IX. ASIATIC CHOLERA (part 1 of 2)

IX. ASIATIC CHOLERA (part 1 of 2)

The Indian or Asiatic cholera, which first showed itself on British soil in one or more houses on the Quay of Sunderland in the month of October, 1831, was a “new disease” in a more real sense than anything in this country since the sweating sickness of 1485. The English profession had been hearing a good deal about it for some years before it reached our shores. The outbreak in Lower Bengal in 1817, from which the modern history of cholera dates, had been the subject of reports and essays by Anglo-Indian physicians and surgeons; an extensive prevalence of it in the Madras Presidency shortly after, as well as in Mauritius in 1819 and 1829, had been observed by other medical men in the service of the East India Company or of the British army or navy. Many who had seen cholera in India, and some who had written upon it, returned to England in due course, so that the formidable new pestilence of the East began to be heard of in medical circles at home. Various essays upon it issued from the English press between 1821 and 1830[1475]; and in 1825 it appeared for the first time, and at considerable length, in the pages of an English systematic treatise, the new edition of Dr Mason Good’s ‘Study of Medicine.’

Previous to 1829, Asiatic cholera had obtained no footing in Europe. The first great movement westwards from India through Central Asia, which was continuous with the memorable eruption in Bengal after the rains of 1817, had reached to Astrakhan, at the mouths of the Volga, and had there caused the deaths of some 144 persons in September, 1823. Another progress westwards from India, after an interval of six years, reached the soil of European Russia in the Government of Orenburg in August 1829, the mortality in the whole province during the autumn and winter (to February, 1830) amounting to about one thousand. A much more severe epidemic of it arose in the summer of 1830 in the town and province of Astrakhan (supposed to have been introduced by an infected brig from Baku), which spread with enormous rapidity, destroying in the course of a month some four thousand in Astrakhan itself and upwards of twenty thousand in other parts of the province[1476]. Thus established in the basin of the Volga, Asiatic cholera overran the whole of Russia. Before the spring of 1831 it had entered Hungary and Poland, and in the end of May had reached Danzig and other German ports on the Baltic and North Seas. Lord Heytesbury, the British Ambassador at St Petersburg, had sent home a despatch upon it early in 1831; in April, the Admiralty issued orders for a strict quarantine of all arrivals from Russia at British ports, which were afterwards extended to arrivals from all ports abroad invaded or threatened by cholera. On 20 June a royal proclamation ordering various precautions was issued, and next day a Board of Health was gazetted, composed of leading physicians in London and of the medical heads of departments, with Sir Henry Halford as president. Local Boards of Health were formed voluntarily in many parts of the country during the summer of 1831. Two medical men were at the same time commissioned by the Government to proceed to Russia to study the disease there, their letters to the Board of Health commencing from the 1st of July. The growing interest in the disease as it came nearer called forth another crop of writings, some of them based on old Indian experience, others speculative[1477]. The most important of these was the treatise by Orton, which had been published in its original form at Madras in 1820. Writing from Yorkshire in August, 1831, he surmised (with a proviso that no one could say confidently what might happen) that Asiatic cholera might be expected to be a mild visitation upon Britain at large, falling most upon the large manufacturing towns in which typhus was common, but that it would be “far otherwise” with Ireland owing to its chronic poverty, distress and over-population. By a singular chance the only town which he specially mentioned in England was Sunderland, where, he had been told by Dr Clanny, there had been an unusual number of cases of malignant cholera nostras in the early part of the autumn: “it is greatly to be feared,” he said, “that those are but the skirts of the approaching shower[1478].”

In other places besides Sunderland there had been perhaps more than the usual amount of summer diarrhoea in 1831. Dr Burne, in his London dispensary reports, entered on the 2nd and 16th July an unusual prevalence of “dysenteric diarrhoea and cholera,” and cases of scarlet fever of an “adynamic” type or with a tendency to fatal collapse[1479]. (Clanny observed the same type of scarlatina at Sunderland along with some typhus.) Choleraic disorders were uncommonly rife on board the ships of war in the Medway[1480]. A succession of twenty-four cases at Port Glasgow, from 2 July to 2 August, chiefly among workers in Riga flax, gave rise to an alarm of the real Asiatic cholera, the more readily that the first case was fatal (the only death)[1481]. Similar alarms arose at Leith and Hull.

Asiatic Cholera at Sunderland in October, 1831.

In the end of July and in August, Sunderland and the adjoining villages and farms in the valley of the Wear were visited with “a very general prevalence of the indigenous cholera of the country, bearing in most instances its usual leading feature--that of excessive bilious discharges[1482].” Few, who were not attacked with actual cholera nostras, were altogether free, it was said, from diarrhoea or disordered digestion. Many of the choleraic cases were unusually malignant, of which the following are instances:

Allison, aged fifty, a painter of earthenware residing in a low situation on the bank of the Wear two miles above the town, was attacked at 4 a.m. on the 5th of August with vomiting and purging of a watery whitish fluid, like oatmeal and water. His hands and feet were cold, his skin covered with clammy sweat, his face livid and the expression anxious, his eyes sunken, his lips blue, thirst excessive, his breath cold, his voice weak and husky, and his pulse almost imperceptible. He passed into a stage of reactive fever and got well. Arnott, a farm-labourer on the opposite bank of the Wear from the man Allison, was seized at 2 a.m. on the 8th August with precisely the same symptoms, and died in twelve hours. Neither he nor Allison had any intercourse or relation with seamen or the shipping of Sunderland[1483]. Another case on the 8th of August came to light afterwards. A woman in the village of West Bolden, four miles from Sunderland, on the Newcastle road, was found by a surgeon from the town to be suffering from choleraic sickness, of which she died twelve hours from its onset[1484].

A week after these cases in the country not far from Sunderland, there occurred the death, on 14 August, of one of the Wear pilots named Henry. He had been troubled with diarrhoea for some time before, but not so as to keep him from his occupation. Having gone down in the direction of Flamborough Head to look for ships, he picked up a vessel between that and the Wear, piloted her in, and, a few days after, piloted her out again. The identity of the vessel was never traced, but it was alleged that she had come from an infected port abroad. The last time Henry was in his boat he was seized with violent vomiting and purging, and died at his house after an illness of twenty hours. A brother pilot, who looked in at the house on the day of his death, fell into a similar choleraic disorder, but recovered[1485]. On the 28th of August a shipwright died of the same; also about the end of August two persons at a distance of four or five miles from Sunderland. In September, it is said, there were other cases and fatalities. Early in October the authentic particulars of cholera in Sunderland begin. Dixon attended one case, which was fatal on the 9th October. Another case, which came to light three months after, was that of a girl of twelve, named Hazard, residing on the Fish Quay, who was well enough on Sunday the 16th October to have been twice at church. She was seized in the middle of the night following with the sudden and appalling symptoms of choleraic disease and died on the Monday afternoon[1486]. A few doors off on the same quay lived a keelman named Sproat, aged sixty; he occupied a large, clean, well-ventilated room on the first-floor of a house in the most open part of the quay, opposite to a crowded part of the anchorage. He was in failing health, and had been troubled with diarrhoea for a week or ten days previous to the 19th October, on which day he had to give up work. Next day, Thursday, the 20th, a surgeon who had been sent for found him vomiting and purging, but not at all collapsed, with no thirst, and in good spirits. He improved so much that on Friday he had toasted cheese for supper and on Saturday a mutton chop for dinner, after which he went out to his keel on the river for a few minutes. On his return he was seized with rigor, cramps, vomiting and purging. Medical aid was not sent for until seven on Sunday morning, when he was found in a sinking state, pulseless, speaking in a husky whisper, his face livid and pinched, his limbs cramped, the purgings like “meal washings.” He continued like that for three days, and died on Wednesday, the 26th October, at noon.

This came to be reckoned the first death from Asiatic cholera in England.

His grandchild, a girl of eleven, while moving about the room an hour after the death, was suddenly seized with faintness, pains in the stomach-region, vomiting and purging of watery matters; she was taken to the Infirmary and soon got well. The day after his father’s death, Thursday, the 27th October, William Sproat, junior, a fine athletic young keelman, who had attended on his parent during his illness, was found lying in a low damp cellar near to the Fish Quay, suffering from choleraic symptoms; he had been ill only a few hours, and was removed (with his daughter as above) to the Infirmary the same evening. He became gradually worse: on the 30th he was continually throwing himself about, moaning and biting the bedclothes; on the 31st he was lying on his back comatose, his eyes open, the pupils wide and insensible, and the breathing stertorous, in which state he died the same day. An old nurse at the Infirmary (Turnbull) helped to place the body in the coffin, went to bed in a state of considerable fear, and was seized at one in the morning with symptoms of cholera, of which she died after a few hours.

Meanwhile there had been two other fatal cases unconnected with the Sproats or the Fish Quay. On the quay of Monk Wearmouth, across the river, lived a shoemaker named Rodenburg, aged thirty-five. He occupied a poor hovel and had a large family, but he was in good work and wages. On Sunday, the 30th October, he had pork for dinner, and what was left of it for supper. In the middle of the night he was seized with vomiting, and with purging of a fluid like water-gruel in vast quantities; when visited by the medical men, he spoke in a husky whisper, his nails were blue, his skin livid, covered by cold sweat, his limbs cramped. The spasms ceased about nine o’clock on Monday morning; about noon he asked to be raised in bed, and died as they were raising him. On the very same night, between Sunday and Monday, a keelman named Wilson, who lived with his wife in a decent room in the High Street, and had attended the Methodist chapel on Sunday, was seized with cholera at 4 a.m. on Monday, and died the same afternoon at three.

These six cases within a few days, all fatal but that of the girl of eleven, looked like the real Asiatic disease. Kell, an army assistant-surgeon stationed at Sunderland with the reserve companies of the 82nd Regiment, had suspected that the earlier case of the pilot Henry was true Asiatic cholera (which he had seen in Mauritius in 1829), and had written to the Board of Health. At a meeting of the faculty at the Infirmary on the morning after the admission of Sproat junior and his child (28th October), Kell urged upon them that the disease was Asiatic cholera, but all the twelve present, save Dr Clanny, who was in the chair, maintained that it was common indigenous cholera. However, when the younger Sproat died, and the nurse after him, and two others in different parts of the town, a full meeting of medical men at the Exchange came unanimously to the opinion that these were cases of “spasmodic cholera.” A meeting of the Board of Health and leading citizens was at once held, who were informed that, in the unanimous opinion of the medical gentlemen of the town, “spasmodic cholera prevailed in Sunderland.” The authorities in London having been kept informed (principally by Kell), a surgeon of Indian experience was sent down by the Board of Health on the 5th November, and a colonel by the lords of the Council on the 6th, to act as commissioners.

It happened that no more cases occurred for three days after the death of the nurse at the Infirmary; so that the doctors, like Pharaoh in the intervals between the plagues of Egypt, were beginning to repent of their diagnosis. The shipping trade of Sunderland was threatened by these newspaper alarms, and by the presence of two Government commissioners in the town; while Kell was demanding a ship of war off the mouth of the Wear, and a battery on shore, to make the quarantine respected. The Marquis of Londonderry, interested in the coal-trade, wrote to the Standard that the alarm was false. The magistrates, shipowners and leading residents, who had met on the 9th November to raise money for a cholera hospital, assembled again in various public meetings or caucuses on the 10th and 11th, and passed resolutions that there was no Indian or other foreign imported cholera in Sunderland, that it was a wicked and malicious falsehood to say there was, and that there was no need of quarantine on the Wear. One of these meetings was attended by fifteen medical men (most of them from the residential suburb of Bishop Wearmouth), who severally expressed the opinion in various terms, that the recent fatal cases were aggravated cases of English cholera, not contagious or infectious, while three more sent letters backing up Lord Londonderry and the shipowners. On the 12th of November, twenty-seven medical men signed a declaration to the same effect. Some of these remained unconvinced by the progress of events, Dixon arguing as late as 23 January, 1832, that the epidemic in Sunderland, which was by that time over, had been one of “spontaneous malignant cholera.”

Two new seizures occurred on the 7th November, none on the 8th, seven on the 9th, one on the 10th, and so on for fully six weeks longer until Christmas, when the cases became very occasional, so that on the 9th of January, 1832, Sunderland was declared by the Board of Health to be free of cholera. The largest number of seizures reported on one day was nineteen on the 8th of December; on the 10th of that month there were sixty-three cases under treatment at once; the whole number of cases from 23rd October to 31st December was 418, of which 202 were fatal; the whole deaths at Sunderland by the cholera of 1831-32 are given at 215, so that the epidemic exhausted itself there before it had well begun elsewhere in the country. The effect of it upon the death-rate is shown in a comparison of the burials for November and December in three successive years[1487]:

Burials in the parish of Sunderland.

November December

1829 29 44 1830 39 76 1831 122 127

The way by which the virus entered Sunderland was never traced. It was known, however, that deaths from cholera had occurred among the crews of Sunderland ships lying at Cronstadt and Riga; and as it was the practice for vessels owned in Sunderland to come home from their summer trading towards the end of the season, so as to lay up during the winter, it was suspected that the clothes of some of the dead men had been brought over and sent ashore. The quarantine in the Wear was far from effective: the station was higher up the river than the loading moorings, so that suspected ships had to pass through a crowd of ordinary shipping to get to it. It appears that hardly any ships were quarantined, except some from Dutch ports where no cholera then existed.

This first experience of Asiatic cholera on British soil brought out very clearly one character of the infection which was seen to attend it everywhere during the following year, and has always attended it in every subsequent invasion of the disease. The virus, for all its opportunities, showed a marked preference for, an almost exclusive selection of the lowest and least cleanly localities, and a considerable preference for persons of drunken or negligent habits. Sunderland consisted of three parts--the parish so named, the parish of Bishop Wearmouth, which was the west end of Sunderland or the residential quarter of the wealthier class, and across the river the parish of Monk Wearmouth, with the adjoining Shore. The cholera was almost wholly confined to Sunderland proper; Ainsworth says that no cases occurred, to his knowledge, in the parish of Bishop Wearmouth, and not above six in Monk Wearmouth; another gave six or eight cases in each of these parishes, but increased the estimate to eighteen or twenty in each according to later information. Bishop Wearmouth stood about seventy feet higher than the highest part of Sunderland; it was well built, and its population of 14,462 (with 363 more in the Pans), included the whole of the wealthier class with the trades dependent on them. Monk Wearmouth, with a population of 1498, and the adjoining Shore with a population of 6051, were irregularly built on the north bank, and occupied by the same class (keelmen, sailors, labourers and workmen in the coal, iron and shipping trades) as Sunderland itself; but for some reason, connected perhaps with its soil and elevation, it escaped with a very few cases of cholera[1488]. The parish of Sunderland, with a population of 18,916, was not all visited equally. The focus of the cholera, says Ainsworth, was the town moor, a large piece of pasture-land stretching to the sea-shore at the south-east end of the town, having a subsoil tenacious of water, marshy in the winter months, and its roads almost impassable. Upon this open space was deposited, and left to accumulate for weeks together, the filth from the narrow lanes and passages of the low-lying and crowded quarter at the seaward end of the parish, to the south of the High Street. Some of the streets occupied by the poorer class consisted of old residences of the well-to-do, now divided into tenements. Certain streets had as many as a dozen or twenty common middens, “let in” to the street fronts of houses and covered by trap-doors, in which the domestic refuse and sweepings of the street were collected as a source of profit, and sold at stated times to farmers for manure. Most of the attacks happened in this low-lying part of Sunderland, with a soil and foundations sodden with filth, houses overcrowded and badly ventilated, and its residents subject to the alternations of excess and want (with much pawning of clothes, &c.) peculiar to a port from which one or two hundred sail would leave with a fair wind or arrive in the river together[1489]. About four hundred were attacked in a population of eighteen thousand during a space of two months. The cases among the wealthier classes were nearly all in the households of medical men:--the mother of one doctor, living with him, died of Asiatic cholera, the wife of another came safely through an attack, one or more medical men had the symptoms in one degree or another. In the end of November, five old people in the poor’s house were fatally attacked all at once, in different parts of the building. A cholera hospital had been provided at an early stage of the outbreak, but the relatives of those attacked seldom permitted their removal to it, a prejudice against it having been aroused by the post-mortem examination of the first victims. Most of the cases were accordingly treated at their homes, which were “always crowded to excess by the immediate attendants or relatives, and by others from mere curiosity.” A fund of two thousand pounds was raised for the distressed families, to which the Government gave one hundred. Sunderland became for two or three weeks a centre of interest to medical men, who came to see the cholera from various parts of England, Ireland and Scotland, while MM. Magendie and Guillot came from Paris, and M. Dubuc from Rouen.

The symptoms and morbid anatomy of cholera as it was known in India were seen without ambiguity in the Sunderland epidemic. In a few cases death followed very quickly without the distinctive intestinal symptoms; but usually the unmistakeable thing was a sudden seizure, often in the night after a hearty supper, marked by profuse “meal-and-water” or “rice-and-water” purging, by vomiting, faintness or sinking at the pit of the stomach, thirst, pulselessness, cramps of the limbs, restless tossing, coldness, blueness and clamminess of the surface, and shrunken features. The facies Hippocratica had not been seen on so extensive a scale in England since the sweating sickness of three hundred years before. The end was sometimes in deep coma, at other times in delirium with convulsive or spasmodic movements. The chief point in the morbid anatomy was the engorgement of the lungs, great veins, and right side of the heart, from which the disease was named “cholera asphyxia.” The blood was thick and tarry[1490].

Extension of Cholera to the Tyne, December, 1831.

Before Sunderland had been declared by the Board of Health to be free of cholera, on the 7th of January, 1832, the infection had gained a footing in Newcastle, Gateshead, North Shields, Houghton-le-Spring, and some places on the road to Edinburgh. The mildness of that winter was somewhat favourable to its diffusion; in November there had been some days of severe frost in the midst of generally mild weather, December was warmer than usual, the pastures being green and spring-like, while January was warm and dry almost beyond precedent. The first cases in new centres were usually tramps or others who had come from Sunderland[1491]; but there were some puzzling attacks. Thus Dixon says that on 12th December, 1831, he visited a woman of fifty who died of cholera after twelve hours, “in a lonely district unconnected in situation with any previously infected place,” and where there had been no personal liability to contagion; a young man lodging in the house died three days after with the same symptoms.

At Newcastle, as at Sunderland, fatal cases of choleraic disease were discovered from the beginning of autumn; one such, on 4 August, at the village of Team, two miles to the south-west of Newcastle, was said to have been as little of the nature of bilious cholera, and as truly spasmodic cholera, as those in the subsequent great epidemic. Another suspicious death occurred a little below Newcastle on the 26th October, the same day as the first acknowledged death from the Asiatic disease in Sunderland. A month passed before the next death, marked by spasmodic and non-bilious symptoms, occurred at Newcastle--on the 26th November.

At length, on the 7th of December, 1831, the Asiatic cholera was declared to be in the town. The earliest cases of it were found in low-lying poor houses along the river[1492]. Gateshead, on the south bank of the Tyne, had only two cases until a day or two before Christmas; at length, on Christmas-day, there was a sudden explosion of the infection simultaneously at many points.

“On the 25th [December, 1831] about one o’clock,” wrote Brady[1493], “we were assailed by a third and fourth example of the disease, and before the next morning at ten o’clock, very considerable numbers had fallen sacrifices to its pestilential ravages. Within a space of twelve hours it spread itself over a diameter of two miles, and appeared to pay but very little distinction to altitude of situation, for the higher parts of the town were laid under its stroke in an equal degree, or nearly so, with the lower. Pipewellgate, Hillgate, the banks above Pipewellgate, Oakwellgate, the lanes leading from it, Jackson’s chare, Nun’s Lane, Wreckington, Gateshead Low Fell, Low Team--situations as different in their external character as can well be conceived--were all indiscriminately exposed to its fury.”

Greenhow’s summary of this remarkable explosion on the afternoon and night of Christmas-day is that “at nearly fifty different points cases occurred almost at the same instant.” The attack at Gateshead was short and severe; at Newcastle it was less concentrated and of longer duration, affecting the population in the low and dissolute localities along the river, such as Sandgate and the Close, while there were two or three fatalities about the 6th January among the wealthier residents. The hospital cases in Newcastle and Gateshead to the 9th of February were:

Cases Deaths

Sandgate Hospital 55 23 Castle Hospital 12 8 St John’s and St Andrew’s 15 8 Gateshead Hospital 36 21 --- -- 118 60

As at Sunderland, the bulk of the cases were treated at their homes--1330 cases, with 437 deaths, to the 9th of February. As the whole number of deaths at Newcastle and Gateshead, while the cholera of 1832 lasted, was 801 in the returns to the Board of Health, it would appear that the epidemic had dragged on through the spring and perhaps the summer, which were its seasons elsewhere.

The colliers’ villages on both sides of the Tyne for two or three miles above and below Newcastle and Gateshead were sharply visited at the same time. Below Newcastle, on the north bank, it invaded Dent’s Hole, a dirty narrow lane along the margin of the river, overhung by its banks, filled with mud and filth rising in heaps above the thresholds of the houses; also on the same side, Walker, Howden-Pans, and so on to North Shields; on the south side below Gateshead it visited Felling and other villages. South Shields and Westoe escaped for several weeks, but at length about the 20th of February the epidemic began there and caused 147 deaths before it ceased.

Some of the worst village outbreaks occurred above Newcastle on both sides of the river. Swalwel, a low dirty village of iron-workers, near the confluence of the Derwent with the Tyne had a very virulent attack. Dunston, another low-lying village on the south bank, two miles above Gateshead, subject to inundation from the small tributary stream running through it, had twenty-three deaths among the 400 inhabitants in about a fortnight, most of the victims being old, dissipated and debilitated. On the other hand, Whickam Fell, standing on the hill between Dunston and Swalwel, escaped with only one case, while Bensham, another elevated village between Gateshead and Dunston, escaped altogether; just as Byker, a high-lying village on the north bank, only half a mile from Dent’s Hole, had but a single mild case.

On the north bank above Newcastle the disease was most severe in the villages of Bell’s Close, Lemington and Newburn. The epidemic in the last of these was indeed unparalleled. As in all the other villages attacked, the epidemic was soon over, but not before two-thirds of the inhabitants had suffered either from choleraic diarrhoea or cholera proper. Newburn was a village of some 131 houses, built in the face of the high north bank of the river five miles above Newcastle, its population being 550. The houses stood in two rows, one above the other, the church and churchyard standing in open ground midway between the lower and upper streets of the village; a small stream ran through it to the Tyne. The inhabitants were mostly wherrymen, coal labourers, or glassworkers; they were a healthy community, above indigence, housed in clean, neat, comfortably furnished clay-floored cottages. The first case of cholera, in a man who lived close to the brook, proved fatal on the 4th of January, 1832. There was no new case until the 10th, after which there were several deaths every day. From the night of the 15th until noon of the 16th fifty were attacked, twelve or thirteen of them with the worst kind of spasmodic cholera, the rest with diarrhoea. By the 2nd of February the epidemic was over. Three hundred and twenty had either cholera or cholerine, of whom fifty-seven died (the Board of Health return gives 274 cases and 65 deaths to 25 January), the daily deaths having been as follows[1494]:

Cholera in Newburn, near Newcastle, 1832.

Deaths

Jan. 4 1 11 4 12 3 13 4 14 6 15 5 16 6 17 3 18 5 19 3 20 3 21 2 22 3 23 2 24 2 25 1 26 2 27 1 28} 29} 1

The other chief centres of cholera in the northern coal district, besides those mentioned, were Houghton-le-Spring and Hetton (which had together 311 cases and 66 deaths to the 28 of January), the colliery village of Earsden, and the port of Tynemouth.

The Cholera of 1832 in Scotland.

It was not until April that the infection began to show itself on the same scale in other parts of England. The next parts of the kingdom to be invaded after the Wear and the Tyne were the coal and iron districts of East Lothian and Lanarkshire, the cities of Edinburgh and Glasgow becoming infected soon after. A fatal case, in a destitute tramping sailor occurred at Doncaster, in the beginning of January, but led to no outbreak; two fatal cases occurred at Morpeth about the same time, the second of the two in a bagman who had just spent three days making his rounds in Newcastle and the infected villages near it. It was on the high road to Edinburgh, at Haddington, Tranent and Musselburgh, that the next focus of cholera was established. Previous to the 14th of January there had been 47 cases, with 18 deaths, in and near Haddington, among the miners and others of the labouring class. At Tranent, seven miles nearer Edinburgh on the main road, with a population of 1700 miners and labourers, a boy died of cholera on the 18th January, the infection spreading so rapidly that before the 25th there had been 61 attacks with 26 deaths, which rose to 205 attacks and 60 deaths by the 8th of February. A few cases occurred also at North Berwick and a good many at Preston Pans; while Musselburgh became the scene of one of the most deadly outbreaks in the whole history.

Musselburgh, with Fisherrow, was not then the place of villas which it afterwards became, but was occupied by a working class, who combined the three industries of coal-mining, weaving or other factory work, and fishing. To add to the ordinary insanitary risks of such a combination, some fifteen hundred hands had been out of work for two months, and were in “a state of great misery.” The first case of cholera appeared there on Wednesday, the 18th January, three days after the first death at Tranent. The virulence and certainty of the infection will appear from the following by D. M. Moir, the distinguished author of Mansie Waugh and other writings in prose or verse, who practised his profession at Musselburgh:

“A girl at Musselburgh, whose mother kept a lodging-house, was found in a state of complete collapse on the morning of Thursday, the 19th January--the day after the first appearance of the pestilence. She died on that afternoon, between five and six, and was buried by moonlight the same evening.... The mother during the night of Saturday was also similarly seized, and fell a victim on the following noon. Her sister, who had walked from Leith on the same morning to condole with her in her family distress, was immediately affected on entering the house; but her symptoms being overlooked in the misery around her, medical assistance was not called in, until, on the return of the nieces from the interment, their aunt was discovered dead on the floor of the dwelling. Her husband, Baxter, a man of intemperate habits, came out to enquire into her fate; and immediately on his return home to Leith was seized with the distemper and died.”

In three weeks there were more deaths from cholera than from all causes in the whole of an ordinary year. To the 22nd of February, just over a month from its outbreak, the disease had attacked 435, of whom 193 died. The medical profession (the senior of whom was a man of original talent, Thomas Brown, author of an essay on smallpox, in 1808, and one on the Indian cholera in 1824), were greatly taxed by the numerous calls upon them: Moir met one night a young colleague who complained of feeling ill, and was advised by the former to go home at once; he continued his rounds for an hour longer, and died of cholera next morning. Edinburgh, only five miles distant, was in constant communication with Musselburgh; and at length three or four cases appeared in the city in persons who had been at the infected place. The Edinburgh cases, however, did not multiply rapidly; to the 8th of February, there had been 8 cases with four deaths; to the 28th of February, 35 cases, with 18 deaths; to the 20th of March, 39 cases, with 20 deaths. On the other hand, the suburb of Water of Leith, had 48 cases, with 23 deaths at the same date. On the 6th April, 1832, the figures for Edinburgh and certain of its suburbs respectively were:

Cases Deaths

Portobello 44 24 Water of Leith 58 30 Canonmills 18 12 Duddingston 10 3 Edinburgh 62 38

Of the border towns, Hawick was infected on the 14th January, probably from Morpeth, and had a not very extensive epidemic, of somewhat mild type[1495]. Coldstream, on the Tweed, a few miles above Berwick, had 109 cases and 37 deaths to the 20th of March.

Meanwhile the infection had sought out the weak spots in the west of Scotland--the mining and weaving villages in Lanarkshire, the city of Glasgow and the manufacturing town of Paisley. On Sunday, the 22nd January, a boy was taken ill in church at Kirkintilloch (a village on the Forth and Clyde canal, seven miles north-east of Glasgow), and died next morning: that was the first case in the west of Scotland. Cases multiplied in Kirkintilloch, so that by the 6th of March there had been thirty-two deaths, but no more for the rest of the season. A few days after the boy was seized in church there, a first case occurred in the mining village of Coatbridge, six or seven miles to the south-east, in an old man living in a “back land” in very poor circumstances, who had not been in Kirkintilloch nor had communication with such as had been there; other cases followed slowly, and at length there was a more severe outbreak.

Glasgow at once took precautions. A Board of Health had been formed there early in the summer of 1831. In February, it had command of £8000 raised by voluntary subscriptions, and it made provision of 236 cholera beds in five hospitals. The theatres were closed, and “evening sermons” discouraged; while all the passenger boats (for a time also the goods barges) on the Forth and Clyde canal, and on the Monkland canal (near to which was Coatbridge) were stopped. District committees were formed in all parts of the city.

The first victim was Janet Lindsay, a drunken old woman who lodged with widow Proudfoot and her daughter in Todd’s Close, Goosedubs; she was asthmatic, and had not been beyond the Goosedubs for weeks. Her seizure, with vomiting and purging, was on the afternoon of Thursday, 9th February, and her death on Saturday morning. Also on the 9th February, in the suburb of Woodside, remote from Goosedubs, the infant of one McGie was attacked with cholera, suffered much from cramps on the 10th and died on the 11th, the father, mother and others of the family afterwards suffering from cholera. The third case, fatal in a few hours, appeared early in the morning of Friday the 10th in a boy living in Millroad Street, a mile east of the Goosedubs, who had been subject to diarrhoea for some weeks. The fourth victim was a gardener in Macalpine Street, a locality also remote from the Goosedubs and in the opposite direction from Millroad Street, who had walked three miles to Pollokshaws on the 9th, and had partaken of tea with friends at Crossmyloof on his way back, in excellent health: he was seized at midnight with purging, and died on the afternoon of the second day. The fifth case was in Partick on the 11th, the sixth in Bridgegate on the 12th, not far from the close in the Goosedubs where the first case had occurred. On the 17th the first of many cases occurred in Paisley, and on the same day there was a case at Maryhill (population of some 500), followed by six more before the next afternoon. Thus there were, besides the case of cholera in the very heart of old Glasgow, half-a-dozen other cases the same day or in the next day or two, at scattered points all round the city. About fifty of the neighbours had visited Janet Lindsay in Todd’s Close, and some had helped to lay her out. The next case in the close was of a woman who had stopped in the street to talk with the widow Proudfoot shortly after the body had been removed; this woman was seized at seven next morning (Sunday, the 12th Feb.), and died in the hospital after twenty-four hours. Three days passed, and then there occurred two other cases, both fatal, in Todd’s Close, one of them being the widow Proudfoot herself, who refused to be taken to the hospital, and would receive no other medicine or cordial but whisky. No other cases occurred in the close for several weeks; but within a range of two hundred yards of it there were 46 cases from the 13th to the 29th of February. It was, indeed to this region of Glasgow, the Goosedubs and the Wynds, that the infection was chiefly confined for the first few weeks; it was especially severe in Francis’s Close, Broomielaw, a collection of small wretched hovels, in which some twenty died of cholera[1496]. The state of the three old Wynds of Glasgow and of other the like localities has been already referred to under a date a year or two before the outbreak of cholera (supra p. 598).

No better instance could be given of the inscrutable ways in which the infection of cholera found out the weak places and the likely subjects than the explosion in the Glasgow Town’s Hospital or pauper infirmary on the 22nd of February, some twelve days after the first cases in various parts of the city and suburbs.

The infirmary, built in two blocks on the north bank of the Clyde, contained 395 inmates occupying 296 beds, some 60 or 70 of whom were insane or fatuous. The fatuous lived in ground-floor cells of the north block, from seven to eleven feet square, with a stone vaulted roof, a stone floor, no fireplace, damp from situation and want of sun, but all the more damp from being often washed owing to the uncleanly habits of the inmates. At eight on the morning of the 22nd February two fatuous paupers in adjoining cells were found cold and pulseless; they had vomited and purged during the night, although they had been well the evening before; each of the two cells had three beds with five occupants. One of the two seized died next day, the other recovered in a week, having had severe spasms and a degree of collapse. Cases appeared almost at the same time in various parts of the building, most of them in scattered individuals, but in one instance in as many as five together in a garret holding twenty-two. From the 22nd February to the 9th of March there were 64 attacks of cholera in this pauper institution[1497]. Besides the five deaths in the Sunderland Workhouse, this was the first of many instances of the remarkable invasion of such institutions.

Until July the infection had been limited in Glasgow to certain of the lowest localities, and even in these it had declined almost to extinction in the last week of May. As the summer advanced it increased somewhat again, and in the first days of August it took a sudden start, reaching a maximum of 181 attacks in one day, and 817 in a week. It was no longer confined to the poorest districts, but became diffused all over Glasgow, so that “there was scarcely a street where one or more cases did not occur.” From this enormous prevalence in August, it declined again in September, but once more took a start in the last few days of that month and in the first week or two of October. The last outburst was ascribed to the effects of the Glasgow public holiday on 28 September, to celebrate the passing of the Reform Bill for Scotland, but the course of the epidemic clearly followed the season, being precisely parallel in Edinburgh, in Dumfries and in the coast towns of Fife. From the middle of October, the disease declined rapidly and was extinct before the middle of November. The following table shows week by week the number of new cases reported daily to the Board of Health, and the deaths in each week[1498].

Cholera in Glasgow, 1832 (population 202,426).

Week New ending cases Deaths

Feb. 19 62 21 26 113 46 Mar. 4 68 39 11 85 60 18 94 50 25 150 61 April 1 138 74 8 112 57 15 99 50 22 120 60 29 71 40 May 6 71 39 13 73 39 20 41 31 27 21 11 June 3 6 7 10 45 17 17 72 39 24 168 70 July 1 127 72 8 131 62 15 143 68 22 229 101 29 218 113 Aug. 5 817 356 12 699 339 Aug. 19 483 228 26 419 178 Sept. 2 231 122 9 117 50 16 60 31 23 84 33 30 165 90 Oct. 7 310 140 14 173 95 21 95 58 28 47 29 Nov. 4 41 18 11 10 11 ---- ---- Total 6208 3005

The effect of the epidemic upon the general mortality of Glasgow is shown in the table of deaths from all causes and from cholera month by month, compiled from the burial registers, which make the cholera deaths 161 more than the returns to the Board of Health.

Glasgow Mortality in 1832.

All Cholera deaths deaths

Jan. 824 -- Feb. 874 87 March 955 264 April 816 229 May 677 125 June 783 196 July 990 441 Aug. 1755 1222 Sept. 749 243 Oct. 755 334 Nov. 529 25 Dec. 571 -- ------ ---- 10,278 3166

While the cholera lasted (12 Feb.-11 Nov.) the burials from all other or ordinary causes were 4958; in the corresponding nine months of 1831 they were 4862, having been excessive in that year owing to fever. The baptisms from 15 December, 1831, to 14 December, 1832, were 3388; so that the cholera alone destroyed nearly as many lives, chiefly adult, as there were children born in the year.

Upwards of a thousand of the cases were treated at the Albion Street Hospital, under the direction of Dr Lawrie, who had had a large experience of cholera in India. His statistics are as follows[1499]:

Albion Street Cholera Hospital, Glasgow, Feb.-Sept. 1832.

Males Females Both sexes Percentages Cases Deaths Cases Deaths Cases Deaths of deaths

370 251 662 419 1032 670 64·9

Percentages Ages Cases Deaths of deaths

0-7 43 25 58·1 7-20 93 47 50·5 20-30 231 112 48·8 30-40 211 137 64·9 40-50 204 136 66·1 50-60 116 95 81·0 Over 60 134 120 89·5

Monthly Cases and Deaths.

Percentages Cases Deaths of deaths

Feb. 40 33 82·5 March 97 69 71·1 April 122 81 66·3 May 56 40 71·4 June 126 94 74·5 July 240 143 59·5 Aug. 273 176 64·4 Sept. 64 33 51·5

The noteworthy points are: first, the great excess of women admitted, which was observed also at Edinburgh; secondly, the higher rate of fatality at the two extremes of life, which is the rule in some other infections; and thirdly, the lower ratio of deaths to cases during the height of the epidemic in the end of summer, which is explained, as Craigie remarked for Edinburgh, simply by the fact that the infection was no longer in the worst localities, but was attacking “a greater number of persons, and consequently much better constitutions.”

The Glasgow cholera of 1832 was far more destructive than that of Edinburgh per head of the population, according to the following:

Glasgow Edinburgh

Population 202,426 136,301 Attacks of Cholera 6208 1886 Deaths by Cholera 3005 1065

The fluctuations of the epidemic in the two cities were closely parallel. In Edinburgh from the middle of February to the middle of June the new cases usually ranged from five to ten or fifteen a day, with an occasional excess, as on the 29th of April when there were twenty-six persons seized. As in Glasgow, there was a marked lull in the end of May and beginning of June, after which the seizures became more common and remained somewhat steady to the end of July, some days having as many as twenty attacks. The largest number in one day in August was nineteen, the September maximum sixteen (on the 28th). Edinburgh thus missed the enormous outburst that Glasgow had in August, while the September experiences were much the same in the two cities. The first week of October, which was the time of a second maximum in Glasgow (far below that of August), was the worst time of the whole epidemic in Edinburgh, the cases coming from all parts of the city, as in Glasgow they had done in August.

Successive days of most extensive Cholera in Edinburgh, 1832.

New cases

Oct. 1 22 2 23 3 44 4 45 5 23 6 30 7 27 8 18 9 13 10 26

This gives 214 cases in the week ending 7th October, as compared with Glasgow’s 310 in the same week.

At the Castle Hill Cholera Hospital, 318 were admitted and 187 died. The ages, with the rates of fatality at each age-period, agree closely with those already given for the chief hospital in Glasgow. The smaller ratio of hospital fatality in the second half of the epidemic was perhaps more marked in Edinburgh: 119 cases, with 85 deaths, from the opening of the hospital to 5 July; 199 cases, with 97 deaths, from 5 July to the closing of the hospital. That larger proportion of recoveries may have been due in part, Craigie thinks, to better methods of treatment; but, in his opinion, it was mainly owing to the greater number of strong constitutions among those attacked over a wider area of the city.

Beyond the statistics and other particulars for Glasgow and Edinburgh, and the minute accounts of the first outbreaks in the beginning of the year, there is little exactly recorded of the cholera of 1832 in the rest of Scotland; but the following table, compiled according to counties from the alphabetical list of the London Board of Health, will serve to show the epidemic in outline.

Deaths by Asiatic Cholera in Scotland, 1832.

No. of places Places with highest mortalities Counties Deaths attacked in each county

Caithness 96 iii Wick 69, Thurso 26, Latheron 1 Sutherland -- -- Ross and Cromarty 102 vii Tain 55, Dingwall 17, Avoch 12, Cromarty 11, Several villages no return Inverness-shire 191 iii Inverness 177 Nairnshire 5 i Nairn 5 Moray -- -- Banffshire 15 i Rathven (Buckie) 15 Aberdeenshire 108 ii Aberdeen and Footdee 99, Collieston 9 Kincardine -- -- Forfarshire 552 iv Dundee 512, Cupar Angus 17, Arbroath 13, Liff and Benvie 10 Perthshire 81 v Perth 66, Auchterarder 7, Kenmore 4, Tulliallan 3 Fife and Kinross 301 xii Cupar and district 108, Kirkaldy and Dunnikier 104, Dysart 39, Wester Wemyss 17, Kinghorn 15, Burntisland 13, Anstruther 10, Leven 14, St Andrews 5 East Lothian 213 vii Tranent 78, Haddington 65, Dunbar etc. 38, Prestonpans 28 Berwickshire 41 Coldstream 41 Midlothian 1780 xiii Edinburgh 1065, Suburbs of, 146, Leith 267, Musselburgh and Fisherrow 202, Newhaven 52, Portobello 33 Linlithgowshire -- -- Clackmannanshire 75 i Clackmannan 75 Stirlingshire 247 x Alloa 72, Stirling 35, Falkirk 36, Larbert 31, Balfron 28, St Ninian’s 15, Bothkenner 10, Carriden 13, Grangemouth 8 Lanarkshire 3575 xii Glasgow 3005, Pollokshaws 143, Govan 77, Old Monkland 125, Rutherglen 65 Renfrewshire 1001 xi Paisley 444, Greenock 436, Port Glasgow 69 Dumbartonshire 86 iii Dumbarton 67, Bonhill 13, Helensburgh 6 Bute 14 i Rothesay 14 Argyle 35 ii Inverary 25, Campbelltown 10 Ayrshire 466 x Kilmarnock 205, Ayr 190, Dairy 22, Irvine 19 Kirkcudbrightshire 133 iv Troqueer (Maxwelltown) 125, Kirkcudbright 3 Dumfriesshire 441 v Dumfries 418, Caerlaverock 15 Roxburghshire 34 i Hawick 34 (second outbreak only).

Near Glasgow numerous centres of cholera were established, among which Paisley, Greenock and Dumbarton suffered heavily during the same space as Glasgow, from February to November. Rothesay, Campbelltown and Inverary had epidemics in spring or early summer. In June and July the infection was carried effectually into Ayrshire (an earlier importation to Doura, near Kilwinning, in March, having proved abortive) and caused great mortalities at Kilmarnock[1500] and Ayr[1501], as well as much alarm and a good many deaths at Dalry, Irvine and Loudoun. In the latter half of September a most disastrous outbreak began in Dumfries and in the neighbouring Maxwelltown[1502].

The epidemic in Leith and Newhaven proceeded at the same time as in Edinburgh. Another important centre was the midland coal-field of Stirlingshire and Lanarkshire, where the mortality was mostly autumnal. Perth had been reached early in March, Dundee at the end of April, the latter having a visitation on the same scale as Glasgow, Edinburgh, Paisley and Greenock. From Dundee, Cupar Fife was infected about the middle of August, and had a severe epidemic almost confined to paupers[1503]. In the autumn there was much cholera among the fishing population from Thurso to Dunbar and Berwick. Inverness had been infected early in May, and was probably the centre from which the disease spread in the end of summer, during the herring fishery, to the coast towns and fishing villages, as well as to Tain and Dingwall. Only a few of these places made returns to the Board of Health; but it is probable from what Hugh Miller relates of the villages near Cromarty that the disease had been more widely spread. That author has described the condition of things in his native town. Its landlocked bay had been made a quarantine station, and was full of shipping flying the yellow flag. Cholera had “more than decimated” the villages of Portmahomak and Inver, and was prevalent in the parishes of Nigg and Urquhart, with the towns of Inverness, Nairn, Avoch, Dingwall and Rosemarkie. The numerous dead at Inver were buried in the sand, infected cottages had been burned down, the infected hamlets of Hilton and Balintore had been shut off from the neighbouring country by a cordon[1504]. The citizens of Cromarty, hitherto untouched, followed the advice of Miller at a public meeting and took the law into their own hands, guarding all the approaches to their peninsula and subjecting all arrivals to fumigation with sulphur and to some undescribed application of chloride of lime. The infection, however, got in by an unguarded channel. A Cromarty fisherman had died of cholera at Wick; his clothes had been ordered to be burned, but a brother of the dead man, who was in Wick at the time, secured some of them and brought them home. He kept them in his chest for a month before he ventured to open it. Next day he was seized with cholera and died in two days. Thereafter the disease crept about the streets and lanes for weeks, striking down both the hale and the worn-out. Pitch and tar were kept burning during the night at the openings of the infected lanes; the clothes of the dead were burned; many of the fishers left their cottages and lived in the caves on the hill until the danger was past[1505].

Among the numerous fishing villages of the Moray Firth, Buckie is the only one given as severely touched by the infection (fifteen deaths). Only one small village of the Aberdeenshire coast, Collieston, is known to have had cholera (nine deaths)[1506]. The Aberdeen epidemic was not severe, and appears to have been mostly in the fishers’ quarter. The Montrose district escaped altogether in 1832; but in June, 1833, the true Asiatic cholera broke out in the fishing villages of Ferryden and Boddin, on the opposite shore of the South Esk from Montrose. Arbroath had a few deaths in August, 1832, while several of the small towns on the coast of Fife had from that time to the end of the year visitations which were only less alarming than those on the south side of the Firth of Forth at the beginning of the year. To sum up the epidemic in Scotland, it caused nearly ten thousand deaths, of which Glasgow and its suburbs had about one-third, Edinburgh, Leith, Dundee, Greenock, Paisley and Dumfries, another third, while a large part of the remainder occurred among the mining and fishing populations[1507].

The Cholera of 1832 in Ireland.

The forecast of Orton in the summer of 1831, that Ireland would be the chosen soil of the Asiatic pestilence owing to the state of misery, at that time, of the mass of its people, was realized in a measure. But the cholera in Ireland, as elsewhere in Europe, showed itself chiefly as an urban disease, falling disastrously upon the poorest quarters of Dublin, Limerick, Cork, Galway, Sligo, Drogheda and other towns, but by no means seriously upon the immense population who occupied the country cabins. Scotland, indeed, had a higher ratio of cholera deaths than Ireland per head of the population; whereas Dublin had nearly twice as many deaths as Glasgow, their populations being almost exactly equal (about 200,000), and Cork had nearly the same number as Liverpool. The following table gives the comparison of the three divisions of the United Kingdom, including the cholera deaths of 1831 in England, but not those of 1833, which were more numerous in Ireland than elsewhere.

Population in 1831 Cholera deaths

England and Wales 13,897,187 21,882 Ireland 7,784,539 20,070 Scotland 2,365,114 9592

The first undoubted case of Asiatic cholera was found in Dublin on 22 March, 1832. On the 25th of that month, Harty, who was physician to all the Dublin prisons, notified to the Board of Health cases in the Richmond Bridewell which he believed to be true spasmodic or malignant cholera[1508]. It was reported from Cork on the 12th of April, from Belfast on the 14th, Tralee on the 28th, Galway on the 12th of May, Limerick on the 14th, Tuam the 4th of June, Waterford the 1st of July, but not until 21 August from Wexford and about the same time from Londonderry. Doubtless remoteness from the ordinary routes of vagrants was the reason why the infection was later in some places, such as Wexford. The old Liberties of Dublin, which harboured crowds of beggars in dilapidated tenement-houses, became a focus of virulent infection. As the summer advanced whole families in some of the most wretched lanes were cut off; news from Dublin on 29 June says that the pestilence was worst in Sycamore Alley, in a single house of which twenty persons had died in the course of four or five days[1509]. Certain streets sent fifty patients to the Cholera Hospital for one sent by other streets that were seemingly no better off[1510]. The great hospital in Grange Gorman Lane, capable of holding 700 and sometimes occupied by 500, would on some nights or early mornings (from midnight to 7 a.m.) receive forty or fifty new cases, and within a week would be having at the same hours only two applications. During four successive days it admitted a total of 285 cases, during the next four days 497 cases, and during four days a fortnight later only 134 cases. The worst time was from the 10th to the 14th of July, when 615 were admitted. A day or two of rain seemed always to send up the number of cases carried to the hospital[1511]. Until the beginning of June hardly anyone under fifteen was attacked; but in July the attacks of children were about one in thirteen or fourteen of adults, a case of pure cholera having been observed in an infant three weeks old. As at Glasgow and Edinburgh, more women than men were taken to the hospital (138·17 females to 100 males)[1512].

As the infection spread in Dublin during the early summer a panic arose in the city, and alarm over the whole province of Leinster. Runners, as in the old times of the torch of war, were to be seen hurrying everywhere through the neighbouring counties carrying a smouldering peat, of which they left a small portion at every cabin in their direct line, with a sacred obligation upon the inmates to carry the charm to seven other houses, and the following exhortation: “The plague has broken out; take this, and while it burns offer up seven paters, three aves, and a credo in the name of God and the holy St John that the plague may be stopped”! Men, women and children scoured the country with the charmed turf in every direction, “each endeavouring to be foremost in finding unserved houses.” One man in the Bog of Allen had to run thirty miles before he had discharged the obligation laid upon him[1513]. It does not appear, however, that the infection was at all general among the scattered cabins, hamlets or even considerable villages. In the rural parts of Wicklow there were only eight deaths from it, in Fermanagh four, in county Derry three, in Armagh thirteen, in Carlow none until the next year. In Clare the deaths in country districts were more than twice as many as in Ennis and other towns of the county. In Sligo county, again, there were only 62 deaths among the peasantry to 698 in the towns, nearly the whole of the latter total belonging to the county town and seaport. The epidemic in Sligo town was one of the worst in Ireland. It was reported that forty or fifty were buried in one day in a trench, one-half of them without coffins but wrapped in tarred sailcloth. It is said, also, that seven of the medical men died of cholera in the course of three months[1514]. Thousands of the population, which numbered about 14,000, fled from the town, the wealthier paying large sums for a room or two in a country cottage, the poorer living in tents or sleeping under the hedges. In August the guard of the mail coach which ran from Sligo by way of Strabane to Londonderry was taken with cholera on the road and died at the latter town, no case having occurred in Londonderry up to that time[1515].

The outbreak at Drogheda was as sudden and disastrous as at Sligo. At Belfast also the disease began with enormous fatality, but, according to the table, the deaths eventually were few in proportion to the attacks. The other towns which had highest mortalities were Cork, Limerick, Galway and Kilkenny--all seaports except the last. In Waterford the great outbreak was delayed until 1833.

Many of the counties had more deaths among the peasantry in 1833 than in 1832, Limerick county in particular. The following instance is related of a small hamlet about a mile to the south-east of Armagh:

The hamlet consisted of five or six dwellings on both sides of the road. On the 19th July, 1833, a man in delicate health, who had received a jar of sea-water two days before, and had drunk three or four pints of it, was seized with cramps, and blueness and collapse, after the purging induced by the sea-water; he died on the 20th and was buried on the 21st. His brother, who lived next door under the same roof, was seized with cholera on the evening of the 21st, having attended the funeral, and died comatose after five or six days’ illness. A man who lived across the road, and had also been at the funeral of No. 1, was seized with cholera the same evening (21st), and died in forty-eight hours. On the night of his burial his son aged thirteen and a married daughter who lived in the house were seized, the boy dying the same night “very black,” and the daughter after a lingering illness of five or six days. The only other attacked was a girl, who recovered under treatment by bleeding &c.[1516]

In 1833 the whole number of deaths assigned to cholera in country places was 2,756, while 2,552 deaths were reported from the towns. It appears to be accepted (by Wilde) that true Asiatic cholera lingered in Ireland until 1834, and that it had caused a considerable part of the 4,419 deaths assigned to “cholera” under that year in the Census of 1841. There is one reference to undoubted cases of the Asiatic type in 1834 in Ross, Nenagh and other places in the same district[1517].

Assuming that all the deaths so called in the three years 1832, 1833 and 1834 were true Asiatic cholera, that imported infection accounted for 1 in 5·68 deaths from all causes in Munster, 1 in 5·98 in Leinster, 1 in 9·86 in Connaught and 1 in 15·15 in Ulster. The proportion of attacks to fatalities in eight of the principal towns in the following table varies much, Belfast having comparatively few deaths for all its many cases, and Kilkenny three deaths to about five cases: these differences must have depended upon the number of cases of “cholerine” or diarrhoea which attended the true “spasmodic” or collapse-cholera, and may or may not have been counted in the returns.

Deaths from Asiatic Cholera in Ireland, 1832-33.

1832 1833 No. of Country Town Country Town places with deaths deaths deaths deaths Cholera LEINSTER Carlow -- -- 64 116 vi Dublin 460 187 32 17 xxiv Dublin City -- 5632 -- 166 Kildare 108 72 55 104 xi Kilkenny 91 14 130 29 ix Kilkenny City -- 296 -- 144 King’s 40 288 10 -- v Longford 22 63 -- -- iii Louth 115 189 -- -- viii Meath 61 105 81 113 vii Drogheda Town -- 491 -- -- Queen’s 17 111 16 -- iv Westmeath 18 121 84 5 iv Wexford 126 362 24 150 v Wicklow 8 40 -- 23 iv

MUNSTER Clare 453 281 166 8 xiii Cork 325 1028 466 240 xxxv Cork City -- 1385 -- 234 Kerry 87 440 109 181 viii Limerick 82 4 668 173 xvi Limerick City -- 1105 -- -- Tipperary 198 910 224 208 xii Waterford 52 52 48 79 ix Waterford City -- 24 -- 245

ULSTER Antrim 70 66 -- 75 v Belfast Town -- 418 -- -- Armagh 13 57 2 -- vi Cavan 21 11 70 51 vi Donegal 37 139 141 -- vii Down 110 423 65 37 xiv Fermanagh 4 50 -- 9 iv Londonderry 3 222 -- -- iv Monaghan 64 50 13 43 iv Tyrone 100 193 17 9 ix

CONNAUGHT Galway 141 430 82 -- xii Galway Town -- 596 -- -- Leitrim 1 -- 101 -- vi Mayo 151 325 12 68 xi Roscommon 47 105 38 25 vii Sligo 62 698 25 -- iv

The Cholera of 1832 in England.

The certainty that Asiatic cholera was at Sunderland in November and at Newcastle in December, 1831, led to quarantine of ships arriving in the Thames from the Wear and the Tyne. The early numbers of the ‘Cholera Gazette’ published lists of vessels from these northern coal ports detained at Stangate Creek on the Medway[1518]. At length about the middle of February, 1832, three suspicious cases occurred together in Rotherhithe, one of them being of a man who had been scraping the bottom of a Sunderland vessel. Other cases came close upon these in the parishes on both sides of the Thames from Rotherhithe and Limehouse to Lambeth and Chelsea, especially in the Southwark parishes.

The diagnosis of Asiatic cholera was vehemently contested for several weeks by a section of the profession, who frequented the Westminster Medical Society and had for their organ the ‘London Medical and Surgical Journal.’ The slow progress of the disease at first, and the apparent extinction of it for a week or two at the end of May (as at Glasgow and elsewhere in Scotland in the same weeks) encouraged these doubts, although the 994 fatalities in 1848 cases from 14 February to 15 May were quite unlike any experience of cholera nostras. After the river-side parishes, cases were reported most from other crowded parts, such as St Giles’s in the Fields. From the middle of June the infection became more severe and widely spread, still making the river-side parishes its chief seat, but extending beyond Southwark on one side, and on the north side to such localities as Fetter Lane, Field Lane and parts of the City. From the 15th of June to the 31st October the cases in London were 9142 and the deaths 4266; in November and December only thirty more cases were known, of which one half were fatal. The total for the year in London came to 11,020 cases with 5275 deaths. This was admitted to have been for Asiatic cholera a slight and partial visitation of the metropolis. London with a population of a million and a half had actually fewer deaths than Dublin with its two hundred thousand inhabitants. Paris had more cholera deaths in one week of April (5523 deaths, April 8-14) than London had in all the year.

The Asiatic Cholera of 1831-32 in England.

No. of places Places with highest Deaths attacked mortalities in each county

London 5275 Surrey, part of -- -- Kent 135 xi Minster (Sheerness) 38 Sussex -- -- Hampshire 91 ii Portsmouth 86, Southampton no return Berkshire 52 iv Wantage 27 Middlesex, part of 62 iv Uxbridge 34, Edmonton 11 Buckinghamshire 105 iv Aylesbury 60, Olney 22 Oxfordshire 219 xii Oxford 86, Bicester 64 Northamptonshire -- -- Huntingdonshire 45 iii Fenstanton 21, Ramsey 20, St Ives 4 Bedfordshire 40 ii Bedford 36 Cambridgeshire 208 iv Whittlesea 97, Ely 61, Wisbech 41 Essex 38 iv Barking 18, Chelmsford 10 Suffolk 1 i Woodbridge 1 Norfolk 232 vi Norwich 129, Lynn 49, Denver 27, Yarmouth no return Wiltshire 14 ii Chippenham 9, Farley 5, Salisbury no return Dorset 19 ii Bridport 16, Charmouth 3 Devon 1901 xxvii Plymouth 702, Devonport 228, East Stonehouse 133, Exeter 386 Cornwall 308 xi St Paul 81, Penzance 64 Somerset 142 v Paulton 66, Bath 49, Tiverton 23 Gloucestershire 932 viii Bristol 630, Clifton 64, Gloucester 123, Tewkesbury 76, Upton 34 Herefordshire -- -- Shropshire 158 vii Shrewsbury 75, Oldbury 37, Madeley 27 Staffordshire 1870 xiv Bilston 693, Tipton 281, Sedgley 231, Wolverhampton 193, King’s Winsford 83, Wednesbury 78, Walsall 77, Newcastle-u.-Lyme 60, W. Bromwich 59, Darlaston 57, Stoke 46 Worcestershire 579 xi Dudley 77, Worcester 79, Kidderminster 67, Droitwich 63, Redditch 38 Warwickshire 188 xii Nuneaton 56, Coleshill 32, Birmingham 21 Leicestershire 5 i Castle Donington 5 Rutland -- -- Lincolnshire 80 viii Gainsborough 41, Owston 17 Nottinghamshire 352 vii Nottingham and suburbs 322, Newark 25 Derbyshire 16 i Derby 16 Cheshire 111 vi Northwich 30, Stockport 29, Runcorn 18, Nantwich 14, Chester 14, Brimmington 6 Lancashire 2835 xiv Liverpool 1523, Manchester 706, Salford 216, Warrington 168, Lancaster 114, Wigan 30 West Riding, York 1416 xxvii {Leeds 702, Sheffield 402, Hull 300, East Riding, York 507 iiii { York 185, Wakefield 62, Rotherham North Riding, York 47 ii { 34, Selby 32, Goole 36, Bradford { 30, Whitby 27, Doncaster 26 Durham 850 viii Sunderland 215, Gateshead 148, S. Shields 147, Stockton 126, Jarrow and Hebburn 70, Hetton &c. 97 Northumberland 1394 xiv Newcastle 801, Villages near 259, N. Shields &c. 98, Berwick 84, Tweedmouth 72, Blyth 42 Cumberland 702 vii Carlisle 265, Whitehaven 244, Workington 119, Maryport 42, Cockermouth 25, Allonby 4 Westmoreland 68 i Kendal 68 Monmouth 15 ii Newport 13, Abergavenny 2 South Wales 343 vii Merthyr Tydvil 160, Swansea 152, Haverfordwest 16 North Wales 140 viii Denbigh 47, Carnarvon 30, Flint 18, Newtown 17 Isle of Man 146 i Douglas 146

It will appear from the annexed table (here compiled according to counties for the first time) that the cholera of 1832 visited most parts of England. The dates of outbreak at each place (omitted in the table) show that its great seasons everywhere, except at Sunderland, Newcastle and Musselburgh, were the summer and autumn. New centres or foci of infection were made in all directions, and in a good many small places there were epidemics which produced much alarm although the figures look insignificant in the statistical table. Some counties, such as Leicestershire, Herefordshire, Derbyshire, Northamptonshire, Lincolnshire, Suffolk, Sussex, Dorset, Wiltshire, and several of the Welsh counties, escaped with a few cases at perhaps one village or town. Some towns, such as Birmingham, Cheltenham, Cambridge and Hereford, had only a few cases (or none) in 1832 as in the later epidemics in England. Most of the towns which now head the list of high death-rates by common summer diarrhoea, chiefly infantile (as in the preceding chapter), had only a few imported cases but no real epidemic extension; these were Preston, Blackburn, Bury, Rochdale, Oldham, Bolton, Halifax, Leicester and Coventry; while Bradford, Stockport and Wigan had comparatively few. The greater epidemics, besides those which started the disease at Sunderland and Newcastle, were, in order of time, at Hull and Goole, Liverpool, Manchester, Warrington, Leeds, Sheffield, Nottingham, Bristol, Plymouth, with Devonport and Stonehouse, Southampton, Portsmouth, Exeter, Salisbury, various towns of the Black Country in South Staffordshire, Dudley, Merthyr Tydvil, Carlisle, Whitehaven, with other ports of the Cumberland coal-fields, and Douglas in the Isle of Man. Devonshire, Cornwall, the West Riding of Yorkshire, Worcestershire and Warwickshire had each a large number of minor centres, besides the greater foci at Plymouth and Exeter, and at Leeds and Sheffield. The severity of the disease in some parts of England called forth a few special accounts, from which certain representative details may be taken.

The most disastrous outbreak in all England was at Bilston, in the centre of the Black Country, near Wolverhampton[1519]. The first cases in that part of England were at Dudley early in June, in some travelling German broom-sellers. In the end of June a canal boatman from Manchester died of cholera in his boat four miles from Wolverhampton; the boat was sunk. In the first week of July another canal boatman died of cholera at Tipton, after returning from Liverpool. The infection became established during July in the parish of Tipton, thickly peopled with miners and iron-workers[1520]. At length on the 4th of August a case occurred in the adjoining town of Bilston, about two and a half miles to the south-east of Wolverhampton.

Bilston was a town of 14,492 inhabitants, nearly all of the working class. It was irregularly built on high ground, full of forges and surrounded by mines. Its soil was perfectly dry “from the water having been drawn off for the purpose of getting the mines[1521].” The streets were for the most part wide and open; many houses stood in courts and back yards, but the town was so irregularly built as not to be densely crowded. The Birmingham and Staffordshire Canal passed through the whole length of the township, and there was one small brook traversing the town. The people usually earned good wages, but trade had been depressed since March, 1832. There was a good deal of drunkenness among them, and a peculiar addiction to the sports for which the Black Country is still celebrated, including at that time bull-baiting. The public health was in general good, the deaths having been 23 in May, 31 in June, and 25 in July. The churchyard of the original chapel was full; a new chapel had been built, and a burial-ground consecrated, in 1831. Bilston wake had been held on 29th July, 1832, with the usual orgies notwithstanding the depression of trade. On the night of Friday the 3rd of August a married woman in Temple Street, occupying a poor and filthy house, who had supped heartily on pig’s fry and had drunk freely of small beer, was seized with purging, which turned to fatal spasmodic cholera. Within an hour medical aid was sought for two more cases of the same in poor and filthy houses in Bridge Street and Hall Street, about four hundred yards from each other and from the house in Temple Street. At the back of the latter was a most offensive pigsty, and beyond the pigsty a poor cottage in which lived a widow and four children; cholera attacked them, two of the children dying on the 6th August and another on the 7th. The night of the 9th of August was most oppressively hot. In the week ending the 10th August there had been 150 cases and 36 deaths from cholera. On the 10th the disease appeared in a new quarter to the west, called Wynn’s Fold; the 12th was again an oppressively hot day, followed by rain over-night. On the 14th the disease began its ravages in Etlingshall Lane, at the western end of the township, a mile from the scene of the first outbreak. The attacks in the week ending 17 August had risen to 616 and the deaths to 133. On the 16th it was remarked that the flies had disappeared and the swallows with them; both came back together when the epidemic was declining. Whole families were now being cut off, father, mother and perhaps three children. Mr Leigh, the curate of the parish, went on the 18th to Birmingham to secure a supply of coffins and medical aid, the medical men of the town being worn out (two of them died a few days after). The deaths between the 19th and 26th of August numbered 309. On the latter date a dispensary was opened, after which the proportion of fatalities to attacks became less. On the 18th of September, the last death occurred, and the epidemic was over, having attacked 3568 in a population of 14,492, and destroyed 742, of whom 594 were over ten years of age. The following is the complete bill:

Cholera at Bilston, 1832.

Week Deaths under ending Attacks Death ten years

Aug. 10 150 36 5 17 616 133 23 24 924 298 58 31 832 184 34 Sept. 7 694 62 18 14 250 23 6 21 102 6 4 ---- --- --- 3568 742 148

No fewer than 450 Bilston children under the age of twelve were left orphans by the cholera; for them a national subscription was made to the amount of £8536. 8_s._ 7_d._, and applied to the building and support of a Cholera Orphan School, which was opened on the 3rd of August, 1833, the first anniversary of the outbreak of cholera in the town.

In the adjoining parish of Sedgley, although the deaths were only 290 in a larger population (20,577), the infection was as severe in certain places. “Sometimes a whole hamlet seemed to be smitten all at once, so that, in some of the streets, or rather rows of tenements, there was scarcely a house without one sick, or dying, or dead.” At Tipton, in one family of 14 no fewer than 12 died; and in eight different tenements every inhabitant was swept off. At Dudley one had a narrow escape of being buried alive. In twelve parishes or townships, with a population of 160,000, cholera attacked about 10,000 and cut off about 2000. The effects of the pestilence were all the more terrible from its swiftness, for in each parish it was in full vigour not above a month. The population of miners and iron-workers, a rough set addicted to brutal sports and to drunkenness, could not believe that brandy was not a specific, and made it circulate at funerals to fortify against infection. A reformation of morals and revival of religion is said to have followed the scourge[1522]. The following is the list of chief centres in the Black Country:

Cholera deaths

Bilston 693 Tipton 281 Sedgley 231 Dudley 277 Wolverhampton 193 King’s Winford 83 Wednesbury 78 Walsall 77 Newcastle-under-Lyme 60 West Bromwich 59 Darlaston 57 Stoke-on-Trent 46

Wolverhampton, which was one of the chief Staffordshire centres of the next cholera in 1849, got off somewhat easily in 1832 with 576 attacks (193 deaths), or one in forty of the population.

It was most common and fatal in a lane called Caribee Island, a narrow filthy cul-de-sac with an open stagnant ditch down the middle, inhabited chiefly by poor Irish. The influence of ground soaked with sewage was shown also in the frequency of cases of cholera among persons in easy circumstances in the residential locality of Darlington Street--“a wide airy street consisting of two rows of houses at its upper end, nearest the centre of the town, but of only one at the lower part, where it is a raised causeway, open on one side to the gardens and meadows beyond. The lower rooms of the houses, being below the level of the street, are consequently very damp; and within a few yards of the backs of these houses runs a wide ditch, the main sewer of that side of the town, which is dammed up and diverted into several large cesspools, or receptacles for the mud and filth which it deposits. These, in warm weather, emit such offensive exhalations as to be almost intolerable to the persons who live near them.... It is singular that this was the only part of the town in which persons in easy circumstances took the disease[1523].”

The cholera had reached Liverpool in the end of April (perhaps from Hull and York), and attacked 4912 in a population of 230,000, causing 1523 deaths before the end of autumn. The very large number of cellar-dwellings and back-to-back houses in the town at that time favoured the infection; but Liverpool was on all subsequent occasions one of the worst centres. Two incidents in 1832 are connected with ships.

On 18 May, 1832, the ‘Brutus,’ of 384 tons, sailed from Liverpool for Quebec, with a crew of 19, and 330 emigrants who were pauper families from agricultural districts sent to Canada at the cost of their respective poor-law Unions. The emigrants were ill-provided with bedding and clothes, and the ship was under-provisioned. Two days after sailing, or seven days, or nine days (accounts differing), a case of cholera occurred in an adult, who recovered. Other cases quickly followed, with enormous fatality, until the deaths reached 24 in a day. On the 3rd of June the captain put back for Liverpool, his provisions having run short, and his drugs (laudanum) being exhausted. By the time the ship reached Liverpool there had been 117 cases of cholera (of which four were among the crew) and 81 deaths, seven cases remaining at her arrival, of which two ended fatally, making the deaths 83[1524].

Another Liverpool incident is noteworthy:

“One morning a mate and one or two men, who had gone to bed the preceding evening in good health on a vessel lying in one of the Liverpool docks, were found suffering from cholera. The men were immediately removed to a hospital and the vessel ordered into the river; when another vessel, with a healthy crew took its situation in the dock: the next morning all the hands on board the second vessel fell sick of the cholera. Upon examining the dock in this part, a large sewer was found to empty itself immediately under the spot where these vessels had been placed[1525].”

One of the ablest accounts of the cholera of 1832 was that by Dr Gaulter, of Manchester. The deaths there were 706, and 216 in Salford; but it appeared surprising that, being so many and widely spread, they should not have been many more.

An inspection by the local Board of Health two months before the first case appeared “disclosed in the quarters of the poor--a name that might be almost taken [at that time] as a synonym with that of the working classes--such scenes of filth and crowding and dilapidation, such habits of intemperance and low sensuality, and in some districts such unmitigated want and wretchedness,” that the picture correctly drawn seemed to many a malicious libel. From that picture, “it was certainly to have been expected that nearly the whole mass of the working population would have been swept away by the disease.” There were few good sewers, and it would have required £300,000 to sewer Manchester thoroughly. As it was, the infection progressed slowly from the first case on 17th May until the end of July[1526]. It was the same in Salford, where it “crept about slowly for three or four weeks attacking solitary individuals or single families in streets and situations the most distant and unconnected, and then suddenly fixing itself in the lower and most populous part of the town.” It was in the end of July and beginning of August that the sharp outburst took place in Manchester also. An old soldier well known in the streets as a seller of matches, who “could take a pint of rum without winking,” died of cholera in Allen’s Court. His body was allowed to lie in the house two days and a half. In four houses of Allen’s Court, 17 cases occurred within forty-eight hours, of which 14 were fatal; this court was afterwards known as Cholera Court. In the same few days the infection was most deadly in Back Hart Street, “infamous as a nest of vagabonds and harlots,” and in a street behind it, in which nearly the whole of fourteen attacks ended fatally. Blakely Street, a bad fever locality in the time of Ferriar (supra, p. 150), had the most malignant kind of cholera in its lodging-houses. It was remarked that few of the factory hands took it: of 1520 employed in Birley and Kirk’s mill, only 4 were attacked during the epidemic; more women than men took cholera, and generally those that were employed about dwelling-houses were the victims[1527].

The whole cholera bill at Manchester was as follows:

Progress of the Epidemic.

Attacks

May 4 June 37 July 108 August 650 Sept. 261 Oct. 172 Nov. 33 Dec. 2 Jan. 2

Ages of the patients.

Attacks Deaths

1-15 199 101 15-25 153 53 25-35 264 98 35-45 192 93 45-55 197 116 55-65 120 85 65-80 85 68

Three cholera hospitals were provided in Manchester, at which about one-half of all the cases were received:

Cases Deaths

Swan Street Hospital 443 234 Knott Mill Hospital 242 122 Chorlton on Medlock Hospital 29 17 At their homes 697 335

In Salford all the patients were treated at their homes--644 with 197 deaths; there were also 60 cases among the prisoners in the New Bailey, with 19 deaths.

The Swan Street Hospital was the occasion of a remarkable cholera riot on the 2nd of September. A mob numbering several thousand persons filled the streets near the hospital; in the thick of it was carried a small coffin, from which the headless trunk of a child was taken at intervals and shown to the crowd. The child had died of cholera in the hospital and the body had been examined post mortem. Some rumours of this had gone abroad, the body was exhumed, and was found unaccountably mangled. This was the time when intense feeling had been roused all over the country by the procuring of bodies for anatomical dissection, the prejudice extending to the ordinary pathological inspection also. At Sunderland the holding of two or three necropsies had turned the people against the Cholera Hospital. At Dublin there was a rigid rule that no body was to be examined after death in the great cholera hospital of some 700 beds. The body of the child exhumed at Manchester had been found with the head severed, and the rioters declared that it had been murdered. They broke into the hospital, carried off the patients to their homes, and wrecked the furniture and fittings of the wards. The military was at length called out to clear the streets[1528].

The epidemic of cholera at Bristol reproduced most of the incidents at other places. There had been numerous suspicious cases of choleraic disease in the early summer, including an outbreak in the gaol in the first week of July.

The first unequivocal cases occurred on the 11th July in a filthy court, in strangers from Bath where there was then no cholera. About the same time the infection showed itself at several places apart, especially in the destitute suburb of St Philip, in the south-east of the city. One of the worst centres was the city Poorhouse, in which 268 cases with 94 deaths occurred from the 24th July to the 20th August. The largest number of seizures on one day was 79 on the 17th August, the largest number of deaths 33 on the 15th. After that it gradually declined, and was over by the middle of November. The attacks reported were 1612, the deaths 626; but these figures came short of the truth, as many cases were not reported, and the burials from all causes were in excess of the average for the season after deducting the reported cholera deaths. Although it fell at Bristol, as elsewhere, upon the poorest quarters and the most abandoned or destitute class, yet it showed caprices among these. Marsh Street, the abode of the lower Irish, and one of the most thickly peopled parts of the city, was the last place visited. Lewin’s Mead, a low and crowded quarter, had only a few scattered cases[1529].

Little is known of the great epidemic in Plymouth, Devonport, and East Stonehouse, beyond the gross result that it caused 1063 deaths in the town and the two dockyards[1530]. Of the outbreak at Southampton not even the figures are known, the only important omission, besides the epidemic at Salisbury, in the whole of the cholera of 1832. On the other hand the Exeter cholera has been related at greater length than any[1531].

It was mainly an autumnal outbreak, the largest number of attacks on one day being 89 on the 13th August, and the maximum daily burials 30 a few days before. The total attacks were 1135, the deaths 345; they were chiefly in the south-western suburb of the city, among the poorer class, the two St Mary parishes having 3·65 and 3·26 per cent. of their population attacked, the parish of St George 3·41, St John 2·73, and Trinity 1·54, while two whole parishes had no cases.

Somewhat late in the autumn the infection spread through Cornwall. Its general prevalence was also late in the South Wales mining district (insignificant compared with its enormous ravages there in the next cholera of 1849) and in Carlisle, in Whitehaven and the other seaports of Cumberland. Hartlepool, for all its nearness to the original centre of cholera infection in Sunderland, was one of the last places to be infected, in the autumn of 1832[1532].

The Central Board of Health made no report upon the cholera of 1832, unless a document sent to the king (William IV.) may have consisted of something more than the alphabetical list of infected places, with dates and numbers, which Sir James Clark found some years after in a drawer of the royal library. But some lessons of the epidemic were obvious without the aid of an official report. The late summer and autumn was undoubtedly its chief season--except in places where the poison had, as it were, spent itself in the winter or early spring, such as Sunderland and Musselburgh. A subsidence and seeming extinction of the epidemic in spring and early summer was observed at Glasgow and Edinburgh as well as in London; but it was far otherwise in Paris, where sixteen thousand deaths occurred in the single month of April[1533]. As to locality, the infection seemed to prefer low grounds, such as the shore quarters of seaports and the banks of rivers. The town moor of Sunderland, around which the infection found its first habitat in Britain, appeared to be a typical cholera soil--a wet bottom of tenacious clay, almost impassable in winter from the water standing in it, the surface covered with heaps of excremental and other refuse from the crowded lanes near it. But the greatest centre of cholera in England in 1832, the town of Bilston, seemed to be the reverse of this--a rising ground from which the water had been drained away by the numerous mines of coal, iron and limestone all round it. Again, in towns or villages built upon a slope or on heights and hollows, such as Gateshead, Newburn and Collieston (most of all in Quebec on the steep bank of the St Lawrence), the infection did not confine itself to the lower part only. But it was remarked that among the Tyneside villages several on high ground escaped altogether, although within a mile or two of others severely visited. This question of elevation comes up more definitely in the cholera of 1849.

Another obvious thing in the epidemic of 1832 was that many of the first victims were among the destitute, drunken or reckless class. But there were innumerable exceptions, notably in Paris, where the multitude of victims included several peers, deputies, diplomatic personages and the prime minister.

One of the most striking things in the habits or preferences of cholera in 1832 was the early and unaccountable selection of the inmates of lunatic asylums, the fatuous paupers of workhouses, prisoners, or other immured persons badly housed and ill-fed. In most of these cases it was a mystery how the poison of cholera had got inside the walls. The earliest important instance was that of the Town Hospital or pauper infirmary of Glasgow. Other instances were the lunatic wards of Haslar Hospital, Hanwell asylum, Bethnal Green lunatic asylum, Lancaster county asylum, the Manchester New Bailey, situated in Salford, Coldbath Fields Prison, London, Clerkenwell workhouse (65 deaths), Bristol poorhouse (94 deaths). In the remote Westmoreland village of Hawkshead, thirteen miles from Kendal, cholera appeared unaccountably among the sixteen inmates of the poorhouse, attacking eight of them with sudden and severe symptoms so that four died; it was impossible to trace the introduction of the virus, but the poorhouse was nearly surrounded with stagnant water[1534].

Hardly anything was more keenly debated than the question as to how cholera spread. It was not difficult to find some instances of infection seemingly got from contact with living or dead cholera bodies: cases suggestive of that occurred at Sunderland at the outset, and later in Ireland more especially[1535]. In the Swan Street cholera hospital at Manchester, eight nurses took the infection, of whom four died. But on the whole the immunity of nurses (as in the Great Gorman Lane hospital of Dublin) and of medical men was remarkable. Although constantly in the presence of cholera patients, sometimes lingering over them, as in the operation of blood-letting, very few took the disease. In Manchester only one medical practitioner was known to have had an attack, a mild one. Gaulter says that Dr Alsop, of Birmingham, and Mr Keane, of Warrington, were the only two medical men known to him to have died of cholera in England; but two of the Bilston doctors died in the height of the epidemic there, one died at Musselburgh, seven at Sligo, and two at Enniskillen. The truth of the matter in cholera appeared to be the same as in plague and yellow fever, the two great infections that resembled cholera most closely as soil-poisons: namely, that contagion from the persons of the sick was a contingency, as Rush, of Philadelphia, had taught for yellow fever in the end of last century, and Blane had taught after him. A London writer stated this very fairly in 1832[1536]:

“I believe that this disease, like many other epidemic diseases, although communicable by miasma in the atmosphere, and originating or being producible from a peculiar state of that acting upon the earth, is sometimes contagious (or communicable from person to person) and sometimes not contagious. I believe the contagious nature of the disease depends: first, upon the number accumulated in one place, and the unhealthiness or ill-ventilated state of that place; or, in other words, upon the degree in which the miasma is condensed; secondly, upon the length of time a person remains exposed to the poison; third, upon the debility, or morbid irritability, and consequent susceptibility of the person’s frame, especially of the abdominal viscera.” The miasmata of an apartment, to be strong enough to become contagious, must arrive at a certain degree of concentration.

Cholera was, at all events, very different from typhus fever in the point of contagiousness: for in the epidemics of the latter many medical men fell victims, and the susceptibility to contagion was greater in proportion to the health and vigour of those who mixed with the sick.

It was well understood in 1832 that foul linen, bedding and clothes were a most certain means of carrying the poison, especially if they had been kept concealed for a time, or packed away in a chest or bundle. This was precisely the old experience of plague. The theory that the poison of cholera was conveyed in the drinking-water, of which illustrations were collected in 1849 and 1854, was not applied to any of the particular outbreaks in 1832. But one writer made a guess at it, assuming, as Snow did in 1849 and 1854, that the stomach and bowels were the organs by which the virus entered the system:

“From an attentive observation of the course this epidemic has taken in those places and countries which it has hitherto visited, I have been induced to draw the conclusion that a noxious matter or poison, being generated in the earth, has been diffused in the different springs in such situations [therefore he suggests the filtering of water through charcoal], and that this matter, being conveyed into the stomach with the fluid in question, produces that train of symptoms which, commencing in this organ, afterwards extends with more or less rapidity to the rest of the body[1537].”

In the treatment of cholera in 1832 many things were tried. The view taken of the pathology naturally determined the means of cure. To check the premonitory diarrhoea was seen to be of the first importance, and to that end laudanum or other form of opium was the familiar means. Lawrie, at Glasgow, found it most satisfactory, at a time when the profession in London were, as he says, denouncing it as a pernicious error. Towards the end of the epidemic in Dublin, Graves combined with the opium acetate of lead in large doses (a scruple of acetate of lead with a grain of opium, divided into twelve pills, one to be given every half-hour until the rice-water evacuations from the stomach and bowels began to diminish)[1538]. Some professed to find great benefit from blood-letting at a sufficiently early stage in the attack[1539]. The enormous drain of the fluids, leaving the blood thick or tarry, suggested to some that saline substances would be beneficial. The saline treatment was indeed the principal subject of writing during the year 1832. One way was to give saline drugs by the mouth; another way was to inject into a vein a large quantity of distilled water with some common salt and bicarbonate of soda dissolved in it, the vein at the bend of the elbow being usually chosen to operate on. Some were confident that they had saved lives in this manner, others were equally clear that salines were useless. One writer had abandoned salines by the mouth as a “most useless remedy,” while he had not lost faith in their intravenous injection, four having recovered out of twenty-three in which he had tried it. At length, however, the intravenous use of salines was abandoned also[1540].

It is well known that the greatest of all the lessons taught by cholera was the need of sanitary reform. The disease in its successive visitations so obviously sought out the spots of ground most befouled with excremental and other filth as to bring home to everyone the dangers of the casual disposal of town refuse. It was not until some years after the first visit of cholera that much was done in the way of extending the main drainage of towns, connecting the house-drainage systematically therewith, getting rid of open nuisances in back yards, and protecting the water-supplies from contamination. The Report of the Health of Towns Commission, 1844, was “the great magazine from which sanitary reformers drew their weapons[1541].” In the next few years an active school of sanitarians arose, including Sutherland of Liverpool, Grainger of London, and others. In 1848 was passed the first Public Health Act, administered by a Board of Health, of which Lord Shaftesbury was chairman, Chadwick and Southwood Smith members. London was excepted from the scope of the Act; but the City had a most vigorous medical officer in the person of John Simon, whose reports dealt with public sanitation on broad principles applicable to the capital and the whole kingdom. The movement in favour of sanitation, thus begun, received an irresistible impulse from the cholera of 1849, the lessons of which were as obvious as those of 1832.

The cholera which reached Orenburg in 1829 and Astrakhan in 1830 lingered in one part of Europe or another until 1837, Portugal and Spain having been its chief theatre in 1833, the south of France in 1834, Italy in 1835 and 1836, Austria, the Tyrol, Bavaria and (for the second time) Poland and the Baltic ports in 1837. In England, there was some revival of the seeds of it in 1833, as many as 1454 deaths being put down to Asiatic cholera in London from the 1st of August to the 7th of September. There was an undoubted epidemic of it at the fishing village of Ferryden, near Montrose, in June, 1833 (27 deaths during four weeks in a population of 700), the infection having been brought by one or more of the crew of the smack ‘Eagle’ from the Thames[1542]. In Glasgow a case occurred in Boar Head Close, High Street, on 30 May, 1833, which had the blueness, pinched face, whispering voice and cold clammy skin of Asiatic cholera[1543]. In Ireland there were a good many outbreaks in 1833, especially in villages or hamlets, and it is believed that these were renewed in 1834. But the most singular reappearance of cholera in the British Isles was in the month of December, 1837, some two months after it is believed to have ceased elsewhere in Europe. Outbreaks of true cholera in that month were observed at several places in the south of Ireland-around Bere Haven[1544], at Youghal, at Waterford, and at Dungarvan, where they went so far as to form a board of health[1545]. It was suspected to have been in Limehouse, on the Thames, in November. The most remarkable explosion of it was in the month of January following (1838) among the inmates of the Coventry House of Industry, of whom no fewer than 55 died in the course of four weeks--a mortality from choleraic disease that could hardly be explained on the hypothesis of cholera nostras even if the season had been the proper one[1546].

The Cholera of 1848-49 in Scotland.

The invasion of cholera from India, which reached Britain in the autumn of 1848, had progressed as far as Peshawur and Cabul from 1842 to 1844, and thereafter step by step continuously through Herat, Samarkand, Bokhara, Astrabad and Teheran by the caravan routes. In the beginning of 1847 it entered Russia by the two great interior waterways of the Volga and the Don. Next year, 1848, it reached the German shores of the Baltic and North Seas, and within a few weeks of its appearance at Hamburg, it was found established on British soil at Edinburgh and Leith in the beginning of October. The severe outburst which followed in the south of Scotland was purely a winter epidemic, like that of Durham, Northumberland and East Lothian on the last occasion in the winter of 1831-32. It will not be necessary to give the details of the cholera of 1848-49 so fully as has been done for 1831-32, but merely to notice special points.

The cholera of 1848 broke out almost simultaneously at Newhaven and Edinburgh, on the 1st and 2nd of October, and at Leith on the 9th. At Newhaven nearly the whole population was suffering from diarrhoea, in the midst of which epidemic the true cholera raged for four weeks only, to the 28th October, attacking 30, of whom 20 died. In Leith the deaths were 185 (males 75, females 110). The Edinburgh outbreak lasted until the 18th of January, 1849, causing 801 attacks, with 448 deaths (or 478 deaths, of which 196 were males and 282 females). A cholera hospital was opened in Surgeons’ Square on the 28th of October, the admissions and fatalities to 14th December being as follows:

Females Males Total

Admitted 152 96 248 Died 90 64 154

Of the whole 248 cases, the Grassmarket sent 42, the Cowgate 37, the Canongate 33, College Wynd 16, High Street 14, and numerous scattered localities of the New and Old towns one or more cases each. Severe outbreaks took place also at Niddry, Restalrig and Loanhead, villages close to Edinburgh[1547]. While this limited epidemic was proceeding in and around the capital, the infection appeared in the mining region of Carron at the head of the Firth of Forth, where there were some 400 cases after the 6th of December, and in some other mining villages of the Scotch midlands.

Glasgow was infected on the night of the 11th November, in the suburban district of Springburn, on the north-west of the city close to the Forth and Clyde Canal. The choice of this spot to begin upon was intelligible enough in one way, but singular in another. Springburn had come into existence as a poor village of weavers about the year 1820; before the cholera year of 1832 it had grown to a population of 600, and was thought a likely spot for cholera inasmuch as it was one of the most wretched communities in Scotland. It occupied the site of a half-drained bog below the level of the canal, from which the water percolated into its subsoil; its houses were low, always damp, and full of filth. During all the cholera in Glasgow in 1832 there had not been a case in Springburn until the 6th of September, when a girl of the village came home with it and died; during her brief illness she was visited by the greater part of the villagers, but no other case occurred until six weeks after, on the 15th of October[1548]. At this spot, where the cholera of 1832 may be said to have left off, it began in 1848 with a sudden explosion of numerous attacks scattered all over the locality; a doctor attended twenty-one cases before he found two together in the same house or even in the same lane. There had been forty cases there in November, before any case was discovered in Glasgow; at length it seemed to spread from Springburn all round as if from a centre, while it also lingered there longer than anywhere else in the city and suburbs[1549]. On the 5th of December a case was reported on the south bank of the Clyde, and another on the 9th in the west end. Within a few days the disease fell upon all parts of the city with the suddenness of a thunder shower; it reached a height in the Christmas week, one day, the 30th December, having 158 burials from cholera. After the orgies of the New Year there was a fresh outburst, 235 cases having been reported on the 5th of January. The proportion of fatalities was as high as 60 per cent. at the beginning of the epidemic, 50 per cent. about Christmas and the New Year, and thereafter from 30 to 40 per cent. The epidemic was short and sharp, declining irregularly after the first or second week of January, and ceasing, but for a few dropping cases, about the 8th of March.

The deaths in Glasgow, which included many among the wealthier class and made the festival season of 1848-49 to be long remembered, were about 3800, or 1·06 per cent. of the population (355,800), a higher total but a lower ratio than in 1832, when the deaths, distributed over many more weeks of the year and largely due to two revivals in August and October, were 1·4 per cent. of the population. At Paisley there were 68 deaths from 26 December to 24 February, and at Charlestown 115 deaths all in some five weeks from 15 January to 19 February.

It was in the same season of midwinter that the cholera burst suddenly upon many mining villages of Lanarkshire and Ayrshire.

In that unlikely season there was an almost universal prevalence of diarrhoea. At the mining village of Carnbroe, near Coatbridge, there were five sudden attacks on the last night of the old year, one of them fatal. On New Year’s day there were forty attacks, thirteen of them fatal in a few hours. Terror seized the whole place: one man cut his throat in sheer fright. Diarrhoea attacked 1100 of the 1200 inhabitants, and turned to spasmodic or rice-water cholera in 240 of them, of whom 94 died, the rate of fatality being excessive only in the first few days. By the end of February the epidemic was over.

In the town of Coatbridge, with a population of 4000, the various grades of sickness were classified as follows:

Vomiting, purging and Rice-water Deaths by Diarrhoea cramp purging Cholera Cholera

2659 480 175 107 61

In the town of Hamilton, population 9000, the infection was most malignant, 440 cases yielding 251 deaths from the 24th of December to the 7th of March. The same ravages of winter cholera occurred at some of the Ayrshire ironworks, such as Glengarnock, among a very rough and drunken class, who were made more than ordinarily reckless and drunken by this unaccountable visitation. It was also severe in Riccarton and other mining villages round Kilmarnock, but less prevalent in that town itself. Dumfries and Maxwelltown, which had been among the last places visited by the cholera of 1832, were infected in the middle of November, 1848, about the same time as Springburn near Glasgow. One of the Dumfries doctors died of rapid cholera on the 10th December, the parochial board fell into disputes with the faculty, and the infection proceeded amidst great confusion in the poorest parts of the town, causing about 250 deaths before Christmas. After that it subsided quickly[1550].

The other centres in the south of Scotland were Selkirk (13 deaths), Kelso (Dec. to end of Jan., maximum of 12 attacks in a day) and Jedburgh, which last had escaped in 1832 but had now a very rapid and extensive epidemic in its lower parts among drunken people especially. A few cases occurred at Moffat, in December; a man who was seized in crossing the hills died in a shepherd’s hut eight miles from Moffat after twenty-one hours illness[1551].

The only recorded epidemic in the north of Scotland in the proper cholera season, the summer of 1849, was at Dundee. But there was a small outbreak in March and April at Campbelton (41 cases, 14 deaths) and Inverness (23 cases, 12 deaths)[1552].

The infection began in Dundee on the 29th of May, 1849, in Fish Street, the filthiest part of the town. It prevailed in high and low situations, but usually in the old localities of typhus fever. One group of houses, said to have had a population of 100, had 40 deaths. Dudhope Crescent, consisting of seventeen large five-storied tenement houses occupied by clean and respectable people, had 57 deaths. In about a fourth part of all the fatalities, death was from sudden collapse; this was a feature of the 1849 cholera also in Ireland; but in Dundee, as elsewhere, there was usually premonitory diarrhoea, and a very general prevalence of diarrhoea which never came to true cholera[1553].

The Cholera of 1849 in Ireland.

The cholera of 1849 found Ireland in a state of exhaustion and confusion. The fever and dysentery that followed the great potato famines of 1845 and 1846 were still far from extinct; the workhouses, which had not existed in 1832, were full of paupers. The mortality of nearly half a million in the famine years, and the emigration of perhaps three times as many, had reduced greatly the population of the scattered cabins, hamlets and villages; but the towns were more populous than ever from the immense number of destitute persons that had gravitated to them. In these circumstances it was not surprising that the cholera of 1849 should have been more disastrous than that of 1832. The infection appeared first in Belfast in November, 1848, in a man who had come with his family from Edinburgh and had been admitted into the workhouse. Some thirty cases of cholera among the inmates followed his death, and at length the infection was started at large in the town, probably by a man who had been discharged from the workhouse[1554]. The cholera of 1849 in the capital of Ulster was more fatal than that of 1832, causing 969 deaths in 2705 attacks. Over Ireland generally its great season appears to have been, as in England, the summer, and in part also the spring. Excepting Belfast, the principal cities and towns had fewer deaths than in 1832; Dublin having only 1664 as compared with 5632, Cork 1329, or nearly the same number as in 1832, Limerick 746, which was about a fourth less, Galway less, Waterford about the same as in 1832 and 1833 together, and Drogheda as severe an epidemic as last time. But the smaller towns and the rural districts generally suffered more. The deaths for all Ireland returned to the Board of Health were 19,325, nearly the same total as in 1832; but there were no returns included from Wicklow, Cavan, Fermanagh and Donegal, and it is probable that the returns were otherwise incomplete, the census taken in 1851 giving 30,156 cholera deaths under the year 1849, and 35,989 in the whole decennial period from 1841. The larger total was distributed as follows:

Urban Rural In hospitals In workhouses

10,653 10,656 7964 6716

The number of rural deaths is much larger than in 1832. There were only a few towns with over 2000 inhabitants that escaped--one in Connaught, six in Munster, one out of forty-one in Leinster, while seventeen towns were visited in Ulster. The counties of Dublin, Carlow, Clare and Galway suffered most; of the smaller towns, Tralee and Dingle lost heavily, both among the poor and the rich. The town of Ballinasloe, near the confluence of the Suck with the Shannon, had 756 deaths from 23 April to 19 August, a great part of them in the workhouse. In clinical characters, the cholera of 1849 was noted in Ireland, as in Scotland and England, for the high proportion of sudden fatalities, about one-third, without the warnings of diarrhoea or the usual choleraic symptoms. It was remarked also that many children under the age of seven died of cholera, about one in ten of all ages. There was a second season in 1850, with 1768 deaths (according to the census), but hardly comparable to the return of cholera in 1833 in the country districts more particularly.

The Cholera of 1849 in England.

The brief but very severe epidemic of cholera in the south of Scotland in midwinter was all over and done with for good before the disease really began in England. Hull, which had a few cases on board ship in the end of 1848, about the same time as the infection began to rage in Edinburgh and Leith, was spared its great visitation, the greatest in all England, until the late summer and autumn[1555]. The progress of the infection in London also was strangely different from that in Scotland. There were undoubted cases in Bethnal Green and other out-parishes in the autumn of 1848, and there seemed no reason why the infection should not run through the population and exhaust itself at once, as in Glasgow. But it will appear from the following table of the deaths in London that the real outburst was delayed until the summer and autumn of 1849:

Cholera deaths

1848 Sept. 11 Oct. 122 Nov. 215 Dec. 131

1849 Jan. 262 Feb. 181 March 73 April 9 May 13 June 246 July 1952 Aug. 4251 Sept. 6644 Oct. 464 Nov. 27

Although a certain number of deaths were returned in October and November, 1848, they came in twos or threes from many parishes of the metropolis and made no great impression upon any one locality. It was not until the beginning of December that the presence of cholera was fully realized, owing to an extraordinary explosion of the disease in a huge pauper institution at Tooting. The school contained about a thousand children, of whom some three hundred took Asiatic cholera, with one hundred and eighty deaths, in the course of three or four weeks: this was the whole cholera mortality that the parish of Streatham had from first to last. In the spring months the cases declined all over London in a very remarkable way, so that it looked for a time as if the infection were extinct, just as in 1832. But in June there was a revival, and thereafter a steady increase to the maximum of 6644 deaths in September. The table given under the year 1866 shows upon what parishes the mortality fell most--those of Southwark, Bermondsey, Rotherhithe, Greenwich, Newington, Lambeth and Battersea on the south side, of Westminster, the City and Liberties, Shoreditch, Bethnal Green and Whitechapel on the north side of the Thames. It was a more severe visitation per head of the inhabitants than that of 1832, cutting off many beyond the limits of the destitute and reckless class who were its most usual victims on the first occasion. Many of the respectable class of workmen and small shopkeepers were among the victims. Several medical men died of it, including one well-known surgeon, Mr Aston Key, at his house in St Helen’s Place, Bishopsgate, on 23 August, after a few hours’ illness. As in Ireland, and at Dundee, an unusually large proportion of the London deaths, perhaps a fourth part, were from sudden collapse and blueness, without premonitory diarrhoea or predominant intestinal symptoms. Opinion was strongly against contagiousness in this epidemic. There were 478 cases treated in St Bartholomew’s Hospital, but not one of the nurses took cholera.

The infection seemed to find out the insanitary spots and to act miasmatically upon the residents. The common remark in all parts of England, Scotland and Ireland was that the localities that suffered most from the typhus fever of 1847-48 suffered most also from cholera. The one black spot in Kensington was a poor district on the north side of the parish known as the Potteries, where an immense number of pigs were kept.

One of the most remarkable features of the cholera-seasons of 1848-49 was the extensive prevalence of common bowel-complaints. Evidence of this has been given for the south of Scotland just before or during the cholera of midwinter, a season when diarrhoea is not usual. It was equally remarked in England in the course of 1849. In the Taunton workhouse, where true Asiatic cholera broke out in November, there had been many cases of bowel-complaint, as well as of fever, in the spring (7 deaths from dysentery and diarrhoea, 5 from fever). In the Exeter workhouse there were eighteen deaths from dysentery in the end of the year, although there is nothing said of cholera, which caused only 44 deaths in the whole city. The efforts of the inspectors sent by the Board of Health were in great part directed to finding out the cases of “premonitory” diarrhoea, by house-to-house visitation, and insisting upon the importance of checking it before it could turn to true cholera. Leeds will serve as an example of English towns. In an incomplete survey after the month of July there were found 5129 cases of simple diarrhoea, 1484 cases of dysentery, 1273 cases of choleraic diarrhoea, and 1090 cases of true cholera[1556]. It was something of a paradox that, with such excessive prevalence of ordinary bowel-complaints, an unusual proportion of the cases of true cholera proved quickly fatal with symptoms of collapse and asphyxia only.

Just as the first startling indication of the presence of Asiatic cholera in London was the enormous fatality in the pauper school at Tooting in the winter, so in some other towns the infection seemed to pick out workhouses or prisons to begin upon. At Belfast there were forty cases in the workhouse before there was one in the town. At Liverpool there were 28 cholera deaths in the first quarter of 1849, of which 8 were in the workhouse. At Wakefield, 19 died of cholera in January, 16 of these in the House of Correction. Among the people at large the infection made little progress until the summer. In the first and second quarters of the year it is heard of, but to a moderate extent, in the towns and colliery districts of Durham and Northumberland, which were the scene of its earliest outbreak in the winter of 1831-32. It was also beginning in the poorest and filthiest parts of Liverpool, Bristol and Plymouth. Its great season all over England was July, August and September, the incidence of the disease according to counties being shown in the table. The right-hand column, showing the number of deaths at the principal centres in each county, must serve for a conspectus of the epidemic.

Cholera Mortality in England and Wales in 1849.

Death-rate per 1000 Deaths inhab. Principal centres in each county

England and Wales 53293 3·0 London 14137 6·2 Lambeth 1618, Newington 907, Bermondsey 734, Southwark 1704 Surrey, part of 255 1·3 Kent, part of 1208 2·5 Gravesend, Milton, Rochester, Chatham, Margate, Ramsgate, Maidstone Sussex 346 1·1 Hastings Hampshire 1245 3·2 Portsmouth 568, Southampton 240 Berkshire 148 ·8 Middlesex 406 2·7 Edmonton, Barnet Hertfordshire 323 1·9 Hitchin 127, Hertford 81, Watford 45 Buckinghamshire 175 1·2 Marlow, Wycombe 100 Oxfordshire 117 ·7 Oxford 44, Witney 33 Northamptonshire 141 ·7 Northampton 49, Peterborough 49 Huntingdonshire 14 ·2 Bedfordshire 72 ·6 Bedford 37, Biggleswade 28 Cambridgeshire 269 1·4 Wisbech 138, North Witchford 85 Essex 580 1·7 West Ham 134, Romford 163, Rochford 105, Harwich Suffolk 79 ·2 Ipswich 18, Mutford 27 Norfolk 223 ·5 Yarmouth 87, Norwich 38 Wiltshire 320 1·3 Salisbury 165, Devizes 67 Dorset 122 ·7 Weymouth 59, Poole 31 Devon 2366 4·2 Plymouth 830, Stonehouse 171, Stoke Damerel 721, Plympton St Mary 151, Tavistock 140, Totnes 107 Cornwall 835 2·4 St Germans 236, Liskeard 132, St Austell 135, Redruth 133 Somerset 923 2 Bridgewater 235, Keynsham 77, Bath 90, Bedminster 281 Gloucestershire 1465 3·5 Bristol 591, Tewkesbury 59, Gloucester 119, Clifton 563, Dursley 58 Herefordshire 1 ·01 Shropshire 316 1·3 Bridgnorth 75, Shrewsbury 116 Staffordshire 2672 4·4 Newcastle-under-Lyme 241, Wolverhampton (incl. Bilston, Tipton, Sedgley) 1365, Stoke 103, W. Bromwich 250, Dudley 412, Walsall 186 Worcestershire 432 1·7 Stourbridge 314 Warwickshire 293 ·6 Coventry 202, Birmingham 29, Warwick 20 Leicestershire 8 ·08 Loughborough 7, Leicester 2 Rutlandshire 7 ·4 Lincolnshire 372 ·9 Gainsborough 246, Boston 35, Grimsby 29 Nottinghamshire 137 ·5 East Retford 21, Basford 42, Nottingham 18 Derbyshire 50 ·06 Derby 18 Cheshire 653 1·6 Nantwich 181, Runcorn 82, Stockport 72, Birkenhead 139 Lancashire 8184 4·1 Liverpool and W. Derby 5308, Wigan 503, Manchester 878, Chorlton 280, Salford 237 West Riding 4151 3·2 Huddersfield 52, Bradford 426, Hunslet 884, Dewsbury 224, Wakefield 241, Pontefract &c. 238, Leeds 1439 East Riding 2140 8·7 Hull and Sculcoates 1834, York 174, Pocklington 37, Howden 58 North Riding 47 ·2 Whitby 10 Durham 1642 4·2 Darlington 4, Stockton 248, Durham 192, Hartlepool, Chester-le-Street 134, Sunderland 363, Gateshead 257, S. Shields 201 Northumberland 1417 4·8 Newcastle 295, Tynemouth 815, Alnwick 142 Cumberland 419 2·2 Carlisle 51, Cockermouth 282, Whitehaven 79 Westmoreland 1 ·02 Monmouth 775 4·1 Newport 246, Pontypool 69, Abergavenny 438 S. Wales 3544 6·1 Merthyr Tydvil 1682, Cardiff 396, Neath 738, Llanelly 45, Swansea 262, Carmarthen 142, Crickhowell 95 N. Wales 245 ·6 Holywell 86, Montgomery 37, Carnarvon 21

The highest rates in the table are for the East Riding, owing to Hull (24·1), for South Wales, owing to Merthyr Tydvil (23·4), for Northumberland and Durham, for Staffordshire, owing to the iron district round Wolverhampton, for Devonshire, owing to Plymouth, for Lancashire, owing to Liverpool, and for Monmouth, owing to a few mining places. The miners suffered most, the lower class in the seaports next most severely. The Black Country in the south of Staffordshire, which had been the worst centre of the 1832 cholera, was again one of its chief centres in 1849, the mortality falling most, as before, upon the town of Bilston, and next to it upon Willenhall and Wolverhampton. But a great rival to the Staffordshire coal and iron mining had sprung up since 1832 in Glamorgan; and it was in this comparatively new region of miners that cholera in 1849 reproduced the Black Country horrors of 1832 and, indeed, surpassed them.

Merthyr Tydvil had sprung up more like a vast miners’ camp than like a well-ordered municipality. Along the eastern side of the Taff valley, on the slopes and in bottoms of the hills, but everywhere at an elevation of some four or five hundred feet above the level of Cardiff docks, were numerous groups of mean-looking miners’ cottages, with their attendant ale-houses, small retail shops, schools and meeting-houses. This peculiar township had drawn to itself the special notice of the Health of Towns Commission in 1844: “From the poorer inhabitants (who constitute the mass of the population) throwing all slops and refuse into the nearest open gutter before their houses, from the impeded course of such channels, and the scarcity of privies, some parts of the town are complete networks of filth emitting noxious exhalations.... During the rapid increase of the town no attention seems to have been paid to its drainage.”

In this district the registrar had returned 162 deaths from “cholera” in the year 1841, which must have been from an unusually severe type of cholera nostras or British cholera. A first case of Asiatic cholera occurred at Cardiff in a sailor on the 13th of May, 1849, a week after there was a case at Lower Merthyr, and a week after that another at Upper Merthyr. In the course of the summer the ravages of the disease were enormous in the hilly mining regions of the interior of Glamorgan and Monmouth, as well as severe in the seaports:

Merthyr Tydvil 1682 Cardiff 396 Neath 738 Swansea 262 Abergavenny district 438 Pontypool 69 Newport 246

The peculiar selection of the mining townships was well shown in the district of Abergavenny: of 378 deaths from cholera in the third quarter of 1849, only 9 occurred in Abergavenny town, while 157 were at the iron-works of Tredegar and 210 at those of Aberystruth, just as, in the winter preceding, the villages of the iron-works all round Kilmarnock had been ravaged by cholera while there was little of it in that town itself.

Another chief centre of cholera in 1849 was the port of Hull. Including the district of Sculcoates, it had the following enormous mortalities from cholera in four weeks of September: 398, 507, 524 and 171, the whole epidemic from July to the 18th of October producing 2534 deaths[1557]. Its neglect of scavenging became a classical instance of the favouring conditions of cholera. An open space at Witham called the “muckgarths,” from the refuse deposited upon it, was one of the worst centres, just as the town moor of Sunderland, used for the same purpose, had been in 1831[1558]. In the other ports, Liverpool, with West Derby, Bristol with Clifton, and Plymouth with East Stonehouse and Devonport, the infection was most severe (see Table), and was observed to choose the poorest streets, lanes and houses, where there had been most typhus for a year or two before[1559]. On the Tyne, the greatest centre on this occasion was not Newcastle, but Tynemouth. The city of Durham, which escaped the cholera of 1832, had a severe visitation. The chief inland centres, besides the mining districts of Staffordshire and Glamorgan, were Manchester and the cloth-making towns of Airedale,--Leeds, Hunslet, Bradford, Dewsbury, and some others in the West Riding. Most of the Lancashire towns occupied with the cotton industry again escaped with little cholera--Preston, Clitheroe, Oldham, Bury, Rochdale, Bolton, Blackburn, Ashton and Chorley. Wigan had nearly twenty times as many deaths as in 1832; on the other hand Sheffield had only a quarter of its former cholera mortality, while Nottingham and Norwich had this time very little. Birmingham, Leicester, Cheltenham, Hereford, Stafford, Ipswich, Cambridge and Colchester were again almost or altogether free from infection. The agricultural counties, notably the Eastern counties, escaped once more with few centres of infection, and these unimportant. Cumberland as a whole had fewer deaths than in 1832, while Cockermouth had more. Exeter, which was severely visited on the former occasion, escaped almost wholly, while Totnes and Tavistock, with the surrounding Dartmoor country and other towns in Devon, had epidemics of the first degree for their size. In England as a whole the cholera of 1849 was more severe relatively to the numbers living than that of 1832, its great centres having been the same, or of the same kind, on both occasions[1560].

The cholera of 1849 reproduced very closely the former characteristics. The attacks were often in the night, especially in persons who had supped heartily on the coarser kinds of savoury meat. With the same undoubted preference for the poorer and more filthy quarters of towns, the infection showed also a certain apparent caprice in fixing on some places and avoiding others.

Thus at Leeds it was most malignant in the locality of York Street and Marsh Lane (an old centre of plague and typhus), which had lately been drained at a cost of some thousands of pounds, “whilst in the adjoining district, which lies nearly level with the river, and will scarcely admit of any sewerage, I have not heard,” writes the registrar, “of a single case of cholera”--an experience similar to that of a low-lying district of Bristol in 1832. At Liverpool, where much had been undertaken for sanitation since the disastrous Irish fever of 1847-48, the cholera appeared to Dr Duncan, the medical officer of health, to attack sewered and unsewered streets impartially. Another singular thing, which used to be noticed in the plague and is observed in the malarial fevers of towns abroad, was the choice of one side of a street only: thus, at Rotherhithe, in a street where numerous deaths occurred, they were nearly all one side of the street, in houses occupied by respectable private families, only one house having been infected on the other side; at Bedford, two streets showed the same thing.

In London, the least elevated parishes on both sides of the Thames were again its chief seats. Dr Farr, the superintendent of statistics, deduced the law that the death-rate from cholera in London was inversely as the altitude of the parish, and he showed, by a somewhat rough grouping of the cholera deaths, that the law applied to all England[1561]. An empirical generality such as that may have some value; but it is the exceptions to it that show the inward meaning of the fact.

Merthyr Tydvil, which was the worst cholera-spot in England with the possible exception of Hull, was five hundred feet above the level of Cardiff, its seaport, where the death-rate was much lower. Neath, also, had much more cholera than Swansea. Newcastle-under-Lyme, situated near the source of the Trent, and the highest town in the course of that river, had a far more severe visitation of cholera than any other town upon it all the way to its mouth. At Tavistock among the Dartmoor hills, cholera “sat for many a week,” as Kingsley says, “amid the dull brown haze, and sunburnt bents and dried-up watercourses, of white dusty granite.” But the poorer and more populous part of Tavistock was a somewhat peculiarly shut-in basin, which was “very often involved in fog during the night.” The town had escaped cholera in 1832, but one of its physicians, writing in 1841, and recalling its dreadful plague of 1626, did not feel sure that it would escape if cholera came back[1562]. Again, one thinks of Salisbury as standing among high downs; but it had a wet subsoil, bad sewerage, and bad water supply, and in 1849 it had 200 deaths from cholera among all classes in two months[1563].

In the not very extensive outbreak at Sheffield, one of its chosen seats was an elevated district called the Park, inhabited by colliers. At Bedlington colliery, near Morpeth, the cholera deaths in November were in the miners’ houses on the hill side. The elevated, airy and clean village of Loanhead, near Edinburgh, had 46 deaths in its population of 1200, during a few weeks of midwinter. In Dundee, built upon a steep slope at the waterside, there were bad centres of cholera in the higher parts as well as in the lower.

The determining thing appears to have been not so much the elevation as the configuration of the ground; any basin, or cup, or shelving terrace, any natural collecting-ground of moisture and organic refuse in the soil, may become a seat of cholera, whether it be at the sea-level or several hundred feet above it, provided it have a sufficient number of human occupants and a mode of drainage inadequate to its peculiar needs. Such was the situation of Merthyr Tydvil, of Neath, of Newcastle-under-Lyme, of Tavistock, of some colliery villages, and of certain localities in towns such as Dundee. Such, of course, was also the situation of the London parishes next the river on the south and east, of Hull, of Plymouth, of Liverpool, and of other seaports on estuaries. Neither altitude nor configuration means anything for cholera unless the ground itself be full of rotting filth. In all England and Scotland the cholera chose, as if by an unerring instinct, those not very extensive mining parts of the counties of Stafford, Glamorgan, Durham, Lanark and Ayr, which had as many hundreds of inhabitants to the square mile, and as little provision for the safe disposal of their excrements, as those village communities of Lower Bengal in which the infection had become established since 1817 as if it were an annual product of the soil.

The Report of the Board of Health brought to light many instances in which it seemed probable that cholera had been favoured, if not induced, by the water of wells contaminated with organic filth soaking through the ground or entering with the surface water. This was especially the case at Merthyr Tydvil. It was during the next cholera, that of 1854, that the question of contaminated water came into great prominence, in connexion both with wells and with the vast volumes of water supplied through the mains of water companies.

The Cholera of 1853 at Newcastle and Gateshead.

The third visitation of Great Britain and Ireland by Asiatic Cholera was in 1853-54. There had been none of it in any part of the kingdom since 1850; but it is not so clear that all other European countries, especially Poland, were equally free from it. Whether due to a new approach from Asia, or to a rekindling of smouldering fires, cholera appeared in the Baltic ports in the summer of 1853, and soon after reached the Tyne. For the third time a severe but localized epidemic was the prelude--this time at Newcastle and Gateshead, just as in 1848 at Edinburgh, Glasgow and the south of Scotland, and in 1831 at Sunderland and Newcastle.

In the cholera of 1849, which was the most general and the most severe visitation that England has had, Newcastle escaped with a light visitation and Gateshead with a moderate or average one, while Tynemouth (with North Shields) had about twice as many deaths as Newcastle and Gateshead together (12·9 deaths per 1000 inhabitants). In 1853 it was the turn of Newcastle--for no better reason, perhaps, than its escape last time. The very thorough and masterly inquiry by Messrs Simon, Bateman and Hume did, indeed, reveal a most unwholesome state of things; but the town was no worse or only a little worse than in 1849, when the cholera had dealt lightly with it, and it was probably an average sample of the insanitary condition of the greater English industrial towns in the time of their rapid growth and before the period of well-ordered local government had arrived. In some parts, such as Sandgate, the dwellings of the labouring class were “not fit to live in”; in the newer mean suburbs, it was found, as in Glasgow twenty years before, that cellars had become the dwelling-places of a class who in former times lived above ground. Those who had been dispossessed by the railways and other public structures had not been provided for elsewhere; so that, with more trade and better wages, the working class were worse housed than before. Overcrowding, for which the ports on the Tyne and Wear are still pre-eminent, was then most excessive. Only the better-class houses had the water laid on. Excremental offences to sight and smell were everywhere. There was a system of main sewers, passably good; but house-drainage or connexions with the main drains were quite casual. The scavenging of the town was greatly neglected. Piggeries, slaughter-houses and other such nuisances, were uncontrolled. The burial-grounds were over-full. With all this the death-rate of Newcastle could be low enough in a good year, such as 1844, when it was 20·9 per 1000; in the year of the Irish fever, 1847, it rose to 32·8; and in other years it fluctuated between those extremes, according to the nature of the seasons[1564].

The cholera of 1853 was a sudden explosion in the heavy stagnant atmosphere of the month of September. No one knew where the infection came from; there were, of course, ships arriving from the Baltic, but no particular source was ever traced. On the 30th or 31st of August, a case occurred of the rapidly fatal kind; before a week there were about a hundred attacks daily all over the town. From the 13th of September the deaths in Newcastle mounted up rapidly as follows:

Cholera deaths

Sept. 13 59 14 90 15 106 16 114 17 103 18 103 19 111 20 85 21 68 22 82 23 60 24 56

In the thirty days of September there were 1371 deaths, and some one or two hundreds more in the first part of October, when the infection ceased almost abruptly, the total of deaths to the 4th of November having been 1533. During the same time Gateshead with a population of 26,000, had 433 deaths, or in a ratio nearly equal to that of Newcastle. On the other hand Tynemouth, with a population of 30,000, had only twelve deaths, several of them in vagrants or other arrivals from Newcastle, the rest in a cluster of pitmen’s cottages on the outskirts of North Shields.

It was freely rumoured at the time, and was even repeated with much unction in so dry and deliberate a work as the report of the Registrar-General, that the cholera at Newcastle and Gateshead in September, 1853, was owing to the sudden contamination of the town’s water with sewage. The facts about the water-supply are as follows: Previous to 1848, Newcastle was supplied with Tyne water pumped up at Elswick, and passed through the settling tanks and filtering beds. In 1848 the Whittle Dean Water Company, incorporated in 1845, had their new supply ready, and the old company, with its pumping station at Elswick, was superseded. The new supply was collected from landward sources, and was apt to be peaty. There was a great demand upon it, especially for public works (it was supplied to comparatively few houses), so that the distribution in 1853 had increased 2½ times since the company began in 1848. They had extended their collecting area to meet this demand; but, owing probably to the drought, they found it necessary on the 6th of July, 1853, to resort to the old pumping-station at Elswick for about a third part of all the water that flowed daily through the mains. This had gone on for eight weeks before the epidemic began, and was promptly discontinued on 15 September, as soon as the possible danger from Tyne water was realized. The pumping-station was higher up the river than the only one of the Newcastle sewers that discharged in its vicinity. There were complaints about the water, but these appear to have been chiefly of the peaty colour or flavour, which came from the Whittle Dean part of the mixture. The water from the mains was not equally bad at all points, as if the suspected contamination might have occurred in its transit through the town. Also the water of some wells was complained of as offensive at the same time, which was the season of the year when the springs are lowest. Gateshead was also supplied by the mains of the Whittle Dean Company. It is clear from the report of the Commissioners that they considered the water of Newcastle and Gateshead to have been a very subordinate factor, if a factor at all, in the epidemic of cholera.

The Cholera of 1854 in England.

The great epidemic at Newcastle and Gateshead was over by November, 1853, those towns having no share in the general epidemic in England in 1854, although it visited their near neighbour Tynemouth. The interest of the cholera of 1854 centres chiefly in London[1565]. Few of the great foci of infection in 1849 were visited severely. Liverpool, which never escaped, had a moderate epidemic, Merthyr Tydvil also had about a fourth part of its 1849 mortality, Dudley had the disease somewhat severely, while some towns, such as Norwich, Wisbech and Sheffield, had more than usual. But Plymouth, Hull, Bristol, Manchester, Leeds, the towns of the Black Country and nearly all the populous places that had suffered heavily either in 1832 or in 1849, or on both occasions, escaped in 1854 with little cholera or none[1566]. The table shows the incidence of the epidemic (as well as that of 1866) according to counties.

Cholera Mortality in England and Wales in 1854 and 1866.

1854 1866 Rate Rate per per Deaths 1000 Deaths 1000

England and Wales 20097 14378 ----------------------------------------------- London 10738 4·3 5596 1·9 Surrey, part of 252 1·2 82 Kent, part of 1056 2·1 284 Sussex 94 ·3 79 Hampshire 130 ·3 417 ·9 Berkshire 49 ·2 3 Middlesex, part of 380 2·4 51 Hertfordshire 97 ·5 9 Buckinghamshire 68 ·5 10 Oxfordshire 183 1·0 4 Northamptonshire 152 ·7 7 Huntingdonshire 18 ·3 1 Bedfordshire 61 ·4 22 Cambridgeshire 270 1·3 7 Essex 513 1·4 471 1·0 Suffolk 67 ·2 15 Norfolk 381 ·8 15 Wiltshire 60 ·2 11 Dorset 45 ·2 6 Devon 188 ·3 525 ·9 Cornwall 24 ·06 21 Somerset 21 ·04 68 Gloucestershire 260 ·6 39 Herefordshire 1 ·01 2 Shropshire 13 ·05 17 Staffordshire 426 ·6 30 Worcestershire 103 ·4 36 Warwickshire 89 ·2 15 Leicestershire 14 ·06 3 Rutlandshire 9 ·08 -- Lincolnshire 134 ·3 48 Nottinghamshire 80 ·3 1 Derbyshire 17 ·06 20 Cheshire 141 ·3 391 Lancashire 1775 ·8 2600 1·0 West Riding 470 ·3 283 East Riding 70 ·3 54 North Riding 84 ·4 21 Durham[1567] 2·9 352 ·6 Northumberland[1568] 5·7 224 Cumberland 35 ·2 32 Westmoreland 1 ·02 1 Monmouth 18 ·1 204 South Wales 887 1·4 2033 2·9 North Wales 34 ·08 256

Principal centres in each county 1854 1866

England and Wales

London South of Thames, Eastern Eastern parishes 3691 parishes Surrey, part of Kent, part of Sussex Hampshire Portsea Island 20, Portsea Island 129, Southampton 48 Southampton 41 Berkshire Middlesex, part of Brentford 196 Hertfordshire Buckinghamshire Oxfordshire Northamptonshire Towcester 86 Huntingdonshire Bedfordshire Cambridgeshire Wisbech 176, Ely 46 Essex West Ham 124, Romford West Ham 389 113, Maldon 102 Suffolk Norfolk Norwich 193, Yarmouth 41 Wiltshire Dorset Devon Plymouth 59, Stonehouse Exeter and St Thomas 247, 15, Devonport 2, Newton Abbot 57, Bideford 46 Totnes 146 Cornwall Somerset Gloucestershire Bristol 76, Clifton 92, Gloucester 48 Herefordshire Shropshire Staffordshire Dudley 256, Wolverhampton 80

Worcestershire Worcester 45 Warwickshire Leicestershire Rutlandshire Lincolnshire Great Grimsby 68 Nottinghamshire Worksop 27, Nottingham 16 Derbyshire Cheshire Chester Lancashire Liverpool 1084, W. Derby Liverpool and W. Derby 206, Wigan 158 2122, Wigan 137

West Riding Sheffield 126, Dewsbury 66, Leeds 48 East Riding Hull 27 North Riding Whitby 33, Guisboro’ 30 Durham Stockton, Auckland, Durham Northumberland Newcastle 1431, Gateshead 525, Tynemouth 203 Cumberland Westmoreland Monmouth South Wales Merthyr Tydvil 455, Swansea 521, Neath 520, Cardiff 255, Neath 54, Llanelly 232, Merthyr Brecon 54 Tydvil 229 North Wales

The London cholera of 1854, like that of 1832 and of 1849, fell most upon the southern (Southwark etc.), eastern and southeastern parishes (Table, p. 858). But it fell somewhat unequally upon these; and for Southwark and Lambeth the water supply was seized upon as the thing that made the difference. There were two water companies in South London, the Lambeth company and the Southwark and Vauxhall company. The parish of Christ Church, Lambeth, chiefly supplied by the Lambeth company, had a death-rate from cholera in 1854 of only 0·43 per 1000 inhabitants; whereas the parish of St Saviour, supplied by the Southwark and Vauxhall company, had a death-rate of 2·27 per 1000. In 1849 there had been no such disparity between them, the death-rate of Christ Church being if anything the higher of the two. Now it happened that in the interval of the two epidemics of cholera the Lambeth company had removed their intake works from opposite Hungerford Market to Thames Ditton, whilst the Southwark and Vauxhall company still continued to draw their supply from the Thames near Vauxhall. Here was a fine instance of the logical method of difference. Farther, within the parish of Christ Church itself, it was sought to show that the cholera followed the lines of old water supplies, and did not follow the mains from Thames Ditton. After 1854 the Southwark and Vauxhall company also made their intake at Thames Ditton. According to the water-hypothesis of cholera, it is not surprising, as we shall duly find, that the whole of the South London parishes, which had been the chief seats of the cholera in 1832, 1849, and 1854, escaped in 1866 with a very slight visitation. Newcastle was another chosen instance of cholera distributed by the water mains; but, as we have seen, that was improbable. Another instance was Exeter: its water supply in 1832, when part of it had a disastrous epidemic of cholera, was taken from the Exe, and was impure; in 1849, when it had only a tenth part of its last cholera mortality, its water supply had been greatly improved; in 1854 it had 10 deaths; but in 1866, Exeter with the registration district of St Thomas had 247 deaths, and Totnes had 146,--for their size about the most severely visited towns in England.

In the London cholera of 1854 a very sudden and simultaneous explosion in the district of Soho attracted much notice[1569]. The district stands high, which did not save it from being the scene of the first outbreak in the great plague of 1665. In the subdistricts of St Anne, Golden Square and Berwick Street, with a population of 42,000, many of them well-to-do families, there were 537 deaths from cholera, a rate of 12·8 per 1000, contrasting with the rate of 6 per 1000 for all London. The attacks and fatalities were remarkably numerous for one or two days, falling at once thereafter to about a half. There was a pump in Broad Street, in the centre of this district, which was supposed to have dispersed cholera broadcast in its contaminated water; a death had occurred in Swain’s Lane, at the foot of Highgate Hill, of a person who had drank the water of the Broad Street pump. The whole incident was seized upon and worked up by Dr Snow, who had written a speculative essay in 1849 upon the probability of cholera being conveyed by water, according to the similar theory of Parkin in 1832[1570]. The Board of Health, having very full data before them of the Soho outbreak in all its aspects (including a whole biological treatise upon the organisms found in water), did not adopt Snow’s conclusion, although he had enthusiastic followers at the time, and has probably more now[1571]:

“In explanation of the remarkable intensity of this outbreak within very definite limits, it has been suggested by Dr Snow that the real cause of whatever was peculiar in the case lay in the general use of one particular well, situate at Broad Street in the middle of the district, and having (it was imagined) its waters contaminated by the rice-water evacuations of cholera patients. After careful inquiry we see no reason to adopt this belief. We do not find it established that the water was contaminated in the manner alleged; nor is there before us any sufficient evidence to show whether inhabitants of the district, drinking from that well, suffered in proportion more than other inhabitants of the district who drank from other sources.”

The Cholera of 1853-54 in Scotland and Ireland.

The cholera of 1853-54 in Scotland has not been so fully recorded as either of the two preceding epidemics. It is said to have caused about six thousand deaths, of which 3892 were in Glasgow alone, and a considerable part of the remainder in Edinburgh and Dundee. The infection began to appear in the end of September, having been derived probably from the dreadful explosion at Newcastle. A few early cases occurred at Dunse, in Berwickshire. On the 16th September, 1853, the old Cholera Hospital at Edinburgh, in Surgeons’ Square, was opened, but received only 45 cases until the beginning of June, 1854, when it was closed. In the autumn of 1854 the real epidemic began, the hospital being re-opened on 24th August, from which date until the 30th November the admissions were 198. These hospital figures indicate for Edinburgh a milder epidemic than that of the winter of 1848, which was itself milder than that of 1832. The cases came mostly from the very same localities of the old town as in 1848. There were 145 females to 97 males; the deaths were 117 in 243 cases admitted[1572].

The epidemic at Dundee was a late autumnal or winter one, in the end of 1853, and of great severity, the mortality having probably exceeded 500. The Glasgow epidemic had a course very nearly parallel to that of 1832, and quite unlike the extraordinary winter explosion of 1848-9. It began, indeed, in winter--about the 15th of December, 1853, and had caused 849 deaths to the 27th of February; there was a sharp rise of the mortality from the 13th to the 24th of March, the total deaths to that date being 1306. As in 1832, the infection appeared to die out in the late spring and early summer; but in June it revived and increased in virulence until August, after which it subsided gradually until November, the whole mortality having been 3892, or ·98 per cent. of the population, nearly the same ratio as in 1848-9, (1·06) and a lower ratio than in 1832 (1·4). The first part of the epidemic fell chiefly on the north and east of the city, the second part, in summer and autumn, was all over the city, as in 1832, and among all classes, as in the winter of 1848-49, but perhaps less disastrously in the best quarters of the city than the last had been. The cholera hospital received a comparatively small part of all the cases--600 of cholera, 253 of diarrhoea, the deaths being 306, or less than a tenth part of the whole mortality[1573].

It is probable that the mortalities in Scotland on this occasion, besides those in Glasgow, Edinburgh and Dundee, were neither so general nor so great as in 1832. One remarkable outbreak happened at the village of Symington, in Ayrshire: in a population of 240 there were 110 attacks and 30 deaths; nearly all the cases were in houses on one side of the village street, which got their water from a public well; the houses on the other side, having private wells (and differing, doubtless, in other respects), were notably free from the infection[1574].

The cholera of 1854 was unimportant in Ireland. Cases appeared among emigrants on board ships in Belfast Lough and at Queenstown in the end of 1853, but no diffusion took place until 1854, and then only to a moderate extent. It is supposed that some 1706 persons died of it in Ireland in that year, according to the retrospective figures of the census of 1861; but a good many deaths from “cholera” were returned for every year of the decennium, so that it is improbable that the whole 1706 in 1854 were of the true Asiatic type. Ulster had 895 of these, Leinster 453, Munster 324, and the whole of Connaught only 34[1575].

The Cholera of 1865-66.

Asiatic cholera reached Europe by a new route in 1865--by the way of Egypt with the pilgrims returning from the Hâj at Mecca. In the course of the autumn it appeared at Southampton and caused 35 deaths from 24 September to 4 November. A strange extension from Southampton (or from Weymouth) took place to the village of Theydon Bois in Epping Forest, where nine deaths were traced to one house from 28 September to 31 October, unhappily including the death of a most estimable medical gentleman who tasted the water of a well into which the evacuations of the sick had probably percolated.

The cholera having become established on the continent of Europe in the end of 1865, was brought into England by emigrants passing from Hull and Grimsby to Liverpool on their way to America. On board one of the emigrant steamships, the ‘England,’ a very severe epidemic arose in mid-Atlantic in April. Liverpool had once more a severe epidemic (2122 deaths); but the only other important centres in England, besides London, were Swansea, Neath, Llanelly and Merthyr Tydvil, Chester and Northwich, a group of towns on the Exe in Devonshire, and Portsmouth with other places in Hampshire. Still, the deaths in all England made the large total of 14,378, no county excepting Rutland being absolutely free. That means that the infection, although widely diffused, now wanted the conditions favourable to its development and effectiveness; and that, again, seems to mean that a vast improvement had been made in the sewering of towns, in scavenging, and in all other matters of municipal police by which the soil of inhabited spots is preserved from saturation with excremental and other filth.

The interest of the cholera of 1866 centres in London, and chiefly in the fact that three-fourths of the deaths, to the number of 3696, took place in the eastern parishes, Whitechapel, Bethnal Green, Poplar, Stepney, Mile End, St George’s in the East, and Greenwich. These had in former epidemics a fair share; but hitherto they had been surpassed by the Southwark parishes and others on the south of the Thames from Battersea to Rotherhithe, and nearly equalled by Shoreditch and the Liberties of the City. The comparative table of the four great choleras of London shows how remarkably the infection in 1866 had left its old principal seats, remaining, as if a residue, only in the East End, with death-rates comparable to those of 1849.

Comparative view of the Four Epidemics of Cholera in the several parishes of London[1576].

1832 1849 1854 1866 (17 wks. end. 4 Nov.)

Rate Rate Rate Rate per Deaths per Deaths per Deaths per Deaths 10,000 10,000 10,000 10,000

Kensington 10 52 24 260 35 490 3·7 85 Chelsea 80 272 46 247 47 300 3·3 22 St George, Hanover Sq. 10 74 18 131 38 295 1·7 18 Westminster 50 450 68 437 60 423 6·2 43 St Martin in the Fields -- -- 37 91 24 58 4·2 10 St James, Westminster -- -- 16 57 152 485 3·5 13 Marylebone 30 355 17 261 16 347 3·0 54 Hampstead -- -- 8 9 11 14 ·8 2 Pancras 20 230 22 360 13 248 6·0 138 Islington 10 39 22 187 8 97 4·3 120 Hackney 2 8 25 139 11 73 10·6 103 St Giles 50 280 53 285 21 115 9·2 49 Strand 1 26 35 156 24 111 6·6 29 Holborn 10 46 35 161 5 25 5·2 22 Clerkenwell 10 65 19 121 9 59 7·0 45 St Luke 30 118 34 183 9 52 8·1 46 East City } 45 182 23 85 15·7 59 West City } 50 605 96 429 10 126 18·8 60 City } 38 207 14 71 5·0 20 Shoreditch 10 57 76 789 20 237 10·7 139 Bethnal Green 50 345 90 789 20 192 60·4 611 Whitechapel 110 736 64 506 40 330 84·2 909 St George in the East 30 123 42 199 30 154 87·9 385 Stepney 50 358 47 501 32 388 107·6 559 Mile End Old Town -- -- -- -- -- -- 67·7 501 Poplar 40 101 71 313 38 208 90·8 837 St Saviour } 120 1128 153 539 134 495 7·4 32 St Olave } 181 349 162 315 8·5 21 Bermondsey 70 210 161 734 158 845 5·3 35 St George, Southwark -- -- 164 836 101 546 6·6 38 Newington 40 200 144 907 101 696 2·8 26 Lambeth 40 337 120 1618 63 941 6·5 114 Wandsworth 10 46 100 484 77 422 4·8 40 Camberwell 30 107 97 504 91 553 5·6 46 Rotherhithe 10 19 205 352 147 285 8·7 25 Greenwich 20 149 75 718 53 576 19·5 284 Lewisham -- -- 30 96 20 81 6·1 56 Stratford -- -- -- -- -- -- 77·6 -- West Ham -- -- -- -- -- -- 49·3 -- Leyton -- -- -- -- -- -- 13·1 --

There was one significant thing associated with the peculiar incidence of the cholera of 1866 upon the East End. The main drainage of London, consisting of a high level and a low level sewer on each side of the Thames, was commenced in 1859, and was formally opened on 4 April, 1865. The two levels on each side of the river made together a length of eighty-two miles; the cost, with pumping station, was £4,200,000. When the cholera of 1866 broke out, only one part of the system was incomplete and not yet in working, namely, the low level main drainage on the northern side, which served the whole of the cholera-stricken parishes from Aldgate to Bow. However, the official mind in this country has somehow become prejudiced against the well-known and usually accepted generalities of von Pettenkofer, which make more of a foul soil in the causation of miasmatic infections, than of contaminated surface water or contaminated water from reservoirs. Accordingly, the somewhat remarkable fact that the East End of London alone retained its old proclivity for choleraic infection was not joined to the fact of its being the only great division of the capital still unsewered, but to the fact that it was supplied by water taken in from the river Lea in Hertfordshire and (it was alleged) insufficiently filtered or otherwise purified at the Old Ford waterworks[1577].

The extension to Scotland in 1866 was late in the season and insignificant compared with former epidemics. It was heard of about the end of summer in Fraserburgh and one or two other ports or fishing places on the East Coast, but it was not until October and November that it attracted notice in the eight principal towns, the whole mortality from it in Glasgow being 53, in Edinburgh 154, in Dundee 105, in Aberdeen 62, in Paisley 2, in Greenock 14, in Leith 95, and in Perth 15. Besides these deaths there were 435 more in smaller towns or villages. The year was a very healthy one, the death-rates of Glasgow, Greenock and Perth having been below the mean of the previous ten years.

In Ireland the cholera of 1866 was even slighter than in Scotland, the only considerable epidemic having been at Belfast.

Cholera has never obtained a footing in London since the epidemic of 1866. In 1873, while the disease was unusually active in some parts of Europe, a few cases occurred in Wapping among Scandinavian emigrants on their way to America, who had been landed for a few days. But the infection did not spread. In 1884, when cholera came from Cochin China to Toulon and Marseilles, two or three cases occurred on board steamships arriving at Cardiff and Liverpool. In 1893, when the disease raged in Hamburg, a number of choleraic cases occurred at Grimsby in August, which were considered certainly Asiatic owing to their high degree of fatality. In August-October, the deaths from cholera, whether cholera nostras or the Asiatic type, or both together, were about thirty in Grimsby, eighteen in Hull, and about fifty more in various other places, chiefly in the south of Yorkshire. The autumn of that year was favourable to bowel-complaints and to enteric fever.

The Antecedents of Epidemic Cholera in India.

The antecedents and circumstances that made the year 1817 so critical for cholera in India, and for its diffusiveness far beyond India, constitute one of the greatest problems in epidemiology. A full and minute examination of them cannot be attempted here; but the chapter would be incomplete without some statement on the subject, which, if summary, need not be dogmatic. Cholera with the same symptoms and a similar degree of fatality was certainly not new to India about the year 1817; it can be traced from the earliest records of the Portuguese and other Europeans in India, if not also in other countries in ancient times[1578]. The mortalities among troops during the military operations in the Northern Circars in 1781 and 1790, and the deaths of some 20,000 pilgrims in eight days during the Hurdwar festival of 1783, were undoubtedly from the same epidemic infective cholera that was seen fifty years after in Europe. But these were occasional great explosions, which arose suddenly and ceased abruptly; whereas from about 1817 onwards the infection became, as it were, a seasonal product of the soil of Lower Bengal year after year, and at the same time began to range widely beyond its “endemic area” to other provinces of India, beyond the North-Western frontier to Central Asia and to Europe, and across the ocean to America. It was not by any sudden change in the year 1817, we may be sure, that cholera began to be endemic at various places far apart in the valley of the Ganges. Things must have been tending towards that manifestation for some time before, and those things must have been of the same kind that made the great explosion at Hurdwar in 1783 and have made many other great explosions at the Indian religious festivals in later times. Briefly the opinion may be hazarded, that it was the permeation with excremental matters of the soil at large in and around Bengali villages that gave rise to the endemic miasmatic infection of cholera. The odor stercoreus of those innumerable village communities is, or used to be, a familiar fact, just as it is well known to be the custom there to dispense with latrines or other systematic provision for the disposal of faecal matters. But it may seem improbable that personal habits of the peasantry, not unknown in other countries, and immemorial in Lower Bengal itself, should have led to a definite disease-effect in a certain year of the 19th century and perennially thereafter. As to the special risk of engendering such a soil-poison in the valley of the Ganges, it has to be said that the region is peculiar in its alternations from extreme saturation to extreme dryness, within a stratum of alluvial or other porous soil which has a bed of impervious blue clay beneath it at a depth seldom more than 10 feet. It is just where such extreme fluctuations of the ground-water within a limited range occur from season to season, that organic matters in the soil are most apt to develop a miasmatic infective property. But why should the year 1817 have been, by the general consent of Anglo-Indian observers, the beginning of a new era in the history of cholera? The guiding principle in all such cases is, that things must have been moving that way before, and that in the particular season there had been reached at length such a degree of aggravation as to make a specific result manifest or the cumulative causes effective. Two things may be indicated as relevant to this assumed aggravation, or integration of accumulating causes. One was a certain gradual change in the beds of rivers, especially in the province of Behar, which entirely altered the relative amount of water flowing above ground and under ground, and must have made a difference in kind and in degree to the decomposition-processes in the soil. (In Burdwan these changes in the ground-water have caused much miasmatic fever since about thirty years ago.) The other thing was the increase of the number of cultivators per square mile under British rule. The latter cannot be stated with even approximate exactness for periods before the census of 1872; but there can be no reasonable doubt that the increase was great and progressive from the end of last century, owing to the cessation of intertribal wars, and of famines which were chiefly caused by the overflow of rivers now no longer subject to floods, and of wilful and barbarous checks to population. Among the cholera localities of 1817 were some that have now the greatest pressure of inhabitants on the soil, not in cities, but in uniformly dispersed rural communities--such as the division of Patna with 637 inhabitants per square mile, the district of Jessore with 693, and of Dacca with 756. This is of course a very general account of the matter, which a minute study of localities and seasons might show to be highly inadequate; but in seeking for some circumstances of aggravation at the particular juncture, the two things that have been mentioned, both of them coincident historical matters of fact, will appear to be not irrelevant according to the received teaching on the favouring conditions of cholera.

NOTE ON CEREBRO-SPINAL FEVER.

British experience, or the records of it, afford so little material for the history of epidemic cerebro-spinal fever (very abundant for France, Germany and the United States of America, see Hirsch, III. 547) that it has not seemed desirable to interpolate the subject in the chapter on Typhus and other Continued Fevers. Although our experience of it has fallen perhaps wholly within the period of exact statistics of the causes of death (saving some doubtful identifications in the 18th century), yet the registration tables contain so few deaths from it that it hardly seems as if a new and remarkable type of fever of the typhus kind had really been in our midst. There are, however, two periods when a good many papers were written upon it in Ireland and England, the years 1865-67 and the year 1876. When the first cases were seen in London in 1865 Murchison pronounced the new fever to be closely allied to typhus (Lancet, 1865, p. 1417). At the same time in Ireland it was sometimes called “the black death,” from the dark or livid vibices of the skin, or purpura maligna, or purpuric fever (J. T. Banks, Dubl. Quart. Journ. Med. Sc. XLIII. 98; E. W. Collins, ibid. XLVI. 170; Cogan, ibid. XLIV. 172; Gordon, ibid. XLIV. 408; H. Wilson, ibid. XLIII.; Haverty, ibid.; T. W. Belcher, Med. Press, N. S. III. 167; J. H. Benson, ibid. III. 387; editor, ibid. 506. For England, S. Wilks, Lancet, 1865, I. 388, Brit. Med. Journ. 1868, I. 427; F. J. Brown, Trans. Epid. Soc. II. (1865), 391; J. N. Radcliffe in Reynolds’ System of Medicine, 1st ed. II. 676; H. Day, Lancet, 1867, I. 731). In the second period, 1876, there were many cases in England, especially in the Midlands, but it is said that they were usually diagnosed as typhoid fever (Sir Walter Foster, Brit. Med. Journ. 1892, II. 278, and Lancet, 1876, I. 849; Neville Hart (for Birmingham), St Barth. Hosp. Rep. XII. (1876), 105; H. Thompson, Lancet, 1876, I. 849. The Irish papers in the second period are by T. W. Grimshaw, Dub. Journ. Med. Sc. LXI. 520, and LVII. 375; E. H. Bennett, ibid. LIX.; Brabazon, Brit. Med. Journ. 1876, I. 509). An epidemic of cerebro-spinal fever, resembling typhoid, was described for a Shropshire village in May, 1891 (Monk, Brit. Med. Journ. 1892, II. 278). A case which came under my notice on 19 March, 1894, in an eastern parish of London, has led me to doubt whether the half-dozen or so of deaths annually certified in London as from cerebro-spinal fever (contrasting with as many hundreds in New York), are of the slightest statistical value.

A young woman, aged 16, an artificial flower maker, became ill with pains in the limbs and was taken as an out-patient to a hospital. Thereafter she became light-headed. A private practitioner (M.R.C.S.) was called in, who found her with a temperature of 103°, excited, and inclined to clutch spasmodically at his arms; her coarse black hair was full of pediculi and nits. She died next day, having had sent her by the practitioner a draught of chlorodyne on account of her extreme restlessness. An inquest was appointed, and the practitioner ordered to make a post-mortem examination. He attended the inquest and gave evidence that death was due to “congestion of the brain.” The jury were dissatisfied, and the coroner adjourned the inquest for a second examination by a skilled pathologist. After spending two hours looking for the cause of death (there was no congestion of the brain), I discovered that the base of the brain had been left in the skull intact, the hemispheres having been sliced off by a horizontal section in the plane of the saw-draught round the cranium. On raising the frontal lobes I saw green flaky lymph lying on the orbital plates and on the corresponding surfaces of the arachnoid; the same was found on the optic commissure, the surface of the pons, the medulla and over a small area of the under convexities of the lateral lobes of the cerebellum, where it amounted to little more than whitish opacity. The lymph was purely basal, solely on the arachnoid, not in the fissures or sulci. The examination having already lasted over two hours, it was found impracticable to expose the spinal cord. The facts previously found were: an extensive blood-shot state of the left conjunctiva with oedema of the upper lid (there was no obvious intra-orbital disease); round dusky-red spots on the outer sides of the thighs and on the shoulders; both lungs in a state of solid purple congestion at the bases, crepitant at the apices, the costal pleura dark red or livid; the tongue large and flabby, congested around the broad papillae; the stomach at the cardiac end, exactly corresponding to the pressure of a mass of hard undigested food, dotted with numerous small round ecchymoses under the serosa; six inches of the lower end of the jejunum, corresponding to a mass of hard impacted faeces, dotted with the same subserous ecchymoses; a narrow belt of deep congestion round the broad ends of the kidney pyramids; the mucosa of the fundus uteri haemorrhagic. There was no herpetic eruption. At the adjourned inquest the cause of death was found to be cerebro-spinal fever, and was so certified by the coroner to the Registrar-General. The practitioner who attended the deceased was unable to say whether the most distinctive of all the symptoms, the violent retraction of the occiput upon the shoulders, was present or absent. It is improbable that this was a solitary case of epidemic cerebro-spinal meningitis in the East End of London in the spring of 1894, (the early spring being the distinctive season of the infection). Even if it were the only case, it narrowly missed being returned as a death from “congestion of the brain,” and that, too, after post-mortem inquisition. The practitioner’s statutory fees were three guineas. There has lately been collected much evidence upon certificates of death, and upon diagnosis under the Notification Act, which makes it doubtful whether our mortality statistics are as correct in substance as they are methodical and exhaustive in form.

INDEX.

Aberdeen, famine of 1622, 30, relapsing fever of 1818, 175, typhus of 1838-40, 189, 192, relapsing of 1843, 204, ratio of enteric in 1864, 210, influenza of 1831, 379 note, smallpox in 1610, 434, measles of 1808, 651-2, putrid sore-throat in 1790, 718, dysentery near, 784, cholera in 1832, 815

Aberystruth, cholera in 1849, 845

Ackworth bill of mortality, 528 note

Acland, Sir H. W., cholera at Oxford in 1854, 851 note

Adams, Joseph, cowpox, 559, liberty for inoculators, 609

=Adynamic= fever, 182

=Ague=, etymology of, 225, 301, name of typhus in Ireland, 301

=Agues=, epidemic, joined with influenzas, 300, summary of in 16th and 17th cent., 306-14, of 1678-80, 329, in Scotland after the union, 341, of 1727-29, 341, of 1780-85, 366, table of, at Kelso Dispensary, 370, of 1826-28, 378, of 1827 in Ireland, 273, in 1846-47, 391, in a Somerset village, 393, no record of, during the influenzas of 1890-94, 397

Aikin, John, Warrington smallpox, 553

Akenside, Mark, dysentery in London 1762, 778, theory of dysentery and rheumatic fever, 782

Alderson, John, contagion of typhus, 153

Alison, William P., no enteric cases in 1827, 187

Althaus, Julius, nervous sequelae of influenza, 397 note

Amyand, sergeant-surgeon, inoculations by, 469-70

Andrew, John, formal inoculation, 497

Anstruther, enteric fever 1835-39, 199

Arbuthnot, John, malignant fever in London, 67, pestilent air of cities, 84, influenza of 1733, 347, theory of influenza, 402-5

Armagh, smallpox burials at in 1818, 572, cholera in a hamlet near, 818

Arnot, Hugh, inoculation a complete remedy, 516

Arrott, James, fever at Dundee, 192-3

Astruc, Jean, history of whooping-cough, 666

=Asylums=, cholera in, 809, 831, dysentery in, 787, 791

Aubrey, T., miasmata of Guinea Coast the cause of dengue, 424

Aylesbury, gaol typhus, 153

Aynho, statistics of smallpox in 1723, 520

Ayr, dysentery, 787, cholera of 1832, 814

Ayrshire, cholera at iron-works, 837

Baillou, G. de, first to mention whooping-cough, 666

Baker, Sir George, history of cinchona bark, 320 note, merits of Talbor, 322, epidemic agues of 1780-85, 366-7, failure of bark in ditto, 368, merits of Jurin, 479, Sutton’s inoculation, 498, cowpox, 558, dysentery of 1762, 778

Ballard, Edward, occupation of mothers as a cause of infantile diarrhoea, 766 note, “healthy” infants have due share of same, 768, slight fatality of diarrhoea in adults, 769

Banff, inoculation not general, 510

Bangor, enteric fever in 1882, 220

Barbone, Nicholas, builder in London after the Fire, 86

Barcelona, sickness at among the troops in 1705, 106

Bard, Samuel, throat-disease in New York, 690

=Bark, cinchona=, use and abuse of in fevers, 318-25, failure of in epidemic agues, 368

Barker, John, of Sarum, epidemic typhus of 1741, 79, 80, 83; Sydenham as phlebotomist, 450

Barker, John, of Coleshill, type of fever in 1794, 157, agues in 1781, 367, influenzas of 1788 and fol. years, 370, smallpox a bugbear, 517

Bartholin, Thomas, transplantation of disease, 474

Bateman, Thomas, decline of fever 1804-16, 163, epidemic fever of 1816-19, 168, cause of differences of type, 169, ratio of relapsing cases, 172, fatal smallpox in Shoe Lane, 547, 568, measles of 1807, 650, dysentery rare, 785

Bath, rumour of plague &c. in 1675, 34, 458, influenza of 1782, 364 note, of 1788, 372, of 1803, 375, smallpox of 1837, 604, age-incidence of same, 624

Beddoes, Thomas, influenza of 1803, 375

Belfast, mortality in military hospital 1689-90, 234, fatality of fever and dysentery 1846, 294, recent enteric fever, 299, cholera in 1832, 818, in 1849, 839, in 1853-4, 856

Bent, Thomas, crystalline smallpox at Derby in 1818, 577

Berkeley, Bishop, queries on Irish economics, 239, dysentery and fever at Cloyne, &c. 1740-41, 241-2, tar water in smallpox, 546

Berkeley, relapsing fever in 1794-5, 156

Berkhamstead, general inoculation at, 509

Bernoulli, saving of life by inoculation, 629

=Bilge-water= a cause of ship-fever, 105, 106 note

Bideford, incidence of influenza in 1803, 376, cholera in 1854, 851 note

Bilston, cholera in 1832, 824, in 1849, 845

Birmingham, scarlatina in 1778, 710

Black, William, safety of inoculation, 608

=Black Assizes= at Taunton in 1730, 92, alleged at Launceston in 1742, 93, at the Old Bailey in 1750, 93, at Dublin in 1776, 98

“=Black Death=,” Irish name of cerebro-spinal fever, 863

=Black Fever=, Irish name of relapsing fever, 289

Blackmore, Sir Richard, hysteric or little fever, 68, against inoculation, 479

Blagden, Charles, materies of influenza, 406

Blakiston, Peyton, influenza of 1837, 387

Blandford, effects of inoculation on smallpox at, 513

=Bloodletting= in fevers, Sydenham’s practice in, 3, attack on in 1741, 83, in ship-fevers, 104, from the jugular by Freind, 107, of doubtful use in low fever, 122, revival of in 1817, 170, 172, in relapsing fever, 174, 175 note, 176, unsuitable in the fevers of 1830-40, 189, unsuitable in the relapsing fever of 1842, 203, in case of Charles II., 325, in influenza of 1743, 350, failure of in influenza of 1833, 381, Whitmore opposed to in influenza of 1658, 381 note, history of in smallpox, 445-50, in whooping-cough, 667, 668, injurious in epidemic angina, 701, in the cholera of 1832, 833

Boate, Gerard, fluxes and fevers of Ireland, 226

Boerhaave, Hermann, antidotes to smallpox, 494

Bolton, dysentery in 1832, 789

Boringdon, Lord, Vaccination Bills in 1813 and 1814, 609

Borlase, Edmund, dysentery of Ireland, 228

Boston, U. S., inoculation, 483, 485, smallpox epidemic of 1721, 485, tar-water in smallpox, 546, adult cases in the smallpox of 1721 and 1752, 626, throat-distemper of 1735-6, 688

Boston, Eng., agues in 1780, 367, 368, statistics of smallpox 18th cent., 525, 540, 557

Boufflers, Madame de, smallpox after inoculation, 495, 500

=Bowel-hive=, meaning of, 758 note

Boyle, Robert, influenza not due to the weather, 399, hypothesis of subterraneous miasmata, 400-2, 408, agues rare in Scotland, 341

Boylston, Zabdiel, inoculations at Boston, 483, 485

Brest, malignant typhus in 1757, 113

Bridgenorth, epidemic agues in 1784, 368

Bright, Richard, enteric fever in London in 1825-6, 186

Bristol, fever in 1696 46, types of the fever of 1817-19, 173, fever-cases in general wards, 179, type of fever in 1834, 201, cholera of 1832, 828, of 1849, 846 note

Bromfeild, William, against Sutton’s inoculations, 499, abandons inoculation, 515

Bromley, malignant sore-throat in 1746, 696

Brown, Andrew, fevers of the seven ill years in Scotland, 48

Browne, Sir Thomas, urn-burial and Norwich churchyards, 38

Brownrigg, William, nature of Leyden fever of 1669, 19 note, contagion of fever in ships of war, 114

Buchanan, Andrew, state of the poor in Glasgow 1830, 598, Edinburgh New Town epidemic of 1828, 788 note

Buchanan, Sir G., desires definition of “influenza proper,” 397 note

Buckie, cholera of 1832, 815

Budd, William, epidemic fever of 1839 at North Tawton, 196

=Burial= in relation to plague, 36-39

Burke, Edmund, dearth of 1795, 158 note

Burns, Robert, distress and fever of 1783, 154 note

Bury St Edmunds, smallpox in 1824, 593

Butter, William, infantile remittent fever, 7

=Buying the smallpox=, in Wales, 471, in Africa, 473, in Poland, 473

Caithness, inoculation in, 510, 542

Calabria, earthquakes and disease, 413, 419

Cambridge, plague of 1666, 34 note, gaol fever, 96, false rumour of smallpox, 458, inoculations near, 592

Cameron, James, scarlatina from milk, 734 note

Campbell, David, typhus in cotton-mills, 151, few children die of typhus, 152

Canterbury, smallpox in 1824, 581, inoculations, 584

Cardiff, diphtheria, 742, cholera of 1849, 845, 847

Carleton, William, tales of Irish famines, 254 note

Carlisle, typhus in 1781, 147, smallpox of infants, 538, rate of fatality, 555, measles, 646, scarlatina, 712, 723, cholera of 1832, 829

Carnbroe, winter cholera in a mining township, 837

Carrick, Dr, fevers of Bristol, 201

Carter, H. W., smallpox and inoculation at Canterbury 1824, 581, 584

Castlebar, gaol-fever in 1847, 292

=Cats=, throat-distemper of in 1798, 719

Ceely, Robert, cowpox near Aylesbury, 561 and note

=Cellar dwellings= make typhus in Liverpool, 141, in Manchester, 149, in Whitehaven, 151

=Cerebro-spinal fever=, question of diagnosis of in Irish epidemic of 1771, 247, at Cork and Dublin in 1864, 297, two recent periods of, 863, statistics of valueless, 863, instance of its being overlooked after autopsy and inquest, 863

Chalmers, Thomas, state of Glasgow in 1819, 599

Chambers, W. F., enteric fever in London 1826, 185

Chandler, John, throat-distemper of 1739, 692

Charles II., patronizes Talbor, 319, 322, his ague treated by bark, 323, his fatal illness, 324, visits his mistress after smallpox, 454

Charleston, inoculation at in 1738, 486, 490, fatal measles, 645

Chelmsford, Sutton’s trial at, 499, 608

Cheshire, epidemic agues, 313, 368

Chester, public health in plague-times and after, 40-42, typhus among military prisoners in 1716, 60, 96, typhus endemic in suburbs, 143, smallpox in 1634, 436, inoculation, 508, 511, 516, smallpox in 1774, 537, 544 note, compared with Warrington, 551-555, cholera in 1866, 857

Cheyne, George, on fevers in 1701, 52

Chichester, mild smallpox in 17th cent., 455, smallpox in 1821, 581, inoculation and vaccination in 1821-22, 591

=Children=, nervous fever of in 1661, 5-8, epidemics among after the Great Plague, 18, typhus in, 152, 276, 571-2, smallpox of in 17th century, 434, 436, alleged mildness of same, 441-2

=Cholera, Asiatic=, Anglo-Indian writings on before 1831, 793, preparations for, 794, diagnosis of from cholera nostras in 1831, 795-6, first case of in England, 797, the Sunderland epidemic, 797-802, extension to the Tyne, 802-5, to Scotland, 805, the Glasgow epidemic in 1832, 808, the Edinburgh epidemic, 812, table of the epidemic in Scotland, 813, among the fishing population, 814, the 1832 epidemic in Ireland, 816, table of same, 819, the outbreak in London, 820, table of 1832 epidemic in England, 821, exempted towns, 823, Bilston, 824, in Liverpool shipping, 826, at Manchester, 826, exemption of cotton mills, 827, microbic hypothesis in 1832, 827 note, chief season of, 830, season of in Paris, 831 note, localities of, 830, susceptible persons, 831, question of contagion, 831, means of transmission, 832, sanitary lessons, 833, revivals of in 1833-34 and 1837, 834

Second epidemic 1848-9: Outbreak at Edinburgh, 835, at Springburn, Glasgow, 836, great mortality at Glasgow in mid winter, 837, in mining townships, 837, summer epidemic in Dundee, 838, in Ireland, 839, great outbreak delayed in London till July 1849, 841, chief London localities of, 841, many deaths from collapse at outset, 842, mixed with much cholera nostras, 842, prevalence in institutions, 841, 843, table for England, 843, in Merthyr Tydvil, 845, in Hull, 845, in Airedale, 846, exempted places, 846, influence of locality, 847, law of altitude, 847, carried in surface water, 848

Third epidemic 1853-4: Outbreak at Newcastle and Gateshead, 849, Commissioners’ report on, 849, suspected water-supply, 850, the epidemic partial in England in 1854, 851, table of same and of 1866 epidemic, 852, supposed connexion with water in South London, 853, and in Soho, 854, the epidemic in Scotland, 855, in Ireland, 856

Fourth epidemic: Outbreak at Southampton in 1865, 856, Liverpool &c. in 1866, 857, chiefly in the East End of London, 857, table of four epidemics in the parishes of London, 858, main drainage incomplete at East End in 1866, 859, slight Scotch epidemic in 1866, 859, no subsequent epidemic, 859

In India before 1817, 860, causes of endemicity since 1817, 861

=Cholera infantum=, see Diarrhoea.

=Cholera nostras=, fatal to adults chiefly in old age, 769, historical references to, 770, distinction of from bilious colic, 771 note, Willis’s symptoms of, 772, in and near Leeds in 1825, 773, diagnosis from Asiatic in 1831, 795-6

Christison, Sir Robert, relapsing fever of 1819, 174, 177, fever cases in general wards, 179, relapsing fever of 1827-29, 182, heat of 1826, 185, rarity of enteric fever in Edinburgh, 187, relapsing fever of 1842, 203, agues at Kelso dispensary 18th cent., 370, ague in 1827, 378, dysentery in and near Edinburgh, 787, 791

Christleton, village smallpox, 556

Churchill, Fleetwood, influenza in Dublin 1847, 389

Circassia, procuring of smallpox in, 472, Voltaire’s legend of, 473 note

Clanny, W. R., Sunderland cholera, 798, 801 note

Clark, John, ship fever, 117, Newcastle typhus, 142, influenza of 1782, 364, agues, 369, inoculation of infants, 507, scarlet fever of 1778, 713, dysentery, 784

Clarke, James, typhus at Nottingham in 1807, 165, ague in 1808, 378 note, gangrene in measles, 706

Clayton, Mr, describes cowpox in the cow, 560

Cleghorn, George, influenza in Minorca, 352, mild and severe smallpox, 547

Clemow, F., origin of influenza in 1889, 393 note

Cleveland, miliary fever or scarlatina in 1760, 127, 703

Clifton, see Bristol

Clouston, T. S., dysentery in asylum, 791

Clowes, William, calls variola measles, 633

Cloyne, dysentery in 1741, 241

Clutterbuck, Henry, excremental effluvia in houses, 87 note, 170

Cobbett, William, the potato in Ireland, 285

Cockburn, William, on “little fever,” 68, sickness in navy, 103

Cockermouth, typhus, 114, cholera, 846

=Coffins=, at Tewkesbury to prevent plague, 36, supersede cerecloths, 37, advantages of, 38, burials without in a Scots parish, 51, and in cholera, 814 note, 818

Coke family, typhus in, 31, 53, smallpox in, 435

Colden, Cadwallader, throat-distemper in New York, 689

Coleridge, S. T., merits of inoculation and vaccination as poetic subjects, 588 note

=Colic, bilious=, distinguished from cholera nostras, 771 note

Collieston, cholera of 1832, 815, 833 note

=Comatose fever=, 5, 20, 75

Connemara, famine and fever of 1821-22, 268

Constantinople, inoculation at 463-467, 475

Copenhagen, adult smallpox in 1833, 612

Cork, types and causes of fever 18th cent., 234-6, state of workhouse in 1846, 286, fever of 1864, 297, cholera of 1832, 816, of 1849, 839

Cormack, John Rose, relapsing fever, 204

=Cotton mills=, typhus in, 152, effects of on married women, 767, adverse to cholera, 827

=Country disease=, name of dysentery in Ireland, 226-7

Coventry, infantile diarrhoea, 765 and note

Covey, John, formal inoculation, 505

Cowan, Robert, Glasgow typhus, 191, little smallpox among Irish adults, 601

=Cowpox=, matter from used to inoculate with, 558, Jenner’s advocacy of, 558, its properties used by Adams to illustrate phagedaena, 559, accounts of by Jenner, Pearson and Clayton, 560, circumstances of its origin in a cow, 561, case of in a milkmaid, 562, obsolete opinions concerning, 562, called by Jenner “smallpox of the cow,” 563, attempts to manufacture it out of smallpox, 564, see also Vaccination

Cox, Daniel, fever of 1741, 83 note

Craigie, David, Edinburgh enteric fever, 187, cholera at Newburn 1832, 804, at Edinburgh, 812, history of cholera, 860 note

Cromarty, cholera of 1832, 814

Cromwell, Oliver, dies of epidemic ague, 303

Crook, John, sells bark in 1658, 320

Crookshank, Edgar, describes cowpox, 561 note, witnesses contamination of milk, 735

Cross, John Green, Norwich smallpox, 578, inoculation in 1819, 591

=Croup=, name for diphtheria in Bucks 1793, 716, in Glasgow in 1819, 738 note

Croydon, scarlatina from blood &c., 735, increase of diphtheria, 742

=Cucumbers=, theory of in fever of 1624, 32

Cupar Fife, crystalline smallpox, 575

Cullen, William, definitions of scarlatina and cynanche, 737, rickets congenital, 767

Currie, James, typhus in Liverpool, 141, inoculation, 508, 511, cold affusions in scarlatina, 723

Darlington, enteric fever and water-supply, 221, cholera nostras 18th cent., 772

Darwin, Charles, quantity of seminal particles, 608 note

Deal, supposed typhoid in 1806, 165

=Dearths= in England, 78, 125-6, 132, 159, in Scotland, 30, 50, 82, 154, 599

Deering, Charles, Nottingham smallpox in 1736, 522, mild smallpox, 845

Defoe, Daniel, the Plague and the Fire of London, 42

=Dengue=, an analogy for influenza, 424

Denman, Thomas, diphtheria of infants, 714

=Depuratory fevers=, 21

Dewar, Henry, smallpox of 1817, 575

=Diarrhoea, infantile=, called “griping in the guts” 17th cent., 747, Harris on mortality from in London 17th cent., 749, London statistics of in 17th and 18th cent., 750-755, less of in provincial cities, 757, first described by Rush, 758, modern statistics of, 758-762, has declined in London since 18th cent., 763, modern prevalence in provincial towns, 765, in infants of workwomen, 766, a congenital risk, 767-8

Dillon, Dr, gaol-fever at Castlebar, 292

Dimsdale, Baron, re-inoculation, 505, opposes infant inoculations, 507, general inoculations, 509

Dingle, escapes famine of 1817, 262, cholera of 1849, 840

=Diphtheria=, identified in 18th cent., 679, 691 note, 702, 737 note, called croup in 1793, 716, reappears in 1856, 736, details of the epidemic of 1858-9, 739, incidence of on town and country, 741, on London, 742, on age and sex, 743, favouring conditions of, 744

=Dispensaries= in London, 16, 135

Dixon, Joshua, Whitehaven fevers, 152, 571

Dobson, Dr, Liverpool smallpox 1772-4, 537

=Dogs= attacked by influenza, 354, 361, 371 note, 372, 398

Donoughmore, fever in 1836, 277

Dorset, epidemic agues in 1780, 369

Douglas, James, post-mortem on case of fever, 55

Douglass, William, smallpox and inoculation at Boston 1721, 486, danger of inoculated smallpox, 607, throat-distemper of New England 1735-6, 686-9

Dover, Thomas, fever at Bristol 1696, 46, agues in Glo’stershire, 74, treated for smallpox by Sydenham, 446 note, his success in smallpox in 1720, 449, mildness of measles, 641 note

Drage, William, epidemic agues of 1658, 315, transplantation of agues, 474 note, incubation of measles, 655 note

Drogheda, dysentery at siege of, in 1649, 227, cholera in 1832, 88, in 1849, 839

=Drunkenness= in London 18th cent., 84

Dublin, Black Assizes of 1776, 98, question of enteric fever in 1826, 187, typhus in 1682, 228, nervous fever in 1734, 239, relapsing fever in 1738-9, 240, dysentery and fever 1740-41, 241-2, relapsing fever in 1746-8, 245, putrid fevers in 1754-62, 245-6, fevers of 1799-1802, 249-50, dysentery and relapsing fever 1825-26, 271, intermittent fever in 1827, 273, typhus in 1837, 277, fever of 1864-5, 297, recent enteric fever, 299, influenza of 1688, 336, of 1693, 337, horse-colds, 345, 354, malignant smallpox, 549, mild and severe scarlatina, 722, 724, cholera of 1832, 816, of 1849, 839

Dundalk, camp sickness, 230

Dundee, typhus of 1836, 192-3, relapsing and typhus in 1842, 204, hospital cases of typhus, 210, dysentery, 789, cholera of 1832, 814, of 1849, 838, of 1853, 855, of 1866, 859

=Dunkirk rant=, 340

Dunse, smallpox in 1733, 527, inoculation revived, 590

Duvillard, M., on saving of life by vaccination, 629

=Dysentery=, four degrees of epidemic prevalence, 774, severe during plague in London, 774, names of in bills of mortality, 775, London epidemics of 1669-72, 776, in Scotland 1731-37, 777, in London in 1762, 778, symptoms of in Newcastle in 1758-9, 780-1, Akenside’s theory of its pathology, 782, epidemic period of 1779-85, 783, in a Scots fishing village in 1789, 784, epidemic period 1800-2, 785, in Glasgow in 1827-29, 786, in Edinburgh 1828, 787, in Wakefield Asylum, 787, occasions of in 1827-29, 787, in Scotland in 1836, 789, at Taunton workhouse in 1837, 790, at Penzance in 1848, 790-1, during the cholera of 1849, 791, 842, relation of to typhus fever, 792

Earlsoham, malignant fever in a farmhouse, 161

=East Indiamen=, fevers in, 117

Edinburgh, mortality bills of 1740-41, 82, 523, fevers of 1699, 49, worm fever in 1731-32, 75, relapsing fever in 1735, 76, state of the poor in 1818, 174, types of fever 1817-19, 174-5, fever cases in general wards of Infirmary, 179, relapsing fever of 1827-29, 182, little enteric fever, 187, 199-200, 202, typhus of 1836-39, 192, relapsing fever of 1843-44, 204, Irish fever of 1846-48, 208, typhus and enteric of 1864, 210, relapsing of 1870, 211 note, influenza of 1733, 346, of 1743, 351, of 1758, 353, of 1775, 361, smallpox in 18th cent., 523, in 1817, 575, in 1830-31, 600, measles in 1735, 642, in 1740-41, 643, in 1808, 651-2, whooping-cough in 1740-41, 670, scarlatina in 1684, 681, in 1733, 684, Cullen’s experiences of the same, 737, in 1804-5, 721, in 1832-33, 725, dysentery in 1734, 777, in 1828, 787, the “New-Town Epidemic” of 1828, 788, cholera of 1832, 807, 812, of 1848, 835, of 1853-4, 855

Ellenborough, Lord Chief Justice, opposes Vaccination Bill, 609

Ellenborough, second Earl of, brings in Vaccination Bill, 606

Elliotson, John, agues in 1826-28, 378

Elyot, Sir Thomas, infantile maladies of 16th cent., 666

Ennis, chief months of fever 1846-48, 288

=Enteric Fever=, epidemic of 1661 identified as, 8 note, “little fever” identified as, 70, probable cases of in 1804-10, 165, in London in 1826, 183-6, alleged at North Tawton in 1839, 196 note, at Anstruther in 1835-39, 199, at Edinburgh, 199-200, Lombard on proportion of in Britain, 201, prevalence of since 1869, 211, favouring conditions of, 217, highest English death-rates, 218, explosions of, 220, age-incidence fatality and predisposition to, 222-3, Edinburgh New Town epidemic of 1828, 788 note

=Epidemic Constitutions= copied by Sydenham from Hippocrates, 10

Evelyn, John, the winter of 1653-4, 23, Norwich graveyards, 38, bark prescribed for Charles II., 323, last illness of Charles II., 324, “new fever” of 1678, 330, attack of ague, 331 note, treated in smallpox, 445

Exeter, influenza of 1729, 345, of 1775, 360, of 1837, 386, smallpox of 1837, 604, measles in 1824, 662, cholera of 1832, 829, cholera and water-supply, 854

Faröe Islands, strangers’ cold, 432

Farr, William, endorses Watt’s doctrine of displacement, 658, cholera and elevation of ground, 847, cholera and Newcastle drinking-water, 850

=Febricula= or “little fever” of 1720-30, 67-70

Feckenheim, camp sickness, 108

Ferguson, Dr, of Aberdeen, measles in 1808, 651-2

Ferguson, Robert, favours inoculation in 1825, 592

Ferriar, John, typhus severe in migrants to towns, 101, fevers in Manchester, 149, need for fever-hospitals, 158, troubles of a young couple, 552

Ferryden, cholera in 1833, 815, 834

=Fever Hospitals=, committee on in 1818, 178

=Fire of London=, alleged effect on plague, 42

Fletcher, Andrew, state of Scotland end of 17th cent., 49

“=Flox and Smallpox=,” meaning of, 436 note

Forbes, Sir John, inoculation in Sussex, 591

Fordyce, John, miliary fever, 130

Fordyce, Sir William, malignant sore-throat in 1773, 707, prevalence of rickets, 756

Foster, Sir Michael, Old Bailey Black Assizes, 93

Foster, Sir Walter, on cerebro-spinal fever diagnosed as typhoid, 863

Fothergill, Anthony, influenza of 1775, 359, in horses, 361

Fothergill, John, fevers of 1751-55, 122, collective inquiry on influenza of 1782, 360, smallpox of 1751, 453, 529, objections to the Parish Clerks’ bills, 530, 638 note, epidemic sore-throat 1746-48, 696, 737

Fothergill, Samuel, scarlatina in 1814, 723

Fowler, Thomas, arsenic in ague, 368

Freind, John, Sydenham’s varieties of fever, 27 note, petition to Commons on drink, 84, sickness of Peterborough’s expedition 1705, 106, adverse to inoculation, 478

Frewen, Thomas, methods of inoculation, 492, Boerhaave’s antidotes, 494 note

Fuller, Thomas, inoculation, 489 note

Gaddesden, John of, uses “mesles” for morbilli, 632

Gairloch, fevers in 18th cent., 155

Galway, plague of 1649, 227, fever of 1741, 243, fever of 1821-22, 269, gaol fever in 1848, 291, cholera of 1832, 816, of 1849, 839

=Gaol Fever=, 90-95, Howard’s discoveries of, 95-97, Lettsom’s cases, 97, infection of in ships, 114, in 1783-55, 153, Neild’s inquiries, 628

Gaskell, Mrs, the fever episode in ‘Jane Eyre,’ 181 note, distress of the working class in Manchester in 1839-41, 197

Gateshead, fever in 1790, 142, cholera in 1832, 803, cholera in 1853, 849

Gatti, Angelo, method and results of inoculation, 495-7

Gaulter, Henry, Manchester cholera of 1832, 826

Geach, Francis, influenza and astrology, 405, dysentery of, 1781, 783

Geary, W. J., the Limerick poor in 1836, 275, age-incidence of typhus, 276

Geneva, vital statistics of, 443 note, 623

George I. sanctions inoculation, 468-9

George Ham, epidemic pneumonia (?) in 1747, 355

Germany, names of influenza in 1712, 339, apparent extinction of smallpox, 612, re-vaccination, 612

Gibraltar, ship fever at, 115, influenza of 1837, 388

Gilchrist, Ebenezer, nervous fever of 1735, 75, inoculations at Dumfries, 509

Gladstone, rt. hon. W. E., on dearth of 1767, 132 note

Glasgow, fever statistics from 1795, 164, fever of 1816-19, 175, fever of 1827-28, 181, spotted typhus after 1835, 189, 193, public health 1831-39, 191, fatality of typhus in adults, 193, fevers of 1842-44, 204, fevers of 1847-48, 208, influenza of 1831, 379, smallpox in end of 18th cent., 539, 557, decline of smallpox 1801-12, 569, statistics of vaccination 1801-18, 582, revival of smallpox 2nd quarter 19th cent., 597-601, immunity from same of Irish in, 602, age-incidence of smallpox compared with same at Paris 1850-51, 611, measles in 1808 etc., 652, comparative table with London 1783-1812, 655, substitution of measles for smallpox, 657, ages of fatal measles, 661, whooping-cough, 670, 672, relation of same to measles, 675, scarlatina 1835-39, 725, milk scarlatina, 734 note, “bowel-hive,” 758, dysentery of 1827-28, 786, of 1836, 789, cholera of 1832, 808, of 1848-9, 836, of 1853-4, 855, of 1866, 859

Gloucester, Duke of, dies of smallpox, 438

Gloucester, agues in 1727-29, 74

Goodsir, John, enteric fever at Anstruther, 199

Goole, infantile diarrhoea, 762, 765 note

Grainger, James, anomalous fever in 1753, 123

Grant, William, pestilential fever in London, 137, influenza of 1775, 359, fever and sore-throat, 707

Graunt, John, exactness of the early bills of mortality, 653 note

Graves, Robert J., typhus fatal to the well-to-do, 102, fever in Galway, 270, jaundice in relapsing fever, 272, spotted typhus a new type, 277, typhus begins like a cold, 278 note, failure of blooding in influenza, 282, mild and fatal scarlatina, 722, 724, type of scarlatina not affected by treatment, 725, writings on cholera, 831 note

Gray, Edward, collective inquiry on influenza of 1782, 363, 365

Greenock, high typhus death-rates, 209, cholera of 1832, 813

Gregory, George, compares London smallpox of 1825 with great 18th cent. epidemics, 593-5, advocates re-vaccination, 612

Gregory, James, follows course of influenza in 1775, 361

Griffin, Daniel, infantile mortality in Limerick, 602

Grimsby, cholera in 1893, 860

Grimshaw, T. W., fever and rainfall in Dublin, 298, relation of whooping-cough to measles, 676 note

Grippe, la, 339 note

Guide, Philip, on Talbor, 319

Guilford, Lord, his fever treated by bark, 321

Gull, Sir William W., report on cholera, 846 note

Haeser, Heinrich, identities of 18th cent. throat-distempers, 691 note

Hague, The, ages in 18th cent. smallpox, 623

Hales, Stephen, ventilation of Newgate, 94, ventilation of ships, 119

Halifax, semi-rural industries of, 145, smallpox at in 1681, 458, inoculation at, 483

Hamilton, Sir David, case of fever in London in 1709, 55, factitious miliary fever, 128, fever and sore-throat in 1704, 704 note

Hamilton, dysentery in 1801, 785, cholera of 1848-9, 838

Hampstead, agues in 1781, 367, scarlatina in 1786, 713

Hampton, U. S., throat-distemper in 18th cent., 690

Harris, Walter, influenza of 1688, 336, mildness of smallpox in infants, 441, reference to inoculation in 1721, 467, whooping-cough, 667, summer diarrhoea fatal to London infants, 749, 763

Harty, William, Irish epidemic of 1817-19, 264, affinities of dysentery, 782, cholera in Dublin prisons, 816

Hastings, smallpox in 1731, 521

Haverfordwest, buying the smallpox, 471, diphtheria in 1849, 738 note

Haviland, Alfred, the Hippocratic “constitutions,” 10 note, village epidemic of ague in 1858, 393

Hawkins, Bisset, cavils at Watt, 658

Hawkins, Caesar, inoculator, 504, 515

Haygarth, John, typhus in Chester, 41, 143, miliary fever, 130, influenza of 1803, 376, procuring the smallpox, 477, census of Chester after smallpox in 1774, 544 note, infantile deaths at Chester, 553-4, letter on Jenner’s cowpox project in 1794, 559

Heberden, William, junior, supposed decrease of dysentery, 747, 774

Heberden, William, senior, smallpox least dangerous to infants, 442, a failure of inoculation, 498, measles in 1753, 644, scarlatina and angina, 712 note

Hecker, J. F. C., identity of throat-epidemics, 691 note, 704 note

Hecquet, Ph., reasons against inoculation, 479 note

Helmont, J. B. van, ridiculed by Barker, 450 note

Henry, Thomas, smallpox in different parts of Manchester, 556 note

Hertford, smallpox in 1722, 519

Hewett, Cornwallis, cases of enteric fever, 185

Heysham, John, Carlisle typhus, 147, smallpox, 538, 555, 570, measles, 646, scarlatina, 712, 723

Hillary, William, Ripon fevers, 72-3, copious bloodings, 74 note, nervous fever in Barbados, 127, influenza in Barbados, 352, 412, volcanic waves at Bridgetown, 411, smallpox mild there, 548

Hippocrates, epidemic constitutions, 9

Hirsch, August, identity of 18th cent. throat-distempers, 691 note, 737 note, history of infantile diarrhoea, 758, degrees of epidemic dysentery, 774

Holland, Sir Henry, advises re-vaccination, 613, “hypothesis of insect life” in cholera, 827 note

Holy Island, ship typhus, 109

Hongkong fever, resembles influenza, 423 note

=Horses= attacked by influenza in 1658, 313, in 1688, 337, in 1727-29, 345, in 1732, 348, in 1737, 348, in 1758, 353, in 1743 and 1750, 354, in 1760, 355, in 1775, 361, in 1783, 371 note, in 1788, 372

Howard, John, effects of the window-tax, 88, discoveries of gaol-fever, 95, smallpox in three gaols, 544

Hull, infantile diarrhoea, 762, 765 note, cholera of 1832, 823, of 1849, 845, of 1854, 851

Hume, David, influence of climate etc., 224

Hunter, John, M.D., typhus in London, 15, 134, 138

Hutchinson, James, change in fevers since 17th cent., 3

Hutchinson, Jonathan, vaccinal syphilis, 562 note

Huxham, John, Plymouth fevers 1727-29, 73-4, worm fever in 1734, 75, typhus, 76-77, ship fever, 78, gaol fever at Launceston in 1742, 93, influenza in 1729, 345, horse-cold in 1727, 345, influenza of 1733, 347, influenza and horse-cold of 1737, 348-9, influenza of 1743, 351, smallpox of 1724-25, 520, smallpox of 1751, 529, malignant measles 1749, 656, anginose fever of 1734, 684, epidemic sore-throat of 1751, 695, 699

Iceland, dust clouds from volcanic action, 414

India, cholera before 1817, 860, creation of the endemic area, 861

=Industrial Revolution=, the, 145

=Infantile Remittent Fever=, 5-8

=Influenza=, historically mixed with epidemic ague, 300, probable etymology of, 304, names of before 1743, 305, retrospect of influenzas to 1659, 306-313, influenza of 1675, 326, of 1679, 328, of 1688, 335, of 1693, 337, of 1712, 339, of 1729, 343, probable in 1728, 346, of 1733, 346, of 1737, 348, of 1743, 349, of 1758, 353, of 1759 in Peru, 354, of 1762, 356, of 1767, 358, of 1775, 359, of 1782, 362, of 1788, 370, of 1803, 374, of 1831, 379, of 1833, 380, of 1837, 383, of 1847-48, 389, minor epidemics, 391, of 1889-94, 393, antiquity and sameness of, 398, views of Willis and Sydenham, 399, miasmatic hypothesis of Boyle, 399-402, theory of Arbuthnot, 402, theory of Noah Webster, 405, a phenomenal cause needed, 407, relation to epidemic agues, 409, the epidemic of 1761 at Barbados and the earthquake, 409, the earthquake of Lisbon and influenzas, 411, earthquakes and the influenza of 1782, 413, miasmatic sickness following earthquakes in Jamaica, 415, in Amboina, 418 note, and in Sicily, 419, possible sources of miasmata of influenza in 1693, 420, epidemic of 1688 and the earthquake of Lima, 421, possible sources of S. American epidemic in 1720, direction in which the true theory lies, 425, outbreaks at sea, 425-431, strangers’ colds, 431-433. See also Horses.

=Inoculation= of smallpox, a Greek practice, 463, begun in London, 467, popular origins of, 471, Voltaire’s legend of Circassian, 472 note, probably grew out of transplantation of disease, 474, religious symbolism of inoculation, 475, etymology of, 476, not an antidote, 477, controversy on in England, 477, reality of as practised by Nettleton, 482, at Boston, New England, 485, cases of failure, 487, cases of death from, 489, revival of in 1741, 489, at Charleston in 1738, 490, as practised by Frewen, 492, by Kirkpatrick, 493, the blister method of, 494, Gatti’s practice in, 495, Sutton’s practice in, 498, opposition to Sutton’s method of, 499, Watson’s experiment in, 500, Mudge’s experiment in, 501, tests of its validity, 502, extent of in England in 18th cent., 504-9, in Scotland, 509, value of, 511, at Blandford, 513, at the Foundling Hospital, 514, known failures of, 515, testimonies to value of, 516, advocates of in 19th cent., 586, Lipscomb’s poem on, 587, preference of populace for, 589, practised by Walker as vaccination, 590, extent of, 590-2, made penal, 606, history of the doctrine that it was a nuisance, 607-10, did not contain the principle of re-vaccination, 610

=Intermittent Fevers=, Sydenham’s view of, 11, in Ireland after the relapsing fever of 1826, 273, and of 1847-9, 297. See also =Ague=.

Inverness, typhus at, 110, cholera of 1832, 814, of 1849, 838

Ipswich, ship typhus at, 110, scarlatina in 1771, 708

Jamaica, sickness after earthquake, 416

Jenner, Edward, relapsing fever in his house, 156, inoculates with crude matter, 502, collects failures of inoculation, 515, inoculates with swinepox, 558, proposes to inoculate with cowpox, 558, indicates ulcerous characters of cowpox, 560, his opinion on origin of smallpox and cowpox, 562, calls cowpox variolae vaccinae, 563, tests the virtue of cowpox, 565, makes interest with the great, 566, demands prohibition of inoculation, 609, opposes Watt’s doctrine of measles, 657

Jenner, J. C., epidemic ague in 1784, 369, general inoculation, 509, why smallpox malignant, 550

Jenner, Sir William, diagnosis of continued fevers, 4, 183, diphtheria, 739 note, rickets a diathesis, 767

Jesty, Benjamin, inoculates with cowpox, 558

Johnstone, James, Kidderminster fevers 1752-56, 124, sequelae of measles, 660 note, sore-throat and fever, 702, 704, the scarlet eruption, 710

Johnstone, James, junior, dies of gaol fever, 153, writes on the scarlatina of 1778, 710

=Jolly rant=, name of influenza in 1675, 327 note, 328

Jones, John, fevers of the Greeks not in our climate, 301, agues of 1558, 307

Jones, John, dysentery in Wales, 777

Jurin, James, arguments for inoculation, 479, his authority, 480, biographical sketch of, 481 note

Kanturk, incidents at in famine of 1818, 265

Katharine, Queen of Charles II., her fever in 1663, 13

Kell, John Butler, cholera at Sunderland 1831, 798

Kellwaye, Simon, measles and smallpox, 633

Kelso, agues in 18th cent., 369, cholera in 1848-9, 838

Kendal, vaccination 1819-21, 584

Kennedy, Henry, type of Dublin fever in 1847, 289, in 1862, 298

Kennedy, Peter, inoculation at Constantinople, 464, procuring smallpox in Scotland, 471

Kerr, George, fever in Aberdeen, 176

Kidderminster, fevers in 1727-29, 124 note, in 1751-56, 124, sequelae of measles, 660, sore-throat and fever in 1748, 701, 704, in 1778, 710

Kilgour, Alexander, typhus one of the exanthemata, 189, ratio of spotted cases, 193

Kilkenny, sickness in 1846, 282

Kilmarnock, 18th cent. smallpox, 526, cholera of 1832, 814, of 1849, 838

Kiltearn, paupers in 1697, 51 note, smallpox in 18th cent., 541

Kingsley, Charles, cholera of 1854, 851 note

=Kink=, old name of whooping-cough, 666

Kirkmaiden, smallpox and fever in 18th cent., 528

Kirkpatrick, or Kilpatrick, J., inoculates at Charleston, 90, in London, 491, 493

Kite, Charles, second inoculations, 503, failures of inoculation, 515

La Condamine, M. de, case of Timoni’s daughter, 488 note, advocates inoculation, 494, estimates saving of life by same, 516

La Motraye, M. de, procuring smallpox in Circassia, 472

Lamport, John, fever in Hampshire 1680, 21, his success in smallpox, 453

Lamprey, Jones, types of famine sickness in Skull 1846, 287, 288

Lancaster, typhus in 1782, 151

Langton, William, opposes formal inoculation, 500

Lansdowne, Marquis of, inoculation and vaccination, 606, 607

Launceston, gaol typhus, 93, 97, diphtheria, 740

Laurie, J. Adair, statistics of Glasgow cholera hospital in 1832, 811

Laycock, Thomas, influenza at York, 389 note

Le Cat, Claude Nicolas, the Rouen fever of 1753, 121

Leeds, typhus in 18th cent., 146, in 1802, 160, statistics of fever hospital, 164, fever in 1817, 171, notification at in 1804, 180 note, typhus in 1847, 207 note, influenza in 1675, 327, smallpox in 1689-99, 458, general inoculations, 510, smallpox in 1781, 538, 555, cholera nostras in 1825, 773, dysentery in 1849, 791, 842, cholera in 1849, 847

Leith, cholera of 1832, 814, of 1848, 836

Lettsom, John Coakley, gaol fever, 97, London fevers in 1773, 135, inoculation of infants, 507, general inoculation at Ware, 511 London smallpox more than in the Bills, 534, smallpox in 1808, 570, inoculation not contagious, 608, saving of life in typhus, 628, scarlatina in 1793, 718

Levett, Robert, amateur in medicine, 134

Levison, George, scarlatina in 1777, 708

Leyburn, fever in 1813, 167

Limerick, famine of 1741, 242, statistics of fever hospital, 258, pauperism of 1836, 275, statistics of fever, 276, of infantile mortality, 602, cholera of 1832, 818, of 1849, 839

Lind, James, desires history of British fevers, 1, ventilation of gaols, 95, ship fever, 111, Sutton’s pipes, 119, smallpox in the ‘Royal George,’ 543, cholera nostras at Portsmouth, 772

Linnaeus, Carolus, as nosologist, 670

Lipscomb, G., his prize poem on Inoculation, 588

Lisbon, ship fever at, 105

Liskeard, diphtheria in 1748, 694

Liverpool, typhus in 18th cent., 140, enteric in 1836, 201, the Irish fever of 1847, 206, recent typhus, 214, influenza atmosphere in 1837, 388, general inoculations, 504, 508, 511, 18th cent. smallpox, 537, age-incidence of same in 1837, 624, diarrhoea, 765, dysentery in the Irish fever, 790, cholera of 1832, 826, of 1849, 847, of 1854, 851, of 1866, 857

Livingston, Dr, Aberdeen sore-throat in 1790, 718, dysentery in 1789, 784

Lombard, H. C., enteric fever in Britain, 188 note, 201

London, Asiatic cholera of 1832, 820, of 1833, 834, supposed in 1837, 835, epidemic of 1848-9, 841, 847, of 1854, 853, of 1866, 857

London, cholera nostras in, in Sydenham’s time, 769, every autumn, 770, in 1669-70, 771, described by Willis, 772

London, diphtheria in 741-2

London, dysentery in, names of in the Bills, 774, symptoms of in 1669, 776, epidemic of 1762, 779, of 1779-81, 783

London, fever in, endemic, 13, in Sydenham’s time, 18-22, epidemic of 1685-6, 22, identified as typhus, 27, statistics of to end of 17th cent., 43, epidemic of 1694, 45, statistics of 1701-20, 54, epidemic of 1709-10, 54, 57, sample case of, 55, a case of relapsing in 1710, 57, epidemic of 1714, 59, in 1718, 64, statistics of 1720-40, 65, weekly maxima 1726-29, hysteric or little, 67, relapsing, 69, identified as enteric, 70, epidemic typhus of 1741-42, 78-81, in Marshalsea prison, 91, at Old Bailey in 1750, 93, in gaols, 97, slow remittent of 1751-55, 122, typhus from 1770 to 1800, 133-140, localities of, 140 note, hospital for in 1802, 160, slight prevalence of from 1803 to 1816, 163, possible enteric cases in 1808, 165, epidemic of 1816-19, 168, bred by insanitary state of houses, 170, relapsing in 1817, 172, cases of mixed in general hospitals, 178, relapsing in 1826-28, 182, enteric in 1826, 183, change of type to spotted, 188, purely typhus in 1837-38, 194, epidemic typhus of 1847, 205, in part relapsing, 208, relapsing in 1868, 211, ratios of typhus and enteric at Fever Hospital, 213, season of enteric, 217

London, Fire of, supposed effect on plague, 42

London, infantile diarrhoea in, entered as “griping in the guts,” 747, Harris on in 1689, 749, weekly bills of in 17th cent., 750, 752, 753, annual deaths 1667-1720, 753, some 18th cent. weekly bills, 754, 755, conditions favouring, 756, 19 cent. statistics, 759-60, recent death-rates moderate, 761, reasons of greater fatality in former times, 763

London influenza weekly mortalities, of 1580, 310, of 1675, 326, of 1679, 329, of 1688, 336, of 1693, 338, of 1729, 343, of 1733 and 1737, 349, of 1743, 350, of 1762, 356, of 1775, 359 note, of 1782, 363, of 1803, 375, of 1831, 379, of 1833, 380, of 1837, 384, of 1847, 390, of 1890-94, 394

London, measles in, deaths from in 17th cent., 634, 635, 640, epidemic of 1670, 653, epidemic of 1674, 656, indirect effects of same contrasted with those of smallpox, 658-9, deaths from in 18th cent., 641, 643, epidemic of 1705-6, 641, fatalities one-tenth those of smallpox, 644, ratio of to all deaths, 647, epidemic of 1807-8, 650-1, compared with Glasgow, 655, deaths from 1813 to 1837, 660, in 1837-39, 662, two seasonal maxima, 664

London, sanitary state of under George II., 84, improvement in after 1766, 133, of workmen’s houses in 1819, 170

London, scarlatina or diphtheria in, Morton’s cases, 682, cases 1739, 692, Fothergill’s cases, 696, Fordyce’s cases, 707, Levison’s cases, 708, Sims’ cases, 713, Willan’s cases, 714, in 1796-1802, 719, Bateman’s notes of, 722, mild in 1822, 723, recent range of fatality, 730, fatalities at home and in hospital, 730, seasonal maximum, 731

London, smallpox of 1628 in, 435, annual deaths 1629-61, 436-437, epidemic of 1641, 437, after the Restoration, 437, ratio of adult cases 17th cent., 444, mild type in 1667-9, 452, compared with that of 1751, 455, estimate of proportion of faces marked by, 454, epidemic of 1694, 458, of 1710, 461, annual deaths 1701-20, 461, private hospitals for, 463, public hospital for, 505, 533, prevalence in middle of 18th cent., 529, table of weekly deaths in 1752, 532, smaller mortality of infants from than in provincial towns, 534, annual deaths 1761-1800, 535, in the Foundling Hospital, 550, annual deaths 1801-37, 568, epidemic of 1817-19, 580, in Christ’s Hospital in 1818, 581, epidemic of 1825, 593, annual deaths 1837-1893, 613, excessive incidence of from 1871 to 1885, 616, age, sex and fatality of in epidemic of 1871-72, 618, varying fatality of from 1871 to 1893, 619, fatality at each age-period in 1893, 619, ages at death from in 1845, 624

London, whooping-cough, ratio of to all deaths 1731-1831, 647, annual mortality 1701-1782, 669, same from 1783 to 1812, 655

Londonderry, sickness in siege of, 229, cholera in 1832, 818

Louis, P. Ch. A fièvre typhoide, 196 note

Lower, Richard, against bark in fever, 323, his advice to Queen Mary, 459

Lucas, James, typhus in Leeds, 146, smallpox and inoculation, 510, 555

Lucretius, air-borne infection, 408

Lynn, smallpox in 1819, 580

Lynn, Walter, opposes blooding in smallpox, 449, smallpox in 1710-14, 462

Macaulay, Lord, on the Soho plague-pit, 38, eloquent on smallpox, 454, on the death of Queen Mary, 460 note

McCarthy, Alexander, state of Skibbereen in 1826, 274

Maidstone, gaol fever at, 153, diphtheria and ground-water, 744

Maitland, Charles, inoculator, 467-71

Mallet, Mr, catalogue of earthquakes, 407

Malthus, T. R., population and potatoes, 253, 284, 285 note, one infection will replace another, 629

Manchester, miliary fever becomes rare, 131, increase of population, 146, typhus in end of 18th cent., 149, statistics of fever hospital, 164, distress and typhus 1839-41, 197, amount of enteric fever in 1836, 201, typhus in 1847, 207, in 1863-5, 209, smallpox in 18th cent., 536, extent of early vaccination, 583, mortality by smallpox in 1826, 593, measles in 18th cent., 644, scarlatina in 1805, 722, cholera nostras in 1794, 773, cholera in 1832, 826, in 1849, 846

Manningham, Sir Richard, on “little” or hysteric fever, 70

Mapletoft, Dr, his experience of smallpox, 546

Mary, Queen of William III, dies of smallpox, 459

=Marsh fevers= distinct from epidemic agues, 302, 367, 369

=Marshalsea prison=, state of in 1729, 91

Mason, Simon, on ague-curers, 325

Massey, Isaac, smallpox seldom fatal in schoolboys, 545

Mather, Cotton, instigates to inoculation, 485

Maty, M. defends Gatti’s inoculations, 496, proposes general inoculation of infants, 506

May, William, fever and influenza in Cornwall, 373

Mead, Richard, the Dunkirk rant, 340, no failures of inoculation, 487, 488

=Measles=, etymology of, 632, variolae translated by, 633, in 17th cent., 634, 640, Sydenham on, 635, indirect mortality from in 1674, 636, in 18th cent., 641, at Manchester, 644, at Northampton, 645, in the Foundling Hospital, 646, increased fatality at end of 18 cent., 647, anomalous at Uxbridge, 649, the great epidemic of 1807-8, 651, the epidemic in Glasgow, 652, comparison of in London and Glasgow, 655, Watt’s doctrine of substitution, 655-7, reception of same, 657, sequelae of, 659, recent statistics of, 660, recent highest death-rates from, 663, progression of epidemics, 663, season of, 664, age-incidence of, 664, an illustrative epidemic of, 665

Merthyr Tydvil, enteric fever, 219, cholera in 1849, 844-5, 847, in 1854, 851, in 1866, 857

=Miasmatic infection=, Sydenham’s and Boyle’s doctrine of, 29, 400, of enteric fever, 222-3, of endemic ague, 302, of influenza in, 401-5, after earthquakes, 415-20, of dengue, 424, not excluded in scarlatina, 732, of diphtheria, 745, of dysentery, 788, of cholera, 842

Middlesborough, enteric fever, 221

=Miliary fever=, 72, 76, 124, 127, 128-131

=Milk=, a vehicle of enteric fever, 222, of scarlatina, 734, of diphtheria, 745

Millar, Dr, isolation of fever patients, 178

Miller, Hugh, Cromarty cholera, 814

Molyneux, Dr, influenza of 1688, 336, of 1693, 337

Minorca, localized influenza of 1748, 352, mild and severe smallpox, 547

Missenden, Great, inoculation revived, 592

Moir, D. M., Musselburgh cholera, 806

Monro, Alexander, primus, influenza of 1762, 357 note, procuring the smallpox in Scotland, 471, inoculation in same, 509

Monro, A. Campbell, measles at Jarrow, 663

Monro, Donald, war typhus, 110

Montagu, Lady Mary Wortley, favours inoculation, 467-8, referred to in prize poem, 588

Moore, John, on “putrid” fevers, 130, improved health of London, 133

Morley, Christopher Love, epidemic agues and influenzas of 1678-79, 329, 332

Morton, Richard, worm fever, 7, scale of malignity in fevers, 16, fevers of 1678-80, 21, smallpox not fatal to infants, 441, opposed to the cooling regimen in do., 448, fourteen things that make smallpox severe, 451-2, pock-pits, 456, measles of 1674, 657, his view of scarlatina, 682, cholera nostras, 771, dysentery infective, 772

Moryson, Fynes, dietetic habits of Irish, 226

Moseley, Benjamin, practice of vaccination in 1808, 586

Moss, Mr, Liverpool public health 18th cent., 141 note, 368

Mudge, John, experiment in inoculation, 501, 558

Mulgrave, Lord, vaccination among rich and poor, 589

Murchison, Charles, enteric fever in Edinburgh, 200, cause of increase of same in London, 202, history of relapsing fever 1842, 203, enteric of 1846, 206 note, table of typhus in hospitals, 210, confuses marsh agues with epidemic agues, 303-4 note, cerebro-spinal fever a variety of typhus, 863

=Murre=, old name of influenza, 305, 432

Musselburgh, cholera in 1832, 806

Nairn, war typhus in 1746, 109, cholera in 1832, 813-14

=Navy=, health of in 17th cent., 102, in 18th cent., 104, Smollett on, 107 note, in the Seven Years’ War and American War, 111-117, improvement in, 119

Neath, high scarlatina death-rate, 728, cholera in 1849, 845, in 1866, 857

=Nervous= fever, of Willis in 1661, 5, or hysteric, 67, 70, of Wintringham and Hillary, 72, of Gilchrist, 75, of Huxham, 76, or putrid, 120-128

Nettleton, Thomas, pioneer of inoculation, 470, inspires Jurin, 479, gives a real smallpox, 483, his theory of inoculation, 483-4, ceases to inoculate, 485, his statistics of smallpox fatality, 518

=New= acquaintance, 308, ague, 306, 307, delight, 332, disease, 312-13, 344, Boyle on, 313 note, distemper of 1688, 335, fever of Sydenham, 23, 27

Newburn, cholera of 1832, 804

Newcastle-on-Tyne, typhus in 18th cent., 142, 156 note, in 1816-19, 172, “jolly rant” of 1675, 327 note, agues of 1780, 369, inoculation of infants, 507, no smallpox statistics, 539, comparison of inoculations and vaccinations, 582, scarlatina in 1778-9, 712, in 1779-1802, 720, in 1802-27, 723, dysentery 18th cent., 780, 784, cholera of 1831-2, 802, cholera of 1853, 849

Newcastle-under-Lyme, cholera of 1849, 847

Newhaven, cholera of 1848, 835

Newman, John Henry, priests in the Irish fever, 207 note, “chemists for our cooks,” 280

Newton Stewart, smallpox of 1816, 574

Norfolk Island, strangers’ cold of, 432

North, Roger, his fever in 1661, 8, on Lord Guildford’s fever, 321, fashion of blood-letting, 325 note

Northampton, smallpox statistics in 1747, 524, vital statistics, 525, measles and whooping-cough 18th cent., 645, infantile diarrhoea, 765

Norwich, high mortality of 1740-42, 82, smallpox beginning of 19th cent., 569, 578, epidemic of 1819, 578, vaccinations at, 585, inoculations at, 591, smallpox in 1838-9, 605, infantile diarrhoea, 766

=Notification= at Leeds in 1804, 180 note, and incorrect diagnosis, 864

Nottingham, fever in 1808, 165, 18th cent. smallpox, 522, infantile diarrhoea, 761-2

O’Brien, John, Dublin dysentery in 1825, 271, relapsing fever in 1826, 272, intermittents in 1827, 273, 297

O’Brien, W. Smith, native resources of Ireland, 281

O’Connell, Daniel, export of Irish corn in famine, 280

O’Connell, Maurice, Irish famine of 1740, 241, dysentery from it, 242, the mortality from it, 244

O’Connor, Dennis, types of fever in Cork 1849-65, 297

O’Rourke, Rev. John, history of the Irish famine of 1847, 279 note

Ogle, William, influenza mortality, 395, progression of measles epidemics, 663, age and sex in scarlatina deaths, 729, diarrhoea and heat, 762

Oglethorpe, General, reports on state of gaols, 91

=Old Bailey=, black assize of 1750, 93

Ormerod, E. L., relapsing fever with miliaria, 129, 208

Oxford, fevers of children in 1655 and 1661, 5-7, epidemic fever in Wadham College, 59, typhus in 1785, 153, smallpox in 1649 and 1654, 437, in 1661, 439, usually mild, 444, cholera of 1854, 851 note

Paderborn, sickness in British troops, 110

Painswick, typhus in 1785, 154, epidemic agues, 369, general inoculation, 509, smallpox fatal during typhus, 550

Paisley, an epidemic of fever in 1811, 165, cholera of 1831-2, 813

Palatinate, war typhus of 1621, 32

=Parish Clerks of London=, the bills of become inadequate, 385, 594, 596, statistics of smallpox from in 1628, 435, scarlatina appears in, 725

Paris, type of fever in 1700, 53, smallpox of adults in 1825, 593, same compared with Glasgow in 1850-51, 601, 611, whooping-cough in 1578, 666, cholera of 1832, 821, 830 note

Parkin, John, epidemics and electricity, 406 note, cholera water-borne, 832

Parsons, H. Franklin, reports on influenza of 1890-92, 396 note

Peacock, T. B., influenza of 1847, 391

Pearson, George, nature of cowpox, 560, cowpox not smallpox of the cow, 563, second infection with cowpox impossible, 610

Peel, Sir Robert, policy in Irish famine of 1817, 266, in famine of 1845-46, 279

=Peninsular War=, decline of fevers in Britain during, 162-64, 557, 569

Pepys, Samuel, fever of 1661, 9, of the queen in 1663, 13, of 1694, 44, duchess of Richmond’s smallpox, 454

Percival, Thomas, decline of miliary fever, 131, Manchester public health, 146, statistics of smallpox, 536, of measles, 644

Perkins, W. L., nosology of putrid sore-throats, 712 note

Perth, fever of 1622, 30, enteric fever in 1864, 210, cholera of 1832, 813-14

Peru, influenza of 1759, 354, earthquake of 1687, 421, influenza of 1720, 422

=Pestilential fever=, 16, 22, 30, 67, in London in 1773, 137

Peterborough, plague in 1666-7, 34

Pettenkofer, Max von, infection in the subsoil, 403, English officials prejudiced against his doctrine, 859

=Peyer’s patches=, theoretical relation of to ague, 2, found diseased in London fevers, 186, in Anstruther fevers, 189

Philadelphia, measles brought to by Irish, 649

=Physicians, College of=, memorial against drink, 84, 756, inquiry on influenza of 1782, 363, their Dispensary, 462 note, declare inoculation in 1754 to be salutary, 516, 608, but in 1807 to be mischievous, 609, inquiries on cholera of 1849, 846 note

=Plague=, extinction of, 34-43, effects of upon Chester, 40, alarm of in 1710, 58, rumour of in London in 1799, 140

Plot, Robert, smallpox mild, 444

Plymouth, 18th cent. types of fever, 74, worm fever, 75, malignant fever, 77, ship fever, 78, anginose fever, 125, 699, dysentery and fever after Corunna, 166, influenza of 1729, 345, horse-colds, 345-6, influenza of 1733, 347, of 1743, 351, of 1788, 371, influenza in the fleet in 1782, 426, smallpox of 1724-25, 520, malignant sore-throat, 695, 699, recent measles and scarlatina, 720, dysentery, 778, cholera of 1832, 829

Pockpitted faces, in 17th cent. London, 454, the Vaccine Board on decrease of, 456 note

Poland, buying the smallpox in, 473

Popham, John, Cork workhouse in 1846, 286

=Population=, increase of North of Trent, 144, in Ireland, 250, after potato famine, 283, principle of, 657

Port Royal, earthquake of 1692, 415

Portsmouth, dysentery in crews in 1696, 104, ship fever in 1779, 116, influenza in new arrivals in 1788, 372, agues and fluxes, 772

=Posse=, old name of influenza or catarrh, 305 note, 308 note

=Potatoes=, in Ireland, 241, 252, 284

Preston, infantile diarrhoea, 705, suffers little from cholera, 823

=Prices=, in 18th cent., 62, 131, in 1801, 159, in second half of French war, 162, 256-7, effects of fall of in Ireland, 268

Prichard, J. C., Bristol fever 1817-19, 173, cases not isolated, 179

Pringle, Sir John, ventilation of Newgate, 94, war dysentery and typhus, 108-10, nosology of continued fevers, 130, improved state of London, 133, little smallpox in campaigns, 545, dysentery rarely epidemic in London, 779 note

=Prisons=, state of early in 18th cent., 90-92, Howard’s visitations of, 95, Lettsom’s cases of fever in, 97, fever in 1785-88, 153, little smallpox in, 544, Neild’s reforms of, 628

Pulteney, R., Blandford, smallpox, 513

=Purples=, meaning of, 680

=Putrid fever=, in the sense of Willis, 16, in 18th century sense, 120-8, 129-30, 683, 700

=Putrid measles=, 705

Pylarini, Jacob, on transplantation of smallpox, 465, 476

=Quarantine=, for plague pressed on the Ministry by Swift, 58 note, in the cholera of 1831-32, 794, 798, 799, 814, 820

Queensferry North, vaccinations during an epidemic, 585

Radcliffe, John, attends Queen Mary in smallpox, 460 note Ranby, John, his pamphlet against Jurin, 481 note, his inoculation practice, 504

Reid, John, enteric fever at Edinburgh, 199

Reid, Seaton, relapsing synocha, 177

=Relapsing fever=, case of in London 1710, 57, in 1727-29, 69, 74, at Edinburgh 1735, 76, in Gloucestershire in 1794, 156, in London in 1817, 168, 172, affinities of, 177, in Scotland in 1817-19, 174, in 1827-28 181, in London, 182, in Scotland in 1842-44, 203, in 1847, 208, in 1869-71, 210, in Dublin in 1738, 239, in 1746-48, 243, in Ireland in 1799-1801, 450, in 1817-19, 266, in 1826, 271-2, in 1846-7, 289, not always associated with want, 211

=Remittent fever=, 68, 69 note, 72, in London in 1751-55, 122, Cormack on, 392 note

Reynolds, Revell, epidemic agues of 1780, 366

=Rheumatic fever=, its relation to dysentery, 782

=Rickets= in London 18th cent., 756, relation of to infantile diarrhoea, 766

Rigby, Edward, vaccinations at Norwich, 584

Ripon, fevers at in 1726-28, 72

Roberton, John, vaccination at Manchester, 583, smallpox after vaccination, 597 note, measles in Edinburgh 1808, 651, criticism of Watt, 658

Robertson, Robert, ship fever, 114, influenza of 1782 in the fleet, 426, no fatalities in smallpox, 546

Rochdale, fever of 1818, 171

Rogan, Francis, slaughter-houses not noxious, 236 note, population in Tyrone 1817, 253, cottiers in same, 255, famine of 1817, 257, dysentery and fever of, 258-260, ratio of attacks, 263, smallpox in the famine of 1817, 573

Rogers, James E. Thorold, starvation wages 18th cent., 62, Malthus and high standard of living, 285 note

Rogers, Joseph, criticism of Sydenham, 10, epidemic in Wadham College, 59, fevers in Cork 18th cent., 234

=Roseola=, epidemic, supposed the scarlatina of Sydenham, 681

Rouen, epidemic fever of 1753-4, 121

Royston, William, epidemic agues of 1780 and 1808, 378 note

Rumsey, Henry, epidemic sore-throat in Chesham, 715, “the croup” in the same, 716

Rush, Benjamin, smallpox after inoculation, 488, infantile diarrhoea, 758

Russell, Lord John, cost of Irish potato famine, 282

Russell, James B., scarlatina from cows’ milk, 734 note

Ruston, Thomas, antidotes to smallpox, 494 note

Rutty, John, “putrid” fevers in Dublin, 127, 245, nervous and relapsing fevers, 239, 240, 243, famine fever of, 1740 244, agues and horse-colds, 354, smallpox in Ireland, 543, malignant during typhus, 549, throat-distemper of 1743, 693

Ryan, Dennis, dysentery in transports, 784

St Andrews, smallpox in 1818, 575, dysentery in 1736, 778

St Kilda, strangers’ cold, 431

Salford, infantile diarrhoea, 761-2, 765 note, cholera of 1832, 828

Salisbury, smallpox in 18th cent., 528, cholera in 1832, 829, in 1849, 847

Sanderson, J. B., diphtheritic membrane, 740 note

Sauvages, F. B. de, his nosology, 670, 678

=Scarlatina= and diphtheria, 18th cent., 678, simplex of Sydenham, 680, of Sibbald, 681, perhaps epidemic roseola, 681 note, Morton’s view of, 682, anginosa at Edinburgh, 684, at Plymouth, 684, popular name of epidemic sore-throat, 687, 697, 701, Cotton’s name for epidemic sore-throat in 1748, 698, called miliary, 688, 703, diagnosis from anomalous measles, 649, 705, mild at Ipswich in 1771, 708, anginosa in London in, 1777 708, Withering on, 711, Heberden on, 712 note, Willan’s statistics 1786, 714, Rumsey on, 715, epidemic period 1796-1805, 719, mildness of type 1805-31, 722-5, modern statistics of, 726, incidence on age and sex, 729, range of fatality, 730, fatalities at home and in hospital, 730, alleged influence of drought, 731, maximum in late autumn, 731, question of miasma, 732, uncertainty of its contagion, 733, in children’s hospitals, 733, from cows’ milk, 734, as a septic disease, 735

Schacht, Lucas, fevers of Leyden, 332

Schultz, Simon, buying the smallpox, 473

=Scurvy=, supposed prevalence of on land in 17th cent., 1, 317, 319

Sedgley, cholera of 1832, 825

=Seven ill years=, fevers of in Scotland, 47-52

=Sewerage= of London 858, of Lancashire towns, 209, defects of in new mining townships, 220, 845

Shapter, Thomas, influenza contagious, 387, Exeter, cholera in 1832, 829

Sharkey, Edmond, Asiatic cholera in 1837 at Berehaven, 834 note

Sheffield, vital statistics of 17th cent., 58, epidemic sore-throat 18th cent., 696, 704, diarrhoea during cholera, 842 note, cholera in 1849, 848

=Ships=, cholera in, 826, 857, fever in, see Navy, influenza in, 425-31

Short, Thomas, scarlatina in 1759, 704

Sibbald, Sir Robert, diseases of Scots 17th cent., 48, bleeding in smallpox, 447, scarlatina, 681

Simon, Sir John, inquiry on diphtheria, 739, general principles of sanitation, 834, report on Newcastle cholera in 1853, 849

=Simple continued fever=, a common form in the epidemic of 1817-19, 168-174, relation of to relapsing fever, 177, 272, in London 1826-28, 182, in Bristol, 189 note, 176, recent statistics of, 212, 216, 296

Simpson, Sir J. Y., cholera of 1832, 815 note

Simpson, William, choleraic season of 1678, 333

Sims, James, London typhus in 1786, 138, Tyrone fevers 18th cent., 127, 246, smallpox, 543, London scarlatina in 1786, 713, in 1798, 719

Skibbereen, dysentery in 1826, 273, exports of food from, 280, sicknesses of the great famine, 286, 287, 288

Slatholm, Dr, against blooding and cooling in smallpox, 447, smallpox transferred to a sheep, 475

Sligo, cholera of 1832, 818

Sloane, Sir Hans, Jamaica earthquakes, 415, procures account of inoculation, 465, advises the king on same, 469

=Smallpox=, references to before 1660, 434, after the Restoration, 437, alleged increase of fatality, 439, alleged mildness in infants, 441, largely a disease of adults in 17th cent., 443, the cooling regimen in, 445, Morton on the causes of a severe type, 451, marks of a recent epidemic visible, 454, estimate of the numbers marked by in 17th cent., 455, London deaths by from 1661 to 1700, 456, in the country at end of 17th cent., 458, death of Queen Mary from haemorrhagic form of, 458, epidemic in 1710, 461, a trouble in great houses, 462, houses for, kept by nurses, 463, at Boston, New England, in 1721, 485, 626, at Charleston, 490, hospital in London for, 505, at Blandford, 513, in the Foundling Hospital, 514, table of epidemics of from 1721 to 1729, 518, at Hertford in 1721, 519, at Plymouth in 1724, 520, at Aynho, 520, at Hastings, 521, at Nottingham, 522, at Edinburgh 18th cent., 523, at Northampton, 524, at Boston, 525, 540, at Kilmarnock, 526, intervals between epidemics of, 527, various epidemics 1751-53, 529, London deaths 1721-60, 531, weekly deaths in 1752, 532, among London infants, 533, London deaths 1761-1800, 535, 18th cent. statistics of Manchester, Liverpool, Chester, Carlisle and Glasgow, 536-40, in parishes of Scotland 18th cent., 541, in Ireland, 543, in the army and navy, 543, wide range of fatality, 544, comparison of epidemics at Chester and Warrington, 550, summary of 18th cent. history, 556, London deaths by from 1801 to 1837, 568, Glasgow deaths 1801-1812, 569, epidemic of 1817-19, 571, the crystalline form of, 574-7, at Norwich in 1819, 578, in Christ’s Hospital, 581, the epidemic of 1825-26, 593, so-called “secondary,” 597, a generation of in Glasgow, 597, in Limerick 1830-40, 601, the epidemic of 1837-40, 604, legislation for in 1840, 606, ages of at Paris and Glasgow compared, 611, more adults attacked abroad than in Britain, 612, London deaths by from 1837 to 1893, 613, table for England, 614, comparison of the epidemics of 1837-40 and 1871-72, 615, has almost ceased in rural parts, 616, London’s recent share of, 617, recent rates of fatality from, 618, in Ireland since 1864, 620, in Scotland since 1855, 622, varying ratios of children and adults attacked at various periods of history, 622-7, reason why fewer children attacked in epidemic of 1871-72, 627, Watt’s doctrine of substitution applied to, 629

Smollett, Tobias, sick bay of the ‘Cumberland,’ 107 note

Snow, John, water-borne cholera, 852, 854

Southampton, a 17th cent, autopsy at, 316

Spalding, diphtheria, 739, 740

Spelman, Sir Henry, on burials, 37

=Spotted fever= in 17th and 18th cent., 13, universal in 1623, 31, cases in Archbishop’s family, 64, Arbuthnot on, 67, return of after 1831, 188, 277

Stark, James, sex-fatality in whooping-cough, 672 note

Stewart, Frances, her beauty after smallpox, 453

Stokes, William, Dublin enteric fever in 1826, 187 note

Story, Rev. George, camp sickness at Dundalk, 230-2

Stow, John, irregular building of London out-parishes, 85-6

Strabane, a congested district in 1817, 253, fever and dysentery in, 259-60, 263, smallpox in 1817, 573

Stranraer, smallpox in 1829, 600

Streater, Aaron, ague curer, 316

Streeten, R. J. N., influenza of 1837, 387 note

Strother, Edward, London fevers of 1727-29, 68-70

Stroud, tests of cowpox at, 565

Sturges, Octavius, whooping-cough mimetic, 677

Sudell, Nicholas, ague curer, 317

Sunderland, recent typhus in, 214, 217, cholera begins at, in 1831, 796

=Surfeit=, meaning of, 775

Sutherland, John, reports on cholera of 1848-49, 837-8, 840

Sutton, Daniel, his method of inoculation, 498

=Sweat, the=, late reference to by Shakespeare, 311 note

Sweden, early statistics of whooping-cough, 670

Swift, Jonathan, urgent for quarantine, 58 note, the stinks in his London lodging, 87, state of Ireland in 1729, 238, on an ague curer, 325

Sydenham, Thomas, on succession of epidemic types, 4, 631, his epidemic constitutions, 9, on intermittents, 11, 302, 314, on comatose fever, 20, on depuratory fever, 21, on the “new fever” of 1685-6, 22, 24, 27, his theory of subterranean miasmata, 29, 80, a Scotch disciple of, 48, on marsh agues, 302, his position in the bark controversy, 320, 321-2, on influenza of 1675, 327, of 1679, 329, on epidemic agues of 1678-80, 331, his view of influenza, 399, his practice in smallpox, 445, smallpox most fatal to the rich, 450, on measles in 1670 and 1674, 655, on pertussis, 677, on scarlatina, 680, on diarrhoea in infants, 749, on cholera nostras, 770, on dysentery, 776

Symonds, John Addington, Bristol cholera in 1832, 828

Tain, cholera in 1832, 814

Talbor, Sir Richard, ague curer, 318, his use of bark, 319, 322

=Tar-water=, in fever, 242, in smallpox, 546

Taunton, dysentery in 1837, 790

Tavistock, cholera in 1849, 847

Tawton, North, epidemic fever of 1839, 196

Tees valley, enteric fever in, 221

Tewkesbury, burial in coffins, 36

Thackrah, Charles T., Leeds cholera nostras in 1825, 773

Theydon Bois, cholera in 1865, 857

Thompson, Theophilus, his ‘Annals of Influenza,’ 360 note

Thomson, John, smallpox of 1817-19, 575-6

Thoresby, Ralph, on influenza of 1675, 327, loses his children by smallpox, 458

Thorne, Richard Thorne, diphtheria from cow’s milk, 745 note

Thorp, Dr, Leeds fevers in 1802, 160

=Throat distemper=, see Scarlatina

Timoni, Emanuel, first writer on inoculation, 463, visited by La Motraye, 472 note, his inoculated daughter dies of smallpox, 488

Tiverton, fever of 1741, 80

Torbay, influenza on board ships in, 426

Torthorwald, 18th cent. fevers, 154, vital statistics, 542

Torrington, strange experience of, in the influenza of 1782, 364

Toynbee, Arnold, the industrial revolution, 145

Tralee, typhus, 259, cholera in 1849, 840

Trallianus, Alexander, dysenteria rheumatica, 782

Tranent, cholera in 1832, 806

=Transplantation= of disease, 474

Tristan d’Acunha, strangers’ colds, 431

Tronchin, Theodore, inoculation by blister, 493

Trotter, Thomas, ship fever, 117, Northumberland fevers 18th cent., 156 note, smallpox in the navy, 544

Turner, John, influenza of 1712, 340

Tullamore, panic at, from fever of 1817, 262

Tynemouth, cholera in 1849, 846, in 1853, 850, in 1854, 851

=Type, change of=, in continued fever, 2, 189, 203, 277, in scarlatina, 724, 730

=Typhoid fever= see Enteric

=Typhus=, see also Simple Continued, Nervous, Putrid, Miliary, Pestilential, War, Gaol, Ship and Workhouse fevers. Perennial in London in 17th and 18th cent., 13, 67, epidemic of 1685-6 identified as, 27, the type of universal fever in 1623-4, 31, corresponds to the malignant fever of 1694, 44, among children at Bristol in 1696, 47, in Scotland at end of 17th cent., 48, 49, at Paris in 1700, 53, a case in London in 1709, 53, in Chester Castle in 1716, 60, or synochus at York in 1718, 63, in 1728, 73, at Plymouth in 1735, 77, the type in the English epidemic of 1741-42, 83, and in the Irish, 243, circumstances of severe type of, 98-102, 290, relation of to dysentery, 108, 231, 792, in Lettsom’s dispensary practice, 136, identified by Hunter in London with gaol or hospital fever, 138, described by Sims in 1786, 138, by Willan in 1799, 139, by Currie at Liverpool, 141, at Newcastle, 142, 156 note, at Chester, 143, at Leeds, 146, 160, at Carlisle, 147, at Manchester, 149, 157, at Lancaster, 151, at Whitehaven, 152, in England generally 1782-85, 153, in Scotland, 154, 161, reference to by Robert Burns, 154 note, epidemic of 1799-1802, 160, in Ireland, 248, epidemic of in fiction in 1811, 162 note, decline of in second period of French war, 163, 167, epidemic of 1817-19, in England, 168, rare in the Scotch epidemic of same years, 175, in the Irish epidemic, 258, in Galway in 1822, 270, the common type of continued fever from 1831 to 1848, 188-198, the epidemic of 1847 in England, 205, in Scotland, 208, 839 note, in Ireland, 289-92, of the Lancashire cotton famine, 209, prevalence of relative to enteric, 211, recent decrease of, 214, 606, recent highest death-rates, 214, 217, mistaken for typhoid, 214, table of for Scotland, 216, for Ireland, 296

Tyrone, over-population in, 254, effects of the famine of 1817-19, 264

Ulverston, smallpox in 1816, 573

Uxbridge, measles in 1801, 649

=Vaccinal Syphilis=, real nature of, 562 note

=Vaccination=, rival of inoculation, 557, its pathological nature, 559-562, tests of its efficacy, 564, approved by the State, 567, extent of its practice to 1825, 582-6, Gregory on the effect of upon the London smallpox of, 1825 595, reasons for treating it as irrelevant to the epidemiology of smallpox, 596, prejudices of working class against, 606-7, made compulsory in 1853 on the precedent of 1840, 610, of adults, or re-vaccination, common on the Continent sooner than in Britain, 611-3 see also Cowpox

=Vagrancy= in Irish famines, 244, 261, 267

“=Variolae Vaccinae=,” figurative name of cowpox, 563

=Ventilation= of gaols, 94, of ships, 118. See also Window-tax.

Verdier, Jean, vaccination incorrect in principle, 587

=Vibrios= in cholera, 827 note

Virchow, Rudolph, dysentery and typhus, 108 note, season of epidemic typhoid in Berlin, 217

Voltaire, M. de, his mythical account of inoculation in Circassia, 473 note

Wagstaffe, William, objects to inoculation, 478, 607

Wakefield, dysentery in asylum, 787

Wakley, James, carries Bill against inoculation, 607

Walker, George A., London graveyards, 87

Walker, John, “vaccinates” with smallpox, 590

Walker, Patrick, sickness in the seven ill years, 50, epidemic agues in Scotland, 341

Wall, John, fever of 1741, 83, epidemic sore-throat of 1748, 701-2, relation of same to murrain, 736 note

Wall, Martin, Oxford typhus in 1785, 153

Walpole, Horace, on middle-class comfort, 60, suffers from nervous fever, 71 note, influenza of 1743, 350, horse-cold of 1760, 355, deaths by sore-throat in 1760, 703

=War typhus= at Chester in 1716, 60, at Feckenheim in 1743, 108, in 1746, 109, at Paderborn in 1761, 110, from Peninsular War, 166

Ward, T. Ogier, Wolverhampton cholera, 825

Ware, inoculation after an epidemic, 511

Warren, Dr, of Boston, two forms of influenza in successive seasons, 398 note

Warren, H., scarlatina anginosa in Barbados 1736, 684

Warrington, fevers at in 1773, 148, smallpox in 1773, 537, 553, comparison of with Chester as regards infant mortality, 551-5, cholera of 1832, 829 note

=Water= from reservoirs, a source of enteric fever, 220 note, 221, and note, 222 note, a source of cholera, 832, 848, at Newcastle in 1853, 550, in London, 853, 859

=Water= from wells, a source of enteric fever, 219 note, source of dysentery, 791, source of cholera, 848, the Broad St pump, 854, Theydon Bois, 857

=Water= in the subsoil, relation to enteric fever, 217, 221, Arbuthnot on its relation to influenza, 403-4, 408, relation to scarlatina years or season, 731, to diphtheria at Maidstone, 744, to cholera at Bilston, 824, 830, to cholera in east of London 1866, 859, to cholera in the endemic area of Bengal, 861

Waterford, fever hospital founded in 1799, 249, statistics of fever 1817-19, 266

Watson, Sir Thomas, epidemic fever of 1837-39 all typhus, 194, “threw the agy off his stomach,” 318 note, cause of intestinal irritation in scarlatina, 697 note, rarity of dysentery, 790

Watson, Sir William, peeling of skin after influenza, 351, inoculation trials at the Foundling, 500, 503, smallpox in the Foundling, 514, 550, putrid measles in same, 705, dysentery in 1762, 779

Watt, Robert, Glasgow vital statistics, 539, 569, 654, vaccination no direct effect on measles fatality, 583, decline of smallpox, 597, its place taken by measles, 629, 653-8, statistics of whooping-cough, 675, meaning of “bowel-hive,” 758 note

Watts, Giles, mildness of Sutton’s inoculation, 499

Webster, Noah, his theory of influenza, 405-7, influenza of 1781 in America, 410, influenza at sea, 428, fatality of measles, 645, insanitary state of American towns, 685, angina of cats in Philadelphia &c., 719 note

West, Charles, nature of infantile remittent fever, 5, exanthematic typhus, 189, no enteric cases in 1837-8, 194

West Ham, diphtheria, 742

Wharekauri, strangers’ cold, 432

Whitaker, Tobias, smallpox more fatal after the Restoration, 439, blooding in smallpox, 447, prevention of pock-pits, 456

White, J., fevers in the navy 17th cent., 104

White, William, public health of York improves, 63

Whitehaven, gaol and ship fever, 114, fevers, 152, 156, few children die of them, 571, fatality of smallpox, 538, 547, vaccination supersedes inoculation, 582, 586, cholera in 1832, 829

Whitmore, H., influenzas and agues of 1658-9, 313, 362, opposes blooding in influenza, 381 note

=Whooping-cough= called “the kink” in medieval book, 666, little regarded till 18th cent., 668, apparent increase of London deaths, 669, nosologically recognized in Sweden, 670, various British statistics 18th cent., 670, recent statistics, 671, probable cause of higher fatality in females, 672, now heads list of its class, 673, as a sequel of other diseases, 674, its pathology, 676, partly contagious by mimicry, 677

Whytt, Robert, influenza of 1758, 353, smallpox fatal in 1758, 547

Wick, cholera of 1832, 815

Wilde, Sir W. R., census of Ireland after the famine, 292

Willan, Robert, London typhus in 1796-99, 139, agues, 373, measles, 648, 18th cent. throat distempers all scarlatinal, 679, 737, the Foundling epidemic of 1763, 705, scarlatina of 1786, 713, of 1796-1801, 719, uncertainty of scarlatinal contagion, 733, dysentery in 1800, 785

Williams, Robert, on 17th cent. agues and dysenteries in London, 304 note, electrical theory of influenza, 406 note

Willis, Thomas, epidemic fever of 1661, 4-7, cases and postmortem of, 6, scale of malignity in fevers, 16, epidemic agues of 1657-58, 314, refers to bark in 1660, 320, smallpox at Oxford in 1649 and 1654, 437, less danger from smallpox in childhood, 441, opinion on Duke of York’s children, 451, whooping-cough left to nurses, 667, convulsions, 749, cholera nostras of 1670, 772, symptoms of dysentery, 776

Wilson, Andrew, bilious colic, 771 note, Newcastle dysentery, 780

=Window-tax=, effects of on health, 88, history of, 88

Wintringham, Clifton, typhus in Yorkshire in 1718, 63, nervous fevers, 72, 73, agues, 341, influenza of 1729, 345, measles, 642, angina and miliary fever, 683

Withering, William, describes scarlatina anginosa in 1778, 710-12

Witney, fever in 1818, 170

Wolverhampton, cholera in 1832, 825, in 1849, 845

Woodward, John, treatment of smallpox, 449

Woodville, William, history of the Inoculation Hospital, 505, value of inoculation, 516, recent vaccination does not keep off smallpox, 565

Worcester, gaol typhus, 153, epidemic sore-throat, 701, infantile diarrhoea, 765-6

=Workhouses= fever in English, 47, 79, 126, 137, 154, 168; established in Ireland, 267, fever in, 286, 289, 293

Wordsworth, William, distress of 1794, 156

=Worm fever=, 7, 75, 111, 247

Worthing, enteric fever in 1893, 220

=Yellow fever= in the navy, 17th cent., 102

York, improved public health 18th cent., 63

Youghal, cholera in 1837, 835 note

Young, Arthur, prices and wages in 1801, 159, potatoes in Ireland, 252, potatoes as the English staple food, 284, Warrington industry, 551

Ystradyfodwg, enteric fever, 220

Cambridge: PRINTED BY C. J. CLAY, M.A. AND SONS, AT THE UNIVERSITY PRESS.

FOOTNOTES:

[1] James Lind, M.D., Two Papers on Fevers and Infection. Lond. 1763, p. 79.

[2] Observations on Fevers and Febrifuges. Made English from the French of M. Spon. London, 1682.

[3] James Hutchinson, M.D., De Mutatione Febrium e tempore Sydenhami, etc. Edin. 1782. Thesis.

[4] Observationes Medicae, 3rd ed. 1676, I. 2. § 23. English by R. G. Latham, M.D.

[5] Reports of Whitehaven Dispensary (Dixon) and of Nottingham General Hospital (Clarke), cited in the sequel.

[6] Rilliet, De la Fièvre Typhoïde chez les Enfants, Thèse, Paris, 2 Janv. 1840, based on 61 cases; West, Diseases of Infancy and Childhood, 3rd ed. Lond. 1854.

[7] “Febris epidemicae cerebro et nervoso generi potissimum infestae, anno 1661 increbescentis descriptio,” in Pathologia Cerebri, Cap. VIII, “De Spasmis universalibus qui in febribus malignis” etc., Eng. transl. p. 51.

[8] “Itaque ventrem inferiorem primo aperiens, viscera omnia in eo contenta satis sana et sarte tecta inveni”--the small intestine being telescoped in several places.

[9] Elsewhere he says the first case of the series was “circa solstitium hyemale anno 1655.”

[10] De Febribus, chapter “De febribus pestilentibus.”

[11] Treatise on the Infantile Remittent Fever. London, 1782.

[12] Pyretologia, 2 vols. Lond. 1692-94, i. 68, at the end of “Synopsis Febrium”:--“Febris verminosa, quae nulli e specibus memoratis praecisé determinari potest.”

[13] Häser gives a reference to an essay in which Willis’s fever of 1661 is compared to enteric fever: C. M. W. Rietschel, Epidemia anni 1661 a Willisio et febris nervosa lenta ab Huxhamio descriptae, etc. cum typho abdominali nostro tempore obvio comparantur. Lips. 1861. Not having found this essay, I cannot say on what grounds the comparison is made.

[14] Lives of the Norths. New ed. by Jessopp. 3 vols. 1890, iii. 8, 21.

[15] Diary of John Evelyn, Esq., F.R.S., 1641-1706, under the date of 18 Sept.

[16] Diary of Samuel Pepys, Esq., F.R.S., 1659-69.

[17] An analysis of the four Hippocratic constitutions, with modern illustrative cases, is given by Alfred Haviland, Climate, Weather, and Disease. London, 1855.

[18] Epist. I. Respons. § 57. Greenhill’s ed. p. 298.

[19] Tillison to Sancroft, 14 Sept. 1665. Cited in former volume, p. 677: “One week full of spots and tokens, and perhaps the succeeding bill none at all.”

[20] H. Clutterbuck, M.D., Obs. on the Epidemic Fevers prevailing in the Metropolis. Lond. 1819, pp. 58-60.

[21] Horace Walpole’s Letters give two instances: he himself had never set foot in Southwark; a small tradesman in the City had never heard of Sir Robert Walpole.

[22] Transactions of the College of Physicians, iii. 366.

[23] Willis, Op. ed. 1682, Amstelod. p. 110. “De febribus pestilentibus”: “Etenim vulgo notum est febres interdum populariter regnare, quae pro symptomatum vehementia, summa aegrorum strage, et magna vi contagii, pestilentiae vix cedant; quae tamen, quia putridarum typos innotantur, nec adeo certo affectos interemunt aut alios inficiunt haud pestis sed diminutiori appellatione febris pestilens nomen merentur. Praeter has dantur alterius generis febres, quarum et pernicies et contagium se remissius habent, quia tamen supra putridarum vires infestae sunt, et in se aliquatenus τὸ θεῖον Hippocratis continere videntur, tenuiori adhuc vocabulo febres malignae appellantur.”

The war-typhus of 1643, which was sometimes bubonic, and was succeeded by plague in 1644, is given as an example of febris pestilens; the epidemic of 1661 as an example of maligna.

[24] Pyretologia, i. 68.

[25] C. L. Morley, De morbo epidemico, in 1678-9, narratio. Lond. 1680.

[26] Guido Fanois, De morbo epidemico hactenus inaudito, praeterita aestate anni 1669 Lugduni Batavorum vicinisque locis grassante. Lugd. Bat. 1671.

[27] Brownrigg cites the Leyden epidemic of 1669, which he calls an intermitting fever, as an instance of the effects of changes in the ground water; it was “powerfully aggravated by the mixture of salt water with the stagnant water of the canals and ditches. This fever happened in the month of August, 1669, and continued to the end of January, 1670.” “Observations on the Means of Preventing Epidemic Fevers.” Printed in the Literary Life of W. Brownrigg, M.D., F.R.S. By Joshua Dixon, Whitehaven, 1801.

[28] Obs. Med. 3rd ed., v. 2.

[29] Epist. I. Respons. §§ 56, 57.

[30] Pyretologie, i. 429.

[31] John Lamport alias Lampard, A direct Method of ordering and curing People of that loathsome disease the Smallpox. Lond. 1685, p. 28.

[32] Hist. MSS. Com. v. 186. Duke of Sutherland’s historical papers.

[33] Schedula Monitoria I. “De novae febris ingressu.” §§ 2, 3.

[34] Ibid. § 46.

[35] In the Belvoir Letters (Hist. MSS. Com. Calendar) Charles Bertie writes from London to the Countess of Rutland, 26 January, 1685, that “many are sick of pestilential fevers.” Evelyn says that the winter of 1685-6 was extraordinarily wet and mild, but does not mention sickness until June, 1686, when the weather was hot and the camp at Hounslow Heath was broken up owing to sickness.

[36] Evelyn’s Diary, which gives other particulars, including a description of the ice-carnival on the Thames.

[37] Thomas Short, M.D. of Sheffield, New Observations on City, Town and Country Bills of Mortality. London, 1750.

[38] Freind (Nine Commentaries upon Fever, &c., engl. by Dale, Lond. 1730, p. 4) has the following general criticism upon Sydenham’s varying constitutions of fevers: “I believe also I may truly affirm that those very fevers which Sydenham explains as distinct species, according to the various temperature of the seasons, do not differ much from one another. For, if perhaps you should except the Petechiae, they differ rather in degree than in kind. There hardly ever appeared a fever in any season where the signs so constantly answered one another, that those which you found collected in one person should unite after the same manner in another; however upon this account you would not deny their labouring under the same distemper.”

[39] Tractatus de Podagra, § 35. Greenhill’s edition, p. 428.

[40] Chronicle of Perth (Maitland Club) under date 14 Oct. 1621.

[41] Thorold Rogers, Hist. of Agric. and Prices, sub anno.

[42] Extracts from Kirk Session Records. Spalding Club, 1846.

[43] Chronicle of Perth.

[44] History of the Burgh of Dumfries. By W. MacDowall. 2nd ed. Edin. 1873, p. 381.

[45] Court and Times of James I., ii. 331.

[46] Ibid., under date 25 Oct. 1423.

[47] Ibid., ii. 439.

[48] Cal. Coke MSS. (Hist. MSS. Com.) i. 158.

[49] C. and T. James I., ii. 469.

[50] Mayerne, Opera Medica, Lond. 1700.

[51] Ibid., ii. 473.

[52] Janus Chunradus Rhumelius, Historia morbi, qui etc. Norimb. 1625.

[53] W. D. Cooper, Archæologia, XXXVII. (1857) p. 1. I had overlooked this important paper on English plagues in my former volume. The chief additional facts that it contains are the very severe plague at Cambridge in the summer of 1666, the deaths of 417 by plague at Peterborough in 1666, and of 8 more in the first quarter of 1667, and the slightness of the Nottingham outbreak, which was in August, 1666 (p. 22).

[54] London Gazette, 17-21 June, 1675, repeated in the number for 28 June-1 July.

[55] Brand, Hist. of Newcastle, II. 509. Report contradicted on 18 Dec.

[56] “The habitations of the poor within or adjoining to the City,” says Willan, “have suffered greatly; and some, I am informed, have been almost depopulated, the infection having extended to every inmate. The rumour of a plague was totally devoid of foundation.”

[57] Rudder, A New History of Gloucestershire, 1779, P. 737.

[58] Spelman, De Sepultura. English ed. 1641, p. 28. He cites the burial fees paid to the parson as twice as much for coffined as for uncoffined corpses. This agrees on the whole with the evidence adduced in the former volume of this history, p. 335.

[59] 18 and 19 Car. II. cap. 4; 30 Car. II. (1), cap. 3. These Acts were repealed by 54 Geo. III., cap. 108.

[60] History of England, I. 359.

[61] He has one or two relevant remarks: “But while we suppose common worms in graves, ’tis not easy to find any there; few in churchyards above a foot deep, fewer or none in churches, though in fresh-decayed bodies. Teeth, bones, and hair give the most lasting defiance to corruption. In an hydropsical body, ten years buried in the churchyard, we met with a fat concretion [adipocere] where the nitre of the earth and the salt and lixivious liquor of the body had coagulated large lumps of fat into the consistence of the hardest Castille soap, whereof part remaineth with us. The body of the Marquis of Dorset seemed sound and handsomely cereclothed, that after seventy-eight years was found uncorrupted. Common tombs preserve not beyond powder: a firmer consistence and compage of parts might be expected from arefaction, deep burial, or charcoal.”

[62] One may allege poverty on general grounds, as well as on particular. Thus, in 1636, the mayor was unpopular: “He was a stout man and had not the love of the commons. He was cruel, and not pitying the poor, he caused many dunghills to be carried away; but the cost was on the poor--it being so hard times might well have been spared.” Ormerod, I. 203.

[63] Printed plague-bill, with MS. additions, Harl. MS. 1929.

[64] Haygarth, Phil. Trans., LXVIII. 139.

[65] Cotton Mather’s Magnalia. Ed. of 1853, I. 227.

[66] History of England &c., IV. 707. Evelyn (Diary, 21 May, 1696) says the city was “very healthy,” although the summer was exceeding rainy, cold and unseasonable.

[67] Thomas Dover, M.B., The Ancient Physician’s Legacy. London, 1732, p. 98.

[68] Broadsheet in the British Museum Library.

[69] Tooke, Hist. of Prices, Introd.

[70] Scotia Illustrata. Edin. 1684. Lib. II. p. 52.

[71] Fynes Morryson, Itinerary, 1614. Pt. III. p. 156.

[72] Edinburgh, 1691, p. 67.

[73] The Epilogue to the Five Papers, etc. Edin. 1699, p. 22. This title refers to a controversy on the use of antimonial emetics in fevers. See Dr John Brown’s essay on Dr Andrew Brown, in his Locke and Sydenham, new ed. Edinb., 1866.

[74] He adds that “the fever has several times before been in my family and among my servants and children.” In mentioning the case of the Master of Forbes in August, 1691, whom he cured, he remarks that “the malicious said he was under no fever”; to disprove which Dr Brown refers to the symptoms of frequent pulse, watching and raving, continual vomiting, frequent fainting, and extreme weakness.

[75] Andrew Fletcher, Two Discourses. 1699.

[76] The English Government took off the Customs duty upon victual imported from England to Scotland, and placed a bounty of 20_d._ per boll upon it.

[77] Patrick Walker, Some Remarkable Passages in the Life and Death of Mr Daniel Cargill, &c. Edinb. 1732. (Reprinted in Biographia Presbyteriana. Edinb. 1827, II. 25.)

[78] Sir John Sinclair’s Statistical Account of Scotland. 1st ed. III. 62.

[79] Ibid. II. 544.

[80] Ibid. VI. 122.

[81] In the remote parish of Kilmuir, Skye, the famine is referred to the year 1688, “when the poor actually perished on the highways for want of aliment.” (Ibid. II. 551.) In Duthil and Rothimurchus, Invernessshire, the famine is referred to 1680, “as nearly as can be recollected:” “A famine in this and the neighbouring counties, of the most fatal consequence. The poorer sort of people frequented the churchyard to pull a mess of nettles, and frequently struggled about the prey, being the earliest spring greens.... So many families perished from want that for six miles in a well-inhabited extent, within the year there was not a smoke remaining.” (Ibid. IV. 316.) In the Kirk session records of the parish of Kiltearn, Rossshire, which I have seen in MS., there are various entries in the year 1697 relating to badges of lead to be worn by those licensed to beg from door to door: on 12 April, 34 such persons are named, and on 19 April, Robert Douglas was reimbursed for the cost of 35 badges. On 2 Aug., the number of poor who were to receive each from the heritors ten shillings Scots reads like “nighentie foure.”

[82] John Freind, M.D., Nine Commentaries on Fevers, transl. by T. Dale. London, 1730.

[83] Cal. Coke MSS. II. 405.

[84] Joannes Turner, De Febre Britannica Anni 1712. Lond. 1713, p. 3. “Vere proximè elapso, per Gallias passim ingravescere coeperunt febres mali moris in nobiles domos, et regiam praecipue infestae; quò Ludovicum Magnum ipsa infortunia ostenderent Majorem, et patientia Christianissima Maximum.”

[85] From London, on 25 February, 1701, we hear of the illness from a violent fever of Mr Brotherton, at his house in Chancery Lane; he was member for Newton, and Mr Coke was advised to look after his seat. A letter of 18 April, 1701, from Chilcote, in Derbyshire, says that it has been a sickly time in these parts and that a certain lady and her daughter were both dead and to be buried the same day. In the same correspondence, cases of fever in London are mentioned on 18 June and 4 December the same year (1701). Cal. Coke MSS. II. 421, 424, 429, 441.

[86] Tractatus Duplex. Lond. 1710. Engl. transl. 1737, p. 253.

[87] W. Butter, M.D., A Treatise on the Infantile Remittent Fever. Lond. 1782.

[88] Philip Guide, M.D., A Kind Warning to a Multitude of Patients daily afflicted with different sorts of Fevers. Lond. 1710.

[89] One death from “malignant fever,” two from scarlet fever.

[90] Hunter’s Hallamshire, ed. Gatty.

[91] Brand, Hist. of Newcastle, II. 308. Swift writes to Stella on 8 December, 1710: “We are terribly afraid of the plague; they say it is at Newcastle. I begged Mr Harley [the Lord President] for the love of God to take some care about it, or we are all ruined. There have been orders for all ships from the Baltic to pass their quarantine before they land; but they neglect it. You remember I have been afraid these two years.” The orders referred to were probably the Order of Council of 9 Nov. 1710. Parliament met on the 25th Nov. and passed the first Quarantine Act (9 Anne, cap. II.). Swift had a good deal to say with Ministers on many subjects, and it is not impossible, however absurd, that his had been the first suggestion to Harley of a quarantine law. I had purposed including a history of quarantine in Britain, but can find no convenient context for it. I shall therefore refer the reader to the historical sketch which I have appended to the Article “Quarantine” in the Encyclopaedia Britannica, 9th ed.

[92] Essay on Epidemic Diseases. Dublin, 1734, p. 34.

[93] Dr Guide, a Frenchman, who had been in practice in London for many years, says in his Kind Warning to a Multitude of Patients daily afflicted with different sorts of Fevers (1710) “the British physicians and surgeons are lately fallen into an unhappy and terrible confusion and mixture of honest and fraudulent pretenders.” Another writer of 1710, Dr Lynn, quoted in the chapter on Smallpox, implies that physicians were taking an unusually cynical view of their business. The most interesting essay of the time on fevers is by J. White, M.D. (De recta Sanguinis Missione &c. Lond. 1712), a Scot who had been in the Navy and afterwards in practice at Lisbon; but it throws no light upon the London fevers.

[94] Elizabeth, Lady Otway, to Benj. Browne, Dec. 1st and 15th, 1715, and Feb. 16, 1716. Hist. MSS. Com. X. pt. 4, p. 352; Hemingway’s Hist. of Chester, II. 244.

[95] Letters, ed. Cunningham, I. 72.

[96] Lecky, History of England in the Eighteenth Century, VI. 204:--“All the evidence we possess concurs in showing that during the first three-quarters of the century the position of the poorer agricultural classes in England was singularly favourable. The price of wheat was both low and steady. Wages, if they advanced slowly, appear to have commanded an increased proportion of the necessaries of life, and there were all the signs of growing material well-being. It was noticed that wheat bread, and that made of the finest flour, which at the beginning of the period had been confined to the upper and middle classes, had become before the close of it over the greater part of England the universal food, and that the consumption of cheese and butter in proportion to the population in many districts almost trebled. Beef and mutton were eaten almost daily in villages.”

[97] Six Centuries of Work and Wages, pp. 398-415.

[98] Gentleman’s Magazine, 1766.

[99] Short.

[100] Clifton Wintringham, M.D., Commentarium nosologicum, morbos epidemicos et aeris variationes in urbe Eboracensi locisque vicinis ab anno 1715 usque ad finem anni 1725 grassantes, complectens. Londini, 1727.

[101] W. White, M.D., Phil. Trans. LXXII. (1782), p. 35. The annual deaths under the old régime exceeded by a good deal the annual births: in the seven years 1728-35, according to the figures from the parish registers in Drake’s Eboracum, the burials from all causes were 3488, and the baptisms 2803, an annual excess of 98 deaths over the births in an estimated population of 10,800 (birth-rate 37 per 1000, death-rate 46 per 1000). But in the seven years, 1770-76, the balance was the other way: the population had increased by two thousand (to 12,800), and the births were on an average 20 in the year more than the deaths (474 births, 454 deaths), the birth-rate being still 37 per 1000, and the death-rate fallen to 35 per 1000. But the correctness of these rates depends on the population being exactly given.

[102] “There has been very great mobbing by the weavers of this town, as they pretend, because they are starved for want of trade; and they pull the calico cloaths off women’s backs wherever they see them. The Trainbands have been up since last Friday, and they were forced to fire at the mobb in Moor Fields before they would disperse, and four or five were shott and as many wounded.” (Benjamin Browne to his father, 16 June, 1719: Mr Browne’s MSS. Hist. MSS. Com. X. pt. 4, p. 351.) The calicoes which the London weavers tore from the backs of women were doubtless the Indian fabrics brought home by the ships of the East India Company. These imports were so injurious to home manufactures that an Act had been passed in 1700 prohibiting (with some exceptions) the use in England of printed or dyed calicoes or any other printed or dyed cotton goods. This prohibition was re-enacted in 1721, two years after the rioting at Moorfields. (7 Geo. I. cap. 7). Blomefield (Hist. of Norfolk, III. 437) says that at Norwich also there was tearing of calicoes, “as pernicious to the trade” of that city. On the 20th of September, 1720, a great riot arose there, the rabble cutting several gowns in pieces on women’s backs, entering shops to seize all calicoes found there, beating the constables, and opposing the sheriff’s power to such a degree that the company of artillery had to be called out.

[103] Ambrose Warren to Sir P. Gell, 16 Sept. 1718, Hist. MSS. Com. IX. pt. 2, p. 400 b.

[104] The sudden rise was due to influenza; but the fever mortality was high for weeks before and after.

[105] John Arbuthnot, M.D., Essay concerning the Effects of Air on Human Bodies. Lond. 1733, p. 187.

[106] Edward Strother, M.D., Practical Observations on the Epidemical Fever which hath reigned so violently these two years past and still rages at the present time, with some incidental remarks shewing wherein this fatal Distemper differs from Common fevers; and more particularly why the Bark has so often failed: and methods prescribed to render its use more effectual. In which is contained a very remarkable History of a Spotted Fever. London, 1729. This book was written before the influenza of the end of 1729. At p. 126 the author was writing on the 24th of May, 1728. The preface is undated.

[107] Bernard de Mandeville, M.D., A Treatise of the Hypochondriack and Hysteric Diseases, 3rd ed. 1730, 1st ed. 1711. It contains nothing about the “little fever.”

[108] Richard Blackmore, M.D., A Discourse upon the Plague, with a prefatory account of Malignant Fever. London, 1721, p. 17.

[109] W. Cockburn, M.D., Danger of improving Physick, with a brief account of the present Epidemick Fever. London, 1730.

[110] I am the more persuaded of the identity with relapsing fever of much that was called remittent in Britain, and even intermittent, after reading the highly original treatise by R. T. Lyons on Relapsing or Famine Fever, London, 1872, relating to the epidemics of it in India.

[111] Huxham, On Fevers, chap. VIII.

[112] Murchison, Continued Fevers of Great Britain, 2nd ed. Lond. 1873, p. 423.

[113] Sir Richard Manningham, Kt., M.D. Febricula or Little Fever, commonly called the Nervous or Hysteric Fever, the Fever on the Spirits, Vapours, Hypo, or Spleen. 1746.

[114] It is clear that the nervous fever established itself as a distinct type in England in the earlier part of the 18th century, both in medical opinion and in common acceptation: thus Horace Walpole, writing from Arlington Street on 28 January, 1760, says: “I have had a nervous fever these six or seven weeks every night, and have taken bark enough to have made a rind for Daphne: nay, have even stayed at home two days.” Letters of Horace Walpole, ed. Cunningham, iii. 281.

[115] Commentar. Nosol. u. s.

[116] William Hillary, M.D., “An Account of the principal variations of the Weather and the concomitant Epidemical Diseases from 1726 to 1734 at Ripon.” App. to Essay on the Smallpox, Lond. 1740.

[117] Brand, History of Newcastle, ii. 517, says that the magistrates of that town made a collection for the relief of poor housekeepers in the remarkably severe winter of 1728-29, the sum raised being £362. 18_s._

[118] Tooke, History of Prices from 1793 to 1837. Introd. chap. p. 40.

[119] Ancient Physician’s Legacy. Lond. 1733, p. 144.

[120] “In the year 1727,” says Hillary, “I ordered several persons to lose 120 to 140 ounces of blood at several times in these inflammatory distempers, with great relief and success; whereas, in this winter [1728] I met with few, and even the strong and robust, who could bear the loss of above 40 or 50 ounces of blood, at three or four times; but, in general, most of the sick could not bear bleeding oftener than twice, and then not to exceed 30 or 34 oz. at most, at two or three times; and especially those who had been afflicted with, and debilitated by, the intermitting fever in the autumn before,--these could not bear blooding oftener than once, or twice at most, and in very small quantities too, though the acuteness of the pain, and the other symptoms in all, seemed at first to indicate much larger evacuations that way; but the first bleeding often sunk the pulse and strength of the patient so much that I durst not repeat it more than once, and in some not at all.” Hillary, u. s. p. 26.

[121] Edin. Med. Essays and Obs. I-VI. This annual publication was the original of the Transactions of the Royal Society of Edinburgh.

[122] Ibid. I. 40; II. 27; II. 287 (St Clair’s case); IV.

[123] Huxham, De aere et morbis.

[124] Ebenezer Gilchrist, M.D., “Essay on Nervous Fevers.” Edin. Med. Essays and Obs. IV. 347, and VI. (or V. pt. 2), p. 505.

[125] Ibid. V. pt. 1, p. 30.

[126] Obs. de aere et morbis; also his essay On Fevers.

[127] Hillary, App. to Smallpox, 1740, pp. 57, 66.

[128] Mr Lecky (History of England in the 18th Century), II., says that the famine and fever of 1740-41, which he describes as an important event in the history of Ireland, “hardly excited any attention in England.” It was severely felt, however, in England; and if it excited hardly any attention, that must have been because there were so many superior interests which were more engrossing than the state of the poor.

[129] Gent. Magaz. X. (1740), 32, 35. Blomefield, for Norwich, says that many there would have perished in the winter of 1739-40 but for help from their richer neighbours.

[130] W. Allen, Landholder’s Companion, 1734. Cited by Tooke.

[131] An Inquiry into the Nature, Cause and Cure of the present Epidemic Fever ... with the difference betwixt Nervous and Inflammatory Fevers, and the Method of treating each, 1742, p. 54.

[132] John Altree, Gent. Magaz. Dec. 1741, p. 655.

[133] White, ibid. 1742, p. 43.

[134] Dunsford, Historical Memorials of Tiverton. The accounts of the great weaving towns of the South-west are not unpleasing until we come to the time when they were overtaken by decay of work and distress, from about 1720 onwards. The district, says Defoe, was “a rich enclosed country, full of rivers and towns, and infinitely populous, in so much that some of the market towns are equal to cities in bigness, and superior to many of them in numbers of people.” Taunton had 1100 looms. Tiverton in the seven years 1700-1706 had 331 marriages, 1116 baptisms, 1175 burials (a slight excess), and an estimated population of 8693, which kept nearly at that level for about twenty years longer (from 1720 to 1726 the marriages were 284, the baptisms 1070 and the burials 1175).

[135] Gent. Magaz. XI. (1742), p. 704.

[136] Blomefield, History of Norfolk III. 449.

[137] Arnot, History of Edinburgh, 1779, p. 211.

[138] Gent. Magaz. 1741, p. 705.

[139] Edin. Med. Essays and Obs. I. Art. 1.

[140] Gent. Magaz. 1742, p. 186.

[141] John Wall, M.D., Medical Tracts, Oxford, 1780, p. 337. See also Obs. on the Epid. Fever of 1741, 3rd ed., by Daniel Cox, apothecary, with cases.

[142] Edin. Med. Essays and Obs. VI. 539.

[143] “And here I cannot but observe how many ignorant conceited coxcombs ride out, under a shew of business, with their lancet in their pocket, and make diseases instead of curing them, drawing their weapon upon every occasion, right or wrong, and upon every complaint cry out, ‘Egad! I must have some of your blood,’ give the poor wretches a disease they never might have had, drawing the blood and the purse, torment them in this world,” etc.--An Essay on the present Epidemic Fever, Sherborne, 1741. The practice of blood-letting in continued fevers received a check in the second half of the 18th century, but it was still kept up in inflammatory diseases or injuries. Even in the latter it was freely satirized by the laity. When the surgeon in Tom Jones complained bitterly that the wounded hero would not be blooded though he was in a fever, the landlady of the inn answered: “It is an eating fever, then, for he hath devoured two swingeing buttered toasts this morning for breakfast.” “Very likely,” says the doctor, “I have known people eat in a fever; and it is very easily accounted for; because the acidity occasioned by the febrile matter may stimulate the nerves of the diaphragm, and thereby occasion a craving which will not be easily distinguishable from a natural appetite.... Indeed I think the gentleman in a very dangerous way, and, if he is not blooded, I am afraid will die.”

[144] Munk, Roll of the College of Physicians, II. 53.

[145] Gentleman’s Magaz. III. 1733, Sept., p. 492.

[146] Effects of Air on Human Bodies, 1733, pp. 11, 17. His excellent remarks on the need of fresh air in the treatment of fevers, two generations before Lettsom carried out the practice, are at p. 54. The curious calculation above cited was copied by Langrish, and usually passes as his.

[147] “Also without the bars both sides of the street be pestered with cottages and alleys even up to Whitechapel Church, and almost half a mile beyond it, into the common field: all which ought to be open and free for all men. But this common field, I say, being sometime the beauty of this city on that part, is so encroached upon by building of filthy cottages, and with other purprestures, enclosures and laystalls (notwithstanding all proclamations and Acts of Parliament made to the contrary) that in some places it scarce remaineth a sufficient highway for the meeting of carriages and droves of cattle. Much less is there any fair, pleasant or wholesome way for people to walk on foot, which is no small blemish to so famous a city to have so unsavoury and unseemly an entrance or passage thereunto.” Stow’s Survey of London, section on “Suburbs without the Walls.”

[148] The line of an old field walk can still be followed from Aldermanbury Postern to Hackney, Goldsmiths’ Row being one of the wider sections of it.

[149] Luttrell’s Diary 10 June, 1684.

[150] Roger North’s “Autobiography,” in Lives of the Norths, new ed. 3 vols., 1890, III. 54.

[151] Willan, 1801: “The passage filled with putrid excremental or other abominable effluvia from a vault at the bottom of the staircase.” See also Clutterbuck, Epid. Fever at present prevailing. Lond. 1819, p. 60. Ferriar, of Manchester, writing of the class of houses most apt to harbour the contagion of typhus, says, “Of the new buildings I have found those most apt to nurse it which are added in a slight manner to the back part of a row, and exposed to the effluvia of the privies.”

[152] C. Davenant to T. Coke, London, 14 Dec. 1700. Cal. Coke MSS., II. 411, “I heartily commiserate your sad condition to be in the country these bad weeks; but I fancy you will find Derbyshire more pleasant even in winter than the House of Commons will be in a summer season. For, though it be now sixteen years ago [1685], I still bear in memory the evil smells descending from the small apartments adjoining to the Speaker’s Chamber, which came down into the House with irresistible force when the weather is hot.”

[153] Report on the Diseases in London, 1796-1800. Lond. 1801.

[154] John Ferriar, M.D., Medical Histories and Reflections. London 1810, II. 217.

[155] Heysham, Jail Fever at Carlisle in 1781. Lond. 1782, p. 33.

[156] John Howard, State of the Prisons.

[157] Notes and Queries, 4th ser. XII. 346. Jenkinson, who was a Minister under George II., was reputed to have set an example of stopping up windows in his mansion near Croydon:

You e’en shut out the light of day To save a paltry shilling.

Others had boards painted to look like brickwork, which could be used to cover up windows at pleasure.

[158] Petition, undated, but placed in a collection in the British Museum among broadsides of the years 1696-1700. In 1725 the imprisoned debtors at Liverpool petitioned Parliament for relief, alleging that they were reduced to a starving condition, having only straw and water at the courtesy of the serjeant. Commons’ Journals, XX. 375.

[159] Commons’ Journals, 20 March, 1728/29, 14 May, 1729, 24 March, 1729/30.

“Mrs Mary Trapps was prisoner in the Marshalsea and was put to lie in the same bed with two other women, each of which paid 2_s._ 6_d._ per week chamber rent; she fell ill and languished for a considerable time; and the last three weeks grew so offensive that the others were hardly able to bear the room; they frequently complained to the turnkeys and officers, and desired to be removed; but all in vain. At last she smelt so strong that the turnkey himself could not bear to come into the room to hear the complaints of her bedfellows; and they were forced to lie with her on the boards, till she died.”

[160] Political State of Great Britain, XXXIX. April, 1730, pp. 430-431, 448.

[161] Gent. Magaz., XX. 235. This authority is twenty years after the event, the incident having been recalled in 1750, on the occasion of the Old Bailey catastrophe.

[162] Huxham.

[163] See the former volume of this History, pp. 375-386.

[164] A Report &c. and of other Crown Cases. By Sir Michael Foster, Knt., some time one of the Judges of the Court of King’s Bench. 2nd ed. London, 1776, p. 74.

[165] The Gentleman’s Magazine however says (1750, p. 235): “There being a very cold and piercing east wind to attack the sweating persons when they came out of court.”

[166] See Bancroft, Essay on the Yellow Fever, with observations concerning febrile contagion etc. Lond. 1811.

[167] Gent. Magaz. 1750, p. 274: “Many families are retired into the country, and near 12,000 houses empty”--an impossible number.

[168] Sir John Pringle, Observations on the Nature and Cure of the Hospital and Jayl Fever. Letter to Mead, May 24. London, 1750.

[169] One of the cases was that of an apprentice: “Some of the journeymen working in Newgate had forced him to go down into the great trunk of the ventilator in order to bring up a wig which one of them had thrown into it. As the machine was then working, he had been almost suffocated with the stench before they could get him up.” Pringle, “Ventilation of Newgate,” Phil. Trans. 1753, p. 42.

[170] Thomas Stibbs to Sir John Pringle, Jan. 25, 1753. Ibid. p. 54.

[171] “Ventilators some years since when first introduced, it was thought, would prove an effectual remedy for and preservative against this infection in jails; great expectations were formed of their benefit, but several years’ experience must now have fully shewn that ventilators will not remove infection from a jail.” Lind, Means of Preserving the Health of Seamen in the Royal Navy. New ed. Lond. 1774, p. 29.

[172] J. C. Lettsom, M.D., Medical Memoirs of the General Dispensary in London, 1773-4. Lond. 1774.

[173] Gent. Magaz. 1776, April 22. p. 187.

[174] Lind, Two Papers on Fevers and Infection. Lond. 1763. pp. 90, 106. Many cases had buboes both in the groins and the armpits.

[175] Carmichael Smyth, Description of the Jail Distemper among Spanish Prisoners at Winchester in 1780. Lond. 1795.

[176] Cal. Coke MSS. Hist. MSS. Commiss. i. 218.

[177] Med. Hist. and Reflect. ut infra.

[178] The following case, which happened five or six years ago, shows disparity of conditions in a twofold aspect. A lady from a city in the north of Scotland travelled direct to Switzerland to reside for a few weeks at one of the hotels in the High Alps. Within an hour or two of the end of her journey she began to feel ill, and was confined to her room from the time she entered the hotel. An English physician diagnosed the effects of the sun; the German doctor of the place, from his reading only, diagnosed typhus fever, which proved to be right, the patient dying with the most pronounced signs of malignant typhus. An explanation of the mystery was soon forthcoming. The lady had been a district visitor in an old and poor part of the Scotch city; she had, in particular, visited in a certain tenement-house in a court, from which half-a-dozen persons had been admitted to the Infirmary with typhus (an unusual event) at the very time when she was ill of it on the Swiss mountain.

[179] Blane, Select Dissertations. London, 1822, p. 1.

[180] Mather’s Magnalia. 2 vols. Hartford, 1853, i. 226 “Life of Sir William Phipps.” “Whereof there died, ere they could reach Boston, as I was told by Sir Francis Wheeler himself [‘but a few months ago’], no less than 1300 sailors out of 21, and no less than 1800 soldiers out of 24.” He had brought 1800 troops with him from England to Barbados in transports.

[181] Churchill’s Collection, VI. 173.

[182] W. Cockburn, M.D. An Account of the Nature, Causes, Symptoms and Cure of the Distempers that are incident to Seafaring People. 3 Parts. London, 1696-97.

[183] J. White, M.D. De recta Sanguinis Missione, or, New and Exact Observations of Fevers, in which Letting of Blood is shew’d to be the true and solid Basis of their Cure, &c. London, 1712. His chief point, that the strongest and lustiest were most obnoxious to malignant fevers, had been urged by Cockburn in 1696.

[184] Lind (Two Papers on Fevers and Infection, London, 1763, p. 113) gives an instance where the poisonous effluvia of the ship’s well did not spread through the ’tween decks: “The following accident happened lately [written in 1761] in the Bay of Biscay. In a ship of 60 guns, by the carpenter’s neglecting to turn the cock that freshens the bilge-water, which had not been pumped out for some time, a large scum, as is usual, or a thick tough film was collected a-top of it. The first man who went down to break this scum in order to pump out the bilge-water was immediately suffocated. The second suffered an instantaneous death in like manner. And three others, who successively attempted the same business, narrowly escaped with life: one of whom has never since perfectly recovered his health. Yet that ship was at all times, both before and after this accident, remarkably healthy.” It was the contention of Renwick, a naval surgeon who wrote in 1794, that it was the stirring of the bilge-water in being discharged from the ship’s well, or the adding of fresh water to the foul, that caused the offensive emanations. “Hence the first cause of febrile sickness in all ships recently commissioned.” Renwick made so much of the foul bilge-water as a cause that he thought the fevers ought to be termed “bilge-fevers.” Letter to the Critical Reviewer, p. 42.

[185] These particulars are not given in Freind’s special work on Peterborough’s campaign, which deals only with the military and political history, but in his Nine Commentaries on Fever (Engl. ed. by Dale, London, 1730), and in a Latin letter to Cockburn, dated Barcelona, 9 Sept. 1706, which was first printed in Several Cases in Physic. By Pierce Dod, M.D. London, 1746.

[186] Smollett joined the ‘Cumberland’ as surgeon’s mate in 1740, before she sailed with the fleet sent out under Vernon and others to Carthagena. His account in Roderick Random of the sick-bay of the ‘Thunder’ as she lay at the Nore is doubtless veracious: “When I observed the situation of the patients, I was much less surprised that people should die on board, than that any sick person should recover. Here I saw about fifty miserable distempered wretches, suspended in rows, so huddled one upon another that not more than fourteen inches space was allowed for each with his bed and bedding; and deprived of the light of the day, as well as of fresh air; breathing nothing but a noisome atmosphere of the morbid steams exhaling from their own excrements and diseased bodies, devoured with vermin hatched in the filth that surrounded them, and destitute of every convenience necessary for people in that helpless condition.” Chap. XXV. He wrote a separate account of the fatal Carthagena expedition in a compendium of voyages.

[187] Coxe’s Life of Marlborough. Bohn’s ed. I. 183.

[188] Grainger’s essay, Historia febris anomalae Bataviae annorum, 1746, 1747, 1748, etc. Edin. 1753, is chiefly occupied with an anomalous “intermittent” or “remittent” fever with miliary eruption, and with dysentery.

[189] For a full discussion of the relation of dysentery to typhus, see Virchow, “Kriegstypus und Ruhr.” Virchow’s Archiv, Bd. LII. (1871), p. 1.

[190] Sir John Pringle, Obs. on the Nature and Cure of Hospital and Jayl Fever, Lond. 1750 (Letter to Mead); and his Obs. on Diseases of the Army, Lond. 1752 (fullest account).

[191] Pringle, Diseases of the Army, pp. 40-45.

[192] Ibid. p. 68.

[193] Donald Monro, M.D. Diseases of British Military Hospitals in Germany, from Jan. 1761 to the Return of the Troops to England in 1763. Lond. 1764. The same campaign called forth also Dr Richard Brocklesby’s Œconomical and Medical Observations from 1758 to 1763 on Military Hospitals and Camp Diseases etc. London, 1764.

[194] Essay on Preserving the Health of Seamen, Lond. 1757; Two papers etc. u. s.

[195] In 1755 a pestilential sickness raged in the North American fleet, the ‘Torbay’ and ‘Munich’ being obliged to land their sick at Halifax.

[196] The Gentleman’s Magazine for December, 1772 (p. 589), records the following: “The bodies of two Dutchmen who were thrown overboard from a Dutch East Indiaman, where a malignant fever raged, were cast up near the Sally Port at Portsmouth; they were so offensive that it was with difficulty that anyone could be got to bury them.”

[197] W. Brownrigg, M.D. Considerations on preventing Pestilential Contagion. London, 1771, p. 36.

[198] Lind writes in his book on the Health of Seamen, “The sources of infection to our armies and fleets are undoubtedly the jails: we can often trace the importers of it directly from them. It often proves fatal in impressing men on the hasty equipment of a fleet. The first English fleet sent last war to America lost by it alone two thousand men.”

[199] R. Robertson, M.D. Observations on Jail, Hospital or Ship Fever from the 4th April, 1776, to the 30th April, 1789, made in various parts of Europe and America and on the Intermediate Seas. London, 1789. New edition.

[200] Given by Blane in a Postscript to his paper “On the Comparative Health of the British Navy, 1779-1814” in Select Dissertations, London, 1822, p. 62.

[201] Blane, u. s. p. 47, from information supplied by Dr John Lind, of Haslar Hospital.

[202] Diseases incident to Seamen, p. 18.

[203] Ibid. p. 34.

[204] Trotter, Medicina Nautica, I. 61. His general abstracts of the health of the fleet in the first years of the French War, 1794-96, give many instances of ship-typhus.

[205] John Clark, M.D. Observations on the Diseases which prevail in Long Voyages to Hot Countries, &c. London, 1773. 2nd ed. 2 vols., 1792.

John Lorimer, M.D., published in Med. Facts and Observations, VI. 211, a “Return of the ships’ companies and military on board the ships of the H. E. I. C. for the years 1792 and 1793.”

+---------------------------------------------------------------+ | | Outward voyages | Homeward voyages | | | |-----------------|------------------| In port | | | Crew | Military | Crew | Invalids | | |----------------|------|----------|-------|----------|---------| | Number of men | 2657 | 3919 | 2701 | 1075 | -- | | Sick | 1253 | 1751 | 1058 | 282 | 1533 | | Dead | 28 | 50 | 51 | 27 | 96 |

[206] Reflections and Resolutions for the Gentlemen of Ireland, p. 28. Cited by Lecky.

[207] Sutton, “Changing Air in Ships,” Phil. Trans. XLII. 42; W. Watson, M.D. ibid. p. 62; H. Ellis, ibid. XLVII. 211.

[208] Ibid. XLIX. 332, “Ventilation of a Transport.”

[209] Ibid. pp. 333, 339.

[210] Lind, Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy. New Ed. London, 1774, p. 29.

[211] Blane, Diseases incident to Seamen, 1785, p. 243.

[212] Id. “On the Comparative Health of the British Navy from the year 1799 to the year 1814, with Proposals for its farther Improvement.” Select Dissertations, 1822, p. 1.

[213] Le Cat, Phil. Trans. XLIX. 49.

[214] “Its cause seemed to be something contagious mixed with the contents of the stomach and intestines, especially the bile and alvine faeces, which absorbed thence contaminates the whole body and affects especially the cerebral functions.” Gent. Magaz., Article signed “S,” 1755, p. 151.

[215] James Johnstone, M.D., senior, Malignant Epidemic Fever of 1756. London, 1758.

[216] Nash, Hist. of Worcestershire, II. 39, found evidence in the Kidderminster registers that the fevers of 1727, 1728 and 1729 had “very much thinned the people, and terrified the inhabitants.” Watson, “On the Medical Topography of Stourport,” Trans. Proc. Med. Assoc., II., had heard or read somewhere that fever was so bad in Kidderminster in the first part of the 18th century that farmers were afraid to come to market.

[217] Huxham, Dissertation on the Malignant Ulcerous Sore-Throat. Lond. 1757, p. 60.

[218] Tooke, History of Prices. Introduction.

[219] In Shrewsbury gaol, in 1756, thirty-seven colliers were confined for rioting during the dearth. Four of them died in gaol, ten were condemned to death, of whom two were executed. Phillips, History of Shrewsbury, 1779, p. 213.

[220] Johnstone, u. s. Short says: “a slow, malignant, putrid fever in some parts of Yorkshire, Cheshire, Worcestershire and the low parts of Leicestershire, which carried off very many.” In October, 1757, it set in at Sheffield and raged all the winter.

[221] Short, Increase and Decrease of Mankind in England, etc. London, 1767, p. 109.

[222] Charles Bisset, Essay on the Medical Constitution of Great Britain, 1 Jan. 1758, to Midsummer, 1760. Together with a narrative of the Throat-Distemper and the Miliary Fever which were epidemical in the Duchy of Cleveland in 1760. London, 1762, pp. 265, 270, &c.

[223] James Sims, M.D., Obs. on Epid. Disorders. Lond. 1773, p. 181.

[224] W. Hillary, M.D., Changes of the Air and Concomitant Epid. Disorders in Barbadoes. 2nd ed., Lond. 1766.

[225] Tractatus duplex de Praxeos Regulis et de Febre Miliari, Lond. 1710. Engl. transl. of the latter, Lond. 1737.

[226] Ormerod, Clin. Obs. on Continued Fever. London, 1848.

[227] Historia Febris Miliaris, et de Hemicrania Dissertatio. Auctore Joanne Fordyce, M.D., Londini, 1758. Symptoms at p. 16. In an Appendix Dr Balguy makes the following curious division of the miliary vesicles: the white in malignant continued fever, the dull red in remittent fever, the “almost efflorescent” in intermittent. Fordyce makes them to appear as early as the third day, and to begin to disappear in four or six days in favourable cases.

[228] London, 1773, p. 9. See also Sir W. Fordyce’s essay of the same year.

[229] John Moore, M.D., Medical Sketches, Lond. 1786. Part II. “On Fevers.” Referring to the “putrid” fever in particular, he says that certain unbelievers, of whom he was probably one, “assert that mankind are tenacious of opinions, when once adopted, in proportion as they are extraordinary, disagreeable and incredible.” Dr Moore is best known as the author of Zeluco.

[230] Haygarth, Phil. Trans. LXIV. 73.

[231] Percival, ibid. LXIV. 59.

[232] Hutchinson, u. s.

[233] Annual Register, 1766, p. 220. The King’s Speech on 11 Nov. was chiefly occupied with the dearth. The use of wheat for distilling was prohibited by an order of Council of 16 Sept. 1766. Gent. Magaz. p. 399. To show the hardships of the rural population at this time, Mr Gladstone, in a speech at Hawarden in 1891, read the following words copied from a stone set up in the park of Hawarden to commemorate the rebuilding of a mill: “Trust in God for bread, and to the king for protection and justice. This mill was built in the year 1767. Wheat was within this year at 9_s._, and barley at 5_s._ 6_d._ a bushel. Luxury was at a great height, and charity extensive, but the poor were starved, riotous, and hanged.”

[234] Lecky, III. 115.

[235] Gent. Magaz., series of letters by various hands in 1766. See also a long essay in the Annual Register for 1767 (then edited by Edmund Burke), “On the Causes and Consequences of the present High Price of Provisions,” p. 165. The evidence of a rise in the standard of living, in the matter of dress and luxuries as well as of food, is equally clear from Scotland in the articles written by the parish ministers for the ‘Statistical Account.’

[236] For a judicious estimate of the value of the Parish Clerks’ bills of mortality see the elaborate paper by Dr William Ogle, Journ. Statist. Soc. LV. (1892), 437.

[237] Diseases of the Army. New ed. 1775, pp. 334-5. Pringle admitted, however, that “in some of the lowest, moistest and closest parts of the town, and among the poorer people, spotted fevers and dysenteries are still to be seen, which are seldom heard of among those of better rank living in more airy situations.”

[238] Medical Sketches, Lond. 1786, p. 464.

[239] Lecky, History of England in the Eighteenth Century, II. 636, generalizes the facts as follows: “The wealthy employer ceased to live among his people; the quarters of the rich and of the poor became more distant, and every great city soon presented those sharp divisions of classes and districts in which the political observer discovers one of the most dangerous symptoms of revolution.”

[240] “This disease, as it appears in jails and hospitals, has been well described by Sir John Pringle; and other authors have given accounts of it on board of ships, especially crowded transports and prison-ships, but I do not find that its originating in the families of the poor in great cities during the winter has been taken notice of.” Med. Trans. Coll. Phys. III. 345.

[241] He has been immortalised by Johnson’s verses:

“Well tried through many a varying year See Levett to the grave descend, Officious, innocent, sincere, Of every friendless name the friend. In misery’s darkest cavern known His ready help was ever nigh;” etc.

[242] John Coakley Lettsom, M.D., Medical Memoirs of the General Dispensary in London, April 1773 to March 1774. London, 1774.

[243] Nothing could be clearer than Dr John Arbuthnot’s reasoning and advice on this matter half a century before.

[244] London, 1775.

[245] Med. Trans. of the Coll. Phys. Lond. III. (1785), 345: “Observations on the Disease commonly called the Jail or Hospital Fever.” By John Hunter, M.D., physician to the army.

[246] James Sims, M.D., “Scarlatina anginosa as it appeared in London in 1786,” Mem. Med. Soc. Lond. I. 414. Willan, who saw the same epidemic of scarlatinal sore-throat in London in 1786, believed that the angina was also “connected with a different species of contagion, namely, that of the typhus or malignant fever originating in the habitations of the poor, where no attention is paid to cleanliness and ventilation.” Cutaneous Diseases, 1808, p. 333.

[247] The rumour of London fevers seems to have reached Barker, who kept an epidemiological record at Coleshill. Referring to the winter of 1788-89, he says: “At this time there were dreadful fevers in London, fatal to many, and a very infectious one in Coventry, of which many among the poor died, most of them being delirious, and many phrenetical.”

[248] Robert Willan, M.D., Reports on the Diseases of London, particularly during the years 1796-97-98-99 and 1800. London, 1801.

[249] He names specially some streets of St Giles’s parish, the courts and alleys adjoining Liquorpond Street, Hog-Island, Turnmill Street, Saffron Hill, Old Street, Whitecross Street, Golden Lane, the two Bricklanes, Rosemary Lane, Petticoat Lane, Lower East Smithfield, some parts of Upper Westminster, and several streets of Southwark, Rotherhithe, etc. “I recollect a house in Wood’s Close, Clerkenwell, wherein the fomites of fever were thus preserved for a series of years; at length an accidental fire cleared away the nuisance. A house, notorious for dirt and infection, near Clare-market, afforded a farther proof of negligence: it was obstinately tenanted till the wall and floors, giving way in the night, crushed to death the miserable inhabitants.”

[250] Medical Reports on the Effects of Water, Cold and Warm, as a Remedy in Fever and other Diseases. 2nd ed., 1798. It need hardly be explained that Dr Currie was competent on fevers, his use of the clinical thermometer marking him as a man of precision. He is best known to the laity as the biographer of Robert Burns and the generous helper of the poet’s widow and family.

[251] “If it be supposed,” says Currie, “that some cases may be denominated typhus by mistake, let it be considered how many cases of this disease do not appear in the books of the Dispensary, though occurring among the poor, being attended by the surgeons and apothecaries of the Benefit Clubs to which they belong.”

[252] Moss (A Familiar Medical Survey of Liverpool, 1784), who had not the same means of knowing the prevalence of typhus in Liverpool as Currie, declares that “there has been but one instance of a truly malignant fever happening in the town for many years; it was in the autumn of 1781, and appeared in Chorley Street, which is one of the narrowest and most populous streets in the town, and nine died of it in one week; it was only of short duration, and did not spread in any other part of the town.” He admits that the habitations of the poorer class were confined, being chiefly in cellars; yet the diet of the sober and industrious is wholesome and sufficient, the comfortable artizans being ship-carpenters, coopers, ropers and the like.

[253] John Clark, M.D., Observations on the Diseases which prevail in Long Voyages, &c. 2nd ed., Lond. 1792; Account of the Newcastle Dispensary from its Commencement in 1777 to March 1789, Newcastle, 1789; and subsequent Annual Reports.

[254] Haygarth, Phil. Trans. LXIV. 67; Hemingway, History of Chester, I. 344 seq.

[255] Arnold Toynbee, Lectures on the Industrial Revolution of the 18th Century, etc. London, 1884.

[256] Toynbee (u. s.) says of the time before the mills were built: “The manufacturing population still lived to a very great extent in the country. The artisan often had his small piece of land, which supplied him with wholesome food and healthy recreation. His wages and employments too were more regular. He was not subject to the uncertainties and knew nothing of the fearful sufferings which his descendants were to endure from commercial fluctuations, especially before the introduction of free trade.”

[257] Percival, “Population of Manchester.” Phil. Trans. LXIV. 54.

[258] James Lucas, “Remarks on Febrile Contagion.” London Medical Journal, X. 260.

[259] In Appendix to Hutchinson’s Cumberland, 1794. Reprinted in Appendix to Joshua Milne’s Valuation of Annuities, Lond. 1815.

[260] John Heysham, M.D., Account of the Jail Fever, or Typhus Carcerum, as it appeared at Carlisle in 1781. London, 1782.

[261] Aikin, Phil. Trans. LXIV. 473.

[262] John Aikin, M.D., The Country from 30 to 40 miles round Manchester. Lond. 1795, p. 584.

[263] John Ferriar, M.D., Medical Histories and Reflections. 4 vols., 1810-13, I. 172.

[264] Ferriar, I. 261.

[265] Ibid. I. 234.

[266] Ibid. II. 213-20.

[267] Ibid. I. 153-6; and II. 57.

[268] Ferriar, I. 166-8.

[269] This is perhaps the first numerical evidence of the slight fatality of typhus in children. A more elaborate proof of the same was given long after by Geary for Limerick. An early age-table for Whitehaven is given under Smallpox, infra.

[270] David Campbell, M.D., Observations on the Typhus or Low Contagious Fever. Lancaster, 1785.

[271] Joshua Dixon, M.D., _Annual Reports of the Whitehaven Dispensary, 1795 to 1805_. Details for 1773-4 in his note in Memoirs of Lettsom, III. 353.

[272] Dixon, Literary Life of Dr Brownrigg, pp. 238-9.

[273] Aikin, Country round Manchester. Lond. 1795, p. 616.

[274] Nature and Origin of the Contagion of Fevers. Hull, 1788.

[275] Account of a Contagious Fever at Aylesbury. Aylesbury, 1785.

[276] Thomas Day, Some Considerations ... on the Contagion in Maidstone Jail, 1785.

[277] See Barnes, in Mem. Lit. Phil. Soc. Manchester, II. 85. Dr Samuel Parr wrote his epitaph in the Cathedral. Also Johnstone sen. to Lettsom, Memoirs, III. 241.

[278] Martin Wall, M.D., Clin. Obs. on the Use of Opium in Low Fevers and in the Synochus. Oxford, 1786.

[279] J. C. Jenner, in Lond. Med. Journal, VII. 163.

[280] Gent. Magaz. 1785, I. 231, March 1.

[281] This is the period and the district to which Robert Burns refers, under date of 21 June, 1783, in a letter to his cousin, James Burness, of Montrose: “I shall only trouble you with a few particulars relative to the wretched state of this country. Our markets are exceedingly high, oatmeal 17_d._ and 18_d._ per boll, and not to be got even at that price. We have, indeed, been pretty well supplied with quantities of white peas from England and elsewhere; but that resource is likely to fail us, and what will become of us then, particularly the very poorest sort, heaven only knows.” The lately flourishing silk and carpet weaving had declined during the American War, and the seasons had been adverse to farmers. The lines in Burns’ poem, “Death and Dr Hornbook”:

‘This while ye hae been mony a gate At mony a house.’ ‘Ay, Ay,’ quoth he, and shook his head.--

are explained by a note, “An epidemical fever was then raging in the country.”

[282] Account by Rev. Geo. Skene Keith, Statist. Act. II. 544.

[283] Also Banff, ibid. XX. 347.

[284]

“Not twenty years ago, but you I think Can scarcely bear it now in mind, there came Two blighting seasons, when the fields were left With half a harvest. It pleased heaven to add A worse affliction in the plague of war, &c.”

Trotter, Medicina Nautica, I. 182, 1797, gives these real cases:--“During the short time that I attended the dispensary at Newcastle, just at the beginning of the [French] war, I was sent for to a poor man in a miserable and low part of the town called Sandgate. He was ill with what is called a spotted fever.” Six children were standing round his bed, the oldest not more than nine. They had been ill first, then his wife, who was recovered and had gone out to pawn the last article they had to buy meal for the children. The man worked on the quay at 1_s._ 2_d._ per diem. Again, “When I practised as a surgeon and apothecary at the end of the late [American] war in a small town in Northumberland, with an extensive country business, some similar scenes came under my view. Two servants of two opulent farmers applied to me for relief. The first had seven children, who took the fever one by one till the whole became sick. His wages were 1_s._ per diem. His master, a rich man, thought himself charitable by allowing them to pull turnips from his field for food. The other servant was a shepherd; but his herding, as the saying is, was a poor one. The first and second of six children were able to work a little, till they got a fever in a severe winter, and down they fell, one after another, the father and mother at last.” They wanted to sell the cow; but some charitable ladies raised a small subscription, by which means the comforts of wine and diet came within their reach; their master, for his part, sent them the carcase of a sheep, which had been found dead in a furrow, with a request that the skin should be returned.

[285] Jenner to Shrapnell, Baron’s Life of Jenner, I. 106-7.

[286] John Barker, Epidemicks, pp. 201-6.

[287] The dearth of 1794-95 called forth one notable piece, the ‘Thoughts and Details on Scarcity,’ drawn up by Mr Burke, from his experience in Buckinghamshire, originally for the use of Mr Pitt, in November, 1795. Burke takes an optimist line, and preaches the economic doctrine of laissez faire: “After all,” he asks, “have we not reason to be thankful to the Giver of all good? In our history, and when ‘the labourer of England is said to have been once happy,’ we find constantly, after certain intervals, a period of real famine; by which a melancholy havock was made among the human race. The price of provisions fluctuated dreadfully, demonstrating a deficiency very different from the worst failures of the present moment. Never, since I have known England, have I known more than a comparative scarcity. The price of wheat, taking a number of years together, has had no very considerable fluctuation, nor has it risen exceedingly within this twelvemonth. Even now, I do not know of one man, woman, or child, that has perished from famine; fewer, if any, I believe, than in years of plenty, when such a thing may happen by accident. This is owing to a care and superintendence of the poor, far greater than any I remember.... Not only very few (I have observed that I know of none though I live in a place [Beaconsfield] as poor as most) have actually died of want, but we have seen no traces of those dreadful exterminating epidemicks, which, in consequence of scanty and unwholesome food, in former times not unfrequently wasted whole nations. Let us be saved from too much wisdom of our own, and we shall do tolerably well.” The last sentence is his favourite principle of “a wise and salutary neglect” on the part of Government.

[288] A labourer at Bury St Edmunds, receiving a weekly wage of five shillings, was able to buy therewith at the old prices:

Cost of same in 1801 £ s. d. {A bushel of wheat 0 16 0 {A bushel of malt 0 9 0 5_s._{A pound of butter 0 1 0 {A pound of cheese 0 0 4 {Tobacco, one penny 0 0 1 ----------- £1 6 5 {Weekly wage in 1801, 9_s._ {Parish bonus 6_s._ 15 0 ---------- 0 11 5 deficiency

[289] Loidis and Elmete, 1816, p. 85.

[290] Thorp, Tract of 1802, cited by Hunter, Ed. Med. Surg. Journ. April, 1819, p. 239.

[291] Currie, Med. Phys. Journ. X. 213.

[292] Beddoes.

[293] Goodwin, Med. Phys. Journ. IX. 509. Cf. Gervis, Med. Chir. Trans. II. 236.

[294] Elizabeth Hamilton, The Cottagers of Glenburnie, Edin. 1808: “The only precaution which the good people, who came to see him [the farmer] appeared now to think necessary, was carefully to shut the door, which usually stood open.... The prejudice against fresh air appeared to be universal.... The doctor did not think it probable that he would live above three days; but said, the only chance he had was in removing him from that close box in which he was shut up, and admitting as much air as possible into the apartment.... While the farmer yet hovered on the brink of death, his wife and Robert, his second son, were both taken ill.... Peter MacGlashan had taken to his bed on going home and was now dangerously ill of the fever.... All the village indeed offered their services; and Mrs Mason, though she blamed the thoughtless custom of crowding into a sick room, could not but admire the kindness and good nature with which all the neighbours seemed to participate in the distress of this afflicted family.”

[295] Charlotte Brontë’s story of Shirley falls in this period and turns upon the industrial crisis in Yorkshire; but it is on the whole a happy idyllic picture. Harriet Martineau wrote in Household Words, vol. I. 1850, Nos. 9-12, a story entitled “The Sickness and Health of the People of Bleaburn,” a Yorkshire village supposed to have been Osmotherly. It is, in substance, an account of a terrible epidemic of fever in the year 1811, the story opening with the news of the victory of Albuera and the rejoicings thereon. It appears to have been constructed very closely from the real events of the plague of 1665-66 in the village of Eyam, in the North Peak of Derbyshire, and had probably a very slender foundation in any facts of fever in Yorkshire or elsewhere in the year 1811. “Ten or eleven corpses,” says the novelist, “were actually lying unburied, infecting half-a-dozen cottages from this cause.” Cf. infra, Leyburn, p. 167.

[296] T. Bateman, M.D., Reports on the Diseases of London ... from 1804 to 1816. Lond. 1819.

[297] Parl. Committee’s Report on Contag. Fev. 1818, p. 33. Table by P. M. Roget.

[298] Adam Hunter, Ed. Med. Surg. Journ., April, 1819.

[299] Cleland, Glasgow and Clydesdale Statist. Soc. Transactions, Pt. I. Nov. 2, 1836.

[300] Sutton, Account of a Remittent Fever among the Troops in this Climate. Canterbury, 1806.

[301] In the first three months of 1811 a singular fever occurred among working people in part of a suburb of Paisley, one practitioner having 32 cases in 13 families. It was marked by rigors at the onset, pain in the back, headache, dry skin, loaded very red tongue, quick fluttering pulse, watchfulness, delirium-like fatuity, abdominal pain in many, foetid stools, great prostration, gradual recovery after fifteen or sixteen days without manifest crisis, and relapses in some. In this fever Murchison discovers enteric or typhoid. Its limitation to a part of one of the suburbs of Paisley is, of course, in the manner of enteric fever; on the other hand, only one of those 32 cases died, which is a rate of fatality perhaps not unparalleled in typhoid but much more often matched in typhus or relapsing fever of young and old together; while the length of the fever, fifteen or sixteen days or sometimes more, is too great for the abortive kind of enteric and too little for enteric fever completing both its first and second stages. James Muir, Edin. Med. and Surg. Journ. VIII. 134. Murchison, Continued Fevers, p. 428.

[302] James Clarke, M.D., “Medical Report for Nottingham from March 1807 to March 1808,” Edin. Med. and Surg. Journ. IV. 422. His account of the unwholesome state of the weavers’ houses is as bad as any of those already given.

[303] McGrigor, “Med. Hist. of British Armies in Peninsula,” Med. Chir. Trans. VI. 381.

[304] Richard Hooper, “Account of the Sick landed from Corunna,” _Edin. Med. and Surg. Journ._ V. (1809), p. 398. See also Sir James McGrigor, ibid. VI. 19.

[305] James Johnson, Influence of Tropical Climates, p. 20.

[306] J. Terry, in Ed. Med. and Surg. Journ., Jan. 1820, p. 247.

[307] Bateman, Account of the Contagious Fever of this Country. Lond. 1818.

[308] The following from the “Observations on Prevailing Diseases,” Oct.-Nov., 1818 (perhaps by Dr Copland), in the London Medical Repository, X. 525, shows that the relapses in the earlier part of this epidemic had been commonly remarked in London: “Fevers are still prevalent.... Relapses have been noticed as of frequent occurrence in the instances of the late epidemic. To what are these to be attributed? Are we to ascribe them to the influence of the atmosphere, to anything in the nature of the disorders themselves, or to the vigorous plans of treatment which are adopted for their removal? These relapses are more common in hospital than in private practice.... It has recently become the fashion to consider the state of recovery from fever as one which will do better without than with the interposition of the cinchona bark. Has the prevalence of this negative practice anything to do with the admitted fact of frequent relapse?”

[309] Report of the Select Committee of the House of Commons on Contagious Fever, Parl. Papers, 1818.

[310] On the Epidemic Fever at present prevailing. Lond. 1819, p. 40.

[311] J. B. Sheppard, “Remarks on the prevailing Epidemic.” _Edin. Med. Surg. Journ._, July 1819, p. 346. Also for Taplow, Roberts, _Lond. Med. Repos._ XIV. 186.

[312] W. Hamilton, M.D., Med. and Phys. Journ., June 1817, p. 451.

[313] Laws and Phenomena of Pestilence, Lond. 1821, p. 39. Christison says: “All great towns, with the exception it is said of Birmingham.”

[314] Adam Hunter, Edin. Med. Surg. Journ., Apr. 1819, p. 234, and Apr. 1820.

[315] Wood, “Cases of Typhus.” Edin. Med. Surg. Journ., April, 1819.

[316] Adam Hunter, u. s.

[317] T. Barnes, Edin. Med. Surg. Journ., April, 1819.

[318] H. Edmonston, ibid. XIV. (1818), p. 71.

[319] T. McWhirter, ibid. April, 1819, p. 317.

[320] J. C. Prichard, M.D., History of the Epidemic Fever which prevailed in Bristol, 1817-19. Lond. 1820.

[321] Obs. on the Cure and Prevention of the Contagious Fever now in Edinburgh. Edin. 1818.

[322] Edin. Med. Surg. Journ. XVI. 146.

[323] Benj. Welsh, Efficacy of Bloodletting in the Epidemic Fever of Edinburgh. Edin. 1819.

[324] Life of Sir Robert Christison, Edin. 1885, I. 142:--“I had been scarcely three weeks at my post in the fever hospital when I was attacked suddenly--so suddenly, that in half-an-hour I was utterly helpless from prostration. I had nearly six days of the primary attack, then a week of comfort, repose and feebleness, and next the secondary attack, or relapse, for three days more. My pulse rose to 160, and continued hard and incompressible even at that rate. My temperature under the tongue was 107° &c.” He was bled to 30 oz. and next day to 20 oz. more. Before the end of the epidemic, in August, 1819, he had another attack of relapsing fever, for which he was bled to 24 oz. and a third, after exposure to chill, the same autumn, which last was a simple five-days’ fever without relapse, also treated by the abstraction of 24 oz. of blood. In 1832 he had two attacks of the same synocha without relapses, and throughout the rest of his life many more: e.g. 16 June, 1861, “I have had something like the relapsing fever of my youth”--a five-days’ fever with a relapse on the 18th day; and again, on 19 March, 1868, “Incomprehensible return of mine ancient enemy.” These experiences coloured Christison’s view of relapsing fever, the so-called relapses being, in his opinion, comparable to the returning paroxysms of ague.

[325] Cleland.

[326] Report signed A. Brebner, provost, printed in Harty, Historic Sketch of the Contagious Fever in Ireland, 1817-19. Dublin, 1820, Appendix, p. 110.

[327] Memoir concerning the Typhus Fever in Aberdeen, 1818-19. By George Kerr, Aberdeen, 1820.

[328] William Gourlay, “History of the Epidemic Fever as it appeared in a Country Parish in the North of Scotland.” Edin. Med. and Surg. Journ., July, 1819, p. 329, dated 20 Nov. 1818.

[329] Trans. K. and Q. Cal. Phys. Ireland, V. 527.

[330] Dub. Q. J. Med. Sc. VIII. 297.

[331] A succession of thirty-one cases of relapsing typhoid at Charing Cross Hospital in 1877-78 were made the subject of an able essay by J. Pearson Irvine, M.D., Relapse of Typhoid Fever, London, 1880.

[332] Cited in Aberdeen Report, 17 Dec. 1818, in Harty, App. p. 110.

[333] Report of Select Committee, u. s. p. 6, and minutes of evidence.

[334] Prichard, pp. 74, 88.

[335] Christison, Month. J. Med. Sc. X.; Bennett, Princip. and Pract. of Med. 944-5.

[336] See above, p. 110-11.

[337] A complementary measure, namely, notification of contagious sickness to the authorities, was put in practice at Leeds in 1804 on the opening of the House of Recovery there. The Leeds House of Recovery, with fifty beds, was opened on 1 November, 1804, the epidemic of fever being then about over. One of its officers was an inspector, whose duty was “to detect the first appearance of infection, to cause the removal of the patient to the House of Recovery, and to superintend the fumigating and whitewashing of the apartment from which he is removed. So great is the solicitude of the physicians to promote early removal that rewards are offered to such as shall first give information of an infectious fever in their neighbourhoods.” It was claimed that this had been a great success, Leeds having been for twelve years previous to the epidemic of 1817 nearly exempted from two of the most infectious and fatal diseases, namely, typhus and scarlet fever. (It happened, however, that the whole of England, Scotland and even Ireland were exempted to the same remarkable, and of course gratifying degree.) Whitaker, Loidis and Elmete, 1816, p. 85.

[338] A strange epidemic of the early summer of 1824 in a semi-charitable girls’ school at Cowan Bridge, between Leeds and Kendal, which is the subject of a moving chapter in ‘Jane Eyre,’ was inquired into by Mrs Gaskell, the biographer of Charlotte Brontë. Forty girls were attacked with fever. A woman who was sent to nurse the sick, saw when she entered the school-room from twelve to fifteen girls lying about, some resting their heads on the table, others on the ground; all heavy-eyed and flushed, indifferent and weary, with pains in every limb, the atmosphere of the room having a peculiar odour. The symptoms, so far as known, and the circumstances of the school, point more to relapsing fever than to typhus, which is the name given to it by Charlotte Brontë. None died of the fever (it is otherwise in the tale), but one girl died at home of its after-effects. Dr Batty, of Kirby, who was called in, did not consider the type of fever to be alarming or dangerous. The dietary of the school had undoubtedly been most meagre for growing girls, and its discipline severe. The house was old and unsuited for the purposes of a boarding-school.

[339] Cowan, Journ. Statist. Soc. III. (1840) p. 271; Glas. Med. Journ. III. 437.

[340] Some of these were treated at the extra fever-hospital in Spring Gardens.

[341] From the table by Christison, Edin. Med. Journ., Jan. 1858, p. 581.

[342] Life of Christison, “Autobiography.”

[343] John Burne, M.D., Pract. Treatise on the Typhus or Adynamic Fever. London, 1828.

[344] To show the effect of emotion in causing a relapse, he gives an instance, almost the only concrete illustration in all his book: An Irishwoman, Ann McCarthy, aged 26, was admitted to Guy’s Hospital on 20 June, 1827, with “adynamic fever of the second degree,” having been already ill for two weeks: the course of her fever was favourable and she was “soon convalescent.” While still in the ward mending her strength, she lent her bonnet to another female patient to go out with; finding that her kindness had been abused by the woman forgetting to return the bonnet, she became exceedingly angry, relapsed into the fever on the 10th of July, was wildly delirious for several days, and died on the 19th of July. At this time it was the practice at Guy’s to examine the bodies after death; but permission was refused in the case in question, so that Burne was unable to say “whether the bowels were affected.” The case, therefore, may have been one of relapsing enteric fever. A similar ambiguity is discussed by Hughes Bennett in his Principles and Practice of Physic (p. 923), and decided in favour of relapsing fever proper, or relapsing synocha.

[345] Sir William Jenner, M.D., Lectures and Essays on Fevers and Diphtheria, 1849 to 1879. London, 1893.

[346] Christison, Life, u. s. I. 341.

[347] “Cases showing the frequency of the occurrence of Follicular Ulceration in the Mucous Membrane of the Intestine during the progress of Idiopathic Fever, with Dissections, and Observations on its Pathology.” Lond. Med. and Physical Journ., Aug. 1826, p. 97.

[348] Ibid. p. 351.

[349] Burne, u. s.

[350] Richard Bright, M.D., Reports of Medical Cases. Part I., 1827.

[351] Life of Sir Robert Christison, I. 144. Also in Trans. Soc. Sc. Assn. 1863, p. 104.

[352] Edin. Med. Journ., Jan. 1858, p. 588. Cf. infra, under Dysentery, 1828.

[353] Reid, Trans. K. and Q. Coll. of Phys. in Ireland, V.; O’Brien, ibid.

[354] Writing in 1839, Dr Stokes, of Dublin, made the following remarkable assertion (Dub. Journ. Med. and Chem. Sc. XV. p. 3, note): “In the epidemic of 1826 and 1827 we observed the follicular ulceration (dothienenteritis of the French) in the greater number of cases.” As the epidemic of 1826-27 was almost wholly one of relapsing fever, the statement is at least puzzling. It was made twelve years after the epidemic, at a time when the discrepancies between British and French observers, as to the occurrence of ulceration of the ileum in continued fever, were much discussed. Dr Lombard, of Geneva, having visited Glasgow, Dublin and other places, and confirmed the fact that the characteristic lesion of enteric fever was at that time only occasional, went on to say that Irish typhus was a species of disease by itself, a morbus miseriae. Whereupon the editor of the ‘Dublin Journal of Medical Science’ (XII. 503, in a review of Cowan’s Glasgow Statistics) gave the following truly Irish reply: “Had Dr Lombard made more inquiries, he would have found that Ireland is not so sunk in misery and debasement but that she can produce occasionally a fever which, in abdominal ulcerations, can compete with the sporadic diseases of her wealthier and more enlightened neighbours.” It may have been in the same patriotic spirit that Stokes declared “the greater number of cases” in the epidemic of 1826 and 1827 to have had follicular ulceration.

[355] G. L. Roupell, M.D., Some Account of a Fever prevalent in 1831. Lond. 1837.

[356] In addition to what has been said on this point already, for particular epidemics, I shall give a statement for ordinary years by Dr Carrick, of Bristol, in his ‘Medical Topography’ of that city: Trans. Prov. Med. Assocn. II. (1834), p. 176. “Continued fever is common enough, but nine-tenths of the cases are of a simple character, terminating for the most part within seven days, and unaccompanied with anything more serious than slight catarrhal or rheumatic disorder. Typhus gravior is rare--much more so than might be expected.”

[357] Charles West, M.D., “Historical Notices designed to illustrate the question whether Typhus ought to be classed among the Exanthematous Fevers.” Edin. Med. and Surg. Journ. 1840, April, p. 279.

[358] Alexander Kilgour, M.D., ibid. Oct. 1841, p. 381.

[359] Cowan, “Vital Statistics of Glasgow,” Journ. Statist. Soc. III.

[360] Cases at Mile-End Fever Hospital.

[361] Including 906 male fever-patients at Albion Street temporary hospital.

[362] Blackwood’s Magazine, March, 1838, p. 289.

[363] In 1819 the Irish in Glasgow had been estimated at 1 in 9·67: in 1831 the Irish part of the population had risen to 1 in 5·69. Dr Cowan, however, said of them: “From ample opportunities of observation, they appear to me to exhibit much less of that squalid misery and habitual addiction to the use of ardent spirits than the Scotch of the same grade.”

[364] Robert Cowan, M.D., “Statistics of Fever in Glasgow for 1837.” Lancet, April 10, 1839.

[365] James Arrott, M.D., Edin. Med. and Surg. Journ., Jan. 1839, p. 121.

[366] Craigie ibid. April, 1837.

[367] Christison, Monthly Journ. Med. Sc. X. 1850, p. 262.

[368] Kilgour, u. s.

[369] Cowan, Journ. Statist. Soc. III. 1841.

[370] Arrott, u. s.

[371] Craigie, u. s.

[372] Edin. Med. and Surg. Journ. July, 1838.

[373] Principles and Practice of Physic, 3rd ed. 1848, II. 742, 732.

[374] First Report of the Registrar-General, London, 1839.

[375] The district registrars had hardly organised their work in the first two or three years of registration. Some gave much more complete returns than others. There was a reluctance to register births, and the marriages were not all registered. But the totals of deaths came out very nearly as the actuaries had expected.

[376] The Third Report of the Registrar-General gives the mortality in all parts of England from typhus in 1839 (as well as from scarlatina) in an elaborate table of the registration districts and sub-districts.

[377] W. Budd, M.D., Lancet, 27 Dec. 1856, and 2 July, 1859. Dr Budd, who had been studying in Paris and seeing much typhoid fever, but little or no typhus, in the service of Louis at La Pitié hospital, took the whole of these cases for enteric or typhoid, and insisted, in his later life, on the ground of his North Tawton experiences in 1839, that typhoid fever spread by contagion. He published numerous papers on this theme (Lancet, 27 Dec. 1856, another series in the same journal from 2 July to Nov. 1859, Brit. Med. Journ. Nov.-Dec. 1861, and, finally, a volume of reprints with additions, Typhoid Fever, its Nature, Mode of Spreading and Prevention, London, 1873). But he published no clinical cases nor post-mortem notes, to make good his 1839 diagnosis, on which the whole matter turned, contenting himself with an assurance that he knew typhoid well from studying it under Louis (who, at that time, believed that the typhus of armies, gaols, &c. and of the British writers, was the same as the fever which he, and others after him, named typhoid). He also made the following six statements, as if he were making affidavit: (1) that the great majority of the cases had early diarrhoea, (2) that three had profuse intestinal haemorrhage, (3) that more or less of tympanitis was almost universal in the epidemic, (4) that in nearly every case he found the rose-coloured lenticular spots, (5) that one case, which was the only one examined post-mortem, had the characteristic ulceration of the intestine, and (6) that one fatal case had the symptoms of perforation of the gut. This summary manner, asking in effect to be taken on trust, is not usually accepted from innovators, none of the great discoverers having resorted to it. Hitherto, however, no one has thought proper to question Budd’s diagnosis of the epidemic fever in his North Tawton practice, nor even to remark upon his strange error of treating the epidemic of 1838-39 all over Britain as purely one of typhoid (Lancet, 27 Dec. 1856). But everyone knew that typhoid fever did not spread in the way that he described (doubtless correctly for the above cases). After the publication of his book in 1873 an attempt was made by an influential layman in the Times (9 Nov. 1874) to popularize Budd’s fallacies or paradoxes on the contagiousness of typhoid. “How,” it was asked, after a summary of the North Tawton epidemic in 1839, “could a disease whose characters are so severely demonstrable, have ever been imagined to be non-contagious? How could such a doctrine be followed, as it has been, to the destruction of human life?”

[378] “For three years past trade had been getting worse and worse, and the price of provisions higher and higher. This disparity between the amount of the earnings of the working classes and the price of their food occasioned, in more cases than could well be imagined, disease and death. Whole families went through a gradual starvation. They only wanted a Dante to record their sufferings. And yet even his words would fall short of the awful truth; they could only present an outline of the tremendous facts of the destitution that surrounded thousands upon thousands in the terrible years 1839, 1840, and 1841. Even philanthropists who had studied the subject were forced to own themselves perplexed in their endeavour to ascertain the real causes of the misery; the whole matter was of so complicated a nature that it became next to impossible to understand it thoroughly.... The most deplorable and enduring evil that arose out of the period of commercial depression to which I refer, was this feeling of alienation between the different classes of society. It is so impossible to describe, or even faintly to picture, the state of distress which prevailed in the town [Manchester] at that time, that I will not attempt it; and yet I think again that surely, in a Christian land, it was not known even so feebly as words could tell it, or the more happy and fortunate would have thronged with their sympathy and their aid. In many instances the sufferers wept first, and then they cursed. Their vindictive feelings exhibited themselves in rabid politics. And when I hear, as I have heard, of the sufferings and privations of the poor, of provision shops, where ha’porths of tea, sugar, butter, and even flour, were sold to accommodate the indigent--of parents sitting in their clothes by the fireside during the whole night for seven weeks together, in order that their only bed and bedding might be reserved for the use of their large family--of others sleeping upon the cold hearthstone for weeks in succession, without adequate means of providing themselves with food or fuel--and this in the depth of winter--of others being compelled to fast for days together, uncheered by any hope of better fortune, living, moreover, or rather starving, in a crowded garret, or damp cellar, and gradually sinking under the pressure of want and despair into a premature grave; and when this has been confirmed by the evidence of their careworn looks, their excited feelings, and their desolate homes--can I wonder that many of them, in such times of misery and destitution, spoke and acted with ferocious precipitation?” Mrs Gaskell, Mary Barton.

[379] John Goodsir, “On a Diseased Condition of the Intestinal Glands,” Lond. and Edin. Monthly Journ. of Med. Science, April, 1842. He does not enter on the question “as to whether the subject of the present paper constitutes a distinct species of disease, or be merely a form of the ordinary continued fever”; but he appears to recognize that a certain district may have a form of fever special to it, as Reid had probably told him.

[380] John Reid, M.D., “Analysis and Details of Forty-seven Inspections after Death,” Edin. Med. and Surg. Journ., Oct. 1839, p. 456.

[381] Reid, u. s., from Home’s records.

[382] Murchison, Continued Fevers, 2nd ed. 1873, p. 444.

[383] Lombard, in Dublin Journal of Med. Sc. X. (1836), p. 17. He bore witness, also, to the rarity of the bowel-lesion in the Glasgow fevers. This was confirmed by Dr Perry, of that city, Ibid. X. 381. See also Julius Staberoh, M.D., “Researches on the Occurrence of Typhus in the Manufacturing Cities of Great Britain,” Ibid. XIII. 426.

[384] Trans. Prov. Med. Assoc. II. (1834), p. 176.

[385] Continued Fevers, 2nd ed. 1873, p. 443.

[386] Christison, “On the Changes which have taken place in the Constitution of Fevers and Inflammations in Edinburgh during the last forty years.” Paper read at Med. Chir. Soc. Edin. 4 March, 1857. Edin. Med. Journ. Jan. 1858, p. 577.

[387] Continued Fevers, under the head of “Typhus,” p. 47.

[388] See especially John Rose Cormack, M.D., Natural History, Pathology and Treatment of the Epidemic Fever at present prevailing in Edinburgh and other towns. Lond. 1843; and the papers by Wardell, Lond. Med. Gaz. N. S. II-V.

[389] Dr Betty, of Lowtherstown, Fermanagh, Dubl. Quart. Journ. Med. Sc. VII. 125.

[390] Murchison says that the enteric fever of the end of 1846 was prevalent at many places in England where the epidemic of typhus never made its appearance, and that in Edinburgh (according to an unpublished essay by Waters) most of the enteric cases not only occurred prior to the outbreak of the epidemic of Irish fever, but came from localities in the neighbouring country and from the best houses of the New Town--not from the crowded courts of the Old Town, to which the later epidemic of typhus and relapsing fever was restricted. Murchison, u. s. p. 49. The following papers relate to the autumnal typhoid of 1846 in England: Sibson, “Fever at Nottingham and neighbourhood in Summer and Autumn of 1846,” Med. Gaz. XXXIX.; Taylor, “Fever at Old and New Lenton in 1846,” Med. Times, XV. 159 and Med. Gaz. XXXVIII. 127; Turner, “Fever at Minchinhampton in Autumn 1846,” Med. Gaz. XLII. 157; Brenchley, “Fever in Berkshire in 1846,” Med. Gaz. XXXVIII. 1082; Bree, “Epidemic Fever at Great Finborough in Autumn of 1846,” Prov. Med. and Surg. Journ. 1847, p. 676.

[391] In the Report of the Registrar-General for the year 1847.

[392] This was the occasion which furnished Father Newman with a famous argument for the bona fides of his co-religionists: “The Irish fever cut off between Liverpool and Leeds thirty priests and more young men in the flower of their days, old men who seemed entitled to some quiet time after their long toil. There was a bishop cut off in the North; but what had a man of his ecclesiastical rank to do with the drudgery and danger of sick calls, except that Christian faith and charity constrained him?” John Henry Newman, D.D., History of My Religious Opinions, London, 1865, p. 272.

[393] Leigh, in Report Reg.-Gen. for 1847, X. p. xx.

[394] H. M. Hughes, “On the Continued Fever at present existing in the southern districts of the metropolis,” Lond. Med. Gaz. Nov. 1847; Laycock, “Unusual prevalence of Fever at York,” Lond. Med. Gaz. Nov. 1847; Bottomley, “Notes on the Famine Fever at Croydon in 1847,” Prov. Med. and Surg. Journ. 1847; Ormerod, Clinical Observations on Continued Fever at Bartholomew’s Hospital, Lond. 1848; Art. in Brit. and For. Med. Chir. Rev. 1848, I. 285; Duncan, Journ. Pub. Health, I. 200 (Liverpool); Paxton, Prov. Med. Journ. 1847, pp. 533, 596 (Rugby).

[395] The following papers relate to the epidemic in Scotland in 1847: Orr, “Historical and Statistical Sketch of the progress of Epidemic Fever in Glasgow during 1847,” Edin. Med. and Surg. Journ. LXIX.; Stark, “On the Mortality of Edinburgh and Leith for 1847,” Ibid. and LXXI.; R. Paterson, “Account of the Epidemic Fever of 1847-8” in Edinburgh, Ibid. LXX.; W. Robertson, “Notes on the Epidemic Fever of 1847-8,” Month. Journ. of Med. Sc. IX. 368; J. C. Steele, “View of the Sickness and Mortality in the Glasgow Royal Infirmary during 1847,” Edin. Med. and Surg. Journ. LXX.; J. C. Steele, “Statistics of the Glasgow Infirmary for 1848,” Ibid. LXXII. 241; J. Paterson, “Statistics of the Barony Parish Fever Hospital of Glasgow in 1847-8,” Ibid. LXX. 357.

[396] Buchanan, Report Med. Officer Privy Council for 1864, and Trans. Epid. Soc. 1865, II. 17; Hamilton, Lancet, II. 1867, p. 608 (Liverpool); Martyn, Brit. Med. Journ. July, 1863; Davies, Med. Times and Gaz. II. 1867, p. 427 (Bristol); Thompson, St George’s Hosp. Reports, I. (1866), p. 47 (London); Allbutt, ibid. p. 61 (Leeds).

[397] Buchanan, Report Med. Off. Privy Council for 1865, p. 210.

[398] James Stark, M.D., “Remarks on the Epidemic Fever of Scotland during 1863-64-65” etc., Trans. Epidem. Soc. N. S. II. 312. See also Russell, Glasg. Med. Journ. July, 1864, and R. Beveridge (for Aberdeen), Lancet, I. 1868, p. 630.

[399] Weber, Lancet, I. 1869, pp. 221, 255; Murchison, ibid. II. 1869, pp. 503, 647; Gee (Liverpool), Brit. Med. Journ. II. 1870, p. 246; Robinson (Leeds), Lancet, I. 1871, p. 644; Muirhead (Edinburgh), Edin. Med. Journ. July, 1870, p. 1; Rabagliati (Bradford), ibid. Dec. 1873; Tennant (Glasgow), Glasgow Med. Journ. May, 1871, p. 354; Armstrong (Newcastle), Lancet, I. 1873, p. 48.

[400] Muirhead (l. c.) says: “In no single instance which came under my observation could starvation be said to be the immediate cause of the disease. Not one of those individuals could be said to be emaciated.... On strict and repeated inquiry, not one of them would confess to having been in destitute circumstances.” During the winter of 1870-71 I attended from the Edinburgh New Dispensary several relapsing-fever patients at their homes, and can clearly remember having been surprised at the condition of decency and comfort in which I found them. The appearance of comfort was certainly due in part to the district visitors, who were numerous and active during the epidemic.

[401] Spear, “Typhus Fever in various parts of England, 1886-87.” Rep. Med. Off. Loc. Gov. Bd. N. S. XVI. p. 169.

[402] 2303 of these fever deaths in 1864 occurred in the eight principal towns of Scotland, classified as follows: typhus, 1450, relapsing fever, 371, gastric, enteric, or typhoid, 382.

[403] G. B. Longstaff, M.D., Trans. Epid. Soc. 1884-5, p. 72, reprinted in his Studies in Statistics, Lond. 1891, p. 402. The seasonal curve for the typhoid admissions to the London Fever Hospital over a longer period is nearly the same, as well as that of the registered deaths by typhoid in all London, 1869-84.

[404] The following large registration districts besides those in the Table, had enteric-fever death rates of ·5 and upwards per 1000 persons living, in the ten years 1871-80; in nearly all of them there has been a marked decline in the ten years 1881-90:--Durham, Hartlepool, Easington, Houghton-le-Spring, Darlington, Gateshead (county Durham); Morpeth (Northumberland); Aysgarth, Todmorden, Dewsbury, Pontefract, Barnsley, Rotherham (Yorkshire); Dudley, Leigh, Ormskirk (Lancashire); Crickhowell (Wales); Worksop, Radford (Nottingham); Shrewsbury; Peterborough; Portsea Island (Hants). Of the London districts, Hackney had the highest enteric fever, 0·46 per 1000 in a general death-rate of 20·78. The high rate of a decennium is not unfrequently brought up by one great explosion. In many of the Lancashire, Yorkshire and Midland towns, with rates about ·4 per 1000 persons, the rate has been somewhat steady from year to year. In the decennium 1871-80, many special outbreaks, some of them in villages, were reported on by the inspectors of the Medical Department, and traced for the most part to water-supplies tainted by the percolation of excrement.

[405] The Registration District of Middlesborough was carved out of Stockton and Guisborough in 1875.

[406] Registration District containing a population of 72,707 on a mean between the census of 1871 and that of 1881. In 1891 the population was 146,812.

[407] F. W. Barry, M.D., in Rep. Med. Off. Loc. Gov. Board for 1882, p. 72. The contention of the inspector was that the water-supply had been tainted by enteric-fever evacuations from a case which began on 22 May in a cottage some half-mile distant from the reservoir but in communication with it through ditches and brooks. The area of the water-supply did not correspond with the area of the fever.

[408] The report for the Medical Department by F. W. Barry, M.D. (Enteric Fever in the Tees Valley, 1890-91, Parl. papers, Nov. 1893), is an elaborate argument to prove that the flooded state of the Tees was indeed the relevant antecedent, not as indexing the rise of the ground-water in the respective towns, but as dislodging and sweeping down the slops, sewage and dry refuse of the market town of Barnard Castle, in upper Teesdale, whereby the water taken in from the Tees two miles above Darlington to the tanks, filters and reservoirs of the Darlington Corporation, and of the Stockton and Middlesborough Water Board, was tainted in some unusual degree--a hypothesis the more remarkable that the refuse, such as it was, had been suspended or dissolved in an unusual volume of water, that little refuse could have collected between the first floods and the second, and that no cases of enteric fever were known in the upper valley of the Tees. This judicial deliverance has not been accepted by the authorities of Darlington, Stockton and Middlesborough, nor by the Royal Commission on Water Supply, before whom it was laid.

[409] Besides the epidemic at Worthing in 1893, which is still sub judice, the best known instance of typhoid following a certain water-supply is the explosion at Redhill and Caterham in Jan.-Feb. 1879, Rep. Med. Off. Loc. Gov. Board, for 1879, Parl. papers, 1880, p. 78. The first instance alleged of the distribution by milk was the Islington explosion in July-August 1870 (Ballard, Med. Times and Gaz. 1870, II. 611). It was soon followed by the Marylebone explosion in the summer of 1873 (Rep. Med. Off. L. G. B., N. S. II. 193); but such instances have become less common, while instances of scarlatina and diphtheria following a milk-supply have become more common.

[410] Second Letter to Sir Hercules Langrishe, May, 1795.

[411] Berkeley’s Querist, Q. 362.

[412] Radulphus de Diceto, Imag. Histor. Eng. Hist. Soc. ed. I. 350.

[413] “Topogr. Hiberniae” in Opera, Rolls ed. V. 67. This and the preceding reference had escaped the notice of Dr John O’Brien, in the historical introduction to his Observations on the Acute and Chronic Dysentery of Ireland. Dublin, 1822.

[414] Polychronicon, Rolls ed. I. 332-3.

[415] “Many of the English-Irish have by little and little been infected with the Irish filthinesse, and that in the very cities, excepting Dublin and some of the better sort in Waterford, where the English continually lodging in their houses, they more retain the English diet.” And again: “In like sort the degenerated citizens are somewhat infected with the Irish filthinesse, as well in lowsie beds, foule sheetes, and all linnen, as in many other particulars.... Touching the meere or wild Irish, it may truely be said of them, which was of old spoken of the Germans, namely, that they wander slovenly and naked, and lodge in the same house (if it may be called a house) with their beasts.” Fynes Moryson, Itinerary, Pt. IV. p. 180.

[416] Ireland’s Natural History, &c. Written by Gerard Boate, late Doctor of Physick to the State in Ireland. And now published by Samuel Hartlib, Esquire. Lond. 1652. The author died at Dublin, shortly after his arrival there, on 9/19 January 1650/49. His information would seem to have come in part from his brother Arnold Boate, resident in Ireland.

[417] Hardiman, History of Galway, p. 126 seq. The plague from July 1649 to Lady Day 1650 is said to have swept away 3700 of the inhabitants, including 210 of the most respectable burgesses and freemen, with their families. The capitulation on 5 April, 1652, was followed by famine throughout the country, and by a revival of plague for two years, “during which upwards of one-third of the population of the province was swept away.”

[418] Cromwell’s Letters and Speeches, II. 55, 77.

[419] Edmund Borlase, History of the Reduction of Ireland to the Crown of England. 1675, p. 172.

[420] Boyle’s Works, fol. Lond. 1744, V. 92.

[421] The war-pestilence at Londonderry in 1689 is the third recorded epidemic of the kind there, not including what may have happened in the capture of the town by the Catholics in O’Neill’s rebellion, when Derry was destroyed, to be rebuilt in 1613 by the London Companies with a new charter under the name of Londonderry. The first historical occasion of sickness was in 1566. The troops of Elizabeth were landed on Loch Foyle in October and built their huts on the site of the old monastery. In the course of the winter the greater part of a force of 1100 men perished by dysentery and the infection which it breeds (see former volume, p. 372). On 12 Dec. 1642, a year after the outbreak of the Rebellion of Confederate Catholics, a petition of the agents of the distressed city of Londonderry to the Commons represented that there were 6059 persons in the city, whereof 5123 were women and children, or sick, aged or impotent; only 2000 were inhabitants of the city, the rest having fled there for safety. Spotted fever had broken out. (Hist. MSS. Comis. V. “MSS. of the House of Lords.”)

[422] With the exception of the last quoted piece of information, the most minute particulars of the siege of Londonderry are in an essay by an army chaplain, John Mackenzie, A Narrative of the Siege of Londonderry, London, 1690, which was written to correct and augment A True Account of the Siege of Londonderry by the Rev. Mr George Walker, rector of Donoghmoore in the county of Tyrone, and late Governor of Derry. London, 1689.

[423] See former volume, pp. 634-43.

[424] Minute particulars of it are given in An Impartial History of the Wars in Ireland [1689-1692]. By George Story, Chaplain to Sir Thomas Gower’s Regiment. London, 1693. Part I.

[425] Gangrene of the extremities was one of the symptoms of the “plague of Athens” as described by Thucydides. There is no need to invoke ergotism for an explanation of it, as some have done.

[426] At that time there was little systematic knowledge of military hygiene. Nearly two generations after, the experiences of Pringle, Donald Monro and Brocklesby in the campaigns of 1743-48 and 1758-63 in Germany and the Netherlands, yielded many valuable hints, some of which Virchow made use of in compiling his “Rules of Health for the Army in the Field,” in the Franco-Prussian War of 1870-71. See his Gesammelte Abhandlungen aus dem Gebiete der öffentlichen Medicin und Seuchenlehre.

[427] Bde. Berlin, 1879, II. 193.

[428] Joseph Rogers, M.D. Essay on Epidemic Diseases. Dublin, 1734.

[429] In further illustration of the power of morbid effluvia, he says: “We see how small a portion of a putrid animal juice, taken into the blood by inoculation, like a most active leaven sets all in a ferment; and in a very short time brings the whole juices of a sound body into an equal state of corruption with itself,”--instancing war-typhus, plague from cadaveric corruption (according to Paré), the Oxford gaol fever, and “a later instance at Taunton not more than five or six years ago.”

[430] Dr Rogan of Strabane, in his Condition of the Middle and Lower Classes in the North of Ireland, 1819, was of a different opinion (p. 90): “No police regulations exist in Strabane to prevent the slaughtering of cattle in any part of the town. The butchers, therefore, most of whom live in the narrow streets near the shambles, have their slaughter-houses immediately behind their dwellings. The garbage is thrown into a large pit, which is generally cleaned but once in the year, at the season when the manure is required for planting potatoes, and at this time an offensive smell pervades the whole town, and is perceptible for a considerable distance around. The families exposed constantly to the effluvia arising from these heaps of putrid offal might have been expected to suffer severely from fever; but on the contrary, they were found to be much less liable to it than others in the same rank of life. This was no doubt owing to their living chiefly on animal food, and thus escaping the debility induced by deficient nourishment, which certainly had the chief share in creating a predisposition to the disease.”

[431] Bp. Nicholson to Archbp. of Canterbury, cited by Lecky (II. 216) from Brit. Mus. Add. MS. 6116.

[432] Cited by O’Rourke, History of the Great Irish Famine of 1847. Dublin, 1875, from pamphlet in the Halliday Collection of the Royal Irish Academy.

[433] See Boulter’s Letters to the English Ministers.

[434] Wakefield’s Ireland, II. 6, cited by Barker and Cheyne.

[435] John Rutty, M.D. Chronological History of the Weather and Seasons and prevailing Diseases in Dublin during Forty Years. London, 1770.

[436] Maurice O’Connell, M.D. Morborum acutorum et chronicorum Observationes. Dublin, 1746.

[437] Boulter’s Letters. Oxford, 1769, I. 226.

[438] Lecky, II. 217.

[439] Berkeley’s Works. Ed. Fraser, Oxford, 1871, III. 369.

[440] Lord John Russell used these historical parallels from England and Scotland in his great speech in the House of Commons, during the debate on Ireland, 25th January, 1847.

[441] Fraser, “Life and Letters of Berkeley,” in Works, IV. 262.

[442] Berkeley to Prior, Feb. 8 and 15, 1740/1.

[443] He published the receipt in a Dublin journal.

[444] Berkeley to Thomas Prior, in “Life and Letters,” u. s., p. 265. Some attempts at relief-works had been made the year before, two of which are still to be seen in the obelisks on Killiney Hill near Dublin and on a hill near Maynooth (“Lady Conolly’s Folly.” O’Rourke, u. s.).

[445] Rutty, p. 93.

[446] (Dublin, 1741).

[447] Cited by O’Rourke. Short, a contemporary, also says that the fever in Galway was like a plague.

[448] Dutton, Statistical Survey of the County of Galway. Dublin, 1824, p. 313: “1741. A fever raged this year that occasioned the judges to hold the assizes in Tuam. Numbers of the merchants of Galway died this year, and multitudes of poor people, caused partly by fever and by the scarcity, as wheat was 28_s._ per cwt.”

[449] The author of The Groans of Ireland (Dublin, 1741) says: “On my return to this country I found it the most miserable scene of distress that I ever read of in history: want and misery in every face; the rich unable to relieve the poor; the road spread with dead and dying bodies; mankind of the colour of the docks and nettles which they fed on; two or three, sometimes more, on a car going to the grave for want of bearers to carry them, and many buried only in the fields and ditches where they perished.” Skelton, a Protestant clergyman, says: “Whole parishes in some places were almost desolate; the dead have been eaten in the fields by dogs, for want of people to bury them.” Skelton’s Works, Vol. V. Cited by Lecky.

[450] Report by Dr Phipps to Baron Wainwright, 10 March, 1741. Cited by F. C. Webb, Trans. Epidem. Soc. 1857, p. 67.

[451] Smith’s Kerry, p. 77. He adds that many were excused the hearth-tax on account of their poverty, by certificate of the magistrates; so that the decrease in 1744 may mean a greater proportion excused the tax, as well as a depopulation.

[452] How near the verge of want the people were is brought out by an experience in Galway county in 1745: a great fall of snow smothered vast numbers of cattle and sheep, which caused a great many farmers to surrender their lands. Wheat rose from six to eighteen shillings the hundredweight, while, after the distress, the best land in Connaught could be rented for five shillings an acre. Dutton’s Galway, p. 313.

[453] For Kinsale, Cork and Bandon, see Marjoribanks, Med. Press and Circ. 1867, II., 8.

[454] James Sims, M.D. Observations on Epidemic Disorders, with Remarks on Nervous and Malignant Fevers. London, 1773, p. 10. The preface is dated from London, whither Sims had removed from Tyrone. He rose to eminence in the London profession.

[455] A Letter to a Member of the Irish Parliament relative to the present State of Ireland. By Philo-Irene. London, 20 May, 1755. The turning of hundreds of acres into one dairy-farm had caused the depopulation which Goldsmith described in the Deserted Village: “By this unhappy policy several villages have been deserted at different times by the inhabitants, and numbers of them set a-begging,” p. 6.

[456] Sims, u. s. pp. 164-5.

[457] F. Barker and J. Cheyne, Account of the Fever lately epidemical in Ireland, 2 vols. London, 1821. This work relates mainly to the epidemic of 1817-19, but there is a short retrospect, the valuable part of which is for the years 1797-1802.

[458] The history of the Limerick and Belfast fever-hospitals is carried back to a few years before the founding of the Waterford hospital; but the latter was the first that was formally organised as a fever-hospital.

[459] “The fever in 1800 and 1801 very generally terminated on the fifth or seventh day by perspiration; the disease was then very liable to recur. The poor were the chief sufferers by it; and it was much more fatal amongst the middling and upper classes in proportion to the number attacked.” Barker and Cheyne, op. cit. p. 20.

[460] Smith’s Kerry. Dublin, 1756, p. 77.

[461] Smith’s Kerry, p. 88.

[462] A Tour in Ireland ... in 1776-78. London, 1780.

[463] The forty-shillings freeholder of Ireland was a life-renter whose farm was worth forty shillings annual rent more than the rent reserved in his lease.

[464] Malthus, Essay on the Principle of Population. Bk. II. chap. 10, Bk. III. chap. 8, and Bk. IV. chap. 11.

[465] Francis Rogan, M.D., Observations on the Condition of the Middle and Lower Classes in the North of Ireland, as it tends to promote the diffusion of Contagious Fever; with the History and Treatment of the late Epidemic Disorders. London, 1819.

[466] William Carleton, the vates sacer of the Irish peasantry, was born, in 1798, in one of those Tyrone thatched cottages, in the parish of Clogher. His father had changed his holding three times before William, the youngest child, was fourteen years old; the last of the four was a farm of sixteen or eighteen acres in the north of Clogher parish, and “nearer the mountains.” Carleton says that he “lived among the people as one of themselves” until he was twenty-two, which would have been until the year 1820; so that he probably saw the famine and fever of 1817-18 among that very Tyrone peasantry whom Dr Rogan brings before us from the medical side. The scenes of famine and fever in the ‘Black Prophet’ are those “which he himself witnessed in 1817, 1822, and other subsequent years,” having been recalled by him in the form of a tale which was published in 1846, at the beginning of the Great Famine of that and the following year. His early recollections of famine and fever come into other tales, such as the ‘Clarionet,’ the ‘Poor Scholar’ and ‘Tubber Derg,’ in which last is related the almost inevitable reduction to poverty and at length to beggary of a most upright and industrious farmer owing to the fall of prices, without fall of rents, after the Peace of 1815. Carleton’s work has always the quality of fidelity, and he may be credited when he says that the scenes of famine and fever are not exaggerated.

[467] Rogan, u. s. p. 95: “A farmer within my knowledge, who holds fifteen acres of arable land, with nearly an equal quantity of cut-out bog, for which he pays £28 per annum, has erected six cabins for labourers. They are built with mud, instead of lime, and are thatched, so that they cannot each have cost more than three or four pounds. For some time he received from three of his tenants six guineas per annum, and from the others two guineas each, the latter only holding a cottage and a small garden [the former three having also grazing for a milch cow, half a rood of land for flax, and half an acre for oats, with privileges of cutting turf and planting as many potatoes as they could each provide manure for]; but they have been all so reduced in circumstances by the late scarcity as to be now unable to keep a cow, and for the two last years have rented their cabins and potato gardens alone. All the straw raised on the farm would scarcely suffice to keep the houses water-fast if applied solely to this purpose.” One of the first things that the Marquis of Abercorn did in the epidemic of 1817 was to call upon the subletting farmers on his manors to repair the roofs of their cottiers’ cabins.

[468] Carleton, in one of his tales, has given a vivid picture of the lurid or gloomy appearance of the country in the late autumn of 1816, as if it foreboded the distress of the following spring.

[469] Probably their cattle had been impounded for rent and tithe. The author of the pamphlet Lachrymae Hiberniae (Dublin, 1822), a resident on the western coast, says (p. 8), with reference to the seizures for rent and tithe: “Oh what scenes of misery were exhibited in Ireland in this way during the years 1817, ’18 and ’19; by that time the people were left without cattle; after this their potatoes and corn were seized and sold, and in some cases their household furniture, even to their blankets.” The hardness of landlords in general is alleged by Dr Rogan, with an exception in favour of the Marquis of Abercorn in his own district.

[470] There was dysentery also in the autumn of 1818. Cheyne, Dubl. Hosp. Rep. III. 1.

[471] Rogan, p. 31.

[472] The following is an instance, from Boyle, in Roscommon: “In the middle of June, 1817, or a little earlier, a soup-shop was established here by subscription, where soup was daily given out to one thousand persons, who, naturally anxious to procure it in time, crowded together during its distribution, though every pains was taken to keep order amongst them. From the 16th to the 23rd of that month the weather became suddenly and unusually hot, and the disease about that period spread rapidly among those persons, the greater number of whom attributed the origin of their complaint to attendance at the soup-shop; among that crowd, many of whom I have seen faint from absolute want during exposure to the sun, there were persons from houses where the disease existed.” Report by Dr Verdon of Boyle, 26 June, 1818, in Barker and Cheyne, I. 325.

[473] Dr King of Tralee (Barker and Cheyne, I. p. 177) wrote as follows: “It is a custom in this country for very poor persons, living in the country parts, and possessing a miserable hovel with a small garden, after they have sowed their potatoes, to shut up their hut and carrying their families with them, to roam about the country, trusting to the known hospitality of the towns and villages for shelter and subsistence till the time for digging the potatoes shall have arrived.”

[474] Barker and Cheyne, I. 60.

[475] In Carleton’s tale of ‘The Poor Scholar,’ it is related how the hay-mowers stopped in their work to erect a hut for the fever-stricken youth, and a much larger hut not far from the first for the numerous persons who ministered to his wants under a kind of quarantine arrangement. The stealing of milk from rich men’s cows for the sick youth is the subject of a dialogue between the Roman Catholic bishop and the leader of the kindly party of mowers, in which the latter shows a skill in casuistry creditable to his religious instructors.

[476] William Harty, M.D., Historic Sketch of the Contagious Fever Epidemic in Ireland during 1817-19. Dublin, 1820. This work contains information collected by a circular of queries addressed to practitioners in the several provinces. It was undertaken by Dr Harty at the instance of Sir John Newport, M.P. for Waterford. The work by Barker and Cheyne on the same epidemic took longer to prepare, having been published in 1821. See also Cheyne, Dubl. Hosp. Rep. II. 1-147.

[477] Barker and Cheyne, p. 65. A similar incident comes into Carleton’s tale of ‘The Clarionet’: “At length, out of compassion, the few neighbours who feared not to attend a feverish death-bed, acting on the popular belief that children under a certain age are not liable to catch a fever, placed the boy in her arms.” This popular belief was well founded.

[478] Accounts from various places in Barker and Cheyne, and in Harty. Rogan (u. s. p. 45) says: “The cases of typhus gravior were infinitely more numerous among the rich and well-fed than among the poor; and with them also the head was most frequently the seat of diseased action.”

[479] Report on the Present State of the Distressed District in the South of Ireland: with an Enquiry into the Causes of the Distresses of the Peasantry and Farmers. Dublin, 1822.

[480] Lachrymae Hiberniae, or the Grievances of the Peasantry of Ireland, especially in the Western Counties. By a Resident Native. Dublin, 1822 (September). The author, a resident of the west coast, was concerned in the distribution of relief, and positively asserts the saving of thousands “from his own personal knowledge.”

[481] Robert James Graves, M.D., “Report on the Fever lately prevalent in Galway and the West of Ireland.” Trans. K. and Q. Col. Phys. IV. (1824), p. 408.

[482] John O’Brien, M.D., “On the Epidemic Dysentery which prevailed in Dublin in the year 1825.” Trans. K. and Q. Col. Phys. V. (1828) p. 221; Burke, Ed. Med. Surg. Journ. July, 1826, p. 56; Speer, Med. Phys. Journ. N. S. VI. 199.

[483] John O’Brien, “Med. Rep. of the H. of Recovery, Cork Street, Dublin, for the year ending 4 Jan. 1827.” Trans. K. and Q. Col. Phys. V. 512.

[484] Graves, Clinical Medicine, 1843. Lect. XVIII.

[485] O’Brien, u. s.

[486] “Remarks on the Epidemic Dysentery of the Autumn of 1826 in the South of Ireland.” By Alexander McCarthy, M.D. Edin. Med. and Surg. Journ. April, 1827, p. 289.

[487] “It is a melancholy picture of society to witness the increase of wealth and luxury on one side, and the greatest want and wretchedness on the other; to meet famine and exhaustion in the great body of the people, in a country that produces as much food as would afford a full supply for once and a half its present population; to see the granaries full of corn and flour, and the great body of the people scarcely existing on a half supply of bad potatoes. Such is the miserable situation of the Irish, a race of people distinguished for their intellect, and above all for their resignation and patience under afflictions the most trying.”

[488] Dub. Quart. Journ. Med. Sc. XI. 385.

[489] W. J. Geary, M.D., “Report of the St John’s Fever and Lock Hospitals.” Dub. Quart. Journ. Med. Sc. XI. 378: XII. 94.

[490] Various descriptions of these exist, of which that by Carleton in the tale ‘Barney Branagan,’ is probably not overdone.

[491] The Report of the Roscrea Fever Hospital for 1827 says: “In March, when the dung is being removed from the back yards for the purpose of planting the potatoes, the number of patients becomes double in the Fever Hospital.” Dublin Medical Press, Jan. 1846, p. 235.

[492] Babington, “Epidemic Typhous Fever in Donoughmore.” Dub. Quart. Journ. X. 404.

[493] G. A. Kennedy, “Report of Cork St. Fever Hosp. 1837-38.” Ibid. XIII. 311. Graves, Ibid. XIV. 363.

[494] Lynch, Ibid. N. S. VII. 388, gives some particulars of it also at Loughrea, Galway, in 1840.

[495] System of Clinical Medicine. Dublin, 1843, p. 57. The “change of type,” with special reference to treatment, is discussed more fully in Lecture XXXIV. pp. 492-500. See also Dub. Quart. Journ. Med. Sc. XIV. 502, where a letter on the changed character of fever at Sligo is cited.

[496] The Census of Ireland, 1841, Parl. Papers, 1843. “Report on the Table of Deaths,” by W. R. Wilde. The deaths in the family, with their causes, &c., in each of the previous ten years were entered on the census paper by the head of the family, or by the parish priest for him. These returns were, of course, far from exhaustive or correct.

[497] Graves, Clinical Medicine, 1843, p. 46. Remarking on the much greater frequency of fever in Ireland than in England, he says (p. 47): “Nothing can be more remarkable than the facility with which a simple cold (which in England would be perfectly devoid of danger), runs into maculated fever in Ireland, and that, too, under circumstances quite free from even the suspicion of contagion--in truth, except when fever is epidemic, catching cold is its most usual cause.”

[498] The principal work on the general circumstances of the Irish famine of 1846-47 is The History of the Great Irish Famine of 1847, with notices of Earlier Irish Famines. By Rev. John O’Rourke, P.P., M.R.I.A. Dublin, 1875.

[499] Joseph Lalor, M.D., Dub. Quart. Journ. Med. Sc. N. S. III. 38.

[500] Cited by O’Rourke, p. 152.

[501] The Census of Ireland, 1851. Part V. Table of deaths, vol. I. Dublin, 1856, p. 235.

The following are a few instances of depopulation between 1841 and 1851.

Union of Loughrea, Co. Galway. 1841 65,636 1851 38,698

Union of Clonakilty, Co. Cork. 1841 52,185 1851 31,473

Union of Kanturk, Co. Cork. 1841 61,238 1851 41,801

Parish of Kanturk. 1841 4,096 1851 6,754

Union of Portumna, Co. Galway. 1841 30,714 1851 19,747

Union of Skibbereen, Co. Cork. 1841 57,439 1851 37,283

Parish of Skibbereen. 1841 9,557 1851 8,931

Union of Skull, Co. Cork. 1841 26,620 1851 16,866

Parish of Skull. 1841 2,895 1851 3,226

[502] Essay on the Principle of Population. Bk. IV. chap. XI. Thorold Rogers has in many passages emphasized the advantages of the English practice from medieval times of living on the dearest kind of corn; but he seems to have overlooked the priority of Malthus throughout the whole of the eleventh chapter of his fourth book. In Six Centuries of Work and Wages (p. 62), Rogers says: “Hence a high standard of subsistence is a more important factor in the theory of population than any of those checks which Malthus has enumerated.”

[503] Cited in Thomas Doubleday’s Political Life of Sir Robert Peel. London, 1856, II. 398 note.

[504] It is a doctrine of economics that the higher standard of living checks population. Thus Marshall says of England: “The growth of population was checked by that rise in the standard of comfort which took effect in the general adoption of wheat as the staple food of Englishmen during the first half of the 18th century.” Economics, p. 230.

[505] Vol. VII. (1849) pp. 64-126, 340-404, and Vol. VIII. pp. 1-86, 270-339 of the Dublin Quart. Journ. of Medical Science, N. S. contain numerous reports collected by the editors from all parts of Ireland, and published either in abstract or in full. These are the chief medical sources. Some particulars are given also in the Dublin Med. Press, 1846 to 1849 in several papers on dysentery.

[506] John Popham, M.D., Dub. Quart. Journ. Med. Sc. N. S. VIII. 279.

[507] Cited by Dr Jones Lamprey, Dub. Quart. Journ. VII. 101.

[508] Lamprey, Dub. Quart. Journ. VII. 101.

[509] O’Rourke.

[510] Ormsbey, Dub. Quart. Journ. VII. 382.

[511] Pemberton, ibid. VII. 369.

[512] Lalor, u. s.

[513] This epidemic called forth two pamphlets on the relation of famine to fever, one by Dominic Corrigan, M.D., On Famine and Fever as Cause and Effect in Ireland (“no famine, no fever”), and a reply to it by H. Kennedy, M.D., On the Connexion of Famine and Fever.

[514] Pains resembling those of rheumatism were common in the fever of 1817-18 at Limerick. Barker and Cheyne, I. 432.

[515] Lamprey, u. s.

[516] Dr Kelly of Mullingar compared the smell of relapsing fever to that of burning musty straw. Dub. Quart. Journ. Med., Aug. 1863, p. 341.

[517] Cusack and Stokes, ibid. IV. 134.

[518] Barker and Cheyne, Harty, and Rogan have been cited to this effect for earlier epidemics. Graves (Clin. Med. pp. 59-60) says: “In the epidemics of 1816, 1817, 1818 and 1819, it was found by accurate computation that the rate of mortality was much higher among the rich than among the poor. This was a startling fact, and a thousand different explanations of it were given at the time.” He cites Fletcher (Pathology, p. 27) an Edinburgh observer, as follows: “The rich are less frequently affected with epidemic fevers than the poor, but more frequently die of them. Good fare keeps off diseases, but increases their mortality when they take place.”

[519] Dub. Quart. Journ. Med. Sc. N. S. VII. 388.

[520] Census of Ireland, 1851.

[521] The Census of Ireland of 1851. Part V. Table of Deaths. 2 vols. Dublin, 1856. Upwards of two hundred pages are occupied with a chronological “Table of Cosmical Phenomena, Epizootics, Epiphitics, Famines and Pestilences in Ireland” from the earliest times. This retrospect, which is very replete but tedious and uncritical, is followed by a summary report of twenty pages on “The Last General Potato Failure, and the Great Famine and Pestilence of 1845-50,” and by a long series of tabulated extracts from contemporary writings on all matters relating to the famine.

[522] Of this total, 18,430 deaths were from dysentery and 7,264 from diarrhoea.

[523] The increase in 1849 was doubtless owing to choleraic diarrhoea during the epidemic of Asiatic cholera, the deaths from dysentery being one-half of the total.

[524] R. Mayne, M.D., “Observations on the late Epidemic Dysentery in Dublin.” Dub. Quart. Journ. Med. Sc. VII. 294. See also papers in Dubl. Med. Press, 1849.

[525] 17th and 26th Reports of the Regr.-Genl. Ireland.

[526] Review of Murchison in Dub. Quart. Journ. Med. Sc., Aug. and Nov. 1863, pp. 169 and 339: “We are able, from extensive opportunities of observing the epidemic [of 1846-48] in Dublin, to verify the statement of Dr H. Kennedy as to the infrequency of enteric fever.”

[527] Dub. Quart. Journ. Med. Sc. Nov. 1865, p. 285.

[528] See p. 273, supra.

[529] O’Connor, u. s. p. 286, “Typhoid has scarcely appeared in this locality, which cannot boast of the excellence of its sewerage.”

[530] “On Atmospheric Conditions influencing the Prevalence of Typhus Fever.” Dub. Quart. Journ. Med. Sc., May, 1866, p. 309.

[531] H. Kennedy, M.D., “Further Observations on Typhus and Typhoid Fevers as seen in Dublin.” Ibid., Aug. 1862, p. 50.

[532] Nearly one-half of all the enteric fever deaths in Ulster and Leinster come respectively from Belfast and Dublin:

Year Belfast Dublin

1889 236 231 1890 190 168 1891 156 185

[533] Higden’s Polychronicon. Rolls Series, I. 332.

[534] Dyall of Agues. London, [1564].

[535] Essay on Epidemic Diseases. Dublin, 1734.

[536] Dissert. Epistol. § 93. Greenhill’s ed. p. 378.

[537] One regrets to find the above mistake in the learned pages of Murchison (p. 8). The following by Dr Robert Williams (Morbid Poisons, II. 423) is absolutely erroneous: “In Sydenham’s time, intermittent fever and dysentery were constantly endemic in London; and the mortality from the former cause alone averaged, in a comparatively small population, from one to two thousand persons annually.” What Sydenham says is that dysentery was endemic in Ireland (on the authority of Boate, no doubt), that it was epidemic in London in the end of 1669 and in the three years following, and that for the space of ten years it had appeared quite sparingly (quae per decennium jam parcius comparuerat). As to intermittents, he says they were absent from London for thirteen years, from 1664 to 1677, except in sporadic or imported cases. In the London bills the deaths from “agues” are sometimes distinguished from “fevers,” and are then seen to be only some dozen or twenty in two thousand.

[538] It is used in the Latin title of an Edinburgh graduation thesis, “De Catarrho epidemio, vel Influenza, prout in India occidentali sese ostendit,” by J. Huggar, which is assigned in Häser’s bibliography to the year 1703. Having been unable to find the thesis, I have not verified the date.

[539] Annales Monastici (St Albans), Rolls Series, No. 191, under the year 1427; Hist. MSS. Commiss. IX. pt. 1, p. 127, records of Canterbury Abbey.--An epidemic in Ireland a century before, in 1328, has been given by Sir W. R. Wilde, and by Dr Grimshaw following him, under the name of “murre,” as if that had been its name at the time. The explanation seems to be that the contemporary Irish name slaedan was rendered by Macgeoghegan, in his translation of the Annals of Clonmacnoise, by the 15th century English term “murre.” The “mure” of 1427 was a universal influenza; but the word was afterwards used for a common cold, along with poss, as in Gardiner’s Triall of Tabacco, 1610, fol. 12 and 15: “stuffings in the head, murres and pose, coughs”; and “the poze, murre, horsenesse, cough” etc.

[540] Cal. Cecil. MSS. I. under the dates.

[541] Munk, Roll of the College of Physicians, I. 32.

[542] Cited in Southey’s Commonplace Book, from Fuller’s Pisgah Sight, p. 54.

[543] Southey, Commonplace Book, from Strype’s Memorials of Cranmer, p. 284.

[544] Thoresby, Ducatus Leodiensis, ed. Whitaker, App. p. 152.

[545] Baines, Lancashire, II. 679: 39 deaths from 17 to 24 August, 1551, set down to “plague,” i.e. sweat.

[546] Lest it may be supposed that there has been adequate discussion of the differences between epidemic agues and influenzas, I quote from Hirsch’s Handbuch der historisch-geographischen Pathologie the passage in which these epidemics or pandemics of “malarial fever” are referred to: “These epidemics of malaria, which extend not unfrequently over large tracts of country, and sometimes even over whole divisions of the globe, forming true pandemics, correspond always in time with a considerable increase in the amount of sickness at the endemic malarious foci, whether near or distant; they either die out after lasting a few months, or they continue--and this applies particularly to the great pandemic outbreaks--for several years, with regular fluctuations depending on seasonal influences. On the very verge of the period to which the history of malarial epidemics can be traced back, we meet with a pandemic of that sort, in the years 1557 and 1558, which is said to have overrun all Europe (Palmarius, De morbis contagiosis. Paris, 1578, p. 322).... It is not until the years 1678-82 that we again meet with definite facts relating to an epidemic extending over a great part of Europe....” (Eng. Transl. I. 229.)

[547] Queen Elizabeth and her Times. Ed. Wright, 2 vols. Lond. 1838, I. 113. Sir W. Cecil writing from Westminster to Sir T. Smith on 29th December [1563] says: “The cold here hath so assayled us that the Queen’s majestie hath been much troubled, and is yet not free from the same that I had in November, which they call a pooss, and now this Christmas, to keep her Majestie company, I have been newly so possessed with it as I could not see, but with somewhat ado I wryte this. We have had perpetuall frosts here sence the 16th of this month. Men doo now ordinarily pass over the Thamiss, which I thynk they did not since the 8th yere of the reign of King Henry the VIII.” Ibid. I. 157. For “poss,” see note p. 305.

[548] Ephemer. Meteorol. anni 1561 [for the latitude of Brabant]. Antwerp, 1561: “Tusses numero infinitae atque tanta contagionis vi praestabunt ut pauci immunes reliquant, praecipuè circa mensis finem.” The almanacks of those times must have been constructed on the same principle as the weather forecasts of our own time--namely, that of using the experience of one year for the next, just as the weather of one day is an indication for the next. In 1575 Dr Richard Foster (who became president of the College of Physicians in 1601) issued an almanack in which he foretold “sweating fevers” for the month of July (Ephemer. meteorol. ad ann. 1575. Lond. 1575). Cogan says that Francis Keene, an astronomer, also prophesied the return of the sweating sickness in 1575, “wherein he erred not much, as there were many strange fevers and nervous sickness.”

[549] Johan Boekel, Συνοψις novi morbi quem plerique medicorum catarrhum febrilem, vel febrem catarrhosam vocant, qui non solum Germaniam, sed paene universam Europam graviss. adflixit. Helmstadtii, 1580.

[550] Hoker’s “Irish historie ... to the present year 1587,” p. 165a in Holinshed’s Chronicles.

[551] This very moderate increase of the deaths in London in 1580 may be compared with the probably fabulous figures which Webster (I. 163) gives for continental cities the same year: Rome, 4000 deaths, Lübeck, 8000 deaths, Hamburg, 3000 deaths. I have given the weekly deaths and baptisms in London for five years, 1578-82, in my former volume, p. 341.

[552] There is a curious reference to “the sweat” in Shakespeare’s Measure for Measure, Act I. scene 2, where the bawd, in an aside, says: “Thus, what with the war, what with the sweat, what with the gallows, and what with poverty, I am custom-shrunk.” It is known that Shakespeare adapted and condensed his play from Whetstone’s Promus and Cassandra, printed in 1578, who took it from an Italian romance. But Whetstone’s dialogue, which is pointless and verbose beside Shakespeare’s, gives an entirely different speech to the bawd at the same place in the action, making no reference to “the sweat.” The date of Measure for Measure is not certain; but it seems to belong to the earlier period of Shakespeare’s work, when he was adapting old plays most freely. Whatever its date, the war, the sweat, the gallows and poverty are evidently topical allusions pointed enough for the audience to have taken up.

[553] The year 1610 is mentioned by Short as a season of universal catarrhal fever abroad; but that epidemic is not in the modern chronologies of influenza.

[554] Chamberlain to Carleton in Court and Times of James I. I.

[555] Same to same 4 Nov. 1612. Ibid. I. p. 201.

[556] Court and Times of James I. I. p. 206.

[557] Ibid. p. 208.

[558] Court and Times of James I. p. 197.

[559] Ibid. p. 237.

[560] Ibid. Letter of 25 Nov. 1613.

[561] Cal. Coke MSS. I. 83.

[563] Graunt, Obs. upon the Bills of Mortality, 1662.

[564] Robert Boyle did not attach much importance to the name of “new disease.” “The term new disease,” he says, “is much abused by the vulgar, who are wont to give that title to almost every fever that, in autumn especially, varies a little in its symptoms or other circumstances from the fever of the foregoing year or season.” (Boyle’s Works. 6 vols. 1772, V. 66.) But it was the name commonly given to the epidemics of catarrhal fever among others, and it does not appear, when the history is examined closely, that it was ever given except to some epidemic separated by several years from the last of the kind.

[565] Sir R. Leveson’s Letters. Hist. MSS. Commiss. V. 146.

[566] Pp. 568-577.

[567] Πυρετολογια sive Gulielmi Dragei Hitchensis Ιατρου καὶ Φιλοσοφου Observationes ab Experientia de Febribus Intermittentibus. Londini, 1665.

[568] His tract is dated 1641.

[569] By Nicholas Sudell, licentiate in physick and student in chimistry. London, 1669.

[570] Πυρετολογια. A rational account of the Cause and Cure of Agues, with their signs, Diagnostick and Prognostick. Also some Specified Medicines prescribed for the Cure of all sorts of Agues, &c. Whereunto is added a short account of the Cause and Cure of Feavers and the Griping in the Guts. Authore Rto. Talbor, Pyretiatro. Londini, 1672.

[571] Sir Thomas Watson (Practice of Physic, I. 725) has a story which shows how long these fancies, encouraged by quacks, may linger: “A coachman by whose side I sat while travelling from Broadstairs to Margate was speaking of the rarity of ague in that part of the Isle of Thanet. His father, he said, once had the complaint, and a fit came on while he was on a visit to him, the coachman, at Ramsgate. The son administered to his suffering parent a glass of brandy; whereupon ‘he threw the agy off his stomach; and it looked for all the world like a lump of jelly.’”

[572] Philip Guide, M.D., A Kind Warning, &c. Lond. 1710.

[573] The best summary of the “history of the use of Peruvian bark” is by Sir George Baker, in Trans. Col. Phys. III. (1785), 173.

[574] Cited by Baker, l. c. p. 190.

[575] Lives of the Norths. New ed. by Jessopp. Lond. 1890, III. 188.

[576] He fell into a kind of decline and died at his country house on 5 September, Dr Radcliffe having been summoned from London without avail.

[577] Baker, l. c., “Had not physicians been taught by a man whom they, both abroad and at home, vilified as an ignorant empiric, we might at this day have had a powerful instrument in our hands without knowing how to use it in the most effectual manner.” This was written at a time when physicians spoke of “throwing in the bark”--throwing it in “with a shovel,” as an Edinburgh professor used to say.

[578] John Barker, M.D., of Sarum, and afterwards physician to the forces, says in 1742 (in his essay on the epidemic fever of 1741, u. s. p. 112) that he had Sydenham’s letter in manuscript before him, and that it was written in October, 1677.

[579] Cited by Baker, Trans. Col. Phys. III. 208.

[580] Beaufort MSS. Histor. MSS. Com. XII. App. 9, p. 85.

[581] Evelyn’s Diary, under the date of 29 Nov. 1694.

[582] Evelyn; Luttrell, I. 327.

[583] Hist. MSS. Com. V. 186. Sutherland correspondence.

[584] The Diary of John Evelyn, under the date 4 Feb. 1685.

[585] The popular imagination at the time appears to have been most impressed by Dr King’s promptitude in whipping out his lancet. Roger North must have had it incorrectly in his mind when he wrote: “About the time of the death of Charles II., it grew a fashion to let blood frequently, out of an opinion that it would have saved his life if done in time.”

[586] Obs. Med. 3rd ed. 1675, V. 5.

[587] Ralph Thoresby, Ducatus Leodiensis, ed. Whitaker, App. p. 151. Brand, Hist. of Newcastle, under the year 1675, says that “the jolly rant” caused 724 deaths in that town, the authority given being Jabez Cay, M.D., who left his papers to Thoresby. The number given is probably the mortality from all causes.

[588] Patrick Walker’s Life of Cargill, pp. 29, 30.

[589] Synopsis Nosologiae. 3rd ed. Edin. 1780, II. 173.

[590] Epist. respons. ad R. Brady, § 42.

[591] Luttrell (Diary, I. 23) enters under Oct. 1629: “About the middle of this month vast great rains fell which have been very prejudiciall to many persons.”

[592] Christopher Love Morley, M.D., De Morbo Epidemico tam hujus quam superioris Anni, id est 1678 et 1679 Narratio. Preface dated London, 31 Dec. 1679.

[593] Lady Chaworth to Lord Roos, Calendar of the Belvoir MSS. II. 47.

[594] Lives of the Norths. Ed. cit. III. 143.

[595] Luttrell’s Historical Relation. Oxford, 1857, I. 19.

[596] Luttrell, loc. cit. I. 20, 21, 44.

[597] On 16 March, the illness of “little Frank ... hath made me suspect some kind of aguish distemper; but, if it be, it is so little that we neither perceive coming nor going.” On 7 July, another child is recovered of her feverish distemper. On 5 October, “all my little ones are very well, but some of my servants have quartan agues.” Lives of the Norths, Letters of Anne, Lady North.

[598] An authentic case of these lingering epidemic agues was that of John Evelyn in the beginning of 1683. On 7th February, 1687, he writes: “Having had several violent fits of an ague, recourse was had to bathing my legs in milk up to the knees, made as hot as I could endure it; and sitting so in a deep churn or vessel, covered with blankets, and drinking carduus posset, then going to bed and sweating. I not only missed that expected fit, but had no more, only continued weak that I could not go to church till Ash Wednesday, which I had not missed, I think, so long in twenty years”--in fact, since his “double tertian” in 1660, which kept him in bed from 17th February to 5th April.

[599] Ralph Thoresby caught it at Rotterdam, suffered from it, in the tertian form, for several weeks of October and November, 1678, and brought it home with him to Leeds. He gives a good account of the illness in his Diary (2 vols. Lond. 1830).

[600] The History of this present Fever, with its two products, the Morbus Cholera and the Gripes. By W. Simpson, Doctor in Physick. London, 1678.

[601] Cal. Belvoir MSS. II. 120. June, 1688. Bridget Noel to the Countess of Rutland.

[602] Walter Harris, M.D., De morbis acutis infantum. Lond. 1689. English transl. by Cockburn, 1693, p. 88.

[603] “Historical Account of the late General Coughs and Colds, with some Observations on other Epidemical Distempers.” Phil. Trans. XVIII. (1694), p. 109.

[604] “’Twas very remarkable that in England as well as this kingdom a short time before the general fever, a slight disease, but very universal, seized the horses too: in them it showed itself by a great defluxion of rheum from their noses; and I was assured by a judicious man, an officer in the army of Ireland, which was then drawn out and encamped on the Curragh of Kildare, there were not ten horses in a regiment that had not this disease.” Molyneux, u. s.

[605] Evelyn says nothing of a great epidemic cold in this season, but makes the following remarks on the weather: “Oct. 31. A very wet and uncomfortable season. Nov. 12. The season continued very wet, as it had nearly all the summer, if one might call it summer, in which there was no fruit, but corn was very plentiful.”

[606] Molyneux, Phil. Trans. XVIII. (1694), p. 105.

[607] “An universal cold that appeared in 1708, and was immediately preceded by a very sudden transition from heat to cold in Dublin and its vicinity.” Molyneux’s Memoirs.

[608] La Grippe may, of course, be taken literally to mean seizure; but the common use of the word seems to have been figurative for some fancy that seized many at once and became the fashion.

[609] Joannes Turner, M.D., De Febre Britannica Anni 1712. Lond. 1713, pp. 3, 4.

[610] Mead, Short Discourse concerning Pestilential Contagion. Lond. 1720, p. 8. But Short, who wrote in 1749, places the “Dunkirk rant” under the year 1710: (Air, Weather, &c. I. 455).--“March 1, began and reigned two months an epidemic which missed few, and raged fatally like a plague in France and the Low Countries, and was brought by disbanded soldiers into England, namely a catarrhous fever called the Dunkirk rant or Dunkirk ague.... It lasted eight, ten, or twelve days. Its symptoms were a severe, short, dry cough, quick pulse, great pain of the head and over the whole body, moderate thirst, and sweating. Diuretics were the cure.”

[611] “The effects and evidences of God’s displeasure appearing more and more against us since the incorporating union [1707], mingling ourselves with the people of these abominations, making ourselves liable to their judgments, of which we are deeply sharing; particularly in that sad stroke and great distress upon many families and persons, of the burning agues, fevers never heard of before in Scotland to be universal and mortal.” Life and Death of Alexander Peden. 3rd ed. 1728. Biog. Presb. I. 140.

[612] Boyle’s Works. Ed. 1772, V. 725.

[613] Ibid. V. 49.

[614] Scotia Illustrata. Edin. 1684. Lib. II. “De Morbis,” p. 52.

[615] Commentar. Nosolog. Lond. 1727.

[616] The Method and Manner of curing the late raging Fevers, and of the danger, uncertainly and unwholesomeness of the Jesuit’s bark. Dated 6 Dec. 1728: “You see that intermitting fevers, when they come to be chronical (and you may see it almost everywhere) make room for a great many distempers, and those very difficult to cure.” p. 49.

[617] An Enquiry into the Causes of the Present Epidemical Diseases, viz. Fevers, Coughs, Asthmas, Rheumatisms, Defluxions, &c. By the author of “The Family Companion for Health.” London, 1729, pp. 6, 7.

[618] “Variations of the weather and Epid. Diseases, 1726-34 at Ripon.” Appendix to Essay on the Smallpox. Lond. 1740, p. 35.

[619] Comment. Nosol. p. 142.

[620] This epidemic appears to have made a much greater impression in Italy. The Political State of Great Britain for 1730, p. 172, under the date of 12th January, N. S. speaks of “the influenza, a strange and universal sickness and lingering distemper,” as causing thirty deaths a day in the public hospital of Milan, as well as fatalities at Rome, Bologna, Ferrara and Leghorn, including the deaths of two cardinals.

[621] Chronological History, p. 10.

[622] Edinburgh Medical Essays and Observations, II. p. 22, Art. 2. “An Account of the Diseases that were most frequent last year in Edinburgh” (June, 1832 to May, 1833): There had been tertian agues throughout the month of June, 1732, and from August to October an epidemic in the suburbs and villages near Edinburgh, of a slow fever, having symptoms like the “comatose” fever of Sydenham, or the remittent of children.

[623] Op. cit. p. 47.

[624] John Arbuthnot, M.D., Essay concerning the Effects of Air on Human Bodies. London, 1733, p. 193. His remarks upon the “hysteric” maladies that were common after the wave of influenza in Jan.-Feb. 1733, are referred to in the chapter on Continued Fevers, along with the corresponding information from Hillary, of Ripon.

[625] Gent. Magaz. 1733, Jan. p. 43.

[626] Huxham, Obs. de aere et morbis epidemicis, 1728-52, Plymuthi factae.

[627] De Aere, &c. pp. 3, 136-8.

[628] Rutty, Chronol. Hist. of Diseases in Dublin. Lond. 1770.

[629] Pringle, Diseases of the Army, p. 16.

[630] Letters of Horace Walpole, ed. Cunningham, I. 235.

[631] Gent. Magaz. XIII. May 1743, p. 272.

[632] R. Chambers, Domestic Annals of Scotland, III. 610.

[633] Rutty, u. s. under the year 1743. In an earlier passage, he says that the influenza of 1743 raised the Dublin weekly bills to a highest point of 67, so that it must have been very slight in that city.

[634] Huxham, Obs. de aere etc., 2nd ed. 3 vols. Lond. 1752-70, II. 99.

[635] W. Watson, Phil. Trans. LII. 646.

[636] Cleghorn, Observations on the Epidemical Diseases in Minorca, 1744-49, p. 132.

[637] This influenza was observed in the North American Colonies. It is noteworthy that Huxham, of Plymouth, records under October, 1752, that hundreds of people at once had cough, sore throat, defluxions from the nose, eyes and mouth, attended with a slight fever, and more or less of a rash, several having a great flux of the belly.--On Ulcerous Sore Throat, 1757, p. 13.

[638] W. Hillary, M.D., Obs. on ... Epid. Diseases in Barbadoes. Lond. 1760.

[639] It is not described for England, unless a reference by Bisset for Cleveland, Yorkshire, should apply to it. Short says, under the year 1758 (Increase and Decrease of Mankind in England, &c. 1767): A healthy year in general, “only in the harvest was a very sickly mortal time among the poor, of a putrid slow fever, which carried off many. An epidemic catarrh broke out in November, and made a sudden sweep over the whole kingdom.” Barker, of Coleshill, says, in his Putrid Constitution of 1777 (Birmingham, 1779, p. 49): “In the remarkable intermittents of 1758 or 9 ... the early and consequently injudicious use of the bark was attended with such fatal effects that a few doses only sometimes totally oppressed the head, brought on a most rapid delirium, and cut off persons in half-an-hour.”

[640] Robert Whytt, M.D., “On the Epidemic Disorder of 1758 in Edinburgh and other parts of the South of Scotland.” Med. Obs. and Inq. by a Society of Physicians, 6 vols. Lond. II. (1762), p. 187. With notices by Millar, of Kelso, and Alves, of Inverness.

[641] Archibald Smith, M.D., “Notices of the Epidemics of 1719-20 and 1759 in Peru,” &c. from the Medical Gazette of Lima, on the authority of Don Antonio de Ulloa. Trans. Epid. Soc. II. pt. 1, p. 134.

[642] Horace Walpole’s Letters, ed. Cunningham, III. 281.

[643] C. Bisset, Essay on the Medical Constitution of Great Britain, 1 Jan. 1758, to Midsummer 1760. Lond. 1762, p. 279.

[644] Extract from the parish register printed by Dr G. B. Longstaff in an appendix to his Studies in Statistics. Lond. 1891, p. 443.

[645] Increase and Decrease of Mankind in England &c. London, 1767.

[646] Rutty, op. cit. p. 275. Compare Watson, supra, p. 351.

[647] G. Baker, De Catarrho et de Dysenteria Londinensi epidemicis, 1762, Lond. 1764; W. Watson, “Some remarks upon the Catarrhal Disorder which was very frequent in London in May 1762, and upon the Dysentery which prevailed in the following autumn.” Phil. Trans. LII. (1762), p. 646.

[648] Professor Alexander Monro, primus, of Edinburgh, describes his own attack in a letter to his son, Dr Donald Monro, 11 June, 1766 (Works of Alex. Monro, M.D. with Life, Edin. 1781, p. 306): “My case is this: in May, 1762, I had the epidemic influenza, which affected principally the parts in the pelvis; for I had a difficulty and sharp pain in making water and going to stool. My belly has never since been in a regular way, passing sometimes for several days nothing but bloody mucus, and that with considerable tenesmus” &c. Dysentery was epidemic in 1762 as well as influenza.

[649] Donald Monro, M.D., Diseases of the British Military Hospitals in Germany, &c. Lond. 1764, p. 137.

[650] Med. Trans. published by the College of Physicians in London, I. 437. Heberden’s paper was read at the College, Aug. 11, 1767.

[651] The nearest approach to Heberden’s London influenza of 1767 is an epidemic that Sims observed in Tyrone in the autumn of 1767; a season remarkable for measles and acute rheumatism. At the same time that the acute rheumatism prevailed, a fever showed itself, like it; the patients for two or three days were languid, chilly, with pains in the bones, headache, stupor, dry tongue, costiveness. It was marked by remissions, was by no means mortal, and usually ended by a sweat from the 14th to the 17th day, followed by a copious deposit in the urine. James Sims, Obs. on Epidemic Disorders, Lond. 1773, p. 84.

[652] Anthony Fothergill, Mem. Med. Soc. III. 30. This paper is not included in John Fothergill’s series. There is also a separate Dublin essay, Advice to the People upon the Epidemic Catarrhal Fever of Oct. Nov. Dec. 1775. By a Physician.

[653] I have not found the weekly bills for this year in London; but the following averages, taken from the four-weekly or five-weekly totals in the Gentleman’s Magazine, will show how slight the rise was:

1775. October weekly average 323 births 345 deaths November " " 334 " 447 " December " " 369 " 449 "

[654] W. Grant, M.D., Observations on the late Influenza as it appeared at London in 1775 and 1782. Lond. 1782. Also, by the same, A Short Account of the Present Epidemic Cough and Fever, in a letter &c. First printed at Bath, and afterwards at London, 1776.

[655] MS. Infirmary Book.

[656] The reports collected by Dr John Fothergill (Med. Obs. and Inquir. VI. 340) were by himself, and by Pringle, Baker, Heberden and Reynolds, of London; Cuming, of Dorchester; Glass, of Exeter (long account): Ash, of Birmingham; White, of York; Haygarth, of Chester; Pulteney, of Blandford; Thomson, of Worcester; Skene, of Aberdeen; and Campbell, of Lancaster. The papers of this collective inquiry, as well as the two collections in 1782, the collection of Simmonds in 1788, that of Beddoes in 1803 (in a digest) and the Report of the Provincial Medical Association in 1837, together with some other extracts from books or papers, were brought together in a volume, without much editing, by Dr Theophilus Thompson, under the title of The Annals of Influenza in Great Britain from 1510 to 1837. London, 1852. This has been reprinted and brought down to date by Dr Symes Thompson, 1891.

[657] Mem. Med. Soc. III. 34.

[658] Life of Sir Robert Christison, 2 vols. Edin. 1885, vol. I. (Autobiography), p. 82.

[659] For the year 1730, under the date 12 January, p. 172.

[660] “An Account of the Epidemic Catarrh of the Year 1782; compiled at the request of a Society for promoting Medical Knowledge.” By Edward Gray, M.D., F.R.S., Medical Communications, I. (1784), p. 1.

[661] “An Account of the Epidemic Disease called the Influenza, of the Year 1782, collected from the observations of several physicians in London and in the Country; by a Committee of the Fellows of the Royal College of Physicians in London.” Medical Transactions published by the Coll. of Phys. in London, III. (1785), p. 54. Read at the College, June 25, 1783.

[662] John Clark, M.D., On the Influenza at Newcastle. Dated 26 May, 1782; Arthur Broughton, The Influenza or Epid. Catarrh in Bristol in 1782. London, 1782; W. Falconer, Account of the Influenza at Bath in May-June, 1782. Bath, 1782.

[663] Gregory, cited by Christison, Life &c. I. 84: “I have been told of the haymakers attempting to struggle with the sense of fatigue, but being obliged in a few minutes to lay down their scythes and stretch themselves on the field.”

[664] Gray, u. s. p. 107.

[665] The London Medical Journal, III. (1783), 318.

[666] College of Physicians’ Report: “A family which came in the Leeward Islands fleet in the end of September, 1782, was attacked by it in the beginning of October. This family afterwards told the physician who attended them that several of their acquaintances, who came over in the same fleet with them, had been attacked at the same time and in the same manner as themselves.”

[667] He had another experience not quite the rule: “Children and old people either escaped this influenza entirely, or were affected in a slight manner.”

[668] R. Hamilton, M.D., “Some Remarks on the Influenza in Spring, 1782,” Mem. Med. Soc. II. 422. This author had some difficulty in deciding where the influenza ended and the epidemic ague began.

[669] Trans. Col. Phys. “On the late Intermittent Fevers,” III. 141. Read at the College, 10 Jan., 1785.

[670] Ibid. p. 168.

[671] Febris Anomala, or the New Disease. Lond. 1659, p. 1.

[672] “Remarks on the Treatment of Intermittents, as they occurred at Hampstead in the Spring of 1781.” By Thomas Hayes, Surgeon. Lond. Med. Journ. II. 267.

[673] Epidemicks (1777-95), pp. 58, 72, 75, &c. Barker’s annals from 1779 to 1786 are full of references to agues, “bad burning fevers” and the like, but are on the whole too confused to be of much use for history. See the Boston bills under Smallpox.

[674] W. Moss, Familiar Medical Survey of Liverpool. Liverpool, 1784, p. 117. This writer’s object is to show that Liverpool escaped most of the epidemic diseases that troubled other places, including typhus fever. As to the influenzas he says: “The influenza of 1775, so universal and very fatal in many parts, was less fatal here; and also that much slighter complaint, distinguished by the same title, which appeared in the spring of 1783.”

[675] Gent. Magaz. LIII. pt. 2, p. 920. Letter dated from “Pontoon.”

[676] William Coley, Account of the late Epidemic Ague in the neighbourhood of Bridgenorth, Shropshire, in 1784 ... to which are added some observations on a Dysentery that prevailed at the same time. Lond. 1785.

[677] Baker, u. s.

[678] “An Account of the Effects of Arsenic in Intermittents.” By J. C. Jenner, surgeon at Painswick, Gloucestershire. Lond. Med. Journ. IX. (1788), p. 47.

[679] Ibid. VII. (1786), p. 163.

[680] Table compiled by Dr Mackenzie, and printed by Christison, Trans. Soc. Sc. Assoc. Edin. Meeting, 1863, p. 97. Christison pointed out very fairly the difficulties in the way of accepting the drainage-theory for the decline of ague (p. 98), but he had not realized the fact that the disease used to come in epidemics at long intervals.

[681] e.g. parish of Dron, Perthshire (IX. 468): “The return of spring and autumn never failed to bring along with them this fatal disease [ague], and frequently laid aside many of the labouring hands at a time when their work was of the greatest consequence and necessity.” That had now ceased, owing to drainage. See also Cramond parish, I. 224, and Arngask, Perthshire, I. 415.

[682] The following extracts are from Barker’s book, Epidemicks, Birmingham [1795]: 1782. Influenza in the latter end of spring. Nine out of ten in Lichfield and other towns had violent defluxions of the nose, throat and lungs, bringing on violent sneezings, soreness of the throat, coughs, &c. attended with a pestilential fever, of which many were relieved by perspiration.... Some had swelled faces, and violent pains in the teeth.... Some, giddiness and violent headaches, accompanied with a slow fever, and even loss of memory.... By its running through whole families it appeared also to be communicable by infection.

1783. The influenza also began to appear again; and those who had coughs last year began now to be afflicted with them again, the disorder at length frequently ending in a consumption. Also dogs in this year and the next had running at the eyes and a loss of the use of their hind legs, which in the end killed most of those that were seized with it. Horses also suffered.

1786. In the middle of this season the influenza returned, and colds and coughs were epidemical.

1788 [spring]. A species of influenza of the pestilential kind, akin to that of 1782, has almost constantly returned in spring and autumn since that time ... [summer] A species of influenza, as in the spring, and it is also at Edinburgh.

1789 [spring]. Influenza returned. Even dogs affected.

1791. Influenza very bad, especially in London.

[683] Samuel Foart Simmons, M.D., F.R.S., “Of the Epidemic Catarrh of the year 1788.” Lond. Med. Journ. IX. (1788), p. 335.

[684] Vaughan May, surgeon to H. M. Ordnance, “Observations on the Influenza as it appeared at Plymouth, in the summer and autumn of the year 1788.” Duncan’s Med. Commentaries, Decade 2, vol. iv. p. 363.

[685] Falconer, “Influenzae Descriptio, uti nuper comparebat in urbe Bathoniae, mensibus Julio, Augusto et Septembri A.D. 1788.” Mem. Med. Soc. III. 25.

[686] George Bew, M.D., physician at Manchester, “Of the Epidemic Catarrh of the year 1788.” Lond. Med. Journ. IX. (1788), p. 354. “The influenza has been very prevalent,” writes Withering, of Birmingham, to Lettsom, 19 Aug. 1788. Mem. of Lettsom, III. 133.

[687] Related to Dr Simmons (1. c. p. 346), by Mr Boys, surgeon, of Sandwich, who was told it by his son, a lieutenant on board the ‘Rose.’

[688] In a note to Simmons’ paper, u. s., p. 342.

[689] “An Account of an Epidemic Fever that prevailed in Cornwall in the year 1788.” Lond. Med. Journal, X. p. 117 (dated Truro, Jan. 26, 1789).

[690] Bew, u. s., p. 365. Carmichael Smyth has a similar remark on the influenza of 1782: “This epidemic distemper very soon declined. But it seemed to leave behind it an epidemical constitution which prevailed during the rest of the summer; and the fevers, even in the end of August and beginning of September, assumed a type resembling, in many respects, the fever accompanying the influenza.”

[691] A solitary reference occurs to an influenza in 1792, which I have not succeeded in verifying:--B. Hutchinson, “An Account of the Epidemic Disease commonly called the Influenza, which appeared in Nottinghamshire and most other parts of the kingdom in the months of November and December, 1792.” New. Lond. Med. Journ., Lond. 1793, II. 174. Cited in the Washington Medical Catalogue.

[692] Robert Willan, M.D., Reports on the Diseases in London, particularly during the years 1796, ’97, ’98, ’99 and 1800. London, 1801, pp. 76, 253.

[693] Published in the Med. and Phys. Journal from August to December, 1803.

[694] Memoirs of the Medical Society, vol. VI.

[695] R. Hooper, M.D., Obs. on the Epidemic Disease now prevalent in London. London, 1803. R. Pearson, M.D., Obs. on the Epid. Catarrhal Fever or Influenza of 1803. Lond. 1803.

[696] J. Herdman, The prevailing Epid. Disease termed Influenza. Edin. 1803.

[697] W. Falconer, M.D., The Epidemic Catarrhal Fever commonly called the Influenza, as it appeared at Bath &c. Bath, 1803.

[698] John Nott, M.D., Influenza as it prevailed in Bristol in Feb.-April, 1803. Bristol, 1803.

[699] Med. and Phys. Journ. X. 104.

[700] Dr Currie of Chester, Med. and Phys. Journ. X. 213.

[701] Ib. X. 527, quoted by Beddoes from memory, the letter from Navan having been lost.

[702] Alvey, Mem. Med. Soc. VI. 462.

[703] Dr Carrick, of Bristol, in Duncan’s Annals of Med. III. Compare the report for Fraserburgh in 1775, supra, p. 360.

[704] Frazer, Med. and Phys. Journ. X. 206, dated 12 June, 1803.

[705] Hirsch cites authorities for influenza in Edinburgh, London, Nottingham and Newcastle in the winter of 1807-8. In Roberton’s monthly reports from Edinburgh (Med. and Phys. Journ. XXI.), and Bateman’s quarterly reports from London, I find only common colds recorded. Clarke for Nottingham (Ed. Med. Surg. Journ. IV. 429) says catarrh was so general “as to have acquired the name of influenza; but there was no reason to suppose it contagious.”

[706] W. Royston, “On a Medical Topography,” Med. and Phys. J. XXI. 1809, (Dec. 1808), p. 92: “After the unusual heat of the last summer, the frequency of intermittents in the autumn was increased in the fens of Cambridgeshire to an almost unprecedented degree; and even quadrupeds were not exempt, for distinctly marked cases of tertian were observed in horses. In the year 1780 a similar prevalence of this disease occurred in the same part; and though in an interval of 28 years many and frequent sporadic cases have arisen, yet its universality during that period was suspended. We have to regret that a correct record of the constitution of the year 1780, as applying to this particular district, has not been preserved in such a manner as to admit of a direct comparison with that of 1808. If it were possible, from authentic documents to compare the history of these two seasons, much light might be thrown on the obscure cause of intermittents.” Clarke, of Nottingham, (l. c.) says there were some cases of irregular ague among a few privates of the regiment there, who had all come from a marshy quarter, some of them with the fever on them. The paroxysms came at unusually long intervals. Bark increased the fever.

[707] Lecture on Agues, in the Lond. Med. Gaz. IX. 923-4, 24 March, 1832.

[708] Lancet, s. d., p. 438.

[709] Lond. Med. Gazette, 2 July, 1831.

[710] John Burne, M.D., Ibid. VIII. (1831), p. 430.

[711] G. Bennett, Lond. Med. Gaz. 23 July, 1831.

[712] Bellamy, Ibid.

[713] “Report of Diseases among the Poor of Glasgow,” Glas. Med. Journ. IV. 444.

[714] McDerment, ibid. V. 230: “In June and July to an extent unequalled” etc.

[715] During the last general election before the passing of the Reform Bill, which was held in the month of June, 1831, a number of the Aberdeen radicals went out on a hot and dusty day to meet the candidate of their party who was posting from the south. It was remarked that all those who had been of this company “caught cold,” unaccountably but as if from some common cause. The date would correspond to the prevalence of influenza elsewhere.

[716] Mr Kingdon, reported in the Lancet, s. d.

[717] Venables, Lancet, II. May, 1833.

[718] Hingeston, Lond. Med. Gaz. XII. 199.

[719] Gent. Magaz., April, 1833, p. 362.

[720] Whitmore, Febris anomala, or the New Disease, etc., London, 1659, p. 109:--“And for a plethora or fulness of blood, if that appears (though this may seem a paradox yet ’tis certain) that it is so far in this disease from indicating bleeding that it stands absolutely as a contradiction to it and vehemently prohibits it. And whereas they think the heat, by bleeding, may be abated and so the feaver took off, they are mistook, for by that means the fermentation through the motion of the blood is highly increased, so as sad experience hath manifested in a great many: upon the bleeding they have within a day or two fallen delirious and had their tongues as black as soot, with an intolerable thirst and drought upon them.... Petrus a Castro, who rants high for letting blood, at last as if he had been humbled with the sad success, saith etc.”

[721] A System of Clinical Medicine, Dublin, 1843, pp. 500-501. Lecture delivered in the session 1834-35.

[722] Rawlins, Lond. Med. Gaz. s. d.

[723] Ed. Med. Surg. Journ. XLIII. 1835, p. 26.

[724] Parsons, “Report of Outcases, Birmingham Infirmary, 1 Jan. to 31 Dec. 1833.” Trans. Provin. Med. Surg. Assoc. II. 474.

[725] In the report upon the influenza of 1837 by a Committee of the Provincial Medical Association, the preceding epidemic is uniformly referred to the year 1834. Graves, in a clinical lecture upon that of 1837, speaks two or three times of the last as that of 1834, and, in another place, he calls it the epidemic of 1833-34. But these, I think, are mere laxities of dating, of which there are many other instances where the date is recent and not yet historical.

[726] As early as 1612 a proposal had been made to James I. for “a grant of the general registrarship of all christenings, marriages and burials within this realm.” State Papers, Rolls House, Ja. I. vol. LXIX. No. 54. It was a device for raising money.

[727] The account in the Gentleman’s Magazine for February, 1837, p. 199, is almost identical with the paragraph in the number for April, 1833: “An influenza of a peculiar character has been raging throughout the country, and particularly in the Metropolis. It has been attended by inflammation of the throat and lungs, with violent spasms, sickness and headache. So general have been its effects that business in numerous instances has been entirely suspended. The greater number of clerks at the War Office, Admiralty, Navy Pay Office, Stamp Office, Treasury, Post-Office and other Government Offices have been prevented from attending to their daily avocations.... Of the police force there were upwards of 800 incapable of doing duty. On Sunday the 13th the churches which have generally a full congregation presented a mournful scene &c. ... the number of burials on the same day in the different cemeteries was nearly as numerous as during the raging of the cholera in 1832 and 1833. In the workhouses the number of poor who have died far exceed any return that has been made for the last thirty years.”

[728] Graves, u. s., p. 545.

[729] Robert Cowan, M.D., Journ. Stat. Soc. III. 257.

[730] Peyton Blakiston, A Treatise on the Influenza of 1837, containing an analysis of one hundred cases observed at Birmingham between 1 Jan. and 15 Feb. Lond. 1837.

[731] These and some former particulars are from the “Report upon the Influenza or Epidemic Catarrh of the winter of 1836-37,” compiled by Robt. J. N. Streeten, M.D. for the Committee of the Provincial Medical Association. Trans. Prov. Med. Assoc. VI. 501.

[732] Streeten’s Report, u. s., p. 505.

[733] Statist. Report on Health of Navy, 1837-43.

[734] Jackson, Dubl. Med. Press, VIII. 69; Brady, Dubl. Journ. Med. Sc. XX. (1842), 76.

[735] Laycock, Dubl. Med. Press, VII. 234. Several cases of sudden and great enlargement of the liver and of suppression of urine were judged to be part of the epidemic.

[736] Ross, Lancet, 1845, I. p. 2.

[737] Report of Holywood Dispensary for 1842, Dublin Med. Press, IX. 204.

[738] Hall, Prov. Med. Journ. 1844, p. 315.

[739] M’Coy, Med. Press, XI. 133.

[740] Fleetwood Churchill, Dubl. Quart. Journ., May, 1847, p. 373.

[741] Farr, in Rep. Reg.-Gen.

[742] Farr, in the Report of the Registrar-General for 1848. He cites (p. xxxi) Stark for Scotland, that it “suddenly attacked great masses of the population twice during November”--on the 18th, and again on the 28th.

[743] A curious trace of the temporary interest excited by influenza in 1847-8 remains in a great book of the time, Carlyle’s Letters and Speeches of Cromwell, the third edition of which, with new letters, was then under hand. One of the new letters related to the death of Colonel Pickering from the camp-sickness among the troops of Fairfax at Ottery St Mary in December, 1645. Carlyle’s comment is: “has caught the epidemic ‘new disease’ as they call it, some ancient influenza very prevalent and fatal during those wet winter operations.” “New disease” was the name given by Greaves to the war-typhus in Oxfordshire and Berkshire in 1643, but neither that nor the sickness at Ottery (which is not called “new disease” in the documents) had anything of the nature of influenza.

[744] But Dr Rose Cormack, who had known relapsing fever well in Edinburgh, wrote from Putney, near London, in October, 1849: “For some months past the majority of cases of all diseases in this neighbourhood have ... presented a well-marked tendency to assume the remittent and intermittent types.” “Infantile Remittent Fever,” Lond. Journ. of Med., Oct. 1849, reprinted in his Clinical Studies, 2 vols., 1876.

[745] T. B. Peacock, M.D., On the Influenza, or Epidemic Catarrhal Fever of 1847-8. London, 1848.

[746] Haviland, Journ. Pub. Health, IV. 288, (94 cases in June-Aug. in a village).

[747] See F. Clemow, M.D., of St Petersburg, “The Recent Pandemic of Influenza: its place of origin and mode of spread.” Lancet, 20 Jan. and 10 Feb. 1894. These papers bring together and discuss the Russian opinions, official and other. The Army Medical Report favoured the view that the birthplace of this pandemic in the autumn of 1889 was an extensive region occupied by nomadic tribes in the northern part of the Kirghiz Steppe. There is evidence of its rapid progress westwards over Tobolsk to the borders of European Russia. Influenza is said to be constantly present in many parts of the Russian Empire; but the circumstances that have, on four or five occasions in the 19th century, set the infection rolling in a great wave westwards from the assumed source are wholly unknown.

[748] The collective inquiry on the epidemics was made by the medical department of the Local Government Board, the result being given in two reports: Report on the Influenza Epidemic of 1889-90, Parl. Papers, 1891, and Further Report and Papers on Epidemic Influenza, 1889-92, Parl. Papers, Sept. 1893. By H. Franklin Parsons, M.D. Statistical tables comparing the epidemics in London with those in some other capitals were published by F. A. Dixey, M.D., Epidemic Influenza, Oxford, 1892.

[749] The notable difference between the type of this epidemic and that of the epidemics of 1833, 1837 and 1847, from which the conventional notion of “influenza cold” was derived, is perhaps the explanation of the following apt and erudite remark by Buchanan, on “influenza proper,” in his introduction to the first departmental report, 1891: “It would be no small gain to get more authentic methods of identifying influenza proper from among the various grippes, catarrhs, colds and the like--in man, horse, and other animals--that take to themselves the same popular title” (p. xi).

[750] The volume by Julius Althaus, M.D., Influenza: its Pathology, Complications and Sequelae, 2nd ed., Lond. 1892, includes a summary and bibliography of recent observations.

[751] Noah Webster, Brief History of Epidemick Diseases, I. 288; Warren, of Boston, to Lettsom, 30 May, 1790, Lettsom’s Memoirs, III. 238: “whether this [the second] is a variety of influenza, or a new disease with us, I am at a loss to determine.”

[752] In Twysden’s Decem Scriptores, col. 579.

[753] Boyle’s Works, 6 vols., London, 1772, V. 52.

[754] Seneca, Nat. Quaest. § 27, cited by Webster. After earthquakes, “subitae continuaeque mortes, et monstrosa genera morborum ut ex novis orta causis.” The passage cited from Baglivi (p. 530) looks like a repetition of this: “imo nova et inaudita morborum genera ... post terraemotus.”

[755] Cited by Horace E. Scudder, in Noah Webster. New York and London, 1881, p. 105.

[756] Brief History of Epidemic and Pestilential Diseases, 2 vols., Hartford, 1799.

[757] Brief History of Epidemic and Pestilential Diseases, II. 15.

[758] Id. II. 34, 84. Dr Robert Williams, in his work on Morbid Poisons (II. 670) argues for Webster’s electrical theory of influenza without knowing, or at least without saying, that it was Webster’s. The much-advertised writings of Mr John Parkin on The Volcanic Theory of Epidemics (or other title) follow Webster very closely both in the main idea and in its ramifications, but without acknowledgment to the American philosophe. Milton’s rule was that one might take from an old author if one improved upon him; but neither Williams nor Parkin has improved upon Webster.

[759] Ibid. II. 30.

[760] “Catalogue of Recorded Earthquakes from 1606 B.C. to A.D. 1850.” British Assocn. Reports, 1852-54.

[761] Abraham Mason, Phil. Trans. LII. Part 2, p. 477.

[762] Webster, I. 150.

[763] Hillary, Changes of the Air, etc., p. 82.

[764] Hillary, Changes of the Air, etc., p. 80.

[765] Webster, I. 250.

[766] Hamilton, Phil. Trans. LXXIII. 176.

[767] Mallet’s Catalogue, u. s.

[768] Holm, Vom Erdbrande auf Island im Jahre 1783, Kopenhagen, 1784, says: “Since the outbreak began, the atmosphere of the whole country has been full of vapour, smoke and dust, so much so that the sun looked brownish-red, and the fishermen could not find the banks.... Old people, especially those with weak chests, suffered much from the smell of sulphur and the volcanic vapours, being afflicted with dyspnoea. Various persons in good health fell ill, and more would have suffered had not the air been cooled and refreshed from time to time by rains,” pp. 57, 60. The real sickness of Iceland in those years had been before the volcanic eruptions, in 1781 and 1782, when some parts of the island were almost depopulated by the famine and pestilential fevers that followed the unusual seasons.

[769] Phil. Trans. II. (1667), p. 499.

[770] Ibid. March-Apr. 1694, p. 81. Sloane had himself felt several shocks at Port Royal on the 20th October, 1687, between four and six o’clock in the morning, which were due to the same earthquake that destroyed Lima in Peru.

[771] Phil. Trans. XVIII. p. 83 (March-April, 1794). Series of reports from Jamaica collected by Sloane.

[772] A few cases have been exceptionally seen at Spanish Town, six miles from the head of the bay, the infection of which was supposed to have been brought from the shore by sailors, and it has also prevailed in the barracks on the high ground of Newcastle not far from the shore.

[773] Without seeking to argue for the connexion between particular earthquakes and influenzas, but merely to illustrate the possibilities, I append here an instance that ought not to be overlooked. On the 1st of November, 1835, there was a great earthquake in the Moluccas, which so completely changed the soil of the island of Amboina, that it became notably subject to deadly miasmatic or malarious fevers from that time forth. For three weeks before the earthquake the atmosphere had been full of a heavy sulphurous fog, so that miasmata were rising from the soil by some unwonted pressure before the actual cataclysm. There is no doubt at all that Amboina became “malarious” in a most marked degree from the date of the earthquake; it is a classical instance of the sudden effect of great changes in the earth’s crust upon the frequency and malignity of remittent and intermittent fevers, according to the testimony of physicians in the Dutch East Indian service. The influenza nearest to the earthquake was about a year after, at Sydney, Cape Town, and in the East Indies, during October and November, 1836. The epidemic appeared about the same time in the north-east of Europe, spread all over the continent, and reached London in January, 1837. There was again influenza in Australia and New Zealand in November, 1838, two years after the last outbreak in that region.

[774] Phil. Trans. for the year 1694, p. 5.

[775] Mallet, “First Report on the Facts of Earthquake Phenomena.” Trans. Brit. Assoc. for 1850, Lond. 1851. Cited from von Hoff.

[776] Archibald Smith, M.D., “Notices of the Epidemics of 1719-20 and 1759 in Peru,” etc. Trans. Epid. Soc. II. pt. 1, p. 134. From the Medical Gazette of Lima, 15 March, 1862.

[777] Bell’s Travels, in Pinkerton, VII. 377.

[778] See an article “Railways--their Future in China,” by W. B. Dunlop, in Blackwood’s Magazine, March, 1889, pp. 395-6. A letter in the Pall Mall Gazette, dated 23 May, 1891, and signed “Shanghai,” recalled the outbreak of Hongkong fever, “the symptoms of which bore a curious resemblance to the influenza epidemic,” at the time when much building was going on upon the slope of Victoria Peak: “It was said at the time--I do not know with what truth--that in this turning-up of the soil, several old Chinese burying-places were included.”

[779] Essay on the Most Effective Means of preserving the Health of Seamen in the Royal Navy. London, 1757, p. 83.

[780] See The Eruption of Krakatoa and subsequent phenomena. Report of the Krakatoa Committee of the Royal Society.... Edited by G. J. Symons, London, 1888.

[781] Edin. Med. Essays and Obs. II. 32.

[782] Trans. Col. Phys. III. 62.

[783] Gent. Magaz. 1782, p. 306.

[784] R. Robertson, M.D., Observations on Jail, Hospital or Ship Fever from the 4th April, 1776, to the 30th April, 1789. Lond. 1789, New ed., p. 411.

[785] Trotter, Medicina Nautica, I. 1797, p. 367.

[786] Notes of a lecture on Influenza, by Gregory, taken by Christison about the year 1817, in the Life of Sir Robert Christison, I. 82.

[787] College of Physicians’ Report, Trans. Col. Phys. III. 63.

[788] This is inferred from the varying number of ships in the two fleets in the several notices of their movements in the Gentleman’s Magazine, for May and June, 1782.

[789] Brian Tuke to Peter Vannes, 14 July, 1528: “For when a whole man comes from London and talks of the sweat, the same night all the town is full of it, and thus it spreads as the fame runs.” Cal. State Papers, Henry VIII. IV. 1971.

[790] Webster, II. 63.

[791] College of Physicians’ Report. Trans. Col. Phys. III. (1785), p. 60-61. “Information has been received” of the incident.

[792] Statist. Report of Health of Navy, 1837-43. Parl. papers, 1 June, 1853, p. 8.

[793] Ibid. p. 14.

[794] Ibid. s. d.

[795] Report on Health of Navy, 1857, p. 69.

[796] Ibid. p. 41.

[797] Ibid. p. 131.

[798] Ibid. p. 112.

[799] Report for 1856, p. 100.

[800] Chaumezière, Fievre catarrhals épidemique, observée à bord du vaisseau ‘Le Duguay-Trouin’ aux mois de Fevr. et Mars, 1863. Paris, 1865. Cited by Hirsch.

[801] Dr Guthrie, of Lyttelton.

[802] Macdonald, Brit. Med. Journ., 14 July, 1886.

[803] Cruise of H.M.S. ‘Galatea’ in 1867-8.

[804] R. A. Chudleigh, in Brit. Med. Journal, 4 Sept. 1886. The experiences are not altogether recent, for they were noted for “the Chatham Islands and parts of New Zealand” by Dieffenbach, in his German translation of Darwin’s Naturalist’s Voyage round the World. See English ed. 1876, p. 435 note.

[805] Pall Mall Gazette, 11 Dec. 1889.

[806] Hirsch, Geograph. and Histor. Pathol. I. 29. Engl. Transl.

[807] See the chapter on Sweating Sickness in the first volume of this History, p. 269, and the author’s other writings there cited.

[808] See the first volume, pp. 456-461. I shall add here a reference to smallpox among young people in Henry VIII.’s palace at Greenwich in 1528. Fox, newly arrived from a mission to France, writes to Gardiner, 11 May, 1528 (Harl. MS. 419, fol. 103): The king “commanded me to goe unto Maystress Annes chamber, who at that tyme, for that my Lady prynces and dyvers other the quenes maydenes were sicke of the small pocks, lay in the gallerey in the tilt yarde.”

[809] Selections from the Records of the Kirk Session, Presbytery and Synod of Aberdeen. Edited by John Stuart, for the Spalding Club, Aberd. 1846, I. 427.

[810] Mead to Stutteville, in Court and Times of Charles I., I. 359. Joan, Lady Coke to Sir J. Coke, 26 June, 1628. Cal. Coke MSS.

[811] Lord Dorchester to the Earl of Carlisle, 30 Aug. 1628, in C. and T. Charles I.: “Your dear lady hath suffered by the popular disease, but without danger, as I understand from her doctor, either of death or deformity.”

[812] Gilbert Thacker to Sir J. Coke at Portsmouth, 9 June, 1628; Thomas Alured to the same, 21 June; Richard Poole to the same, 23 June. Cal. Coke MSS., I. Thomas Alured’s house “hath been visited in the same kind, once with the measles and twice with the smallpox, though I thank God we are now free; and I know not how many households have run the same hazard.”

[813] Harl. MS., No. 2177.

[814] The original heading in the Bills of Mortality was “flox and smallpox.” “Flox” meant flux, or confluent smallpox, which was so distinguished, as if in kind, from the ordinary discrete form, seldom fatal. Huxham, in 1725, Phil. Trans. XXXIII. 379, still used these terms: “When the pustules broke out in less than twenty-four hours from the seizure, they were always of the flux kind, as is commonly observed.... Pocks which at first were distinct would flux together during suppuration.” Dover, Physician’s Legacy, 1732, p. 101, has “the flux smallpox, or variolae confluentes,” as one of the varieties: and again, pustules “fluxing in some parts, in others distinct.”

[815] Having been omitted by Graunt in his table. Op. cit. 1662.

[816] Cal. State Papers, under the dates. The epidemic seems to have revived in 1642. An affidavit among the papers of the House of Lords, excusing the attendance of a witness, states that Thomas Tallcott has recently lost his wife and one child by smallpox, and that he himself, six of his children and three of his servants are now visited with the same disease. 13 July, 1642, Hist. MSS. Com. V. 38. The Mercurius Rusticus, 1643, says that Bath was much infected both with the plague and the smallpox. Cited in Hutchins, Dorsetshire, III. 10.

[817] Remaining Works. Transl. by Pordage. Lond. 1681. “Of Feavers,” p. 142. In one of his cases Willis was at first uncertain as to the diagnosis, because “the smallpox had never been in that place.”

[818] Histor. MSS. Commis. V. 156-154. Sutherland Letters.

[819] Sutherland Letters, u. s. Andrew Newport to Sir R. Leveson at Trentham.

[820] Mary Barker to Abel Barker, 26 May and 2 June, 1661. Hist. MSS. Com. V. 398: “There is many dy out in this town, and many abroad that we heare of”; the squire’s mother is living “within a yard of the smallpox, which is also in the house of my nearest neighbour”; her own children had whooping cough, but do not appear to have taken smallpox.

[821] Hactenus Inaudita, or Animadversions upon the new found way of curing the Smallpox. London, 1663. Dated 10 July, 1662. The burden of his own complaint is of a prominent personage in the smallpox who was killed, as he maintains, by enormous doses of diacodium, an opiate with oil of vitriol, much in request among the partisans of the cooling regimen.

[822] His first book was Περὶ ὑδροποσίας, or A Discourse of Waters, their Qualities and Effects, Diaeteticall, Pathologicall and Pharmacuiticall. By Tobias Whitaker, Doctor in Physicke of Norwich. Lond. 1834. In 1638, being then Doctor in Physick of London, he published The Tree of Humane Life, or the Bloud of the Grape. Proving the Possibilitie of maintaining humane life from infancy to extreame old age without any sicknesse by the use of wine. An enlarged edition in Latin was published at Frankfurt in 1655, and reprinted at the Hague in 1660, and again in 1663. The passages cited in the text occur in his Opinions on the Smallpox. London, 1661.

[823] His only reference to the deaths in the royal family, which were currently set down to professional mismanagement, comes in where he opposes the prescription of Riverius to bathe the hands and feet in cold water: “this hath proved fatall,” he says, “in such as have rare and tender skins, as is proved by the bathing of the illustrious Princess Royal. Therefore I shall rather ordain aperient fomentations in their bed, to assist their eruption and move sweat.”

[824] Pyretologia, II. 94, 112.

[825] Walter Harris, M.D., De morbis acutis infantum, 1689. There were several editions, some in English.

[826] Jurin, Letter to Cotesworth. Lond. 1723, p. 11.

[827] Speaking of malignant sore-throat, he says: “The younger the patients are, the greater is their danger, which is contrary to what happens in the measles and smallpox.” Commentaries on Diseases, p. 25.

[828] Andrew’s Practice of Inoculation impartially considered. Exeter, 1765, p. 60.

[829] Duvillard (Analyse et Tableaux de l’Influence de la Petite Vérole sur la Mortalité à chaque Age. Paris, 1806) gives the ages at which 6792 persons died of smallpox at Geneva from 1580 to 1760, according to the registers of burials:

Total at all ages. 0-1, -2, -3, -4, -5, -6, -7, -8, -9, -10, -15, -20, -25, -30.

6792 1376 1300 1290 898 603 381 301 189 109 78 126 54 39 31

The public health of Geneva altered very much for the better in the course of two centuries from 1561 to 1760. From 1561 to 1600, in every hundred children born, 30·9 died before nine months, on an annual average, and 50 before five years. From 1601 to 1700 the ratios were 27·7 under nine months, and 46 before five years. From 1701 to 1760 the deaths under nine months had fallen to 17·2 per cent., and under five years to 33·6 per cent. (Calculated from a table in the Bibliothèque Britannique, Sciences et Arts, IV. 327.) Thus, with an increasing probability of life, the age-incidence of fatal smallpox may have varied a good deal within the period from 1580 to 1760. It is given by Duvillard separately for the years 1700-1783 (inclusive of measles): during which limited period a smaller ratio died under nine months, and a larger ratio above the age of five years, than in the aggregate of the whole period from 1580 to 1760. Whatever may have been the rule at Geneva, it cannot be applied to English towns; for, while some 30 per cent. of the smallpox deaths were at ages above five in the Swiss city (1700-1783), only 12 per cent. were above five in English towns such as Chester and Warrington in 1773-4.

[830] Pyretologia, 2 vols. Lond. 1692-94, vol. II.

[831] Natural History of Oxfordshire. Oxford, 1677, p. 23.

[832] In his Diary, under the year 1646, homeward journey from Rome.

[833] The physician was “a very learned old man,” Dr Le Chat, who had counted among his patients at Geneva such eminent personages as Gustavus Adolphus and the duke of Buckingham.

[834] Dr Dover has left us an account of Sydenham’s practice in the smallpox as he himself experienced it: “Whilst I lived with Dr Sydenham, I had myself the smallpox, and fell ill on the twelfth day. In the beginning I lost twenty ounces of blood. He gave me a vomit, but I find by experience purging much better. I went abroad, by his direction, till I was blind, and then took to my bed. I had no fire allowed in my room, my windows were constantly open, my bedclothes were ordered to be laid no higher than my waist. He made me take twelve bottles of small beer, acidulated with spirit of vitriol, every twenty-four hours. I had of this anomalous kind to a very great degree, yet never lost my senses one moment.” The Ancient Physician’s Legacy. London, 1732, p. 114.

[835] Scotia Illustrata. Lib. II., cap. 10.

[836] De Febribus &c., Lond. 1657: cap. ix. “De Variolis et Morbillis,” p. 141.

[837] “First of all,” he says, “let the patient be kept with all care and diligence from cold air, especially in winter, so that the pores of the skin may be opened and the pocks assisted to come out. Therefore let him be kept in a room well closed, into which cold air is in no manner to enter, and let him be sedulously covered up in bed.... I desire the more to admonish my friends in this matter, for that Robert Cage, esquire, my dear sister’s husband,” etc.

[838] Besides cases to show the ill effects of blooding, vomits, purges and cooling medicines such as spirit of vitriol, he gives examples as if to refute Sydenham’s favourite notion that salivation, diarrhoea and menstrual haemorrhage were relieving or salutary. Morton’s chief object was to bring out the eruption, and to get it to maturate kindly; an eruption which languished, or did not rise and fill, was for him the most untoward of events. Sydenham, on the other hand, argued that the danger was in proportion to the number of pustules and to the total quantity of matter contained in them; and he sought, accordingly, to restrain cases which threatened to be confluent by an evacuant treatment or repressive regimen.

[839] Walter Lynn, M.B., A more easy and safe Method of Cure in the Smallpox founded upon Experiments, and a Review of Dr Sydenham’s Works, Lond. 1714; Some Reflections upon the Modern Practice of Physic in Relation to the Smallpox, Lond. 1715. F. Bellinger, A Treatise concerning the Smallpox, Lond. 1721.

[840] Letter from Woodward to the Weekly Journal, 20 June, 1719, in Nichols, Lit. Anecd. VI. 641.

[841] Rev. Dr Mangey to Dr Waller, 4 March, 1720, London. Nichols’ Lit. Anecd. I. 135.

[842] Huxham, Phil. Trans. XXXII. (1725), 379.

[843] Gent. Magaz., Sept. 1752.

[844] John Barker, M.D., Agreement betwixt Ancient and Modern Physicians, Lond. 1747. Also two French editions. It is on Van Helmont that Barker pours his scorn for “breaking down the two pillars of ancient medicine--bleeding and purging in acute diseases.” That upsetting person forbore to bleed even in pleurisy; the only thing that he took from the ancient medicine was a thin diet in fevers; “and yet this scheme, as wild and absurd as it seems, had its admirers for a time.”

[845] Lynn (u. s. 1714-15) agrees as to the matter of fact, namely, that the mortality from smallpox was greater among the richer classes, who were too much pampered and heated in their cure, than among the poorer, who had not the means to fee physicians and pay apothecaries’ bills.

[846] He was under the tutelage of John Churchill, duke of Marlborough, who does not give a name to the malady (Coxe’s Life of Marlborough). Dr James Johnstone, junr., of Worcester, in his Treatise on the Malignant Angina, 1779, p. 78, claims the death of the Duke of Gloucester as from that cause, on the evidence of Bishop Kennet’s account.

[847] In the Gentleman’s Magazine, under the dates.

[848] A Direct Method of ordering and curing People of that Loathsome Disease the Smallpox, being the twenty years’ practical experience of John Lamport alias Lampard, London, 1685. The writer was probably an empiric, “Practitioner in Chyrurgery and Physick,” dwelling at Havant, and attending the George at Chichester on Mondays, Wednesdays and Fridays, the Half Moon at Petersfield on Saturdays. He says: “One great cause of this disease being so mortal in the country is because the infection doth make many physicians backward to visit such patients, either for fear of taking the disease themselves or transferring the infection to others.” He has another fling at the regular faculty: “Do not run madding to Dr Dunce or his assistance to be let bloud.” Empirics, although they were commonly right about blood-letting, were under the suspicion of not speaking the truth about their cures.

[849] Macaulay, History of England, IV. 532. The moving passage on the former horrors of smallpox, à propos of the death of Queen Mary in 1694, is familiar to most, but it may be cited once more in the context of a professional history: “That disease, over which science has since achieved a succession of glorious and beneficent victories, was then the most terrible of all the ministers of death. The havoc of the plague had been far more rapid: but plague had visited our shores only once or twice within living memory; and the smallpox was always present, filling the churchyards with corpses, tormenting with constant fears all whom it had not yet stricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover.” It is not given to us all to write like this; but it is possible that the loss of picturesqueness may be balanced by a gain of accuracy and correctness.

[850] Kellwaye, u. s., 1593.

[851] Dr Richard Holland in 1730 (A Short View of the Smallpox, p. 75), says: “A lady of distinction told me that she and her three sisters had their faces saved in a bad smallpox by wearing light silk masks during the distemper.”

[852] As I do not intend to come back to the subject of pockmarked faces, I shall add here that I have found nothing in medical writings of the 18th century, nor in its fiction or memoirs, to show that pockpitting was more than an occasional blemish of the countenance. At that time most had smallpox in infancy or childhood, when the chances of permanent marking would be less. The disappearance of pockpitted faces was discovered long ago. The report of the National Vaccine Board for 1822 says: “We confidently appeal to all who frequent theatres and crowded assemblies to admit that they do not discover in the rising generation any longer that disfigurement of the human face which was obvious everywhere some years since.” The members of this board were probably seniors who remembered the 18th century; and it is quite true that the first quarter of the 19th century was singularly free from smallpox in England except in the epidemic of 1817-19. But the above passage became stereotyped in the reports: exactly the same phrase, appealing to what they all remembered “some years since,” was used in the report for 1825, a year which had more smallpox in London than any since the 18th century, and again in the report for 1837, the first year of an epidemic which caused forty thousand deaths in England and Wales. These stereotyped reminiscences are apt to be as lasting a blemish as the pockholes themselves.

[853] Collinson, Hist. of Somerset, III. 226, citing Aubrey’s Miscellanies, 33.

[854] Blomefield, Hist. of Norfolk, III. 417.

[855] Thoresby, Ducatus Leodiensis, ed. Whitaker. App. p. 151.

[856] Cal. Le Fleming MSS. p. 408 (Hist. MSS. Com.). There are also many references to smallpox from 1676 onwards in the letters of the Duke of Rutland at Belvoir, lately calendared for the Historical MSS. Commission.

[857] In the London Gazette of 11-14 May, 1674, the Vice-Chancellor and two doctors of medicine of the University of Cambridge contradicted by advertisement a report that smallpox and other infections were prevalent in the university.

[858] Marquis of Worcester to the Marchioness, [London] 8 June, 1675 (Beaufort MSS. Hist. MSS. Commis. XII. App. 9, p. 85): “They will have it heere that the smallpox and purple feaver is at the Bath, and the Dutchesse of Portsmouth puts off her journey upon it. The king askt me about it as soon as I came to towne. Pray enquire, and lett me know the truth.” The London Gazette of 17-21 June and 28 June-1 July, 1775, had advertisements “that it hath been certified under the hands of several persons of quality” that Bath and the country adjacent was wholly free of the plague or any other contagious distempers whatsoever.

[859] Burnet, History of his own Time, IV. 240.

[860] Walter Harris, M.D., De morbis acutis infantum. Ed. of 1720, p. 161.

[861] John Cury, M.D., An Essay on Ordinary Fever. Lond. 1743, p. 40.

[862] See p. 438.

[863] Macaulay hardly realized the anomalous character of the queen’s attack of smallpox. “The physicians,” he says, “contradicted each other and themselves in a way which sufficiently indicates the state of medical science in that day. The disease was measles; it was scarlet fever; it was spotted fever; it was erysipelas.... Radcliffe’s opinion proved to be right.” There had been some doubt on the first appearance of the eruption whether it would turn to measles or smallpox. Sydenham says that it was often difficult to make the diagnosis at that stage, and in the queen’s case the first signs were anomalous as well. Next day, however, the eruption all over the body became “smallpox in its proper and distinct form.” But it did not long remain so; the livid spots, into which the pustules subsided, again raised doubts in the minds of some of the physicians whether it was not measles after all; and there was undoubtedly erysipelas of the face. Harris took the middle course of diagnosing “smallpox and measles mingled,” a name by which the form that we now call haemorrhagic smallpox had been known from the early part of the seventeenth century. It was at this late and ominous stage of the illness that Radcliffe was called in; it is not correct to say, as the historian says, that he was the first to pronounce “the more alarming name of smallpox.” The diagnosis was then a matter of little moment, for the queen was dying. He declared that “her majesty was a dead woman, for it was impossible to do any good in her case when remedies had been given that were so contrary to the nature of her distemper; yet he would endeavour to do all that lay in his power to give her ease.” (Munk’s Roll of the College of Physicians, II. 458.) For some unexplained reason Radcliffe was made to bear the blame of the queen’s death, an accusation which he deserved as little as he deserved the credit given him by the historian of having been the only physician to make the correct diagnosis.

Macaulay is equally unfortunate in his remark that smallpox “was then the most terrible of all the ministers of death,” in his comparison of it to plague, and in his rhetoric generally. The haemorrhagic form, of which the queen died, was rare. Dover adds it as a fourth variety, but admits that he had seen only five cases of it. Ferguson, of Aberdeen, as late as 1808, in a paper on measles (Med. and Phys. Journal, XXI. 359), described a haemorrhagic case of smallpox which he once saw, without knowing that it was a recognized variety of smallpox at all. However terrible a minister of death smallpox may sometimes have been, it happened that there was comparatively little of it in London during the period covered by Macaulay’s history; and it certainly did not “fill the churchyards,” as he might have found out by referring to that not altogether recondite source, the bills of mortality. From 1694 to 1700 fevers caused three and a half times more deaths than smallpox. In the year 1696, when “the distress of the common people was severe,” the smallpox deaths in London were 196, or about one-hundredth part of the mortality from all causes.

[864] Blomefield, III. 432. The following are two cases from the London epidemic of 1710: June, 15.--“Lord Ashburnham’s brother has the smallpox, and the first, concluding he had had it, went to him, and now himself very ill of them. Doctor Garth, who says none has them twice, examined the servants, and they tell him he was but six days ill then; so he concludes that was not the smallpox.” Cal. Belvoir MSS., II. 190.

[865] Lynn, u. s. He recalls a remark made by a writer in 1710 that the severity of that epidemic “was not due to a peculiar state of the air, but to a defect in some of our great physicians, who, being too fully employed, could not give due attendance to all or even to any of their patients through the multiplicity of them: for want of which, and the severity of their injunctions, which hindered others from applying anything in their absence, many persons were lost who might otherwise have been saved with due care.”

[866] John Woodward, M.D., The State of Physick and Diseases, with an inquiry into the causes of the late increase of them, but more particularly of the Smallpox; with some considerations on the new practice of purging in that disease. London, 1718.

[867] See the account of the Dispensary of the College of Physicians in Warwick Lane, in Munk’s Roll of the Coll. of Phys. II. 499, under the head of Sir Samuel Garth. The dispensary was started in 1687 and languished until 1724. The General Dispensary in Aldersgate Street was opened in 1770 with Dr Hulme as physician, and Dr Lettsom as additional physician in 1773.

[868] Letter of 27 March, year not given. Hist. MSS. Com. V. 618. See also the letter of 4 March, 1720, from Mangey to Waller, cited above, p. 450.

[869] Dr Philip Rose, of Bedfordbury (“over against a baker, next door to the Old Black Horse, two doors from Chandos Street, St Martin’s parish”), having been called by Lady Wyche to see her butler, pronounced him to be in the smallpox; whereupon the lady informed the physician that “she knew an eminent nurse who had managed above twenty of my Lord Cheyney’s servants in the smallpox, and every one of them had recovered.” Her butler was accordingly carried to this nurse’s house in a by street near Swallow Street. An Essay on the Smallpox. By Philip Rose, M.D. Lond. 1724, p. 18.

[870] “An Account or History of the Procuring the Small Pox by Incision, or Inoculation; as it has for some time been practised at Constantinople.” Being the Extract of a Letter from Emanuel Timonius, Oxon. et Patav. M.D., S.R.S., dated at Constantinople, December, 1713. Communicated to Phil. Trans. XXIX. (Jan.-March, 1714) 72, by Dr Woodward, Gresham Professor of Physic. Timoni had been in England in 1703, and had been incorporated a doctor of medicine at Oxford on his Padua degree: hence, perhaps, his correspondence.

[871] An Essay on External Remedies, Lond. 1715, p. 153. Kennedy settled in practice in London as an ophthalmic surgeon, and appears to have enjoyed the patronage of Arbuthnot. His other work, Ophthalmographia, or Treatise of the Eye and its Diseases, with appendix on Diseases of the Ear, Lond. 1723, which is dedicated to Arbuthnot, shows a knowledge of optics and of the structure of the parts concerned in operations on the eye.

[872] Sloane, Phil. Trans. XLIX. (1756), p. 516, “An Account of Inoculation given to Mr Ranby to be published, anno 1736.”

[873] Jacobus Pylarinus, Nova et Tuta Variolas excitandi per Transplantationem Methodus, nuper inventa et in usum tracta, qua rite peracta immunia in posterum praeservantur ab hujusmodi contagio corpora. Venetiis, 1715. Privilege dated 10 Nov., 1715. Reprinted in Phil. Trans. XXIX. (Jan.-March, 1716), p. 393.

[874] A Dissertation concerning Inoculation of Smallpox. By W. D[ouglass], Boston, 1730.

[875] loc. cit.

[876] Published under the initials J. C., M.D.

[877] De Peste dissertatio habita Apr. 17, 1721, cui accessit descriptio inoculationis Variolarum, a Gualt. Harris, Lond. 1721.

[878] Phil. Trans. XLIX. 104.

[879] Sloane, u. s., 1736.

[880] Jurin, Account of the Success of Inoculating the Smallpox. Annual reports from 1723 to 1726.

[881] Alexander Monro, primus, An Account of the Inoculation of the Smallpox in Scotland. Edin. 1765 (Reply to circular of queries issued by the dean and delegates of the Faculty of Medicine of Paris).

[882] Phil. Trans. 1722: papers by Perrot Williams, M.D. (p. 262), and Richard Wright (p. 267).

[883] Voyages du Sr. A. de la Motraye. Tome II. La Haye, 1727, Chap. III. p. 98. He saw Timoni at Constantinople on his return from the Caucasus. Timoni used “a three-edged surgeon’s needle,” which is more intelligible than three needles tied together. La Motraye’s travellers’ tales have not enjoyed the best credit. But this of the inoculation in Circassia has been made by Voltaire the sole basis of his spirited account of inoculation as the national practice of that country (Lettres sur les Anglais, Lettre XI. “Sur l’insertion de la petite-vérole,” 1727, reprinted as the article “Inoculation” in his Dict. Philosophique, 1764). There has never been a grosser instance of a myth constructed in cold blood. The fable does not need refutation because it is mere assertion, in the manner of a philosophe. But the British ambassador at Constantinople made inquiries concerning the alleged Georgian or “Circassian” practice in 1755, at the instance of Maty, the foreign secretary of the Royal Society (Phil. Trans. XLIX. 104). A Capuchin friar, “a grave sober man” who had returned shortly before from a sixteen years’ residence in Georgia and “gives an account of the virtues and vices, good and evil, of that country with plainness and candour,” solemnly declared to Mr Porter that he never heard of inoculation “at Akalsike, Imiritte or Tiflis,” and was persuaded that it had never been known in the Caucasus. It was impossible that either the public or private practice of inoculation could have been concealed from him, as he went in and out among the people practising physic. He had often attended them in the smallpox, which, he said, was unusually severe there. On the other hand La Motraye says: “I found the Circassians becoming more beautiful as we penetrated into the mountains. As I saw no one marked with the smallpox, it occurred to me to ask if they had any secret to protect them from the ravages which this enemy of beauty makes among all nations. They told me, Yes; and gave me to understand that it was inoculating, or communicating it to those whom they wished to preserve by taking the matter from one who had it and mixing the same with the blood at incisions which they made. On this I resolved to see the operation, if it were possible, and made inquiry in every village that we passed through if there was anyone about to have it done. I soon found an opportunity in a village named Degliad, where I heard that they were going to inoculate a young girl of four or five years old just as we were passing.” This was published fifteen years after, Timoni’s account being given in an Appendix.

[884] Travels, IV. 484. See also for Algiers, Lond. Med. Journ. XI. 141. In those cases there was no inoculation by puncture or otherwise.

[885] Miscell. Curiosa s. Ephemer. Med.-Phys. Acad. Nat. Curios. Decuria I., An. 2, Obs. CLXV. 1671. D. Thomae Bartholini, “Febris ex Imaginatione.” Scholion by D. Henr. Vollgnad, Vratislaviae practicus.

[886] Miscell. Curiosa, l. c. 1677.

[887] See Drage, Pyretologia. Lond. 1665.

[888] Nuremberg, 1662, p. 529.

[889] La Condamine cites Bartholin’s essay on Transplantation as if it really contained the germ of inoculation, which it does not, the single reference in it to smallpox being in a passage where the contagion of that, as well as of plague, syphilis and dysentery, is said to be capable of being turned aside from one to another.

[890] Drage (Pyretologia) gives a case where an ague passed from one person to another in the fumes of blood drawn in phlebotomy. He says also (Sicknesses and Diseases from Witchcraft, 1665, p. 21) that a witch could be made to take back a disease by scratching her and drawing blood.

[891] De Transplantatione Morborum. Hafniae, 1673, p. 24.

[892] De Febribus, u. s. In the plague, a live cock applied to the botch was thought to draw the venom; the cock was then to be buried. Also crusts of hot ryeloaf hung in the room where one had died of plague absorbed the venom. Gabelhover, The Boock of Physicke, Dort, 1599, p. 298. Bread was used for the same purpose in fevers as late as 1765. Muret, Mém. par la Société Econom. de Berne, 1766.

[893] Dissertationes in Inoculationem Variolarum, a J. à Castro, G. Harris, et A. le Duc. Lugd. Bat. 1722.

[894] Gardiner’s Triall of Tabacco. London, 1610, fol. 38.

[895] Ibid. fol. 43. The City Remembrancer, 1769, a work claiming to be Gideon Harvey’s, says that in the Great Plague of London, 1665, some low persons contracted the French pox of purpose to keep off the infection of plague.

[896] Inquiry how to prevent the Smallpox, Chester, 1785:--“No care was taken to prevent the spreading; but on the contrary there seemed to be a general wish that all the children might have it.” Cited from Mr Edwards, surgeon, of Upton, near Chester. Again (Sketch of a Plan, &c., 1793, p. 491), “They neither feared it nor shunned it. Much more frequently, by voluntary and intentional intercourse, they endeavoured to catch the infection.”

[897] History of Physic, Lond. 1725-26, II. 288. This was written at a time when the novelty of inoculation had passed off, and may be taken as Freind’s mature opinion. Douglass, of Boston, writing in 1730, implies that Freind’s objections had been overcome; which may mean no more than he says in general: “Yet from repeated tryals the Anti-Inoculators do now acknowledge that inoculation, generally speaking, is a more easy way of undergoing the smallpox.” Condamine, in his French essay of 1755, counts Freind among the original supporters of inoculation, and ridicules the opposition to it. Munk, in citing the title of Wagstaffe’s Letter to Dr Freind showing the danger and uncertainty of Inoculating the Smallpox (London, 1722), omits the words “to Dr Freind,” at the same time describing the pamphlet as “specious.” There seems no reason to doubt that Freind shared Wagstaffe’s views.

[898] Hecquet, of Paris, who is supposed to have been the original of Dr Sangrado in ‘Gil Bias,’ gave the following reasons against inoculation (Raisons de doutes contre l’Inoculation): “Its antiquity is not sufficiently ascertained: the operation rests upon false facts: it is unjust, void of art, destitute of rules: ... it doth not prevent the natural smallpox: ... it bears no likeness to physic, and savours strongly of magic.”

[899] James Jurin, M.D., Account of the Success of Inoculation, 1724, p. 3.

[900] G. Baker, M.D., Oratio Harveiana, 1761, p. 24.

[901] Sloane, Phil. Trans. XLIX. 516.

[902] They are given in Maitland’s Vindication, 1722, and in one of Jurin’s papers.

[903] In regard to the last of them, when Frewen in 1759 was controverting the fancy of Boerhaave and Cheyne that smallpox might be hindered from coming on in a person exposed to contagion by a timely use of the Aethiops mineral, he said there was a fallacy in the evidence, because many persons ordinarily escape smallpox “who had been supposed to be in the greatest danger of taking it.” Huxham also pointed out that a person might be susceptible at one time but not at another, or insusceptible altogether; and the elder Heberden wrote: “Many instances have occurred to me which show that one who had never had the smallpox may safely associate, and even be in the same bed with a variolous patient for the first two or three days of the eruption without any danger of receiving the infection.” William Heberden, sen., M.D., Commentaries on Disease, 1802, p. 437.

[904] Dr James Jurin was educated at Cambridge, and elected a fellow of Trinity College. He became a schoolmaster at Newcastle, where he also gave scientific lectures. Coming to London, with a Leyden medical degree, he devoted himself to the Newtonian mathematics and was made one of the secretaries of the Royal Society, Newton being the president. He was one of the original physicians of the new hospital founded in the Borough by Guy, the rich bookseller. He made a fortune by medical practice, and was elected president of the College of Physicians a few weeks before he died. In medicine his name is associated with the inoculation statistics, the idea of which, as well as most of the substance, he got from Nettleton, and with “Jurin’s Lixivium Lithontripticum,” or solvent for the stone, the idea of which belonged originally to Mrs Johanna Stevens, and was sold by her to the State for five thousand pounds on the 16th of June, 1739, the prescriptions having been made public in the London Gazette of 19th June. On the 15th of December, 1744, Jurin was called to see the Earl of Orford (Sir Robert Walpole), who was suffering from stone, either renal or vesical. He began administering his alkaline solvent, “four times stronger than the strongest capital soap-lye,” and during the six weeks of his attendance had given his patient thirty-six ounces of it. Horace Walpole made him angry by arguing on the medicine: “It is of so great violence that it is to split a stone when it arrives at it, and yet it is to do no damage to all the tender intestines through which it must first pass. I told him I thought it was like an admiral going on a secret expedition of war with instructions which are not to be opened till he arrives in such a latitude.” (Letters of Horace Walpole, Cunningham, I. 339.) His services were at length dispensed with, and the earl, whose case was probably hopeless before, died in a few weeks. A war of pamphlets followed, Ranby, the serjeant-surgeon, maintaining that the patient had “died of the lixivium.” Mead, also, expressed himself strongly upon the attempt to use a modification of Mrs Stevens’s solvent.

[905] The fatalities are given somewhat fully in Jurin’s annual accounts of the Success of Inoculation, 1723-27.

[906] John Wreden, body-surgeon to the Prince of Wales, author of An Essay on the Inoculation of the Smallpox (Lond. 1779), may also be counted among those who gave a more real smallpox. See especially his cases at Hanover.

[907] H. Newman, “Way of Proceeding in the Smallpox Inoculation in New England.” Phil. Trans. XXXII. (1722), p. 33.

[908] Thomas Nettleton, Letter to Whitaker. Ibid. p. 39.

[909] Phil. Trans. l. c. p. 46. A remark follows which is not quite clear: “There is one observation which I have made, tho’ I would not yet lay any great stress upon it, that in families where any have been inoculated, those who have been afterwards seized never had an ill sort of smallpox, but always recovered very well.”

[910] Phil. Trans. 1722, p. 209. Dated from Halifax, 16 Dec. 1722.

[911] Dr William Douglass to Dr Cadwallader Colden, 28 July, 1721, and 1 May, 1722, in Massachu. Hist. Soc. Collections, Series 4, vol. II. pp. 166-9. Also A Dissertation concerning Inoculation of Smallpox. By W. D[ouglass]. Boston, 1730; and A Practical Essay concerning the Smallpox. By William Douglass, M.D. Boston, 1730.

[912] Boylston, Account of the Smallpox inoculated in New England. London, 1726.

[913] This was admitted, in a manner, for the great Boston epidemic of 1752, by the Rev. T. Prince, Gent. Magaz. Sept. 1753, p. 414. The epidemic attacked 5545 (in a population of 15,684), and cut off 569. The numbers inoculated were 2124 (including 139 negroes), of which number 30 died and were included in the total of 569. Many of the inoculated, says Prince, were not careful to avoid catching the infection in the natural way; “for I have known some, as soon as inoculated, receive visits from their friends, who had been with the sick of the same disease and ’tis likely carried infection with them; it seems highly probable that the inoculated received the infection from them into their vitals.” It may be supposed that the inoculated who were more careful formed a part of the 1843 who “moved out of town.” More than a third of the population took natural smallpox in some four months (April to July) of 1752, more than a third had had it before, a severe epidemic having occurred in 1730 as well as in 1721.

[914] Clinch, Rise and Progress of the Smallpox, with an Appendix to prove that Inoculation is no Security from the Natural Smallpox. 2nd ed. 1725.

[915] C. Deering, M.D., An Account of an Improved Method of treating the Smallpox. Nottingham, 1736, p. 27. Woodville appears to accept this case as authentic.

[916] Pierce Dod, M.D., F.R.S., Several Cases in Physic. London, 1746.

[917] Kirkpatrick, and after him Woodville, treat the alleged experience of Jones as pure fiction.

[918] La Condamine, of Paris, an amateur enthusiast for inoculation, did all he could to upset the case. He got his friend Dr Maty, foreign secretary of the Royal Society, to make inquiry through the British ambassador to the Porte. It happened that Angelo Timoni, son of the inoculator, was at that time an interpreter at the British Embassy; he applied to his mother, who re-affirmed the facts as to the inoculation of her child in infancy, and her death by the natural smallpox twenty-four years after. The only defence left was that the inoculation had not been done by Dr Timoni’s own hand. La Condamine, Mémoires pour servir à l’Histoire de l’Inoculation. 2me Mémoire. Paris, 1768.

[919] Rush to Lettsom, Philadelphia, 17 June, 1808, in Pettigrew’s Memoirs of Lettsom, III. 201.

[920] Fuller, in his Exanthematalogia, makes a somewhat late defence of it in 1729. But Richard Holland, who published in 1730 A Short View of the Smallpox, does not mention inoculation, and in the following passage he writes of smallpox as if the extravagant hopes of the preceding years had vanished: “This last season having afforded too many melancholy instances of the fatal effects of the distemper, though under the care and direction of the most eminent physicians, since the disease, notwithstanding the plainness of its symptoms, is become the opprobrium medicinae,” &c. (p. 3).

[921] Phil. Trans. Jan.-March, 1722: “The way of proceeding in the Small Pox inoculated in New England.” Communicated by Henry Newman, Esq. of the Middle Temple, p. 33, § 3: “Yet we find the variolous matter fetched from those that have the inoculated smallpox altogether as agreeable and effectual as any other.”

[922] An Essay on Inoculation: occasioned by the Smallpox being brought into S. Carolina in the year 1738. By J. Kilpatrick. London, 1743, p. 50. The essay had been “first printed in South Carolina,” the London edition of 1743 having an Appendix dealing historically with the Charleston epidemic of 1738.

[923] Thomas Frewen, M.D., The Practice and Theory of Inoculation. London, 1749.

[924] J. Kirkpatrick, M.D., Analysis of Inoculation, with a consideration of the most remarkable appearances in the Small Pocks. Lond. 1754.

[925] Kirkpatrick, Analysis.

[926] La Condamine, Mémoires pour servir, &c. (Deuxième Discours), 1768, p. 91. It matters little what Lobb may or may not have done. But it does not appear that Boerhaave ever tried to get rid of the eruption of smallpox by means of drugs. In the chapter of his Aphorisms, “De Variolis” (§ 1392) he says that he imagines a specific might be found, in the class of antidotes, to correct and destroy the variolous virus, indicating antimony and mercury as likely agents for the purpose owing to certain physical properties of the medicinal preparations of them. Ruston (An Essay on Inoculation, 3rd ed. 1768) says that Boerhaave, who died in 1738, “never practised it himself; nor seems to have understood the manner in which these medicines operate to produce their salutary effects.” However they were known as the Boerhaavian antidotes to smallpox, and were used in Rhode Island, it is said with great success and as a secret. Ruston used them in England, and discovered by an analysis that Sutton’s secret powders were the same. They seem also to have been used by Cheyne to prevent the development of smallpox in persons who had been exposed to contagion and had presumably taken the contagion. Frewen, in 1759, published a pamphlet to show the improbability of antimony and mercury having any such action, and the fallacy of the claims made for their success.

[927] The Duchess gave the following account of her own case (Gent. Magaz. Nov. 1765, p. 495, sent by Gatti to a friend in London): “On the 12th of March, 1763, I was inoculated for the smallpox, and about four or five days afterwards a redness appeared round the orifice, which Mons. Gatti called an inflammation, and assured me was a sign that the smallpox had taken effect: these were the very terms he used. The redness or inflammation increased every day, and about the seventh or eighth day, the wound began to suppurate. There appeared also about the wound six small risings, or pimples, which successively suppurated and disappeared the next day. Mons. Gatti, upon their appearance, again assured me that the smallpox had taken effect. In the afternoon of the eleventh or twelfth day of my inoculation I felt a general uneasiness and emotion, a pain in my head and my back, and about my heart, in consequence of which I went to bed sooner than ordinary. I slept well, however, and rose without any disorder in the morning. These symptoms Mons. Gatti assured me were the forerunners of the eruption. The next day a pretty large rising or pimple appeared in my forehead, turned white, and then died away, leaving a mark which continued many days.

“The wound in my arm continued to suppurate seven or eight days, and Mons. Gatti now assured me that I had nothing to fear from the smallpox; and upon this assurance I relied without the least doubt, and continued in perfect confidence of my security till the natural smallpox appeared. I continued very well during the whole time of my inoculation, except one day, as mentioned above, and I went out every day.

“Monmorency, D. de Boufflers.”

[928] Gibbon’s Autobiography. It was to Dr Maty that Gibbon, in 1759, submitted his French essay on the Study of Literature, having had a fair copy of it transcribed by one of the French prisoners at Petersfield. Of Maty he says: “His reputation was justly founded on the eighteen volumes of the Journal Britannique, which he had supported almost alone, with perseverance and success. This humble though useful labour, which had once been dignified by the genius of Bayle and the learning of Le Clerc, was not disgraced by the taste, the knowledge and the judgment of Maty.”

[929] Angelo Gatti, M.D., New Observations on Inoculation. Translated from the French by M. Maty. Lond. 1768. The French edition was published at Brussels in 1767.

[930] John Andrew, M.D., The Practice of Inoculation impartially considered. Dated 17 June, 1765, Exeter, p. 61.

[931] La Pratique de l’Inoculation. Paris, An. VII. (1798), p 51.

[932] Andrew, u. s. p. 53.

[933] “I am sorry to have found that this operation has not always secured the patient from having the smallpox afterwards, if the eruptions have been imperfect without maturation. I attended one in a very full smallpox, which ran through all its stages in the usual manner; yet this patient had been inoculated ten years before, and, on the 5th day after inoculation, began to be feverish, with a headache, followed by a slight eruption, which eruption soon went off without coming to suppuration; the place of inoculation had inflamed and remained open ten days, leaving a deep scar, which I saw.” William Heberden, Senr., M.D., Commentaries on Disease (p. 436). This was published in 1802, after the author’s death; but as he was in the height of his practice from 1760 onwards, the case, which is undated, may be taken as illustrating Heberden’s position in the Suttonian controversy.

[934] Benj. Chandler, M.D., An Essay on the Present Method of Inoculation. Lond. 1767.

[935] Method of Inoculating the Smallpox. Lond. 1766. Baker thought he was “an enemy of improvement and no philosopher,” who stood upon the antecedent improbability of securing the patient by a minimal inoculation such as Sutton used.

[936] Giles Watts, M.D., Vindication of the Method of Inoculating. London, 1767.

[937] William Bromfeild, Thoughts on the Method of treating Persons Inoculated for the Smallpox. Lond. 1767. He was a Court surgeon and a man of some eminence. Morgagni dedicated one of the books of his De Sedibus et Causis Morborum to him as representing the Royal Society.

[938] W. Langton, M.D., Address to the Public on the present Method of Inoculation. London and Salisbury, 1767. Dr Thomas Glass, of Exeter, replied in 1767 to Bromfeild and Langton, in A Letter to Dr Baker on the Means of procuring a Distinct and Favourable Kind of Smallpox. Lond. 1767, and in a Second Letter to Dr Baker, 1767.

[939] W. Watson, M.D., An Account of a Series of Experiments instituted with a view of ascertaining the most successful Method of Inoculating the Smallpox. London, 1768.

[940] John Mudge, Surgeon at Plymouth, A Dissertation on the Inoculated Smallpox. London, 1777. A copy of this essay was found in the library of Dr Samuel Johnson. The Doctor was a friend of the author’s father, the Rev. Archdeacon Mudge, whose published sermons he has characterized in one of his most amusing balanced sentences of praise qualified with blame. Johnson stood godfather to one of John Mudge’s children. Notes on “Dr Johnson’s Library,” by A. W. Hutton.

[941] Edward Jenner, M.D., Inquiry into the Causes and Effects of the Variolae Vaccinae, or Cowpox. Lond. 1798, p. 56. See also his Further Observations on the Cowpox. 1799.

[942] Langton cites the following advertisement put out on 18 June, 1767, in his own district by Messrs Slatter and Duke, surgeons, of Ringwood, Hants: “The first objection I shall take notice of is that the disorder being in general so light, it is imagined there is danger of a second infection [i.e. a natural attack]. Whenever this has been supposed to have happened, I am certain the operation has failed, which not being discovered by the operator, proves to me that he was not experienced in the practice; for it may always be determined in four, five, or six days, sometimes sooner; and if there is the least reason to doubt, it is very easy to inoculate a second, third or fourth time, which may be done without the least inconvenience. I have inoculated several patients three or four times for their own satisfaction, having very little or perhaps no eruption.”

[943] Mem. Med. Soc. Lond. IV. 114.

[944] John Covey, of Basingstoke, 8 May, 1786, in London Medical Journal, VII. p. 180.

[945] Address to the Inhabitants of Liverpool on the subject of a General Inoculation for the Smallpox. 1 September, 1781.

[946] The account of the London charity is taken from the History of Inoculation in Great Britain (1796) by Woodville, who became physician to it in 1791.

[947] Med. Obs. and Inquiries, III. (1767), p. 287. The passage quoted (p. 306, note) is almost exactly in the words of Hufeland long after, with reference to the probable extinction of smallpox by cowpox. See his Journal, X. pt. 2, p. 189.

[948] J. C. Lettsom, A Letter to Sir Robert Barker, F.R.S. and G. Stacpoole, Esq. upon General Inoculation. London, 1778.

[949] A Plan of the General Inoculating Dispensary, &c. Lond. (no date).

[950] T. Dimsdale, Thoughts on General and Partial Inoculation. Lond. 1776. An Introduction to the Plan of the Inoculation Dispensary. 1778. Remarks on Dr Lettsom’s letter to Barker and Stacpoole. 1779.

[951] Lettsom, Obs. on Baron Dimsdale’s Remarks, &c. 1779; and other pamphlets on both sides.

[952] Clark, Report of the Newcastle Dispensary. 1789.

[953] Currie to Haygarth, 28 Nov. 1791, in Sketch of a Plan, etc., pp. 451, 207.

[954] J. C. Jenner, “An Account of a General Inoculation at Painswick.” Lond. Med. Journ. VII. 163-8.

[955] Gent. Magaz. April, 1788, reported by the Hon. and Rev. Mr Stuart, who was a grandson of Lady Mary Wortley Montagu.

[956] Monro, Account of Inoculation in Scotland, 1765; in his Works. Edin. 1781, p. 693.

[957] Statistical Account of Scotland. 1791-99, III. 376.

[958] Ibid. IV. 130. It was about the year 1782 that the College of Physicians of Edinburgh appointed a committee to inquire into the mode of conducting the gratis inoculations of the poor, which had been tried at Chester, Leeds, Liverpool, &c. in 1781-82. Haygarth, u. s. 1784, p. 207.

[959] Ibid. III. 582.

[960] Ibid. XX. 502-7.

[961] Ibid. XX. 348. Account by Rev. Abercromby Gordon, who gives in a note (p. 349) the following instance of professional zeal: “A surgeon in the north, presuming that self-interest has a stronger hold on man than superstition, has lately opened a policy of insurance for the smallpox! If a subscriber gives him two guineas for inoculating his child, the surgeon in the event of the child’s death pays ten guineas to the parent; for every guinea subscribed, four guineas, for half a guinea, two guineas, and for a crown one guinea.”

[962] James Lucas, Lond. Med. Journ. X. 269.

[963] Currie to Haygarth, 28 Nov. 1791, in the latter’s Sketch of a Plan, &c. p. 453.

[964] A Conscious View of Circumstances and Proceedings respecting Vaccine Inoculation. Bath, 1800. The author was probably James Nooth, senior surgeon to the Bath Hospital, who removed to London and practised in Queen Anne Street, holding the appointment of surgeon to the Duke of Kent. He wrote on cancer of the breast.

[965] Tracts on Inoculation. London, 1781.

[966] R. Pulteney, M.D., in a letter of 21 June, 1766, to Dr G. Baker, given in his Inquiry into the Merits of a Method of Inoculating the Smallpox. Lond. 1766.

[967] Pulteney, “Births, Deaths and Marriages of Blandford Forum, 1733-1772.” Phil. Trans. LXVIII. 615.

[968] Pulteney to Baker, App. to Inquiry into the method of Inoculating. 1766; Hutchins, Dorsetshire, I. 217.

[969] On 23 July, 1785, the apothecary makes a note in his book: “Some inspectors are not sufficiently careful to send information to the Hospital when children have had the smallpox.” MS. Records.

[970] Experiments, &c. 1768.

[971] Sir W. Watson, M.D., F.R.S., “On the Putrid Measles of London, 1763 and 1768.” Med. Obs. and Inquiries, IV. 153.

[972] Charles Kite, surgeon, Gravesend, “An Account of some anomalous Appearances consequent to Inoculation of Smallpox.” Memoirs Med. Soc. Lond. IV. (1794), p. 114.

[973] Fosbroke, Lond. Med. Repository. June, 1819, p. 466.

[974] Jenner to James Moore, in Baron’s Life of Jenner, II. 401: “Is not that a precious anecdote for your new work?” See also Court and Private Life of Queen Charlotte (Journals of Mrs Papendiek). Lond. 1887, I. 41, 70, 270.

[975] In Baron, u. s.

[976] A Conscious View, &c. u. s.

[977] Earle, in Jenner’s Further Observations. 1799.

[978] T. Adams to Richard Pew, M.D., of Sherborne. Lond. Med. and Phys. Journ. April, 1829.

[979] John Forbes, M.D., “Some Account of the Smallpox lately prevalent in Chichester and its vicinity.” Lond. Med. Reposit. Sept. 1822, p. 218.

[980] Discourse on Inoculation. Eng. Transl. 1755.

[981] A Series of Experiments, &c. 1768.

[982] John Haygarth, M.B., Inquiry how to prevent the Smallpox. Chester, 1784, p. 154.

[983] History of Inoculation in Britain. Vol. I. London, 1796, p. 33.

[984] History of Edinburgh. Edin. 1779, p. 260.

[985] W. Hillary, Rational and mechanical Essay on the Smallpox. Lond. 1735.

[986] J. Barker, The Nature of Inoculation explained and its Merits stated. London, 1769, p. 33. He taught that a depraved habit, by ill diet, &c., “serves for a nidus wherein the variolous matter rests.” If the variolous matter to be expelled is small, “by reason of natural health, temperance, or the power of preparation,” the disease is of the distinct kind; when large, of the confluent. “And wise indeed must he be who can find out any laws respecting the reception and expulsion of diseases superior on the whole to those which are original.” p. 9.

[987] “I have taken an account in this town [Halifax], and some parts of the country, and have procured the same from several other towns hereabouts, where the smallpox has been epidemical this last year, with as much exactness as was possible.” Phil. Trans. XXXII. 211.

[988] “A small neighbouring market town.”

[989] “More than usually mortal.”

[990] “A small market town in Lancashire, including two neighbouring villages.”

[991] Account taken “by a person of credit” and sent to Dr Whitaker. Jurin says, more generally: “Taken in several places by a careful enquiry from house to house.” Account, &c. 1724, p. 7.

[992] “At Uxbridge and in the neighbourhood, the smallpox having been exceedingly fatal all thereabouts.”

[993] Mr Maitland’s Account of Inoculating the Smallpox vindicated. 2nd ed. Lond. 1722.

[994] Phil. Trans. XXXIII. 379. “A short account of the Anomalous Epidemic Smallpox beginning at Plymouth in August, 1724, and continuing to the month of June, 1725, By the learned and ingenious Dr Huxham, physician at Plymouth.”

[995] The totals are given in Jurin’s Account for 1725. The ages are in the original communication of the Rev. Mr Wasse, among the MS. papers which Jurin had deposited with the Royal Society.

[996] The most singular thing in the Aynho experience is that there should have been no cases in infants under two years. It was observed, however, some two generations after this, that smallpox attacked children at the earliest ages in the great towns (Haygarth, Sketch of a Plan, &c., 1793, p. 31), and even in the worst conditions of infancy it has attacked relatively few in the first three months of life. Again, it is nearly as remarkable that there should have been only three cases at Aynho in the third year of life and only four in the fourth. However, the fewness of cases in the five first years of life must be taken as exceptional, even for a village epidemic. If Nettleton, who made the first of these censuses of smallpox epidemics and suggested to Jurin that they should be carried out elsewhere, had given the ages, he would certainly have included some in infancy, for he mentions, in the course of his inoculation experiences, particular cases at nine months, eighteen months, etc.

[997] Frewen, Phil. Trans. XXXVII. 108.

[998] See above, pp. 485-6 and 490-1.

[999] Deering, Nottingham vetus et nova. 1751, pp. 78, 82. He says, in an essay on smallpox (Improved Method of treating Smallpox. Nottingham, 1737) that he treated fifty-one cases in the epidemic of 1736, of which only three proved fatal.

[1000] Gent. Magaz. 1741, p. 704.

[1001] Alex. Monro, primus, in his Report to the Dean of the Faculty of Medicine of Paris on Inoculation in Scotland, 1765. Reprinted in his Works. Edin. 1781, p. 485. He does not give ages, but an inspection of the burial registers is said to show that they were nearly all under five.

[1002] Gent. Magaz. 1742, p. 704. Blomefield gives 1710 and 1731 as great smallpox years in Norwich.

[1003] Ibid. 1747, p. 623. The population of Northampton in 1746 was 5136. Price, Revers. Payments. 4th ed. I. 353.

[1004] Part of the account extracted from the parish registers by the Rev. Samuel Partridge, F.S.A., vicar of Boston, and sent to Dr George Pearson, who published it in the Report of the Vaccine Pock Institution for 1800-1802. London, 1803, p. 100.

[1005] J. C. M’Vail, M.D. in Proc. Philos. Soc. Glasgow, XIII. 1882, p. 381, from a MS. register kept by the session clerk of Kilmarnock, now in the General Register House, Edinburgh. The baptisms and burials have not been extended from the MS. for more years than the table shows.

[1006] Statist. Acct. of Scotland.

[1007] Sketch of a Plan, &c. 1793, pp. 33-34.

[1008] The following is the Ackworth bill given by Price, Phil. Trans. LXV. 443.

1747-57 1757-67 Christened 127 212 Buried 107 156 ---------------------------- Consumption 23 38 Dropsy 5 3 Fevers 35 23 Infancy 13 13 Old age 24 30 Smallpox 1 13 Chincough -- 2 Convulsions -- 6 Dysentery -- 2 Measles -- 2 Sundries 6 24 ---------------------------- Total deaths in ten years 107 156

[1009] The following are some examples of rural fecundity and health: Middleton, near Manchester, 1763-72, births 1560, deaths 993, average of 4·75 children to a marriage. Tattenhall, near Chester, 1764-73, births 280, deaths 130; Waverton, same county and years, births 193, deaths 84. Stoke Damerel (now the dockyard near Plymouth), in 1733 (in part an influenza-year), births 122, deaths 62, population 3361. Landward townships of Manchester in 1772, births 401, deaths 246. Darwen, in 1774-80, births 508, deaths 233, population 1850. From Papers in Phil. Trans. by Percival and others.

[1010] Statist. Acct. of Scot. I. 155.

[1011] Hoare’s Wiltshire, VI. 521. There had been a general inoculation to the number of 422, from 13 August, 1751, to February, 1752, just before the epidemic. Brown to Watson, in Phil. Trans. XLVII. 570.

[1012] Huxham, Ulcerous Sore-throat, 1757.

[1013] Gent. Magaz. 1751, Supplement, p. 577. See also June, 1751, p. 244, and letter of “Devoniensis,” ibid. 1752, p. 159. The subject had been raised by Corbyn Morris in his Observations on the past growth and present state of London, and was discussed, from an actuary’s point of view, by Dodson in Phil. Trans. XLVII. (Jan. 1752), p. 333.

[1014] The weekly average deaths for eight weeks of September and October is 30·5 from two to five years and 11·1 from five to ten, which are about half the average at each age period during the maximum prevalence of smallpox.

[1015] W. Black, M.D. (Observations Medical and Political on the Smallpox, etc. London, 1781, p. 100) says: “I am induced by various considerations to believe that whatever share of smallpox mortality takes place in London amongst persons turned of twenty years of age, is almost solely confined to the new annual settlers or recruits, who are necessary to repair the waste of London, and the majority of whom arrive in the capital from twenty to forty years of age.”

[1016] Maddox, bishop of Worcester, preaching a sermon in 1752 for the Smallpox and Inoculation Charity, enforced his pleading by relating the recent case of “a poor man sick of this distemper, of which his wife lay dead in the same room, with four children around her catching the dreadful infection, but destitute of all relief, till they found some in that too narrow building which now importunately begs your compassionate bounty to enlarge its dimensions.”

[1017] The Gent. Magaz. Sept. 1752, p. 402, contains a long letter to refute the very prevailing notion among many people that there is very little occasion for doctors and apothecaries in smallpox, but that a good nurse is all the assistance that is usually wanted. “Whence this notion took its rise I cannot conceive, unless it was from the disease being visible, so that every one who has been at all used to it knows it when they see it.”

[1018] This was an argument used in the first writings on Inoculation, so as to prove the real hazard of dying by the natural smallpox. Thus, Maitland in his Vindication of 1722, which Arbuthnot is said to have had a hand in, deducts a quarter of the annual London deaths before he begins to estimate the ratio of smallpox among them, for the reason that eight out of nine infants who die in their first year are “non-entities” quâ smallpox, other causes of death having had the priority (p. 19). Jurin used the same argument for the same purpose in his Letter to Caleb Cotesworth, M.D., 1723, p. 11: “It is notorious that great numbers, especially of young children, die of other diseases without ever having the smallpox”; and again, “very young children, or at most not above one or two years of age,” including the stillborn, abortives and overlaid, chrisoms and infants, and those dead of convulsions. “It is true, indeed, that in all probability some small part of these must have gone through the smallpox, and therefore ought not to be deducted out of the account”; but he does deduct 386 in every 1000 London deaths before he estimates the ratio of smallpox deaths, which so comes out 2 in 17.

[1019] Percival, Med. Obs. and Inquiries, V. 1776, p. 287; population in Phil. Trans. LXIV. 54.

[1020] Haygarth, Inquiry how to prevent the Smallpox, 1784.

[1021] Haygarth, Sketch of a plan to exterminate the Natural Smallpox. Lond. 1793, p. 139.

[1022] John Heysham, M.D. “An Abridgement of Observations on the Bills of Mortality in Carlisle, 1779-1787,” in Hutchinson’s History of Cumberland. 2 vols. Carlisle, 1794, and separate reprint, Carlisle, 1797; also reprinted in Appendix to Joshua Milne’s Treatise on the Valuation of Annuities. London, 1815, pp. 733-752.

[1023] See Loveday’s Diary of a Tour, 1732, p. 120.

[1024] Gent. Magaz. 1755, p. 595. In a parish near Glasgow, Eaglesham, eighty children are said to have died of smallpox in 1713. Chambers, Domest. Annals, III. 387.

[1025] Robert Watt, M.D., Treatise on the History, Nature and Treatment of Chincough ... to which is subjoined an Inquiry into the relative mortality of the Principal Diseases of Children, and the Numbers who have died under ten years of age in Glasgow during the last thirty years. Glasgow, 1813.

[1026] This high mortality was probably caused by the epidemic agues of 1780, which specially affected Lincolnshire.

[1027] In 1802 the smallpox epidemic recurred, with 33 deaths. In 1801 there was one death.

[1028] Barker and Cheyne, u. s.

[1029] James Sims, M.D., Observations on Epidemic Disorders. London, 1773.

[1030] Two papers on Fever and Infection, 1763, p. 112.

[1031] Medicina Nautica.

[1032] Haygarth, Sketch of a Plan, &c., 1793, p. 32.

[1033] Gaol at Bury St Edmunds: In the winter of 1773, five died of the smallpox. No apothecary then. Leicester County Gaol: In 1774 three debtors and one felon died of the smallpox. “Of that disease, I was informed, few ever recover in this gaol.” Oxford Castle: In 1773 eleven died of the smallpox. In 1774 that distemper still in the gaol. In 1775 one debtor died of it in May, three debtors and a petty offender in June; three recovered. No infirmary, no straw to lie on. State of the Prisons.

[1034] I append Haygarth’s full table of the Chester smallpox epidemic, 1774:

Recovd. from Died of Not had Parish Families Persons smallpox smallpox smallpox

{St Oswald 924 4027 321 40 350 Suburbs {St John 774 3187 284 52 218 {St Mary 583 2392 240 45 205 {Trinity 330 1605 127 24 97

Old {St Peter 193 920 52 6 39 Parishes{St Bridget 154 623 52 6 35 {St Martin 154 611 47 18 35 {St Michael 135 575 15 2 31 {St Olave 134 536 42 8 43 {Cathedral 47 237 3 1 7 ---- ---- ---- --- ---- 3428 14713 1183 202 1060

[1035] Isaac Massey, Remarks on Dr Jurin’s last yearly Account of the Success of Inoculation. Lond. 1727, p. 6. Huxham held that children might be “prepared” for the natural smallpox, as it was then the custom to prepare them for the inoculated disease, so that few of them need have it severely: “I am persuaded, if persons regularly prepared were to receive the variolous contagion in a natural way, far the greater part would have them in a mild manner.” On Fevers. 2nd ed. 1750, p. 133.

[1036] C. Deering, M.D., Account of an improved Method of treating the Smallpocks. Nottingham, 1737.

[1037] John Lamport alias Lampard, u. s.

[1038] Obs. on Ship Fever, &c. New ed. Lond. 1789, p. 448.

[1039] Thomas Phillips, “Journal of a Voyage,” &c. in Churchill’s Collection of Voyages, VI. 173.

[1040] Berkeley’s claim for tar-water in smallpox was a double one, as a preventive or modifier, and as a cure. Of the former he says: “Another reason which recommends tar-water, particularly to infants and children, is the great security it brings against the smallpox to those that drink it, who are observed, either never to take that distemper, or to have it in the gentlest manner.” Further Thoughts on Tar-water, 1752. In his Second Letter to Thomas Prior, Esq. 1746 (in Works. 4 vols. Oxford, 1871, III. 476) he gives the famous case of curing by it:--“the wonderful fact attested by a solemn affidavit of Captain Drape at Liverpool, whereby it appears that, of 170 negroes seized at once by the smallpox on the coast of Guinea one only died, who refused to drink tar-water; and the remaining 169 all recovered, by drinking it, without any other medicine, notwithstanding the heat of the climate and the incommodities of the vessel. A fact so well vouched must, with all unbiassed men, outweigh, &c.”

[1041] Prince, Gent. Magaz. Sept. 1753, p. 414.

[1042] Walter Lynn, u. s. 1715, ad init.

[1043] Reports, &c. 1819.

[1044] Whytt, Med. Obs. and Inquiries, II. (1762), p. 187.

[1045] Cleghorn, Diseases of Minorca. London (under the years).

[1046] Hillary, Changes of the Air, and Epidemical Diseases of Barbados.

[1047] Muret, Mém. par la Société Économique de Berne, 1766. “Population dans le pays de Vaud”: p. 102, “J’ai vu à Veney, la petite vérole être générale dans toute la ville, des centaines d’enfans attaqués de cette maladie, et qu’à peine il en mouroit sept ou huit.”

[1048] Gent. Magaz. 1753, p. 114. Letter from Sam. Pegge, rector, 17 Feb. 1753.

[1049] Haygarth, Phil. Trans. LXV. 87.

[1050] Morton, Pyreologia, II. 338: “Et quidem omnes haereditario quasi jure benignis istis variolis tentabantur, quae (Deo favente) eventum secundum habuerunt; nunquam enim quemquam meâ vel conjugis meae stirpe ortum hoc morbo periisse memini.” The case of hereditary tendency to fatal smallpox is No. 53, p. 470: “Domina Theodosia Tytherleigh, virgo elegans ac formosa, stirpe celeberrima (sed cui hic morbus jure quasi haereditario funestus esse solebat)” &c. She died in a late stage of the disease.

[1051] Cal. Coke MSS. (Hist. MSS. Commis.) II. 429.

[1052] Rutty, Chronological History of the Weather and Seasons, and prevailing Diseases in Dublin during forty years. London, 1770, under the dates.

[1053] Short (Comparative History of the Increase and Decrease of Mankind in England, &c. Lond. 1767) has found somewhere a statement that in 1717 there was “a most fatal continual fever in the West of Scotland, in January and February, and not less fatal confluent smallpox in March and April.”

[1054] Lond. Med. Journ. VII. 163.

[1055] W. Watson, in Medical Observations and Inquiries by a Society of Physicians in London, IV. (1771), p. 153. Whether the epidemic that preceded the smallpox was measles or scarlatina is a question that was raised by Willan, and is referred to in the chapter on “Scarlatina and Diphtheria.”

[1056] Annals of the Lords of Warrington and Bewsey from 1587. By W. Beamont. Manchester, 1873, p. xix.

[1057] John Aikin, M.D., Descriptions of the Country from thirty to forty Miles around Manchester. London, 1795, p. 302.

[1058] Taken out of the register by Aikin at the request of Dr Richard Price, and published by the latter in the 4th ed. of his Obs. on Reversionary Payments. Lond. 1783, II. 5, 100.

[1059] Arthur Young, Six Months Tour through the North of England. 4 vols. London, 1770-71, III. 163.

[1060] Percival, Phil. Trans. LXV. 328.

[1061] Beamont, u. s. p. 116-17.

[1062] Ferriar, Med. Obs. and Reflections.

[1063] Price, Reversionary Payments. 4th ed. II.

[1064] Aikin, Phil. Trans. LXIV. (1774), p. 438; Haygarth, ibid. LXVIII. 131.

[1065] “Almost ended at the winter solstice, only 19 remaining ill in January, 1775.”

[1066] Percival, for Warrington, Med. Obs. and Inquiries, V. (1776), p. 272 (information from Arkin); Haygarth, for Chester, Phil. Trans. LXVIII. 150. Haygarth (Sketch of a Plan, &c. p. 141) gives the following table of the smallpox deaths and the deaths from all causes at several ages of children up to ten years at Chester from 1772 to 1777 inclusive:

Under one 1-2 2-3 3-5 5-10 Total

Smallpox deaths 91 75 83 86 34 369 All other deaths 392 155 68 68 53 736

[1067] Sketch of a plan, &c. p. 31.

[1068] Heysham, Obs. on Bills of Mortality in Carlisle, 1779-1787. Carlisle, 1797. Reprinted from App. Vol. II. of Hutchinson’s Cumberland.

[1069] Lucas, Lond. Med. Journ. X. 260: “The number of those who were still uninfected was found on a survey to be 700.”

[1070] Dr Henry, of Manchester, to Haygarth, 20 March, 1789, in the latter’s Sketch of a Plan, &c. p. 369: “In large and populous places such as Manchester, the smallpox almost always exists in some parts of the town. I have known it strongly epidemic in one part without any appearance of it in others.... At present it is prevalent and fatal in the outskirts, but very rarely occurs in the interior parts of the town.”

[1071] “Most of them [Jenner’s colleagues] had met with cases in which those who were supposed to have had cowpox had subsequently been affected with smallpox.” Baron, Life of Jenner, I. 48.

[1072] Haygarth to Worthington, 15 April, 1794, in Baron’s Life of Jenner, I. 134.

[1073] See the cases and remarks by John Hunter, Sir W. Watson, Lettsom and others.

[1074] Joseph Adams, Observations on Morbid Poisons, Phagedaena and Cancer. 1st ed. Lond. 1795. Preface, 31 March.

[1075] I have collected all the scattered references in Jenner’s writings to cowpox in the cow or in infected milkers in my Natural History of Cowpox and Vaccinal Syphilis. London, 1887, pp. 53-57.

[1076] G. Pearson, Inquiry concerning the History of Cowpox. Lond. 1798.

[1077] Beddoes’ Contributions to Physical and Medical Knowledge. Bristol, 1799, p. 387.

[1078] See my Natural History of Cowpox, &c. u. s. 1887. The most systematic descriptions, both for cows and milkers, are by Ceely, in Trans. Provinc. Med. and Surg. Assocn. VIII. (1840) and X. (1842). Professor E. M. Crookshank has reproduced these valuable memoirs, with the coloured plates, in his History and Pathology of Vaccination. 2 vols. London, 1889. The plates are in vol. I., the memoirs in vol. II. Crookshank’s volumes, which are a convenient repertory of the more important earlier writings on cowpox, contain also the author’s original observations (with plates), of cowpox in Wiltshire in 1887-88.

[1079] In my essay of 1887 (u. s.) I maintained, as an original opinion, that the true affinity of cowpox was to the great pox of man, and that the occasional cases of so-called vaccinal syphilis were not due to the contamination of cowpox with venereal virus but to inherent (although mostly latent) properties of the cowpox virus itself. This opinion was at first received with incredulity, but is now looked upon with more favour. See Hutchinson, Archives of Surgery, Oct. 1889, and Jan. 1891, p. 215. The concessions hitherto made are only for cases that have arisen since my book was published, such as the case at the Leeds Infirmary in 1889. I believe that my explanation of vaccinal “syphilis” will at length be accepted for all cases, past or future.

[1080] An Inquiry, &c. 1798. “Remarks on the term Variolae Vaccinae.”

[1081] That Dr Jenner foresaw this line of proof, and dismissed it as irrelevant, is made clear by G. C. Jenner, Monthly Magazine, 1799, p. 671, in reply to Dr Turton, of Swansea: “It is possible that variolous virus inserted into the nipples of a cow, might produce inflammation and suppuration, and that matter from such a source might produce some local affection on the human subject by inoculation. But all this tends only to show, what was well known before, that virus taken from one ulcer is capable of producing another by its being inserted into any other part of the body.”

[1082] Jenner, Further Observations on the Variolae Vaccinae, 1799.

[1083] Thornton, in Beddoes’ Contributions to Physical and Medical Knowledge. Bristol, 1799.

[1084] Hughes, Med. and Phys. Journ. I. (1799), p. 318. Many other tests, English and foreign, are detailed in my book, Jenner and Vaccination. London, 1889, for which see the Index under “test.”

[1085] Woodville tabulated 511 cases of applicants for inoculation at the hospital in whom cowpox matter was used, giving “the number of pustules” opposite the name of each; 90 had from a thousand to a hundred pustules, 215 had less than one hundred. William Woodville, M.D., Reports of a Series of Inoculations for the Variolae Vaccinae or Cowpox; with remarks on this disease considered as a substitute for the Smallpox. London, 1799. In a subsequent letter (Med. Phys. Journ. V., Dec. 1800), he thus explained the occurrence of smallpox among those recently inoculated with cowpox: “If a person who has been exposed to the contagion of smallpox for four or five days be then inoculated for this disease, the inoculation prevents the effects of the contagion, and the inoculated smallpox is produced. But if the vaccine inoculation be employed in a case thus circumstanced, the smallpox is not prevented, although the tumour produced by the cowpox inoculation advance to maturation. It was not before the commencement of the present year [1800], that I ascertained that the cowpox had not the power of superseding the smallpox. For, though from the first trials that I made of the new inoculation it appeared that these diseases, as produced in the same subject from inoculation, did not interrupt the progress of each other; yet as the casual does not act in the same manner as the inoculated smallpox, and may be anticipated by the latter, I thought it still probable that the cowpock infection might have a similar effect. Numerous facts have, however, proved this opinion to be unfounded, and that the variolous effluvia, even after the vaccine inoculation has made a considerable progress, have in several instances occasioned an eruption resembling that of smallpox.”

[1086] European Magazine, XLIII. 137.

[1087] Bateman, u. s. 1819, Aug.-Nov. 1807: “In a court adjoining Shoe Lane, in the course of one month, twenty-eight persons had died of smallpox.” Autumn, 1812: “In one small court in Shoe Lane, seventeen have lately been cut off by this variolous plague.” Also in the summer of 1812, “perhaps universally through the metropolis.”

[1088] Extracted from the Annual Reports of the Dispensary.

[1089] Heysham to Joshua Milne, in the latter’s Treatise on the Valuation of Annuities. London, 1815. App. p. 755.

[1090] Cross, 1819, u. i. p. 2.

[1091] Most of these were brought to light by inquiries upon the alleged failures of cowpox to avert the epidemic. The serial numbers of the Medical Observer contain frequent references to them.

[1092] Letter to Joshua Dixon, in Memoirs, III. 368.

[1093] Bateman, Edin. Med. Surg. Journ. VIII. 515.

[1094] C. Stuart, ibid. VIII. 380.

[1095] Rigby, ibid. X. 120.

[1096] Joshua Dixon, The Literary Life of William Brownrigg, M.D. Whitehaven, 1801, pp. 238-9.

[1097] Haygarth says: “With us in Chester, smallpox is seldom heard of except in the bills of mortality. There its devastation appears dreadful indeed.” Sketch of a Plan, &c. 1793, p. 491.

[1098] Barker and Cheyne, Account of the Fever, &c. 2 vols. 1821. I. 92.

[1099] Francis Rogan, M.D., Obs. on the Condition of the Middle and Lower Classes in the North of Ireland. Lond. 1819, p. 17. He proceeds to say:--“The numerous cases, which came to my knowledge, of children in the neighbouring towns who had taken smallpox, after having been vaccinated by medical practitioners of high respectability, led me to pay particular attention to those whom I myself inoculated [with cowpox]; and, although they were numerous both in private practice and at the Dispensary, not one instance occurred among them.” It comes out however that he did not keep them long in sight; he saw them on the 7th day after vaccination, and again on the 11th; and as they were meanwhile almost daily exposed to contagion, without catching it, he concluded that his own cases never would do so.

[1100] W. L. Kidd. “A concise Account of the Typhus Fever at present prevalent in Ireland, as it presented itself to the Author in one of the towns in the North of that country.” Edin. Med. and Surg. Journ. XIV. (1817), 144. He goes on: “A great number of those attacked were reported to have been formerly vaccinated. At Londonderry, in particular, great numbers who were said to have undergone vaccination were the subjects of smallpox; and, whether justly or not, vaccination has in that part of the country lost much of its credit as a preservative against smallpox.”

[1101] Redhead (dated Ulverston, 3 July, 1816) in Med. and Phys. Journ. Jan. 1817, p. 3.

[1102] James Black, “On Anomalous Smallpox.” Ed. Med. and Surg. Journ. Jan. 1819, p. 39.

[1103] Henry Dewar, M.D., Account of an Epidemic of Smallpox which occurred in Cupar in Fife in the Spring of 1817. Lond. 1818.

[1104] P. Mudie, M.D. to Thomson, 18 Oct. 1818: “Many of the cases occurring after vaccination so much resembled smallpox that, if my mind had not been prejudiced against the possibility of such an occurrence, I should have pronounced the eruption to have been of a variolous nature”--which, of course, it was.

[1105] Thomson, Account of the Varioloid Epidemic in Scotland, &c. Edin. 1820.

[1106] In Thomson, u. s.

[1107] Thomas Bent, M.D., “Observations on an Epidemic Varioloid Disease lately witnessed in the County of Derby.” Med. and Phys. Journal, Dec. 1818, p. 457. One Jennerian, Dr Pew, of Sherborne, adopted an arrogant tone towards Bent (Ibid. April, 1819, and farther correspondence). Jenner employed Fosbroke, of Berkeley, son of his friend and neighbour the antiquary Fosbroke, to traverse the whole case of the epidemic of 1817-19, in a long paper in the Medical Repository for June, 1819. The object of the paper appears to be to confuse the issues with a view to a verdict of non liquet. The Edinburgh Review thought Thomson’s book on the epidemic of 1817-19 important enough for an article, which has been attributed to Jeffrey. The article pronounced vaccination to be a very great blessing to mankind, but not a complete protection. This was not enough for Jenner, who wrote of the article: “It will do incalculable mischief: I put it down at 100,000 deaths at least.”

[1108] John Green Cross, A History of the Variolous Epidemic which occurred in Norwich in the year 1819. Lond. 1820.

[1109] Cross, u. s. Appendix.

[1110] W. Shearman, M.D., “Cases illustrating the Nature of Variolous Contagion and the Modifying Influence of Vaccine Inoculation.” Lond. Med. Repos. Dec. 1822. Case of a mother, with good vaccine marks, attacked with smallpox, which became dry and horny about the fifth day; case of her child, in which the eruption ran the full course of pustules, but also a mild case.

[1111] Lond. Med. and Phys. Journ. May, 1818, p. 488: “By Mr Field’s report of Christ’s Hospital smallpox in a mild form has been frequent post vaccinationem.”

[1112] Thomas Stone, F.R.C.S. “Table of Deaths from Smallpox in Christ’s Hospital, 1750 to 1850, with remarks,” in Appendix to Papers on the History and Practice of Vaccination: Parl. Papers, 1857. In 1761 there were four deaths from smallpox. For ten years, 1775 to 1784, there were none. In some other years of the latter half of the 18th century there were one or two deaths from that cause. There must have been some special reason for the four deaths in 1761. According to Massey (supra, p. 545), the apothecary in the beginning of the 18th century, not one death happened in forty attacks, the ages from five to eighteen being the most favourable of all for smallpox to fall in. In the present century scarlatina has displaced smallpox as an infectious cause of death in that school as in others. The deaths from scarlatina at Christ’s Hospital during the six years 1851-56 were nine.

[1113] John Forbes, M.D., “Some Account of the Smallpox lately prevalent in Chichester and its Vicinity.” Lond. Med. Repos. Sept. 1822, p. 208.

[1114] H. W. Carter, M.D., in Lond. Med. Repos. Oct. 1824, p. 267: “The cases which came to light of smallpox after vaccination were unfortunately numerous; some, it must be confessed, were exceedingly severe; others were exaggerated.”

[1115] The vaccinations are given in Cleland’s Rise and Progress of the City of Glasgow. Glasgow, 1820. The smallpox deaths from 1813 to 1819 are given, on Cleland’s authority, in the Edin. Med. and Surg. Journal, XXVI. p. 177.

[1116] R. Watt, M.D., Appendix to Treatise on Chincough.

[1117] John Roberton, Obs. on the Mortality, &c. of Children. Lond. 1827, p. 59, note.

[1118] Gregory, Report of the London Smallpox Hospital for the year 1825. Cited in the Med. and Phys. Journ. Feb. 1826, p. 176.

[1119] Cross, u. s.

[1120] Carter, u. s.

[1121] T. Proudfoot, M.D., Ed. Med. and Surg. Journ. July, 1822.

[1122] C. Stuart, u. s.

[1123] Dr Stokes, of Chesterfield, Med. and Phys. Journ. v. 17.

[1124] Benjamin Moseley, M.D., A Review of the Report of the Royal College of Physicians on Vaccination. 1808, p. 11. Jenner writing to James Moore, 18 Nov. 1812 (in Baron, II. 383), enumerates his various grievances against Pearson, “and finally, finding all tricking useless, his insinuations that vaccination is good for nothing.”

[1125] The equality of the two methods in this respect comes out incidentally in two reports of the Whitehaven Dispensary. In the report for 1796, when smallpox matter was in use, it is said that “173 were inoculated, all of whom, soliciting little medical assistance, recovered.” In 1801, when cowpox matter had been substituted in every case, the same phrase is used: “We seldom find any medical assistance required in this disease.”

[1126] The Beneficial Effects of Inoculation. Oxford University Prize Poem. Oxford, 1807. It seems probable that this was the “Oxford copy of verses on the two Suttons” that Coleridge (Biographia Literaria (1817), Pickering’s ed. II. 89) professed to quote from in the following passage; at least it would be remarkable if there had been printed another Oxford poem on the same subject and in the same manner: “As little difficulty do we find in excluding from the honours of unaffected warmth and elevation the madness prepense of pseudopoesy, or the startling hysteric of weakness over-exerting itself, which bursts on the unprepared reader in sundry odes and apostrophes to abstract terms. Such are the Odes to Jealousy, to Hope, to Oblivion, and the like, in Dodsley’s collection and the magazines of the day, which seldom fail to remind me of an Oxford copy of verses on the two Suttons, commencing with

‘Inoculation, heavenly maid! descend!’”

It appears that Coleridge himself contemplated a poem on Cowpox Inoculation, which was to have exemplified what poetry should be, just as the 18th century Oxford poem on Smallpox Inoculation exemplified what poetry should not be. It was clearly more than the difference ’twixt tweedle-dum and tweedle-dee. Writing to Dr Jenner on 27 Sept. 1811, from 7, Portland-place, Hammersmith, he said: “Dear Sir, I take the liberty of intruding on your time, first, to ask you where and in what publication I shall find the best and fullest history of the vaccine matter as the preventive of the smallpox. I mean the year in which the thought first suggested itself to you (and surely no honest heart would suspect me of the baseness of flattery if I had said, inspired into you by the All-preserver, as a counterpoise to the crushing weight of this unexampled war), and the progress of its realization to the present day. My motives are twofold: first and principally, the time is now come when the ‘Courier’ ... is open and prepared for a series of essays on this subject; and the only painful thought that will mingle with the pleasure with which I shall write them is, that it should be at this day, and in this the native country of the discoverer and the discovery, be even expedient to write at all on the subject. My second motive is more selfish. I have planned a poem on this theme, which after long deliberation, I have convinced myself is capable in the highest degree of being poetically treated, according to our divine bard’s [Milton’s] own definition of poetry, as ‘simple, sensuous, (i.e. appealing to the senses by imagery, sweetness of sound, &c.) and impassioned, &c.’” The Life of Edward Jenner, M.D. By John Baron, M.D. 2 vols. II. 175.

[1127] Edin. Med. and Surg. Journ. I. 507.

[1128] Jenner to James Moore, 26 Feb. 1810, in Baron, II. 367.

[1129] Walker to Lettsom, 1 Sept. 1813, in Pettigrew’s Memoirs of Lettsom. Lond. 1817, III. 350.

[1130] Dr Smith to Dr Monro, Dunse, 2 June, 1818, in Monro’s Obs. on the different kinds of Smallpox, 1818. There appears to have been some reluctance to face the facts. “Though I have seen,” says Smith, “a multitude of cases in which smallpox has in every possible shape taken place after vaccination, I feel myself placed in the painful situation [why painful?] of bringing forward many facts to which gentlemen of the first eminence in the profession will probably give little or no credit.”

[1131] Lond. Med. Repository. Sept. 1822.

[1132] J. J. Cribb, Smallpox and Cowpox. Cambridge, 1825.

[1133] Ibid. Letter of Rev. R. Marks, of Great Missenden, 6 May, 1824: “The summer I came here the smallpox was introduced, and as the weather was very hot, and the confluent sort was what appeared, the people began to die almost as fast as they took the plague. Great prejudice prevailed against vaccination, in consequence of the parish having some years ago been vaccinated by a gentleman who knew nothing of the matter, and contaminated the people with decomposed virus, when it was good for nothing but to make ulcers and produced very wretched arms, and left them all liable to smallpox, which they were all inoculated for the same year.” This clergyman subsequently vaccinated 500 cases, and the parish surgeon 300: “and here,” says the former, “I had the happiness of seeing the plague and destruction of a most horrid smallpox completely stopped.”

[1134] Robert Ferguson, M.D. A Letter to Sir Henry Halford, proposing a method of Inoculating the Smallpox, which deprives it of all its Danger, but preserves all its Power of Preventing a Second Attack. London, 1825.

[1135] John Roberton, Observations on the Mortality and Physical Management of Children. London, 1827, p. 59, note.

[1136] J. Dalton, “Smallpox as it prevailed at Bury St Edmunds in 1825.” Lond. Med. and Phys. Journ. May, 1827, p. 406.

[1137] Cribb, u. s.

[1138] “Observation on Smallpox as it has occurred in London in 1825.” Med. and Phys. Journ. Feb. 1826, p. 117.

[1139] Med. and Phys. Journ. 1826, p. 122. “The general voice of the public satisfactorily showed that the upper ranks of society suffered during the past year from smallpox much less than the lower.”

[1140] Gregory, Report on the Smallpox Hospital, 4 Dec. 1825.

[1141] Farr, in the First Report of the Registrar-General (1839, p. 100), said: “It may be safely asserted that the parish clerks registered little more than half the deaths that occurred within the limits of the London bills of mortality.” Outside the limits of the bills there were large parishes, such as St Pancras, Marylebone, Kensington and Chelsea, which had large mortalities from smallpox in the first years of registration.

[1142] Tables in Murchison’s Continued Fevers of Great Britain.

[1143] Med. Chir. Trans, XXIV. 15. His other papers are: “Cursory Remarks on Smallpox as it occurs subsequent to Vaccination,” ibid. XII. 324; and “Notices of the Occurrences at the Smallpox Hospital during the year 1838,” ibid. XXII. 95. He contributed the treatise on Smallpox to Tweedie’s Library of Medicine, I. 1840, and indicated his final opinions (which are interesting) in his Lectures on the Eruptive Fevers, 1843.

[1144] Kenrick Watson, “Medical Topography of Stourport and Kidderminster.” Trans. Prov. Med. and Surg. Assoc. II. 195.

[1145] John Roberton, “On the Increasing Prevalence of Smallpox after Vaccination.” Lond. Med. Gaz. 9 Feb. 1839, p. 711. Roberton had been a warm supporter of the Jennerian method from as early a date as 1808, when he was resident in Edinburgh, and again in his book on The Mortality of Children, in 1827. The above cited paper is somewhat satirical, the disappointing facts of it being referred to the Island of Barataria. His conclusions are (p. 713): (1) “It is not fact, but conjecture, that the protective power of cowpox gradually ceases in the human system. (2) It is not fact, but conjecture, that a person successfully re-vaccinated is less liable to smallpox than he was before. (3) To affirm that, when re-vaccination fails in individuals, they are thereby proven to be secure from smallpox, is conjecture.”

[1146] Cowan, “On the Mortality of Children in Glasgow,” Glas. Med. Journ. V. (1831), p. 358, does not give Cleland’s figures, but says: “No bills of mortality except those for the Royalty in the Glasgow Courier are in existence for the period from 1812 to 1821”; and again: “Finding that the suburbs were excluded, and the Calton being the burying-place in which the greatest number of children are interred, I thought it needless to insert any tabular view of the deaths by measles since the date of Dr Watt’s tables.” Watt could have made no tables if he had not gone direct to the sixteen MS. volumes of burial registers, including those of the Calton.

[1147] J. C. Steele, Glas. Med. Journ. N. S. I. 60: “From 1812 to 1835 it is much to be regretted that no record of the deaths from smallpox has been kept for even a limited period.”

[1148] Glas. Med. Journ. I. 105: “There exists at present among the poorer classes an increasing carelessness and aversion to vaccination, from a belief that it does not afford adequate protection from the varioloid disease.”

[1149] Andrew Buchanan, M.D. “Present Condition of the Poor in Glasgow.” Glasg. Med. Journ. III. (1830), 437.

[1150] Chalmers had been urging the repeal of the Corn Law since 1819. In a letter to Wilberforce, Glasgow, 15 Dec. 1819, he says: “From my extensive mingling with the people, I am quite confident in affirming the power of another expedient to be such that it would operate with all the quickness and effect of a charm in lulling their agitated spirits--I mean the repeal of the Corn Bill.” Hanna’s Memoirs of Dr Chalmers, 1850, II. 250.

[1151] J. Orgill, “Obs. on the Measles and Smallpox that prevailed epidemically in Stranraer, in the autumn of 1829.” Glasg. Med. Journ. IV. 351.

[1152] McDerment, ibid. IV. 201.

[1153] Howison, ibid. V. 256-7.

[1154] J. C. Steele, Glasg. Med. Journ. N. S. I. 59.

[1155] Eleventh detailed Report of the Regr.-Genl. for Scotland, 1865, p. xxxix. The Report says that vaccination was general during the above period, although there was no Vaccination Act for Scotland (until 1864). This was familiar knowledge in Scotland, so much so that the necessity for a compulsory law, on the English model, was not quite obvious in the medical circles of Edinburgh. See Christison’s address to the Social Science Association at Edinburgh in 1863 (p. 106). In my own recollection of Aberdeenshire, the vaccination of infants was as little neglected as their baptism; the law made no real difference.

[1156] “An Enquiry into the Mortality among the Poor in the City of Limerick.” Journ. Statist. Soc. Jan. 1841, III. 316.

[1157] The Census of Ireland, 1841. Parl. Papers, 1843. Report on the Tables of Deaths, by W. R. Wilde.

[1158] From the Second Report of the Registrar-General, Lond. 1840, p. 180.

[1159] 1840.

1st qr. 2nd qr. 3rd qr. 4th qr.

Liverpool 172 184 90 85 Bath 25 42 22 8 Exeter -- -- 1 1 Bristol 6 54 49 76 Clifton 11 28 22 42

[1160] Douglass to Colden, 1 May, 1722, in Massach. Hist. Soc. Collect. Series 4, vol. II. p. 169.

[1161] Philip Rose, M.D., Essays on the Smallpox. London, 1724, p. 76.

[1162] Rev. R. Houlton, App. to A Sermon in Defence of Inoculation, Chelmsford, 1767, p. 59: “For, had the indictment been found, he would have assuredly nonsuited his enemies, and have proved beyond a possibility of doubt that he never brought into Chelmsford a patient who was capable of infecting a bystander, notwithstanding such person would convey infection by inoculation. However paradoxical this may seem, it is truth, and would have been proved to a demonstration.”

[1163] Darwin, Animals and Plants under Domestication, II. 356: “From these facts we clearly see that the quantity of the peculiar formative matter which is contained within the spermatozoa and pollen-grains is an all-important element in the act of fertilization, not only for the full development of the seed, but for the vigour of the plant produced from such seed.”

[1164] J. C. Lettsom, M.D., A Letter to Sir Robert Barker, F.R.S. and G. Stackpoole, Esq. upon General Inoculation. London, 1778, p. 8.

[1165] W. Black, M.D., Observations Medical and Political on the Smallpox, etc. London, 1781, p. 103.

[1166] “But, in the cowpox, no pustules appear, nor does it seem possible for the contagious matter to produce the disease from effluvia, or by any other means than contact, and that probably not simply between the virus and the cuticle; so that a single individual in a family might at any time receive it without the risk of infecting the rest, or of spreading a distemper that fills a country with terror.”

[1167] Parliamentary Papers, 1807, 8th July.

[1168] Bateman, Reports etc. 1819, p. 102. The principle of the Common Law on which the judgment rested was, “Sic utere tuo ut alienum non laedas.”

[1169] Joseph Adams, An Inquiry into the Laws of Epidemics, with Remarks on the Plans lately proposed for Exterminating the Smallpox. London, 1809. The Edin. Med. and Surg. Journal (VI. 231), in a long review of this essay, declared that Adams was inconsistent in reaffirming his old faith in cowpox and at the same time demanding liberty for the inoculators.

[1170] J. C. Steele, M.D., “Increase of Smallpox in Glasgow.” Glas. Med. Journ. N. S. I. 59. The Paris figures are cited from the Annuaire pour l’an 1852-53.

[1171] I do not, of course, answer for the correctness of Gregory’s statements.

[1172] Lancet, 12 Dec. 1838.

[1173] 409 of these in Sheffield.

[1174] There are two notable exceptions, marked †, Lancashire and Yorkshire; but, in regard to their higher mortality from smallpox in 1837-40, it should be kept in mind that they were the chief scenes of the great distress among the working class in those years, the same causes which produced an enormous mortality from typhus fever in adults having tended to increase the fatality of smallpox among the children.

[1175] In the first universal and very fatal epidemic of measles, that of 1808, a good many adults, who had not had measles before, were attacked. See the chapter on Measles.

[1176] The accounts by Fothergill, Wall and others, of the malignant sore-throat with scarlet rash about 1740 give prominence to cases in early manhood or womanhood.

[1177] Supplement (Decennial) to the 45th Report of the Regr.-Genl. 1885, p. cxii.

[1178] The figures for 1721 are cited above (p. 485) from Douglass and others. Those for 1752 are given in the Gent. Magaz. 1753, Sept., p. 413, as “collected from the Accounts of the Overseers in the Twelve several Wards,” and sent by the Rev. T. Prince.

[1179] Supplementary Report of the Registrar-General, 1883. The mean death rate per 1000 living, for the period 1838-82, has been 71·0 males, and 61·2 females under five years of age; but as late as 1878 the annual average was the mean of the period, namely 71·2 males and 61·1 females.

[1180] Lettsom (Gent. Magaz. 1804, Aug. p. 701), in a preface to Neild’s papers on the state of the prisons, estimated that 40,000 lives might be saved every year in England by preventing infectious fevers, “for in this metropolis my respectable friend Thomas Bernard, Esq., whose caution and accuracy no person will doubt, calculates the number of victims at 3000 each year [doubtless from the London Bills of Mortality].... If to this pleasing view we add the preservation of 48,000 victims to the smallpox, which may now be preferred by the cowpox, we have in our power to possess the sublime contemplation of forming a saving fund of human life of nearly 88,000 persons annually in this empire, by the exercise of reason, philanthropy and judicious policy.”

[1181] Duvillard, Tableaux etc. Paris, 1806.

[1182] Essay on the Principle of Population. Bk. IV. chap. 5.

[1183] Robert Watt, M.D. Treatise on Chincough, with Inquiry into the Relative Mortality of the Diseases of Children in Glasgow. Glasgow, 1813.

[1184] John Graunt, Natural and Political Observations upon the Bills of Mortality, London, 1662, says: “The original entries in the Hall books were as exact in the very first year [he probably means 1629, which is the first year of his own extracts from them, but the classification of deaths began in 1604] as to all particulars, as now; and the specifying of casualties and diseases was probably more.” The searchers, he explains, were in many cases able to report the opinions of the physicians, receiving the same from the friends of the deceased; while for certain causes of death, among which he includes smallpox, “their own senses are sufficient.”

[1185] Cal. Coke MSS. (Hist. MSS. Commis.) I. 21 June, 1628.

[1186] Sutherland Letters, in Rep. Hist. MSS. Com. V. 152.

[1187] Cal. State Papers, Domestic. Charles II. s. d. It appears from the Pyretologia by Drage, of Hitchin (1665), that the natural history of measles must have been familiar, for he mentions that its incubation period was from fourteen to fifteen days: p. 20.

[1188] Obs. Med. 3rd ed. (1675), Bk. IV. chap. 5.

[1189] Sydenham, Obs. Med. 1675, V. 3. “Morbilli anni 1674.” It entered almost every household, as on the last occasion, attacking infants more especially. It had some points of difference from the measles of 1670. The rash was less uniformly on the fourth day, now sooner, now later; it would come on the arms or trunk before the face; nor was it followed by the branny powdering which was as obvious in the measles of 1670 as it was usual to see it after scarlatina. Along with these anomalies of the rash, the consecutive fever and peripneumonia were also more severe, and a more frequent cause of death. But in the principal characters of measles the disease of 1674 was the same as that of 1670, and called for no fresh description. Among Sydenham’s patients were the children of the Countess of Salisbury, who all took measles in turn, and all passed through the attack and its sequelae without danger, under a particular regimen which is detailed. It is of great interest to see how this season of anomalous measles looks in the weekly bills, as in the above table.

[1190] Richard Morton, M.D. Pyretologia. 2 vols. Lond. 1692-94, I. 427. He places it in the year 1672 and in the six months of autumn and winter; and in another place (II. 71), where he cites clinical cases, he again gives the year 1672 as that in which measles “epidemice Londini publice grassabantur.” He compares the epidemic to a pestis mitior, and says that the disease had never been epidemic again to the date of his writing (1692-94). It is tolerably clear that, in writing twenty years after, he had forgotten the year and even the season--not the only error in dates in his work. Sydenham’s account of the great measles epidemic of spring and summer, 1674, was published the year after, and is exactly borne out by the weekly bills of mortality. Morton’s obvious mistake of the date is the subject of a refutation four pages long by Thomas Dickson, M.D., F.R.S., physician to the London Hospital, in Med. Obs. and Inquiries, IV. (1771), p. 266.

[1191] Fothergill (Gentleman’s Magazine, Dec. 1751) says, in a criticism of the Bills of Mortality: “If the body is emaciated, which may happen even from an acute fever, ’tis enough for them to place it to the article of consumption.” And of course they would do so the more readily if the acute fever, say measles, were past, and its sequelae had been the cause of death. Referring to Kidderminster in 1756, Johnstone says: “Measles at this time went through our town and neighbourhood: vast numbers of children died tabid.” It is to be remarked that the fever column is augmented but little during the measles of 1674, a fact which shows that the inflammatory causes of death, such as capillary bronchitis and pneumonia (specially recorded by Sydenham for this epidemic), were more apt to be entered under “consumption” than under “fevers.”

[1192] See Watson’s account of smallpox following measles at the Foundling Hospital, supra, p. 550.

[1193] It may have been this high mortality that Dover had in mind when he wrote, in 1733: “I do not remember I ever heard of anyone’s dying of this disease [measles] till about twenty-five years since; but of late, by the help of Gascoin’s powder and bezoartic bolusses, together with blisters and a hot regimen, the blood is so highly inflamed and the fever encreased to that degree that it is become equally mortal with the smallpox.” Physician’s Legacy, 1733, p. 116.

[1194] Memorial to the House of Commons, supra, p. 84.

[1195] Edin. Med. Essays and Obs. V. 26.

[1196] Pronounced by Sims to have been wholly scarlatina, and by Willan to have been in part that disease.

[1197] Monthly reports in the Gentleman’s Magazine, under the dates.

[1198] Heberden’s paper on measles in Trans. Col. Phys. III. (1785), pp. 389, 395.

[1199] W. Black, M.D., Obs. Med. and Political on the Smallpox, &c. London, 1781, p. 207: “Few escape measles in infancy or childhood, and as we find one-tenth fewer to die of measles than of smallpox, etc.... In their future consequences, measles, especially in cities, are not without hazard, and are not unfrequently followed by hecticks.”

[1200] Percival, in Med. Obs. and Inquiries, V. (1776), p. 282.

[1201] Omitting the year 1760.

[1202] Compiled from the tables in the Gentleman’s Magazine, 1742-57. All Saints parish contained more than half the population.

[1203] Pearce, writing from St Croix, West Indies, 12 Oct. 1782, to Lettsom (Memoirs, III. 429), says the measles had been “very rife and fatal” there.

[1204] MS. Apothecary’s Books at the Foundling Hospital.

[1205] R. Willan, M.D., On Cutaneous Diseases. Vol. I. 1808, p. 244.

[1206] Heysham, u. s., p. 538.

[1207] James Lucas, “On Measles.” Lond. Med. Journ. XI. 325, dated 22 Aug. 1790.

[1208] Reports on the Diseases of London, 1796-1800. Lond. 1801, pp. 2, 13, 18, 32, 229.

[1209] John Roberton, in Med. and Phys. Journ. XIX. 185. Measles seems to have been more usual than scarlatina in Scotland as well as in Ireland. In the accounts of the several parishes written for the Statistical Account, about 1791-99, measles is often mentioned (and would appear at that time to have been more usual in country districts than smallpox), while hardly anything is said of scarlatina under that name, and not much of sore-throat.

[1210] Med. and Phys. Journ. VII. (1802), p. 316.

[1211] “Observations on Measles.” By Mr Edlin, surgeon, Uxbridge. Med. and Phys. Journ. VIII. (July-Dec. 1802), p. 28. An earlier epidemic of anomalous eruptive fever (“dark coloured eruption of the neck and breast which spread at length over the whole body”) was described for Uxbridge and its vicinity in the summer and autumn of 1799, in an essay reviewed in British Critic, XV. 435.

[1212] T. Bateman, M.D., Report on the Diseases of London, 1804-16. Lond. 1819, p. 90-91.

[1213] Samuel Fothergill, M.D., and others, in Med. and Phys. Journ. XVIII. (Dec. 1807), pp. 569, 572; XIX. 91, 185.

[1214] “The Epidemic Measles of 1808.” By Dr Ferguson. Med. and Phys. Journ. XXI. 359.

[1215] John Roberton, Med. and Phys. Journ. XIX. 182, 272, 278, 471.

[1216] Roberton, loc. cit. XIX. 471.

[1217] In the earlier period, according to Grainger, Lind and others, numerous cases of measles sometimes occurred on board ships of war.

[1218] Published as an Appendix to his Treatise on the History, Nature and Treatment of Chincough. Glasgow, 1813. Reprinted by John Thomson, Glasgow, 1888. Dr Watt is best known by his Bibliotheca Britannica (Edinburgh, 1819. 4 vols. 4to.), a wonderfully complete bibliography under the dual arrangement of subjects and authors, which is still indispensable for research in every branch of knowledge. Perhaps the many who use it are not all aware that it was the labour of a physician in Glasgow (originally a surgeon at Paisley), who died (in 1819) at the age of forty-five, having reached such professional distinction in his own city as to be elected President of the Faculty of Physicians and Surgeons.

[1219] De Febribus, 1659. Cap. XV.

[1220] Sketch of a Plan to exterminate the Casual Smallpox, &c. London, 1793, p. 152.

[1221] It was believed that smallpox left ill effects in some constitutions. William III. is said to have had the dregs of smallpox in his lungs. Roberton (u. s.) cites Saunders as teaching that smallpox caused scrofula, and he is himself doubtful whether an attack of it ever improved the constitution. Dr Moses Younghusband, of New Lebanon Springs, Med. Phys. Journ. XI. (1804), 317, wrote: “I see no more of the glandular suppurations formerly so frequent and unavoidable” after smallpox.

[1222] Johnstone, Malignant Epidemic Fever of 1756, London, 1757, says of Kidderminster during a season of high mortality from fever and other diseases: “The measles at this time went through our town and neighbourhood. The children commonly got over the usual course of this distemper; but vast numbers died tabid of its consequences. The chincough succeeded the measles.”

[1223] The Edin. Med. and Surg. Journ. XXVI. 177, cites from Cleland, with a reference which I have not succeeded in verifying, the following Glasgow figures for the period 1813-19: all deaths 22,060, smallpox 236 (1·07 per cent.), measles 614 (3·69 per cent.). But see Cowan, Glas. Med. Journ. V. 358, supra, p. 597.

[1224] Cowan, Journ. Statist. Soc. III.

[1225] Griffin, ibid. III.

[1226] Macmichael, in an essay on scarlatina and other contagions, 1822, says: “Parents considering the measles as a disease almost inevitable have wisely chosen to expose their children to the contagion at such auspicious times [summer season]; so that the disorder may be once well over, and all further anxiety at an end.” p. 30.

[1227] P. Macgregor, Med. Chir. Trans. V. 436, obtained from Henry, of Manchester, the burials from measles at the Collegiate Church and St John’s Church for two years, 1812-13, which when compared with those abstracted by Percival from the former register for twenty years, 1754-74, showed a higher ratio of measles to the burials from all causes.

[1228] Cross, u. s.

[1229] Delagarde, Med. Chir. Trans. XIII. 163.

[1230] A. Campbell Monro, M.D., “Measles: an Epidemiological Study.” Chiefly from the Jarrow statistics. Trans. Epid. Soc. N. S. X. (1890-91), p. 94. The author connects the recent increase with the greater concourse of children to infant and elementary schools under the Education Act.

[1231] Rep. Reg.-Genl. LIV. p. xviii, and LV. p. xi. The explanation given is as follows: “When a county or other area has been visited by a severe epidemic [of measles] there is for several succeeding years scarcely sufficient material, in the shape of unprotected children, for another considerable outbreak, unless it be in very populous areas such as London or Liverpool; and in such places the disease is endemic.”

[1232] Buchan and Mitchell, Journ. Scot. Meteor. Soc. July, 1874, p. 194.

[1233] Ogle, in the 47th Report of the Registrar-General (for 1884), p. xv.

[1234] Cited by Hirsch, Geogr. and Histor. Pathology. Eng. transl. III. 28.

[1235] Harl. MSS. No. 2378. Moulton’s This is the Myrour or Glasse of Health, circa 1540, is in the main a printed reproduction of this manuscript prescription-book. The same receipt which is “for ye kink” in the one, is “for the chyncough” in the other (formula LXXIX.).

[1236] “Sycknesses happenynge to children:--When they be new borne, there do happen to them sores of the mouth called aphte, vometyng, coughes, watchinge, fearefulness, inflamations of the nauelle, moysture of the eares. When they brede tethe, ytchinge of the gummes, fevers, crampes and laskes. When they waxe elder, than be they greved with kernelles, opennesse of the mould of the head, shortnesse of wynde, the stone of the bladder, wormes of the bealy, waters, swellynges under the chynne, and in Englande commonly purpyles, measels and small pockes.”

[1237] Obs. Med. 3rd ed. Bk. IV. chap. V. § 8; Epist. Respons. I. § 42.

[1238] Mary Barker at Hambleton, to Abel Barker at the Dog and Ball in Fleet Street. Hist. MSS. Commis. V. 398.

[1239] Tractatus de morbis acutis infantum. Lond. 1689. Englished by W. Cockburn, M.D. London, 1693, pp. 38, 78, 87.

[1240] Gent. Magaz. 1751, pp. 195, 578.

[1241] Treatise on Chincough. Glasgow, 1813.

[1242] Vierordt, Physiologie des Kindesalters, Tübingen, 1877, p. 82, without adducing evidence that the larynx is congenitally different in the two sexes (a matter of very nice measurements which even Beneke does not appear to have attempted), says that the development of the posterior glottidean space has advanced before puberty much more in boys than in girls. Stark, a former Superintendent of Statistics for Scotland (Rep. Reg. Gen. Scot. for 1856, p. xxxviii), has raised the question thus: “The causes of this greater liability of the female sex to death while suffering from whooping-cough are worthy of being investigated. So far as one’s own limited experience goes, it would appear to be produced by the greater tendency which the female sex exhibits to have fits or convulsions when attacked by a paroxysm or fit of coughing in that disease.”

[1243] Changes in the Air, &c. ... in Barbadoes. Lond. 1760.

[1244] In the Irish Decennial Summary for 1871-80 (Suppl. to 17th Report of Reg.-Gen. Ireland, 1884) it is said: “A general relation has been noticed by many observers between the prevalence of whooping-cough and measles, and there is no doubt that in many localities an epidemic of measles is frequently accompanied by or followed by a prevalence of whooping-cough. A comparison of the figures in Table XV. does not point to any very close relationship. Whooping-cough was a much more fatal disease than measles, but it is more than probable that measles was equally prevalent.”

[1245] Illustrations of Unconscious Memory in Disease. London, 1886 [1885]. Chapter VI. pp. 64-83.

[1246] Med. Times and Gaz. 1885, II. p. 6.

[1247] Preface to 3rd ed. of Obs. Med., Greenhill’s ed. p. 16.

[1248] Sydenhami Opera, ed. Greenhill, 1844, p. 243.

[1249] Maton, Med. Trans. Col. Phys. V., having seen an extensive epidemic attended by a red rash in one of the great public schools, was disposed to erect it into a new type of roseola, owing to its mildness, while he admitted that it was the same as Sydenham’s scarlatina simplex. Macmichael (New View of the Infection of Scarlet Fever, 1822, p. 78) thought that this was “rather a proof of extreme refinement,” and that there was no need to give it a new designation. Gee, Brit. Med. Journ., 1883, II. 236, cites this “refinement” of Maton’s as one of the noteworthy things in the history of the diseases of children in this country.

[1250] Sir Robert Sibbald, M.D., Scotia Illustrata, sive Prodromus Historiae Naturalis. Edin. 1684. Lib. II. cap. 5, p. 55.

[1251] Richard Morton, M.D. Pyretologia. 2 vols. London, 1692-94, II. 69.

[1252] Engl. transl. 1737, p. 80. The reference by Dover (Ancient Physician’s Legacy, 1732, p. 117), is almost in the words of Sydenham, his master: “This is a fever of a milder kind than the measles [of which latter he did not remember anyone’s dying till about twenty-five years since], and does not want the assistance of a doctor. The skin seems to be universally inflamed, but the inflammation goes off in forty-eight hours.”

[1253] Edin. Med. Essays and Obs. III. 26.

[1254] Obs. de aere et morb. epid.

[1255] H. Warren, M.D., On the Malignant Fever in Barbados. London, 1740, p. 73.

[1256] Le Cat, in Phil. Trans. XLIX. 49: In 1736 and 1737, a prevalence of gangrenous sore-throats which chiefly attacked children. They reappeared in 1748 in young persons of the first distinction, not only at Rouen, but also at St Cyr, near Versailles, and at Paris.

[1257] Webster, Brief History of Epidemick and Pestilential Diseases. Hartford, 1799, II. 253: “Away, then, with crowded cities--the thirty feet lots and alleys, the artificial reservoirs of filth, the hot-beds of atmospheric poison! Such are our cities--they are great prisons, built with immense labour to breed infection and hurrying mankind prematurely to the grave.”

[1258] W. Douglass, M.D., The Practical History of a New Epidemical Eruptive Miliary Fever, with an Angina Ulcusculosa, which prevailed in New England in the years 1735 and 1736. Boston, N.E. 1736. This rare essay was reprinted in the New England Journ. of Med. and Surg. XIV. 1 (Jan. 1825).

[1259] In Belknap’s History of New Hampshire. Boston, 1791.

[1260] Gent. Magaz. Feb. 1752, p. 73.

[1261] The account by Kearsley, of Philadelphia, written about 1769 (Gent. Magaz. XXXIX. 251), refers to a great epidemic of throat-disease in New England in the spring, summer and autumn of 1746; but the date is almost certainly a mistake for 1736, as no such epidemic is known on contemporary authority.

[1262] Cadwallader Colden, M.D. “Letter to Dr Fothergill on the Throat Distemper,” dated New York, 1 Oct. 1753, in Med. Obs. and Inquiries, I. 211.

[1263] Belknap, III. 421.

[1264] Samuel Bard, M.D. “An Inquiry into the Nature, Cause and Cure of the Angina Suffocativa, or Sore throat Distemper, as it is commonly called by the inhabitants of this city and colony.” Trans. Amer. Philos. Soc. I. (1769-1771). Philad. 1771, p. 322. What purports to be a translation of this, is given in Reutte’s Recueil d’Obs. sur le Croup (Paris, 1810), the name of “croup” being introduced into the title, and some strange liberties taken with the text.