of the members and leaping up of the tendons did
grievously infest them. In almost all, there were loose and stinking motions, now yellow, now thin
and serous; vomiting was unusual; the urine deep red. The sufferers in this prolonged sickness
wasted to a skeleton, with no great heat or evacuations to account for the wasting. Some, at the
end of the disease, had a severe catarrh. In others, with little infection of the head, soon after the
beginning of the fever a cruel cough and a stinking spittle, with a consumptive disposition, grew
upon them, and seemed to throw them suddenly into a phthisis, from which, however, they
recovered often beyond hope. In some there were swellings of the glands near the hinder part of
the neck, which ripened and broke, and gave out a thin stinking ictor for a long time. “I have also
seen watery pustules excited in other parts of the body, which passed into hollow ulcers, and
hardly curable. Sometimes little spots and petechiales appeared here and there.” But none of
the spots were broad and livid, nor were there many malignant spots.

Willis then gives several cases clinically, in his usual manner. The first is of a strong and lively
young man, who was sick above two months and seemed near death, but began to mend and
took six weeks to recover, sweating every night or every other night of his convalescent period.
The second case, aged twelve, was restored to health in a month. Numbers three and four were
children of a nobleman, who both died, the convulsive type being strongly marked; one of the
two was examined after death, and found to have several sections of the small intestine
telescoped, but all the abdominal viscera free from disease[8], the lungs engorged, the vessels of
the brain full, much water in the sub-arachnoid space, and more than half a pint in the lateral
ventricles.

In farther illustration of this type of fever, epidemic in 1661, Willis goes back to his notes of a
sporadic outbreak of what he thinks was the same disease in a certain family at Oxford in the
winter of 1653-4[9]: “yea I remember that sometime past very many laboured with such a fever.”
In the family in question, five children took the fever one after another during a space of four
months, two of the cases proving fatal; the domestics also took it, and some strangers who came
in to help them, “the evil being propagated by contagion.” The cases in the children are fully
recorded[10], the following being some of the symptoms:

In case 1, aged seven, the illness began at the end of December, 1653 (or 1655): there were
contractions of the wrist tendons, red spots like fleabites on his neck and other parts,
drowsiness, and involuntary passage of the excrements. At the end of a fortnight, a flux set in and
lasted for four days; next, after that, a whitish crust or scurf, as it were chalky, began to spread

[Pg 5]

[Pg 6]

over the whole cavity of his mouth and throat, which being often in a day wiped away, presently
broke forth anew. He mended a little, but had paralysis of his throat and pharynx, was reduced
to a living skeleton, but at length got well.

Case 2, a brother, aged nine, had frequent loose and highly putrid motions on the eleventh day;
and next day, the flux having ceased, the most severe colic, so that he lay crying out day and
night, his belly swollen and hard as a drum, until, on the 24th day, he died in an agony of
convulsions.

Case 3, a brother, aged 11, was taken with similar symptoms on the 13th February, and died on
the 13th day.

Case 4, a sister, was taken ill in March, with less marked symptoms, and recovered slowly,
having had no manifest crisis.

Case 5, a boy of the same family, and the youngest, fell ill about the same time as No. 4, and
after the like manner, “who yet, a looseness arising naturally of itself, for many days voiding
choleric and greenish stuff, was easily cured.”

Then comes a general reference to the domestics and visitors, who fell sick of the same and all
recovered.

The prolonged series of cases in the household of this “venerable man” appears to have made a great impression
upon Willis, as something new in his experience, as well as in the experience of several other physicians who gave
their services. That it was malignant he considers proved “ex contagio, pernicie, macularum pulicularum
apparentia, multisque aliis indiciis.” He adds that he had seen the same disease sporadically at other times; and
again “I remember that formerly several laboured under such a fever.” Those cases were all previous to the
general prevalence of the fever which he identifies with them in the summer of 1661, under the name of a “fever of
the brain and spinal cord.”

The signs given by Willis are as nearly as may be the signs of infantile remittent fever, or worm fever, or febris
synochus puerorum, or hectica infantilis, or febris lenta infantum, or an acute fever with dumbness, of which
perhaps the first systematic account in this country was given by Dr William Butter of Lower Grosvenor Street, in
1782[11]. It is, he says, both a sporadical and an epidemical disease, “and when epidemical it is also contagious.”
The age for it is from birth up to puberty; but “similar symptoms are often observed in the disorders of adults.”
Morton, writing in 1692-94, clearly points to the same fever under the name of worm fever (febris verminosa).
He adds it at the very end of his scheme of fevers, as if in an appendix, having been unable to find a place for it in
any of his categories owing to its varying forms—hectic, acute, intermittent, continued, συνεχής, inflammatory,
but for the most part colliquative or σύνοχος, “and malignant according to the varying degrees of the venomous
miasm causing it[12].” Butter also recognizes its varying types: it has many symptoms, but they seldom all occur in
the same case; there are three main varieties—the acute, lasting from eight to ten days up to two or three weeks;
the slow, lasting two or three months; and the low, lasting a month or six weeks. The slow form, he says, is only
sporadic; the low is only epidemic, and is never seen but when the acute is also epidemical; it is rare in
comparison with the latter, and not observed at all except in certain of the epidemical seasons. Waiving the
question whether the remittent fever of children, thus systematically described, was not a composite group of
maladies, of which enteric fever of children was one, we can hardly doubt that Willis found a distinctive uniform
type in the epidemic of 1661, in Oxford as he saw it himself, in other parts of England by report. It had symptoms
which were not quite clearly those of enteric fever: spots, like fleabites, on the neck and other parts, swelling and
suppuration of the glands in the hinder part of the neck, effusion of fluid on the brain and in the lateral ventricles,
and the intestine free from disease[13].

Confirming Willis’s account for Oxford, is the case of Roger North, when a boy at Bury St Edmunds Free School
in 1661, as related by himself in his ‘Autobiography[14].’ Being then “very young and small,” after a year at school
he had “an acute fever, which endangered a consumption.” Elsewhere he attributes his bad memory with
“confusion and disorder of thought,” to that “cruel fit of sickness I had when young, wherein, I am told, life was
despaired of, and it was thought part of me was dead; and I can recollect that warm cloths were applied, which
could be for no other reason, because I had not gripes which commonly calls for that application.” That “great
violence of nature,” while it had impaired his mental faculties, had sapped his bodily vigour somewhat also, of
which he gives a singular illustration.

This special prevalence of epidemic fevers in the summer and autumn of 1661 is noticed also by the London
diarists.

Evelyn says that the autumn of 1661 was exceedingly sickly and wet[15]. Pepys has several entries of fever[16].
On 2 July, 1661: “Mr Saml. Crewe died of the spotted fever.” On 16 August: “At the [Navy] Office all the
morning, though little to do; because all our clerks are gone to the burial of Tom Whitton, one of our Controller’s
clerks, a very ingenious and a likely young man to live as any in the office. But it is such a sickly time both in the
city and country everywhere (of a sort of fever) that never was heard of almost, unless it was in a plague-time.
Among others the famous Tom Fuller [of the ‘Worthies of England’] is dead of it; and Dr Nichols [Nicholas],

[Pg 7]

[Pg 8]

[Pg 9]

Dean of St Paul’s; and my Lord General Monk is very dangerously ill.” On 31 August: “The season very sickly
everywhere of strange and fatal fevers.” On 15 January, 1662: “Hitherto summer weather, both as to warmth and
every other thing, just as if it were the middle of May or June, which do threaten a plague (as all men think) to
follow; for so it was almost the last winter, and the whole year after hath been a very sickly time to this day.”

The great medical authority of the time is Sydenham. His accounts of the seasons and reigning diseases of London
extend from 1661 to 1686, so that they begin with the year for which Willis described the epidemic fever “chiefly
infestous to the brain and nervous stock,” popularly called the new disease. But Sydenham did not describe the
epidemic in the same objective way that Willis did. He records a series of “epidemic constitutions of the air,” the
particular constitution of each year being named from the epidemic malady that seemed to him to dominate it
most. It was, perhaps, because it had to conform to Sydenham’s “preconceived fancy,” as Lind said, that his
account of the dominant type of fever in 1661 differs somewhat from that given by Willis.

Sydenham’s epidemic Constitutions.

Sydenham adopted the epidemic constitutions from Hippocrates, as he did much else in his method and practice.
In the first and third books of the ‘Epidemics,’ Hippocrates describes three successive seasons and their reigning
diseases in the island of Thasos, as well as a fourth plague-constitution which agrees exactly with the facts of the
plague of Athens as described by Thucydides. The Greek term translated “constitution” is κατάστασις, which
means literally a settling, appointing; ordaining, and in the epidemiological sense means the type of reigning disease
as settled by the season. The method of Hippocrates is first to give an account of the weather—the winds, the
rains, the temperature and the like,—and then to describe the diseases of the seasons[17]. Sydenham followed his
model with remarkable closeness. The great plague of London has almost the same place in his series of years
that the plague-constitution, the fourth in order, has in that of Hippocrates. It looks, indeed, as if Sydenham had
begun with the year 1661, more for the purpose of having several constitutions preceding that of the plague than
because he had any full observations of his own to record previous to 1665. He is also much influenced by the
example of Hippocrates in giving prominence to the intermittent type of fevers. It was remarked by one of our
best 18th century epidemiologists, Rogers of Cork, and with special reference to Sydenham’s “intermittent
constitutions,” that fevers proper to the climate of Thasos were not likely to be identified in or near London
excepted by a forced construction.

Sydenham’s Constitutions.

Constitutions

Total
deaths

in

London

Plague

Fever
and

Spotted
Fever

Smallpox
Measles

Griping
in the
Guts

1661
“Intermittent” constitution:

with a continued fever
throughout.

16,665
20
3,490
1,246
188
1,061

1662
13,664
12
2,601
768
20
835

1663
12,741
9
2,107
411
42
866

1664
15,453
5
2,258
1,233
311
1,146

1665
Constitution of plague and

pestilential fever.

97,306
68,596
5,257
655
7
1,288

1666
12,738
1,998
741
38
3
676

1667
Constitution of smallpox,

with a continued
“variolous” fever.

15,842
35
916
1,196
83
2,108

1668
17,278
14
1,247
1,987
200
2,415

1669
19,432
3
1,499
951
15
4,385
1669
Constitution of dysentery

and cholera nostras,
with a continued fever.

1670
20,198
0
1,729
1,465
295
3,690

1671
15,729
5
1,343
696
17
2,537

1672
Measles in 1670.
18,230
5
1,615
1,116
118
2,645

1673
Constitution of

“comatose” fevers.
Influenza in 1675.

17,504
5
1,804
853
15
2,624

1674
21,201
3
2,164
2,507
795
1,777

1675
17,244
1
2,154
997
1
3,321

1676
18,732
2
2,112
359
83
2,083

1677
Not recorded.
19,067
2
1,749
1,678
87
2,602

1678
Return of the

“intermittent”
constitution, absent
since 1661-64.

20,678
5
2,376
1,798
93
3,150

1679
21,730
2
2,763
1,967
117
2,996

1680
21,053
0
3,324
689
49
3,271

1681
“Depuratory” fevers, or

dregs of the
intermittents.

23,951
0
3,174
2,982
121
2,827

1682
20,691
0
2,696
1,408
50
2,631

1683
20,587
0
2,250
2,096
39
2,438

1684
23,202
0
2,836
1,560
6
2,981

1685
Constitution of a “new”
23,222
0
3,832
2,496
197
2,203

[Pg 10]

1686
continued fever.
22,609
0
4,185
1,062
25
2,605

The foregoing is a Table of Sydenham’s epidemic constitutions from 1661 to 1686, compiled from his various
writings, with the corresponding statistics from the London Bills of Mortality.

I give this Table both as a convenient outline and in deference to the great name of Sydenham. But we should be
much at fault in interpreting the figures of the London Bills, or the history of epidemic diseases in the country at
large, if we had no other sources of information than his writings. Only some of the figures in the Table concern us
in this chapter; plague has been finished in the previous volume, smallpox, measles and “griping in the guts” are
reserved each for a separate chapter, as well as the influenzas and epidemic agues which formed the chief part of
the “strange” or “new” fevers. If this work had been the Annals of Epidemics in Britain, it would have been at
once proper and easy to follow Sydenham’s constitutions exactly, and to group under each year the information
collected from all sources about all epidemic maladies. But as the work is a history, it proceeds, as other histories
do, in sections, observing the chronological order and the mutual relations of epidemic types as far as possible;
and in this section of it we have to cull out and reduce to order the facts relating to fevers, beginning with those of
1661.

Cases of fever, says Sydenham, began to be epidemic about the beginning of July 1661, being mostly tertians of a
bad type, and became so frequent day by day that in August they were raging everywhere, and in many places
made a great slaughter of people, whole families being seized. This was not an ordinary tertian intermittent; indeed
no one but Sydenham calls it an intermittent at all, and he qualifies the intermittence as follows:

“Autumnal intermittents do not at once assume the genuine type, but in all respects so imitate
continued fevers that unless you examine the two respectively with the closest scrutiny, they
cannot be distinguished. But, when by degrees the impetus of the ‘constitution’ is repelled and its
strength reined in, the fevers change into a regular type; and as autumn goes out, they openly
confess themselves, by casting their slough (larva abjecta) to be the intermittents that they really
were from the first, whether quartans or tertians. If we do not attend to this diligently” etc. And
again, in a paragraph which does not occur in the earlier editions, he writes as follows in the
context of the “Intermittent Fevers of the years 1661-1664:”

“It is also to be noted that in the beginning of intermittent fevers, especially those that are
epidemic in autumn, it is not altogether easy to distinguish the type correctly within the first few
days of their accession, since they arise at first with continued fever superadded. Nor is it always
easy, unless you are intent upon it, to detect anything else than a slight remission of the disease,
which, however, declines by degrees into a perfect intermission, with its type (third-day or
fourth-day) corresponding fitly to the season of the year.”

The intermittent character of these fevers seems to have struck Sydenham himself in a later work as forced and
unreal. Writing in 1680, when the same kind of fevers were prevalent, after the epidemic agues of 1678 and
1679, he calls them “depuratory,” and says that “doubtless those depuratory fevers which reigned in 1661-64
were as if the dregs of the intermittents which raged sometime before during a series of years,” i.e. the agues of
1657-59[18].

Theory or names apart, Sydenham’s account of the fatal epidemic fever of the summer and autumn of 1661,
comes to nearly the same as Willis’s. Without saying expressly, as Willis does, that the victims were mostly
children or young people, he speaks in one place of those of more mature years lying much longer in the fever,
even to three months, and he specially mentions the same sequelae of the fever in children that Willis mentions,
and that Roger North remembered in his own case—namely that they sometimes became hectic, with bellies
distended and hard, and often acquired a cough and other consumptive symptoms, “which clearly put one in mind
of rickets.” He refers also to pain and swelling of the tonsils and to difficulty of swallowing, which, if followed by
hoarseness, hollow eyes, and the facies Hippocratica, portended speedy death. Among the numerous other
accidentia of the fever, was a certain kind of mania. Among the symptoms were phrensy, and coma-vigil;
diarrhœa occurred in some owing, as he thought, to the omission of an emetic at the outset; hiccup and bleeding at
the nose were occasional.

But, although Sydenham must have had the same phenomena of fever before him that Willis had, the epidemic
being general, according to the statements of both, one would hardly guess from his way of presenting the facts,
that the fever was what Willis took it to be—a slow nervous fever, with convulsive and ataxic symptoms, specially
affecting children and the young. Both Willis and Sydenham recognised something new in it; the common people
called it, once more, the “new disease,” and Pepys calls it a “sort of fever,” and “strange and fatal fevers.”

As Sydenham maintains that the same epidemic constitution continued until 1664 (although the fever-deaths in
London are much fewer in 1662-3-4 than in the year 1661, which was the first of it), we may take in the same
connexion Pepys’s account of the Queen’s attack of fever in 1663. The young princess Katharine of Portugal,
married to Charles II. in 1662, had the beginning of a fever at Whitehall about the middle of October, 1663;
Pepys enters on the 19th that her pulse beat twenty to eleven of the king’s, that her head was shaved, and
pigeons put to her feet, that extreme unction was given her (the priests so long about it that the doctors were
angry). On the 20th he hears that the queen’s sickness is a spotted fever, that she was as full of the spots as a

[Pg 11]

[Pg 12]

[Pg 13]

leopard: “which is very strange that it should be no more known, but perhaps it is not so.” On the 22nd the queen
is worse, 23rd she slept, 24th she is in a good way to recovery, Sir Francis Prujean’s cordial having given her
rest; on the 26th “the delirium in her head continues still; she talks idle, not by fits, but always, which in some lasts
a week after so high a fever, in some more, and in some for ever.” On the 27th she still raves and talks, especially
about her imagined children; on the 30th she continues “light-headed, but in hopes to recover.” On 7th
December, she is pretty well, and goes out of her chamber to her little chapel in the house; on the 31st “the queen
after a long and sore sickness is become well again.”

Typhus fever perennial in London.

Sydenham says that a continued fever, the symptoms of which so far as he gives them suggest typhus, was mixed
with the masked intermittent, (or the convulsive fever of children, as in Willis’s account), in every one of the years
1661-4; and that statement raises a question which may be dealt with here once for all. Fever in the London bills
is a steady item from year to year, seldom falling below a thousand deaths and in the year 1741, during a general
epidemic of typhus, rising to 7500. The fevers were a composite group, as we have seen, and shall see more
clearly. But the bulk of them perennially appears to have been typhus fever. Where the name of “spotted fever” is
given there can be little doubt. Every year the bills have a small number of deaths from “spotted fever,” and the
number of them always rises in the weekly bills in proportion to the increase of “fever” in general, sometimes
reaching twenty in the week when the other fevers reach a hundred. It would be a mistake to suppose that only
the fevers called spotted were typhus, the other and larger part being something else. The more reasonable
supposition is that the name of spotted was given by the searchers in cases where the spots, or vibices or
petechiae of typhus were especially notable. If a score, or a dozen or half-a-dozen deaths in a week are set down
to spotted fever, it probably means that a large part of the remaining hundred, or seventy, or fifty cases of “fever”
not called spotted were really of the same kind, namely typhus. In the plague itself, the “tokens,” which were of
the same haemorrhagic nature as the larger or more defined spots of typhus, were exceedingly variable[19]. One
of the synonyms of typhus (the common name in Germany) is spotted typhus; but the spots were of at least two
kinds, a dusky mottling of the skin and more definite spots, sometimes large, sometimes like fleabites.

Assuming that the cases s...