Chapter I · (continued 4)

Exactly covering the period of these fevers at Rouen, there were low putrid fevers in London, in Worcestershire, in Ireland, and among the English colonists in Barbados. It was certainly not a mere fashion in medicine which produced the accounts of a similar fever, for these accounts came from places far apart and were independent of each other. Dr Fothergill, of Lombard Street, published in the Gentleman’s Magazine every month for five years a short account of the weather and prevalent diseases of London, beginning with April, 1751, and ending with December, 1755. He had the weekly bills of mortality before him, and he makes various comments upon them; but his accounts of prevalent diseases are from his own observation and by way of illustrating the bills. His first reference to a fever is under October, 1751: “A slow continual fever, with acute pain in the forehead: not many attacked, few mortally.” The year 1752 was remarkably free from fevers until November, when we read of a fatal fever which had rheumatic symptoms at first (as at Rouen in 1744), attacking the head later, with coma-vigil and a dark-coloured ichor on the tongue and lips. It continued into January and February, 1753, proving fatal to several. In the summer and autumn months there were fevers of the low, depressed kind, sometimes called “remittents,” with copious sweats, or “slow, remitting, dangerous fever,” or “slow, treacherous, remittent fever, too often fatal.” The references to it are most numerous in the months from November, 1753, corresponding to Le Cat’s Rouen narrative. It was slow and imperceptible in its approach, the sick often going about ill for a week before seeking advice; it was attended with profuse sweats which never relieved, and was fatal to many. It continued more or less through the summer, and from August, 1754, it is again prominent. In September, it was the most alarming form of disease, and was then commonly vehement in its access, with lassitude, and pain in the head and back; unrelieving sweats are again mentioned, with dry tongue, delirium, coma-vigil, and death about the 14th-15th day. Fothergill was at a loss to know whether he should order blood to be drawn, owing to the low depressed nature of the fever. In February, 1755, the fever is still “too much of the nature of those which prevailed in the preceding months to allow a repetition of bleeding.” In April it is called the petechial and miliary fever, the miliary eruption being of a white sort with a very noisome scent; the petechial spots turned livid, black and gangrenous; few patients escaped who had been sweated at the beginning. The fever was truly malignant, the patient restless from the outset, the sweats weakening. Fothergill’s last entries of it are important, under the months of May and June, 1755. In May, 1755, the fevers were “for the most part allied to that dangerous remittent which has for some years past more or less prevailed in different places of this kingdom.” In June: “It does not appear that either in the hospitals or any part of the city a disease has broken out of so dangerous a nature as has been reported. The same kind of fever that has long continued in this city with some small variations in its type, still remains, but it is by no means more frequent than it has been in the preceding months, nor is it attended with more unfavourable symptoms.”

It is impossible to say how general over England this fever may have been in the years 1751-57. Our fullest accounts come from Worcestershire; but the putrid fever is heard of more widely. Thus a short Latin piece in the Gentleman’s Magazine, dated 14 April, 1755, is on the putrid fever lately epidemic, and not yet extinct, in some parts of the county of Somerset and adjoining places; its signs were contagiousness, pains of the head and loins, nausea and vomiting, diarrhoea, quick weak pulse, purple spots, delirium and coma[214]. Grainger, writing from Edinburgh in 1753, declares his motive for publishing an account of the anomalous fever of the Netherlands in 1746-48 to be that the same had lately been raging over almost the whole of Britain.

We have some particulars for Kidderminster, which can hardly have been exceptional for an industrial town, and according to the accounts were true also for villages and market towns near. Kidderminster was, in the year 1756, a town of about four thousand inhabitants, mostly hand-loom weavers of worsted and silk. There were no power-looms anywhere in England at that time; and the condition of the Kidderminster weavers’ houses was doubtless what that of the Tiverton community had been fifteen years before. Many of the weavers, we are told, are lodged in small nasty houses, for the most part crowded with looms and other utensils[215]. Many of these houses were built on a low flat of the river Stour, whence rose putrid vapours after floods. Its situation had served to render the town specially unhealthy before, as in the epidemic of 1727-29[216].

The first notice by Dr Johnstone is of a low miliary fever from Midsummer 1752 to the end of the year. This was a comparatively mild affair, although it carried off several. But after Christmas it was succeeded by a fever which would then have been classed as of the putrid kind. The first great season was in 1753, it ceased in the fine years 1754-55, but came back in 1756 and 1757. It began with languor, lowness, flutterings, faintness, vague pains in the limbs, a low quick pulse, giddiness and slight sickness. Some had a propensity to loose stools and to profuse hurtful sweats; some bled at the nose, others coughed and spit blood; some had pain in the throat, and crimson-red tongue, the sweat and breath of the sick had a strong, offensive, putrid smell. In some of the worst cases livid petechiae, large livid blotches, and dark brown spots occurred over the trunk and limbs. The successful treatment was by mineral acids, bark, port wine, and vesication. “This malignant fever was very often (though not constantly) complicated with, and in general bore great analogy to the malignant sore-throat which at this time prevailed in many parts of England.” The fever which prevailed during that remarkable year (1753) was very evidently contagious, for whole families were either all together or one after another seized with it. One of the most distinctive symptoms was a tendency to trembling of the whole body, as well as leaping of the tendons at the wrists. In some the tonsils were beset with aphthous sloughs, and towards the decline there would be aphthae of the mouth, but symptomatic only, and not the dominant lesion as in the ulcerous sore-throat. About the 15th day the fever was generally at its height. The miliary eruptions were critical to the few that had them; the flat livid petechiae appeared at all times of the disorder. Johnstone then compares the fever with that described by Le Cat at Rouen in the winter of the same year; and although he had been unable to satisfy his curiosity by opening any body dead of the fever, he felt sure that these dreadful symptoms arose from some affection of the stomach and small guts, at first erysipelatous, afterwards gangrenous, and at last truly sphacelous.

Johnstone’s statement that the putrid fever in Worcestershire in 1752-53 was often complicated with and bore great analogy to the malignant sore-throat is borne out by Huxham’s accounts for Plymouth during the same season:

“In all sorts of fevers,” he writes, “there was a surprising disposition to eruptions of some kind or other [including miliary], to sweats, soreness of throat and aphthae.” It is hardly possible to make out all his cases of “malignant anginose fever” to have been scarlet fever with sore-throat. Thus there occurred stench, swelling, and samious haemorrhages “commonly in those that died of malignant anginose fever above described. I have known the whole body swell vastly, even to the ends of the fingers and toes, with a cadaveric lividity, though almost quite cold, and an intolerable stench, even before the person was actually dead, blood issuing at the same time from the ears, nose, mouth and guts[217].”

The first years of this putrid or miliary fever were not seasons of scarcity, there having been no failure of the crops since 1741 (unless in Ireland, in the province of Ulster mostly, in 1744); on the contrary, many of the seasons had been unusually fine and abundant, the exports from England of wheat, barley, malt and rye in the three years 1748, 1749 and 1750 amounting to four million quarters. Prices were at the same time favourable to the poorer classes[218]. But there had been a destructive murrain for several years (30,000 cows are said to have died in Cheshire in 1751), and the harvest of 1756 was a failure.

To the month of February, 1756, the season had been very forward, but the early promise of spring was blighted by cold, a wet summer and autumn ensued, the fruit crop was ruined, and the corn harvest spoiled by long, heavy rains. A dearth, bread-riots, &c. ensued[219]; but it is to be noted that the revival of the dangerous malignant contagious fever began at Kidderminster as early as April, becoming much worse after harvest. “Many for weeks or months laboured under an uncommon depression of spirits, felt their strength abate, with great lassitude, and very often a great proneness to faint away.” As the summer advanced the fever became truly epidemic not only in Kidderminster but in many other parts of the West and North-west of England.

It went through whole families, who succumbed either all together or one member after the other, and was carried from place to place by the attendants on the sick. “It prevailed chiefly in poor families, where numbers were lodged in mean houses, not always clean, but sordid and damp. It seemed to affect such poor families most where there was reason to think a sufficiency of the necessaries of life, on account of the dearth, had for some time been scantily supplied; yet the other poor persons, given to the intemperate use of malt liquors and ardent spirits, were observed to be very much liable to its influence. And not a few persons in easy circumstances of life were affected with this fever like others.”

Frost in October checked it, and then measles of a malignant type had its turn among the children, the whooping-cough succeeding the measles. From November to Christmas the putrid fever, which chiefly affected persons from ten to fifty, and more women than men, returned with increased force. In fatal cases, the face was ghastly, sunken and livid (the facies Hippocratica), the patient sweated profusely, but seldom became cold till death was at hand. There was an abominable cadaverous stench in the breath, perspiration and stools. In these cases death took place from the 12th to the 14th day.

The intense and long frost of the opening months of 1757 nearly put a stop to the fever at Kidderminster.

“But in other neighbouring villages and market towns it has since the spring hitherto (Dec. 1757) been very frequent in places that were little affected with it last year. The families of the poorer sort of people universally are the most subject to it. And it is observable that the fever in some places first broke out in the parish workhouses, and from thence spread among the neighbouring people with great malignity. Wherever it has appeared it has given very apparent and fatal evidence of its infectious nature[220].”

Parliament was summoned to meet in December, 1756, on account of the dearth, which formed the topic of the Speech from the throne. The export of corn (which had reached a million quarters a year not long before) was prohibited, and the use of grain in distilling stopped for two months. The distress was more acute in 1757, and was enhanced by the greed of corn-dealers and millers, who used French bolting-mills to grind the mere husks of wheat, pease, rye and barley together into meal. Short, who practised at Sheffield, says that the fever in October and November, 1757, “was neither so rife nor fatal as in 1741[221].” It raged fiercely in several towns at a distance, “where it went by the name of the miliary fever,” and was mostly among the poor, half-starved in the dearth of 1756-57. It is heard of again in the district of Cleveland in the winter of 1759-60, where it seems to have been mostly a disease of children complicated with sore-throat, and allied more to scarlet fever than to the putrid fever of adults[222]. But at Sunderland, near at hand, there was spotted fever at the same time, and in Newcastle there was dysentery.

The accounts of fever in Ireland in the same period as in England (see chapter II.) are not without value, as showing that the “putrid” or nervous type of fever, contrasting with the ordinary typhus of the country, had been remarked there also. Rutty and Sims describe, during a certain period, the symptoms of the low, putrid fever, sometimes with miliary eruptions, identifying it both by name and in character with the fever then prevalent in England. The most significant thing in Rutty’s annals is that there occurred in the midst of the low, putrid fever with miliary pustules in 1746, a more acute fever, ending after five or seven days in a critical sweat, and relapsing. The same fever, not very fatal, reappeared in 1748. Sims brings the history of the nervous or putrid or miliary fever in Ireland (Tyrone) continuously down to the year 1772, as elsewhere related. The remarkable phenomenon of tremors or shakings, which most witness to, was seen by him in perfection in the year 1771:

The tremulousness of the wrists, he says, extended to all the body, “insomuch that I have seen the bed-curtains dancing for three or four days, to the no small terror of the superstitious attendants, who, on first perceiving it, thought some evil spirit shook the bed. This agitation was so constant a concomitant of the fever as to be almost a distinguishing symptom.” These were not the shakings of an ague, for there might be no intermission for days[223].

Perhaps the most surprising testimony to the existence of an “epidemic constitution” of slow, continued nervous fever comes from the island of Barbados. Hillary, who had kept a record of the prevalent diseases at Ripon, continued the same when he settled in Barbados in 1751[224]. There can be no doubt as to the appearance of this fever in February 1753, its prevalence all over the island for eighteen months, and its disappearance in September 1754, when, as he writes, “It now totally disappeared and left the island, and, I think, has not been seen in it since” (1758). He gives the same account of it as the observers in England and Ireland, except that he does not describe miliary eruptions and describes jaundice in convalescent children. It was insidious in its onset (as in London), the patient often keeping afoot five or six days; the symptoms included pains in the head, vertigo, torpor, lassitude, vigil, delirium, faintings, partial sweats, involuntary evacuations, gulpings, tremors, twitchings, catchings, coma and convulsions. Recovery was marked by copious equable sweats and plentiful spitting. “This slow, nervous fever was certainly infectious, for I observed that many of those who visited, and most of them that attended the sick in their fever were infected by it, and got the disease, and especially those who constantly attended them and performed the necessary offices of the sick.” It was last heard of in the remoter parts of the island.

Miliary Fever.

It will have been observed in the foregoing accounts of the predominant fevers of the years (roughly) from 1750 to 1760 that there was often a miliary eruption, but that it was far from constant. The constant things were the lowness, depression, ill-smelling sweats, tremors of the whole body or of the wrist-tendons, and other nervous or ataxic symptoms. But we hear more of a miliary eruption in connexion with that than with any other period of fevers in the history; and this was the time when a controversy arose as to whether there was in reality a distinctive kind of fever marked by miliary eruption. Some of the school of Boerhaave contended that the phenomenon of miliary vesicles was due solely to the heating and sweating treatment of the alexipharmac physicians. De Haën and others answered that miliary fever was a natural form, independent of the mode of treatment. The Boerhaavian contention may be admitted as good for such miliary fevers as were described under that name in 1710 by Sir David Hamilton[225]; nearly the whole of his sixteen cases appear to have been made miliary by treatment, in so far as they became miliary at all. What this physician did was to foretell the approach of miliary symptoms in various maladies (about one-half of the cases being of lying-in women, and the rest various), and then to prescribe Gascoign’s powder, Goa stone, Gutteta powder, Venice treacle or other diaphoretics, along with diluents and the application of blisters; the miliaria appeared about the breast, neck, and clefts of the fingers in due course (tenth to fourteenth day).

So far as his clinical cases are concerned, the late appearance of miliary vesicles, lasting a few days, is sufficiently explained by the powerful drenches administered; and it can hardly be doubted that much of what was called miliary fever was of that factitious kind. But even in Hamilton’s essay we find indications of a real miliary type of fever; thus he mentions a class of cases which look to be the same as those described by Johnstone, Rutty, Sims and others forty years after—cases with wakefulness, depression, tremblings of the tongue and hands, convulsive movements and delirium. He mentions also a complication of this with sore-throat in 1704, which destroyed many.

As to the association of miliary eruption with the low putrid fever so characteristic of the sixth decade of the 18th century, it is asserted by too many and in too various circumstances for any doubt as to its reality. There is nothing to show that the alexipharmac treatment was the one always used; and it is not certain that some in Ireland and elsewhere who had miliary eruption received any medical treatment at all. Again, miliary vesicles, not always with perspiration, were commonly found in the relapsing fever of Irish emigrants in London during the great famine of Ireland in 1846-47, by which time the powerful drenches of the alexipharmac treatment had been long disused[226]. The controversy as to the reality of miliary fever was one of the kind usual in medicine: certain physicians, of whom Hamilton in 1710 was an obvious instance, took up an untenable position; they were answered according to the weakness of their argument; and that has been held in later times to be an answer to all who alleged the existence of a type of fever marked by miliary eruptions. There can be no question as to a low, “putrid” kind of fever in which miliary eruptions were usual; but offensive sweats were perhaps more usual, whence the name of putrid in a literal sense, different from the theoretical sense of Willis; more constant also were the starting of tendons, the tremors and shakings, together with very varied hysteric symptoms, from which the fevers received the name of nervous. Dr John Fordyce in his ‘History of a Miliary Fever’ (1758) really describes under that name the symptoms of the low, nervous, putrid fever, often attended with miliary vesicles, which had been the common type in England in the years immediately preceding, and was a common type for some time after, although less is heard of the miliary eruptions in the later history[227].

About the last quarter of the 18th century medical writers were inclined to drop the names of nervous and putrid as distinctive of certain fevers. Pringle, in his edition of 1775, says he had been careful to avoid the terms nervous, bilious, putrid and malignant, which conveyed either no clear idea or a false one. Armstrong, another army physician, writing in 1773, says: “Nervous, putrid, bilious, petechial or miliary, they are all of the malignant family; and in this great town [London] these are almost the only fevers that have for many years prevailed, and do so still, to the great destruction of mankind. For inflammatory fevers ... have for many years been remarkably rare[228].” Dr John Moore becomes sarcastic over the variety of names given to continued fever, some such generic name as Cullen’s “typhus,” then newly introduced, being what he desired[229].

Haygarth, writing of the Chester fevers in 1772, said that the miliary fever had been “supposed” endemic there for more than thirty years past, but he thought it probable that the eruption had generally, or always, been fabricated “by close, warm rooms, too many bed-cloaths, hot medicines and diet.” He had seen only one case in the epidemic that year, and he believed its rarity at that time was due to the treatment by fresh air and by “such regimen and medicines as are cooling and check putrefaction[230].” We shall see later that Percival, for Manchester, contents himself with saying that miliary fevers, which were formerly very frequent in that town and neighbourhood, now [1772] rarely occur[231]. In Scotland as late as 1782 the type was still nervous or low, and hardly ever inflammatory[232].

Mortalities in London from fever and all causes.

Year Fever deaths All deaths

1741 7528 32169

1742 5108 27483

1743 3837 25700

1744 2670 20606

1745 2690 21296

1746 4167 28157

1747 4779 25494

1748 3981 23069

1749 4458 25516

1750 4294 23727

1751 3219 21028

1752 2070 20485

1753 2292 19276

1754 2964 22696

1755 3042 21917

1756 3579 20872

1757 2564 21313

1758 2471 17576

1759 2314 19604

1760 2136 19830

1761 2475 21063

1762 3742 26326

1763 3414 26148

1764 3942 23202

1765 3921 23230

1766 3738 23911

1767 3765 22612

1768 3596 23639

1769 3430 21847

1770 3214 22434

It is singular to observe that in the five successive years in this period with lowest fever-deaths and deaths from all causes, the years 1757-61 England was at war on the Continent. A similar low fever-mortality corresponded with the wars under Marlborough and Wellington.

The era of agricultural prosperity in England, which had its only considerable interruptions in the years 1727-29 and 1740-42, may be said to have met with a more serious check from the bad harvest of 1756. There was a recurrence of agrarian troubles in 1764-67, partly through actual scarcity caused by the extreme drought of 1764, partly through the pulling down of cottages and the discouragement of country villages, which Goldsmith has pathetically described in his poem of the time. Short says that the country in 1765 was in general very healthy but for children’s diseases. “In some parts the putrid fever roamed about from place to place in the highest degree of putrefaction, so as several dead bodies were obliged to be buried the same day as they died.” The price of provisions was excessive, meal riots broke out, and the export of corn was stopped, Parliament having been summoned for the occasion in November, 1766[233]. In 1769, at the time of the formation of Chatham’s ministry, the same train of incidents recurred,—bread-riots, flour-mills wrecked, corn and bread seized by the populace and sold at low prices, collisions with the military, the gaols full of prisoners[234]. The long period of cheapness, having lasted half a century, was coming to an end. Moralists and economists had much to say as to the meaning of the national distress which began to be felt in the sixties. Want of industry, want of frugality, want of sobriety, want of principle, said one, had brought trouble on the working class. “The tumults that have lately arisen in many counties of England are no other than the murmurs of the people, which have been heard for some years, bursting forth at last into riot and confusion.” The English, it seems, had returned to their old medieval taste for the best food they could get; they would not give up the finest bread, although the Irish lived on potatoes, and the French on turnips and cabbage: “The ploughman, the shepherd, the hedger and ditcher, all eat as white bread as is commonly made in London, which occasions a greater consumption of wheat.” Women must have tea and snuff, though children go naked and starved. Another writes: “The poorest people will have the finest or none.” The enclosures had made a want of tillage. “What must become of our poor, destitute of work for want of tillage?” The country had for the most part been sickly, labourers scarce, and the farmers not able to get their usual quantity threshed out. The profligacy of the poor, profane swearing, etc., are remarked upon[235].

In the last thirty years of the 18th century the accounts of fever in England became more detailed as to its circumstances, and more numerically precise. I shall accordingly bring together all that I can find relevant to fever in London, Liverpool, Newcastle and Chester, and thereafter in those towns, such as Manchester, Leeds, and others in the North, which were specially touched in their public health by the movement known as the Industrial Revolution.

Typhus Fever in London, 1770-1800.

In the London bills of mortality the item of fevers diminishes steadily during the latter part of the 18th century, the deaths from all causes diminish, the births come nearer to the number of the deaths, and in three years of the last decade they exceed them. This statistical result is doubtless roughly correct; but the bills were becoming more and more inadequate to the whole metropolitan area; and even for the original parishes which they included they have not the same value for fever in the later period as they had for plague at their beginning[236]. On the other hand, from about the year 1770 we begin to have more exact medical accounts of fever in London, which are not indeed numerically exhaustive, but good as samples of what was going on. Whatever improvement there was in the prevalence of typhus fever touched the richer classes. The Paving Act of 1766 is credited with having improved the health of the City, and there were many new streets and squares being built in the west end that were, of course, free from typhus. It is to these desirable residential quarters that the eulogies of Sir John Pringle[237], Dr John Moore[238] and others apply. The slums of London were as yet unimproved, and but little known to the physicians. Lettsom, who was one of the first of his class to visit among the poor in their homes, has much to say of typhus fever; but he is emphatic that it was nearly all an infection of the poor. “In the airy parts of this city,” he writes in 1773, “and in large, open streets, fevers of a putrid tendency rarely arise.... In my practice I have attentively observed that at least forty-eight out of fifty of these fevers have existed in narrow courts and alleys.” The same is remarked by Currie for Liverpool, by Clark for Newcastle, by Percival and Ferriar for Manchester, by Haygarth for Chester, and by Heysham for Carlisle.

The quarters of the rich had gradually become detached from those of the poor. I have shown this more especially for Chester, where the old walls made a clear division; but it was general in the second half of the 18th century[239].

Medical practice lay mostly among the richer classes; the physicians knew little of the state of health in the cellars and tenement-houses of large towns. Those physicians who did know how much typhus fever there was in these purlieus had to enter a caveat against the incredulity of the rest. Dr Currie of Liverpool, whose facts I shall give in their place, protested that he was not exaggerating; a protest the more necessary that a contemporary of his own, Mr Moss, a middle-class practitioner, who wrote a book specially on the medical aspects of Liverpool, declares that fever is “rare” in that city, while Currie was treating from his dispensary a steady average of three thousand cases of typhus every year. In the same years, in February, 1779, a physician to the army, Dr John Hunter, who had commenced practice in Mayfair, found on visiting in the homes of the poorer classes in the west of London cases of fever for which he had no other name than the gaol or hospital fever of his military experience; it was so much a novelty to him, apart from campaigns or transport ships, that he gave an account of his discovery of domestic typhus to the College of Physicians[240]. At length he found so many cases steadily winter after winter that he had them sent to the infirmary of the Marylebone Workhouse. The practitioners who knew most of the sicknesses of the poor were such as Robert Levett, Dr Samuel Johnson’s dependant, who lived with the doctor in the house in Gough Square. Levett had been a waiter in a Paris coffee-house frequented by the medical fraternity, and had acquired a taste for and perhaps some knowledge of the healing art. He made his modest living by the small fees or articles of food and drink which his poor patients gave him. He had only to issue from the back of Gough Square by the courts and alleys behind Fleet Street, and he would find in the region between Chancery Lane and Shoe Lane hundreds of families seldom visited by a physician or by a qualified surgeon-apothecary. The good Levett was only one of a class. There had always been such humble medical attendants of the poor in London. An Act of the third year of Henry VIII. was directed against them at the instance of the privileged practitioners; but the regular faculty is said to have proved in the sequel both greedy and incompetent, and after thirty years there came another Act, couched in terms that the bluff king himself might have indited (31-32 Henry VIII.), which asserts those qualities of the profession in so many words, and establishes the right of any subject of the king to practise minor surgery and the medicine of simples upon his or her neighbours. That Act is still part of the law of England, and under it Levett exercised a statutory right, perhaps without knowing it[241]. There were many other regions of courts and alleys all round the City on both sides of the water, which must have been medically served by such as Levett, if served at all. It was there that typhus was found and at length clinically described by competent physicians, among the earliest of whom was Lettsom.

The General Dispensary in Aldersgate Street having been started in 1770 with one physician, Lettsom was chosen additional physician in 1773, and threw himself into the work with great zeal[242]. In the first twelvemonth he saw many cases of fever, as in the following table:

Lettsom’s practice in Fevers at the Aldersgate Dispensary.

1773 1774

Febris April May June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. March Total in 12 months Died

hectica 2 2 4 13 4 2 3 4 9 12 18 13 86 3

inflammatoria — — — — — — — 1 1 1 — 2 5 —

intermittens 3 1 7 1 1 1 1 — 2 1 2 2 22 —

nervosa 4 3 4 14 7 11 4 5 1 1 5 4 65 3

putrida 14 19 14 25 14 21 34 22 11 6 7 5 192 8

remittens 6 10 5 4 3 6 7 3 12 13 10 3 82 —

simplex vel diarium — 2 1 6 2 5 4 5 — — — 4 29 —

The nervous, putrid and remittent fevers, belonging, to the same group, make up the bulk of the fevers. The hectic fevers were almost all of children. The fatal cases of fever were fourteen, the fatal cases in all diseases for the year having been forty-four. What these putrid, nervous and remittent fevers were, will now appear from some of Lettsom’s descriptions. Fevers with symptoms of putrescency were marked by nausea, bitter taste, and frequent vomiting, by laboured breathing and deep sighing, offensive breath, sweats offensive and sometimes tinged with blood, almost constant delirium, the tongue dry, the tongue, teeth and lips covered with black or brown tenacious foulness, thrush and ulceration in the mouth and throat, the urine with a dark sediment, the stools excessively nauseous and foetid, and blackish or bloody, the eyes horny or glassy, with the whites often tinged of a deep blood colour, spots on the skin like fleabites, or larger haemorrhagic vibices, bleeding from the gums, nose or old ulcers, hiccup near death, often a cough through the fever. Lettsom’s treatment consisted in good liquors, Peruvian bark, and above all fresh, or “cold” air: “When it is considered that putrid fevers originate in close unventilated places, the introduction of fresh air seems so natural a remedy that I have often admired its aid should have been so long neglected[243].” Accordingly he persuaded the poor people to open their windows, and dragged the sick out of doors as soon as it was safe to do so; the effects, he says, were wonderful. His fifty-one cases are most valuable illustrations of the perennial fever in the crowded parts of London:

Case 1 is of a man aged forty who had occasion to visit a miserable crowded workhouse in Spitalfields. He was instantly seized with such a nausea and debility as induced him to keep his room as soon as he got home. At the end of a week Lettsom found him in “the true jail-fever, or, what is the same, a true workhouse-fever.” He had involuntary stools and leaping of the tendons, and took more wine in a week than he had done for many years.

Cases 2 to 12 were of several families in one house in a court in Long Lane, Aldersgate Street, who had been infected by a discharged prisoner from Newgate. Other cases follow, where the infection was caught from visiting the sick. In Case 17, Lettsom applied blisters “owing to the importunity of the friends,” but without advantage. Case 30, on 26th October, 1773, was of a family of six persons near Christ Church, Lambeth, father, mother, boy of seventeen, child of two (slight attack) and two maids. Other localities were courts off Whitecross Street, Jewin Street, Little Moorfields, Chiswell Street, and St Martin’s-le-Grand. Case 43 was of a woman, aged thirty, in Bunhill Row; she attended a relation who died of a putrid fever, and was herself attacked; her eyes were bloodshot, her skin marbled and interspersed with a general deep-coloured eruption, her cheeks and nose mortified. Cases 44-47 were of people in a “very helpless situation” in Gloucester Court, Whitecross Street.

The year 1773, to which these experiences in a small part of London relate, was one of high febrile mortality, according to the Bills. Two years after, Dr William Grant was moved to write an ‘Essay on the Pestilential Fever of Sydenham, commonly called Gaol, Hospital, Ship and Camp Fever[244],’ which, as he said in his preface, “I often see in this city: and though so common and fatal, appears not at present to be generally understood.” It was, he says, “an indigenous plant, frequent in this city, being produced by close confinement; but it often passes unnoticed, because unknown.” The deaths by “fever” in the London Bills were as follows until the end of the century:

Deaths from Fever and from all causes in London.

Year Fever deaths All deaths

1771 2273 21780

1772 3207 26053

1773 3608 21656

1774 2607 20884

1775 2244 20514

1776 1893 19048

1777 2760 23334

1778 2647 20399

1779 2336 20420

1780 2316 20517

1781 2249 20719

1782 2552 17918

1783 2313 19029

1784 1973 17828

1785 2310 18919

1786 2981 20454

1787 2887 19349

1788 2769 19697

1789 2380 20749

1790 2185 18038

1791 2013 18760

1792 2236 20213

1793 2426 21749

1794 1935 19241

1795 1947 21179

1796 1547 19288

1797 1526 17014

1798 1754 18155

1799 1784 18134

1800 2712 23068

There were higher figures in the years immediately before 1771, the years to which the generalities of Fordyce and Armstrong relate. There is a decline in the fever-mortality towards the end of the century; but it is just from the years 1799-1800 that we have an account by Willan of the prevalence and conditions of London typhus, than which nothing can well be imagined worse. The intermediate glimpses we get of typhus in London in the writings of Dr Hunter, physician, and of Dr James Sims, show that the disease was perennial.

“In the month of February, 1779,” says Hunter[245], “I met with two examples of fever in the lodgings of some poor people whom I visited that resembled in their symptoms the distemper which is called the jail or hospital fever. It appeared singular that this disease should show itself after three months of cold weather. Being therefore desirous of learning the circumstances upon which this depended I neglected no opportunity of attending to similar cases. I soon found a sufficient number of them for the purpose of further information. It appeared that the fever began in all in the same way and originated from the same causes. A poor family, consisting of the husband, the wife, and one or more children, were lodged in a small apartment not exceeding twelve or fourteen feet in length, and as much in breadth. The support of them depended on the industry and daily labour of the husband, who with difficulty could earn enough to purchase food necessary for their existence, without being able to provide sufficient clothing or fuel against the inclemencies of the season. In order therefore to defend themselves against the cold of the winter, their small apartment was closely shut up, and the air excluded by every possible means. They did not remain long in this situation before the air became so vitiated as to affect their health and produce a fever in some one of the miserable family. The fever was not violent at first, but generally crept on gradually ... soon after the first a second was seized with the fever, and in a few days more the whole family perhaps were attacked, one after another, with the same distemper. I have oftener than once seen four of a family ill at one time and sometimes all lying on the same bed. The fever appeared sooner or later as the winter was more or less inclement, as the family was greater or smaller, as they were worse or better provided with clothes for their persons and beds, and with fuel, and as their apartment was more or less confined. The slow approach of the fever, the great loss of strength, the quickness of the pulse with little hardness or fulness, the tremors of the hands, and the petechiae or brown spots upon the skin, to which may be added the infectious nature of the distemper, left no doubt of its being the same with what is usually called the jail or hospital-fever.”

Dr James Sims, who had seen much of Irish typhus in Tyrone in his earlier years, and had removed to London, wrote of typhus among the poor there in 1786, ten years before the more systematic and more circumstantial descriptions by Willan[246].

This fever was exceedingly mortal, several medical men, he had reason to believe, falling sacrifices to it. Sims never saw the cases till the 7th or 8th day, when they were desipient, insensible, with pulse scarcely to be felt and not to be counted, all having petechiae. None had scarlet rash or sore-throat. They sank and died quietly; the strongest cordials did not produce the smallest effect, and blisters in many did not even raise the skin[247].

It is in the year 1796 that we begin to have the full and accurate records by Willan of the prevailing diseases of London month by month as he saw them at the Carey Street Dispensary, situated in the crowded quarter between Holborn and the Strand[248]. His first reference to typhus is as follows:

“In September, also, fevers usually appear which from their commencement exhibit symptoms of malignancy; being attended with a brown dry tongue, violent pain of the head, delirium, or coma, deep-seated pains of the limbs, petechial spots and haemorrhagy. These fevers become highly contagious, especially when they occur in close, confined situations, and in houses where little attention is paid to ventilation or cleanliness. The disease is extended by infection during the months of October and November, but its progress is generally stopped by the frosts of December.”

Willan says little more of fever in London until September, 1798, when these contagious malignant fevers became more numerous, both in the city and adjacent villages, than had been known for many years before; also the fever was more fatal than usual, one in five or six dying, whereas one in seven was formerly a very unfavourable death-rate, and one in twenty not unknown. Haemorrhages, aphthae, diarrhoea, starting of the tendons, picking the bedclothes, violent delirium, ending in deafness, stupor, hiccough and involuntary evacuations, were the usual accompaniments of this fever. In the corresponding months of 1799 he recurs to the symptoms of this “malignant contagious fever,” and depicts typhus as clearly as may be. In September, 1799, it was “attended with a dull pain of the head, great debility or sense of lassitude and pains referred to the bones, tremblings, restlessness with slight delirium, a querulous tone of voice, a small and frequent pulse, heat of the skin, thirst and a fur upon the tongue, first of a dirty white colour, but turning in the latter stage of the disease to a yellowish brown. In this form the fever continued thirteen days without any dangerous symptoms, and then suddenly disappeared, leaving the patient, for some time after, languid and dispirited. All the individuals of a family were successively affected with the same train of symptoms; many of them so slightly as not to be much confined to their beds.” In October and November he describes the symptoms of the disease in a more dangerous form. By this fever, he was informed, some houses of the poor had been almost depopulated, the infection having extended to every inmate. “The rumour of a plague was totally devoid of foundation.”

He then describes the state of the dwellings where such fevers occurred—the unwashed bed-linen, the numbers in one bed, the rooms encumbered with furniture or utensils of trade, the want of light and air in the cellars and garrets and in the passages thereto, the excremental effluvia from the vault at the bottom of the staircase. It cannot be wondered at, he concludes, that contagious diseases should be thereby formed, and attain their highest degree of virulence; and he estimates that “hundreds, perhaps thousands” of labourers in and near London, heads of families and in the prime of life, perished annually from such fevers. He denies that his account is exaggerated, and appeals for the truth of it to medical practitioners whose “situation or humanity has led them to be acquainted with” the localities[249].

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

Liverpool, in the last quarter of the 18th century, came next in size to London, having a population (in 1790) of 56,000 to the capital’s estimated 800,000. According to a medical author, whose experiences lay among the middle classes, it was everything that could be wished in the way of healthfulness and prosperity; but it had a dark side as well. About 7,000 of the people lived in cellars underground, and nearly 9,000 in back houses, in small confined courts with a narrow passage to the street. “Among the inhabitants of the cellars,” says Currie[250], “and of these back houses, the typhus is constantly present; and the number of persons under this disease that apply for medical assistance to the charitable institutions, the public will be astonished to hear, exceeds three thousand annually.... In sixteen years’ practice I have found the contagious fever of Liverpool remarkably uniform among the poor. Seldom extending itself in any considerable degree among the other classes of the community, it has been supposed that Liverpool was little subject to fever; but this will be shewn from authentic documents to be a great and pernicious error.” At the Dispensary in the year 1780 the cases of typhus averaged 160 per month, the numbers being as remarkably steady from month to month as from year to year. In the ten years from 1 January, 1787, to 31 December, 1796, 31,243 cases of fever were entered on the books of the Dispensary, an average of 3124 per annum[251].

Of 213,305 cases of all diseases at the Dispensary in seventeen years, 1780 to 1796, 48,367, nearly one-fourth, were labouring under typhus. Supposing that these were all the cases of typhus in Liverpool, and that 1 in 15 died, we should have some 150 deaths from typhus in a year. Supposing also that typhus was relatively as common at that time in London, it will follow that nearly all the deaths under “fever” in the bills of mortality might well have been from typhus fever; for London in its several densely populated out-parishes was the fever-quarter of Liverpool a dozen times over[252].

The Newcastle Dispensary was opened in October, 1777, by the exertions of Dr John Clark, who was in correspondence with Lettsom in London[253]. Dr Clark had been in the East India Company’s service, and had seen much of ship-fever and of the fevers of the East. During a visit to his home in Roxburghshire in the summer of 1770, between his voyages, he attended several persons in continued fever. When he settled at Newcastle he saw the worst kinds of contagious fever, in workhouses and “in the sordid and crowded habitations of the indigent.” Putrid fever, or typhus, was by far the most common disease attended from the new dispensary, although less than at Liverpool, the operations of the charity being on a much smaller scale. It was seldom out of Newcastle a whole year; and in some years, as 1778, 1779, 1783, 1786 and 1787 it was unusually rife in particular districts, often attacking whole families. Scarlet fever was epidemic and very fatal in 1778 and 1779, while dysentery attacked great numbers of the poor in the autumns of 1783 and 1785. The following Table shows the principal diseases attended from the Dispensary during the first twenty-three months of its working, 1 Oct. 1777, to 1 Sept. 1779:

Newcastle Dispensary 1777-79.

Cases visited Cured Too far advanced Dead

Putrid fever 391 357 9 16

Ulcerated sore-throat 146 125 11 9

Dysentery 72 55 5 4

Smallpox 45 29 5 6

From 1 Oct. 1777, to 1 Sept. 1789, the cases of typhus visited were 1920, of which 121 were fatal. During the winter of 1790 and the spring and summer of 1791 it was prevalent amongst the poor, and was frequently introduced into genteel families and sometimes even into those of the first distinction. That outbreak was supposed to have been generated in the Gateshead poorhouse. For some time its ravages were confined chiefly to the low, ill-aired, narrow street called Pipewell Gate. In September it made its appearance in Newcastle; at first the contagion was easily traced from Pipewell Gate, and afterwards from one house to another. In that outbreak, 188 poor persons were visited from the Newcastle Dispensary, the Gateshead poor having been attended by the parochial surgeon. Clark’s ten cases recorded of the epidemic were all of people in good circumstances. The Dispensary Tables show cases of typhus every year down to 1850, the largest totals being in 1793 (374, 18 deaths), 1801 (435, 20 deaths), and 1819 (368, 14 deaths); and these, we may take it, were but a small fraction of all the cases in Newcastle.

Perhaps the most unexpected revelation of typhus is at Chester, from the time when Haygarth began to write upon its public health in 1772. Chester was then one of the most desirable places of residence in England. Boswell wrote to Johnson, “Chester pleases me more than any town I ever saw.” The old city within the walls was occupied by a superior class of residents, including the cathedral clergy, county families, retired officers and Anglo-Indians, professional men, merchants and tradesmen. It had the best theatre out of London. Squares, crescents and broad streets were replacing most of the old buildings. The six parishes that lay entirely within the walls had a population, in 1774, of 3502, and an annual average death-rate (in the ten years 1764 to 1773) of 1 in 58 or 17·2 per 1000, the central parish of St Peter having a rate of 1 in 62, and the cathedral parish 1 in 87. It passed as one of the healthiest cities in the kingdom, being far before Shrewsbury and Nottingham, to say nothing of the large towns where the burials exceeded the baptisms. But its moderate death-rate over all, 1 in 42 living, would have been much lower but for the four poor suburban parishes, with a population of 11,211, which had a death-rate of 1 in 35. Haygarth gives a deplorable account of them. The houses were small, close, crowded and dirty, ill supplied with water, undrained, and built on ground that received the sewage from within the walls. The people were ill-fed and they seldom changed or washed their clothes; when they went abroad they were noisome and offensive to the smell. Many of them worked on the large farms around Chester, others at shipbuilding and shipping (Chester had then a considerable foreign trade), others at the mills and markets, others at a nail-factory, while others were employed by the tradesmen within the walls. Fever seems to have been perennial among them, the deaths from typhus having been 23 in 1772, 33 in 1773 and 35 in 1774. “In these poor habitations,” says Haygarth, “when one person is seized with a fever, others of the family are generally affected with the same fever in a greater or less degree.” It became rifer than usual in August, 1773, and attacked 285, proving fatal to 28, or to one in ten. It had the common symptoms of malignant fevers produced by human effluvia, and particularly affected the head with pain, giddiness and delirium. It attacked in general the lowest, few of the middle rank, and none (or only one) of the highest rank[254].

Chester had no manufactures. Its population had grown rapidly of late, as that of Liverpool had grown, the poorer classes being the prolific part of the community; but it had no share in the industrial revolution, it did not employ its women and children in factories, and it was in some respects better than Leeds, Warrington, Manchester, or Carlisle. It is a good illustration of a town growing rapidly without manufactures, and of a community divided by the old walls into two quite distinct sections, a rich and a poor. Such had been the drift of things in England apart from the industrial revolution; but it is the latter which furnishes the best illustrations of a poor prolific populace, of a growing struggle, and of the attendant typhus fever.

Fever in the Northern Manufacturing Towns, 1770-1800.

The prosperity of the first two-thirds of the 18th century had been attended with a very small increase of population. From 1700 to 1750 the numbers in England are estimated to have grown no more than from about six millions to six millions and a half. The fecundity of many rural parishes was swallowed up by emigration to the American and West Indian colonies, by the army and navy, and by the great waste of life in London and some other towns. The increase was nearly all north of the Trent, while the old weaving towns of the south-west had actually declined. Gloucestershire, Somerset and Wilts were the most crowded counties in 1700. During the next fifty years, the greatest increase was as in the following rough estimate[255]:

1700 1750 Increase per cent.

Lancashire 166,200 297,400 78

West Riding of Yorks. 236,700 361,500 52

Warwickshire 96,600 140,000 45

Durham 95,500 135,000 41

Staffordshire 117,200 160,000 36

Gloucestershire 155,200 207,800 34

In the counties where population had increased most, much of the increase was still rural or semi-rural. Defoe describes how the land near Halifax was divided into lots of from two to six or seven acres, hardly a house out of speaking distance from another, at every house a tenter, and on almost every tenter a piece of cloth, or kersey or shalloon. Every clothier kept one horse at least, to carry his manufactures to the market, and nearly every one kept a cow, or two or more, for his family. The houses were full of lusty fellows, some at the dye-vat, some at the looms, others dressing the cloths, the women and children carding or spinning, being all employed from the youngest to the oldest: not a beggar to be seen, nor an idle person[256]. We have no accounts of the health of this population, except Nettleton’s statistics of smallpox in and around Halifax in 1721 and 1722, given elsewhere, and the “epidemic constitutions” recorded by Wintringham at York during the same period, and by Hillary at Ripon.

Before the earliest of the inventions of spinning by machinery, the weavers were gathering to the towns of Yorkshire, Lancashire and other counties north of the Trent. The spinning-jenny of Hargreaves was wrecked by a Blackburn mob in 1768, and a mob wrecked the cotton-mill built by Arkwright at Chorley eleven years later. This was decidedly a time of movement from the country to the towns, a movement which preceded the spinning ingenuity of the sixties and may have been stimulated by the earlier use of the fly-shuttle in weaving.

Much of the country round Manchester, though it doubtless retained those farm-houses, hedgerows, and field paths which come into the idyllic opening of ‘Mary Barton’ more than half a century later, was “crowded with houses and inhabitants,” as Percival says: so populous were the environs of Manchester that every house in the township had been found by a late survey to contain an average of six persons. The proportion of deaths was less than in 1757; but that was chiefly due to the accession of new settlers from the country, which raised the ratios of marriages and births[257]. Manchester had increased from a population of about 8000 in 1717 to one of 19,839 (inclusive of Salford) in 1757. When the inhabitants were next counted in 1773, they were found to be 22,481 in Manchester (5317 families in 3402 houses) and 4765 in Salford (1099 families in 866 houses). According to Percival, who gives these figures, the death-rate in 1773 was 1 in 28·4, the births exceeding the deaths by forty in a year. The poor, he says, were now better lodged, and some of the most dangerous malignant distempers were less violent and less mortal. Manchester, however, was still an unhealthy place compared with the country, especially to young children. Thus, the thirty-one townships in the parish of Manchester contained, exclusive of the city, 13,786 inhabitants (2525 families in 2371 houses), and of these only 1 in 56 died annually (compared with 1 in 28 in the city)—the births being to the deaths as 401 to 246 in the year 1772.

Again, the bleak upland parish of Darwen with a population in the year 1774 of 1850 souls mostly occupied in the cotton manufacture, had, during the seven years before, more than twice as many baptisms as burials (508 to 233), the birth-rate (1 in 25·5) being high and the death-rate (1 in 56) low.

Leeds had a population of some six or seven thousand at the time of the Civil Wars, and lost 1325 in nine months of the year 1645 from plague, all of them the poorer class. A generation or two later, in the time of Thoresby’s ‘Diary,’ it was a centre of the cloth trade; and it appears to have grown steadily throughout the 18th century. In 1775 it had a population of 17,117. We hear from Lucas of an epidemic typhus in it previous to 1779[258]. Eighty persons had died of that fever in one year, and many who struggled through the disease died afterwards of lingering complaints. In two courts or yards (such as might have been the Lantern Yard which Silas Marner found pulled down when he revisited Leeds) forty persons were affected with the fever; some families had received ten shillings a week from the assessment for the poor. As early as 1779 Lucas proposed a house of reception for contagious fever, a proposal which was carried into effect in 1804, after a whole generation of typhus and at a time when there was little fever in Leeds or elsewhere. The infectious fevers, being chiefly confined to the poor, often prevailed, says this writer, for a length of time without exciting much alarm, or without their fatality being attended to; but, he adds about the year 1790, “should a few of the higher rank receive the infection, then the disease is described in most exaggerated terms.”

Carlisle was a good instance of the increase of urban population and the breeding of typhus. In seventeen years, from 1763 to 1780, the inhabitants had increased from 4158 to 6229, many of the immigrants being Scots and Irish with their families. The chief industry was the making of calico, in which the women and children were employed as well as the men. When Dr Heysham surveyed the town and suburbs for his census of 1779, he had “opportunity of seeing many scenes of poverty and filth and nastiness[259]”; and in the bill of mortality for that year he confesses himself astonished that there should be so little fever.

The great outburst of typhus at Carlisle began in the end of March, 1781, with no very obvious special provocation[260]. Upwards of 600 had typhus to February 7th, 1782, at which date 12 or 15 were still suffering from it. The deaths were less than 1 in 10 of all attacked: viz. 2 in May, 4 in June, 8 in July, 8 in August, 7 in September, 9 in October, 8 in November, 6 in December, and 3 in January, 1782, a total of 55. Of this total of fatal cases, 3 were boys, 4 bachelors, and 15 husbands: 3 girls, 2 maids, 22 wives, and 6 widows. Two-thirds of all the deaths were of married people; Heysham saw no case in a child under three years. It affected about a tenth part of the inhabitants of Carlisle (6299), and raged most among the lower class who lived in narrow, close, confined lanes and in small crowded apartments, of which there were a great many in Carlisle, generally going through all the inmates of a house where it had once begun. On seeking to trace the origin of the epidemic, he found that it began in the end of March, 1781, in a house in Richard-gate, which contained about half-a-dozen very poor families. Every window that could be spared was shut up, to save the window-tax. The surgeon who attended some of these poor wretches told Dr Heysham that the smell was so offensive that it was with difficulty he could stay in the house. One of the typhus patients in this house was a weaver, who, on his recovery, went to the large workshop where he worked, and there, it was supposed, gave the infection (in his clothes) to his fellow workmen, by whom new centres of infection were made in various other houses. In August, a young man just recovered from the fever went to his mother’s in the small village of Rockliffe, four or five miles from Carlisle, to get back his strength in the country air; his mother soon took the fever and died, and a neighbour woman who came to her in her sickness likewise caught it and died. These were all the cases known in the village, and they show the enormously greater fatality of typhus in those not inured to its atmosphere and conditions.

The state of population and health at Warrington was peculiar, and is given fully in another chapter. There could be no more striking instance of the growth of what the foreign writers call the proletariat; an old market-town, with a small sail-cloth industry from Elizabethan times, it became a busy weaving town owing to the demand for sail-cloth during the war with the American colonies. The whole population of some 9000 men, women and children, were wage-earners; the women were all the while unusually prolific, and the sacrifice of infant life was enormous, especially by smallpox. We have no particular accounts of fevers; but in the bill of mortality for 1773, the year of a disastrous smallpox epidemic, there were 25 deaths from fever, of which 10 were of “worm fever,” or the remittent of children[261].

By the year 1790, when Ferriar’s accounts of fever in Manchester begin, the industrial revolution had been accomplished, mills were everywhere, and the characteristic hardships and maladies of a prolific working class in a time of slack trade were already much the same as we find them pictured with fidelity and pathos in the pages of Mrs Gaskell half a century after.

But, so as not to exaggerate the ill health of the working class in Manchester at the end of the 18th century, let us compare the births with the deaths according to the doubtless imperfect registers[262]:

Manchester, Births and Deaths, 1770-91.

Year Births Deaths

1770 1050 988

1771 1169 993

1772 1127 904

1773 1168 923

1774 1245 958

1775 1359 835

1776 1241 1220

1777 1513 864

1778 1449 975

1779 1464 1288

1780 1566 993

1781 1591 1370

1782 1678 984

1783 1615 1496

1784 1958 1175

1785 1942 1734

1786 2319 1282

1787 2256 1761

1788 2391 1637

1789 2487 1788

1790 2756 1940

1791 2960 2286

The mean lodging-houses in the outskirts of the town, says Ferriar, in 1790[263], were the principal nurseries of febrile contagion: some of these were old houses with very small rooms, into each of which four or more people were crowded to eat, sleep, and frequently to work. They commonly bore marks of a long accumulation of filth, and some of them had been scarcely free from infection for many years past. As soon as one poor creature dies or is driven out of his cell he is replaced by another, generally from the country, who soon feels in his turn the consequences of breathing infected air. There was hardly any ventilation possible, many of these old houses being in dark narrow courts or blind alleys. In other parts of the town the lodging-houses were new, and not yet thoroughly dirty; but in these there was a long garret under the tiles, in which eight or ten people often lodged, the beds almost touching. Again, many lived in cellars, sleeping on the damp floor with few or no bedclothes; the cellars of Manchester, however, were better ventilated than those of Edinburgh, and freer from fever. These cellar-tenants were subject to the constant action of depressing passions of the mind. “I have seen patients,” says Ferriar, “in agonies of despair on finding themselves overwhelmed with filth and abandoned by everyone who could do them any service, and after such emotions I have seldom found them recover.” Addressing the Literary and Philosophical Society of Manchester previous to 1792, he pointed out in an argumentum ad hominem that “the situation of the poor at present is extremely dangerous, and often destructive to the middle and higher ranks of society[264].” And again, “the poor are indeed the first sufferers, but the mischief does not always rest with them. By secret avenues it reaches the most opulent, and severely revenges their neglect or insensibility to the wretchedness surrounding them[265].”

In an address to the Committee of Police in Manchester, he instances the following cases:

A family of the name of Turner in a dark cellar behind Jackson’s Row: they have been almost constantly patients of the Infirmary for three years past on account of disorders owing to their miserable dwelling. There are other instances of the same kind in Bootle Street.

In Blakely Street, under No. 4, is a range of cellars let out to lodgers, which threatens to become a nursery of disease. They consist of four rooms communicating with each other, of which the two centre rooms are completely dark; the fourth is very ill-lighted and chiefly ventilated through the others. They contain four or five beds in each, and are already extraordinarily dirty.

In a nest of lodging-houses in Brook’s entry near the bottom of Longmill-gate, a very dangerous fever constantly subsists, and has subsisted for a considerable number of years. He had known nine patients confined in fevers at the same time in one of those houses and crammed into three small dirty rooms without the regular attendance of any friend or of a nurse. Four of these poor creatures died, absolutely from want of the common offices of humanity and from neglect in the administration of their medicines. Another set of lodging-houses constantly infected is known by the name of the Five Houses, in Newton Street[266].

The fever in Manchester was not always malignant typhus: sometimes it had the symptoms and low rate of mortality that suggest relapsing fever. Thus, in the winter epidemic of 1789-90, very prevalent in Manchester and Salford, out of Ferriar’s first ninety patients only two died; in some the skin had a remarkable, pungent heat, in others there were profuse watery sweats; women were commonly affected with hysterical symptoms during convalescence, which was often tedious[267]. A certain number of these cases would run into “a formed typhus,” with petechiae and all the other signs of malignity; and in some seasons, as in the distressful year 1794, typhus was the usual form. Two fatal cases in children, examined after death, had peritonitis; “in the one no marks of the disease were discernible within the cavity of the [intestinal] tube;” in the other, the patient was covered with petechiae[268]. These cases of localized inflammation in typhus he compares with Pringle’s cases of spotted fever complicated with abscess of the brain.

The years 1792 and 1793 passed, says Ferriar, without any extraordinary increase of fever patients, although the noxious influences were always present. But in the summer and autumn of 1794 “the usual epidemic fever” became very prevalent among the poor in some quarters of the town, particularly after a bilious colic had raged among all ranks of people. This was a time when work was slack; many workmen enlisted and left their families. In November and December 1794, as many as 156 sent applications to the Infirmary in a week to be visited in fever at their homes.

This was a memorable time of scarcity and distress all over the country, the beginning of a twenty-years’ period of so-called “war-prices,” when farmers’ profits were so large that they could afford to double or treble their rents to the landlords. The history of epidemics comes at this point into close contact with the economic history, which I shall touch on in the sequel, after giving a few more particulars of typhus in England and Scotland generally, previous to the outbreak of the war with France in 1793.

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

The introduction of machinery and the building of mills brought typhus fever to places much less crowded than Leeds, or Manchester, or Carlisle.

Dr David Campbell of Lancaster saw much of typhus in that town, and in mill villages near it, in the years 1782, 1783, and 1784. In Lancaster town he saw about 500 cases, of which 168 were in men, with 20 deaths, 236 in women, with 11 deaths, and 94 in children under fourteen, with 3 deaths. At Backbarrow cotton mill, twenty miles from Lancaster, there were 180 cases, of which 38 were in men, with 5 deaths, 11 in women, with 2 deaths, and 131 in children under fourteen, with no deaths[269]. At this mill there was an extremely offensive smell in the rooms, which came from the privy; the doors of the latter, “for indispensable reasons in the economy of these works, where so many children are employed, always communicate with the workrooms.” Every care had been taken to keep the air sweet, but without effect. The offensive smell was in all the cotton mills from the same cause; and in the Radcliffe mill belonging to Mr Peel, the typhus was ascribed to that source, the nuisance having been at length got rid of. Both at Backbarrow and Radcliffe the houses of the workpeople were new, airy and comfortable. In the same years typhus raged with uncommon severity at Ulverston and in various parts of Lancashire, where cotton-mills had been set up[270].

The typhus of Liverpool and Newcastle was reproduced in Whitehaven and Cockermouth on a scale proportionate to their size. Whitehaven, the port of the Cumberland coal-field, was the Newcastle of the west coast, and had a large trade with Ireland. Many of the labourers lived in cellars. Brownrigg’s experiences of typhus fever in it went back to near the middle of the 18th century. The Whitehaven Dispensary was opened in 1783, the occasion for it being thus explained:—

“Previous to the establishment of dispensaries Whitehaven and Cockermouth were infested by nervous and putrid fever. Many of their respectable inhabitants became its victims; and among the lower class of people it prevailed with deplorable malignancy. The present period happily exhibits a different picture. Notwithstanding our connection with the metropolis of Ireland, and other commercial places, contagion rarely appears; or, when accidentally introduced, is readily suppressed[271].”

The following is the abstract of “contagious fever cases” from the records of the Whitehaven Dispensary from 30 June, 1783, to 9 June, 1800[272]:

Year Cured Dead Total

1783 75 1 76

1784 401 9 410

1785 350 20 370

1786 91 6 97

1787 21 1 22

1788 53 7 60

1789 103 2 105

1790 288 21 309

1791 74 6 79

1792 17 2 19

1793 7 3 10

1794 13 1 14

1795 28 2 30

1796 48 1 49

1797 35 2 37

1798 12 1 13

1799 11 1 12

Total 1627 85 1712

The year 1790 is indicated as an unhealthy one, by the excess of burials over christenings, also at Macclesfield, where there were 316 christenings to 380 burials, the proportion being usually the other way[273].

Dr John Alderson of Hull wrote in 1788 an essay on the contagion of fever, in which there are no authentic details for Hull: “The calamity itself is the constant complaint of every neighbourhood, and almost every newspaper presents us with an example of the direful consequences of infection”—the reference being to gaols more particularly[274]. Whatever was the reason, there was undoubtedly a great deal of typhus in England in the eighties of the eighteenth century. Oxfordshire, Gloucestershire, Worcestershire, Wiltshire and Buckinghamshire experienced much typhus from 1782 to 1785, although we have few particulars. “The remembrance of its ravages at Gloucester, Worcester and Marlborough,” says Dr Wall of Oxford, “is still fresh in every mind, where its virulence proved so peculiarly fatal to the medical world.” At Aylesbury, Dr Kennedy survived an attack of the “contagious fever,” to write an account (1785) of the epidemic, which he traced to the gaol (the date, be it observed, is subsequent to Howard’s visitations)[275]. At Maidstone, also, in 1785, the gaol fever was the subject of a special account[276].

At Worcester in 1783 the younger Dr Johnstone caught typhus while visiting the gaol, which was thereafter rebuilt at great expense. A prisoner took it to Droitwich where 14 died[277].

Dr Wall gives clinical details of fifteen cases of typhus treated by him in private practice at Oxford in 1785; one of his patients was an apothecary whose business had exposed him very much to the influence of contagion, as he was much employed amongst the poor in the suburbs of the town and neighbouring villages and in the House of Industry[278]. In the year 1783-85, much of the epidemic fever was of the nature of ague, as described in another chapter. It is not always easy to separate it from typhus; but there is no doubt that both were prevalent together. Thus in the parish of Painswick, Gloucestershire, in the spring of 1785 there occurred both “a contagious fever” and an “epidemic ague,” the latter having left a good many persons dropsical and cachectic[279]. This had been part of an epidemical fever which had raged for some time in the county of Gloucestershire, and is said to have lately carried off a great number of poor. At Norton, within five miles of Gloucester, there lived in two adjoining tenements two families: in one a man and his wife and three children, in the other a man and his wife, of whom only one remained alive on the 1st of March, 1785[280].

The extraordinary failure of the harvest in Scotland in 1782 produced much distress, and with it fever, in the winter following. The Glasgow and Edinburgh municipalities imported grain for the public benefit. Various traces of the scarcity and fever appear in the Statistical Account written a few years after. Thus, in Holywood parish, Dumfriesshire, some fevers were wont to appear in February and March among people of low circumstances living in a narrow valley; and the unusual mortality in the dear year 1782 was owing to an infectious fever in the same cottages. In the regular bills of mortality of Torthorwald parish, Dumfriesshire, the deaths from “fever” fall in the dear years, 1782-3, 1785, &c. In Dunscore parish, in the same county, the burials of 1782 rose to the most unusual figure of 30 (the baptisms being 17), “owing to a malignant fever[281].”

But Scotland was now past the danger of actual famine from even a total failure of the harvest. Some farmers were ruined, and many more were unable to pay the year’s rent; but the very poorest were enabled to find food, one source being “the importation of white pease from America.” From Delting, in Shetland, one of the poorest parishes, the report is: “There is reason to believe that none died from mere want; but there is no doubt that many, from the unwholesome food, contracted diseases that brought them to their graves.”

The following relating to the parishes of Keithhall and Kinkell, Aberdeenshire, in the scarcity following the lost harvest of 1782, is a curiously detailed glimpse of the time:

“Several families who would not allow their poverty to be known lived on two diets of meal a day. One family wanted food from Friday night till Sunday at dinner. On the last Friday of December, 1782, the country people could get no meal in Aberdeen, as the citizens were afraid of a famine; and a poor man, in this district, could find none in the country the day after. But the distress of this family being discovered, they were supplied. Next day the [Kirk] session bought at a sale a considerable quantity of bere, which was made into meal. This served the poor people until the importation at Aberdeen became regular, and every man of humanity rejoiced that the danger of famine was removed[282].”

We hear most of fevers in the Highland parishes, with their subdivisions of holdings and an excess of population. Thus of Gairloch, Ross-shire, it is said: “Fevers are frequent, sometimes they are of a favourable kind, at other times they continue long and carry off great numbers”—the poor in this parish, upon the Kirk Session roll, numbering 84 in the year 1792, and the aggregate money paid to the whole number averaging £6. 7s. in a year, whereas the fertile parish of Ellon, Aberdeenshire, with 40 on the poor’s roll, paid them £43 per annum.

Again, of the fishing village of Eyemouth, it is said: “The only complaints that prove mortal in this place are different kinds of fevers and consumptions; and these are mostly confined to the poorest class of people, and ascribed to their scanty diet.” And of another fishing parish, in Banffshire, Fordyce, including Portsoy, it is said: “The most prevalent distemper is a fever, and that for the most part not universal, but confined to particular districts. It is sometimes thought to arise from infection and communication with other parts of the country; at other times from local situations and circumstances of the people’s houses and habits of living in particular districts[283].”

The beginning of the great French war was the occasion of a considerable increase of fever; although no records make it appear so fatal a time as the years 1783-86. The commercial distress and want of work which began in the autumn of 1792, were intensified by the bad harvests of 1794 and 1795, which followed two harvests also deficient. This was the period of distress and of epidemic fever to which Wordsworth referred in the passage in the first book of the ‘Excursion,’ where he is relating the story of Margaret’s ruined cottage[284].

There is little medical writing upon the epidemic fever of 1794-95; and, in the very district of Wordsworth’s story, the records of the Whitehaven Dispensary bear no traces of a great concourse of patients. There is reason to think that the fever, if slow and weakening, was seldom fatal, that it was typhus mitior, and that it was sometimes, perhaps often, relapsing. One glimpse we get of it in the family of the afterwards celebrated Dr Edward Jenner of Berkeley, in the winter of 1794-95. He thus writes to a friend about the visitation of “grim-visaged typhus:”

“You shall hear the history of our calamities. First fell Henry’s [his nephew and assistant] wife and sister. From the early use of bark, they both appeared to recover; but the former, after going about her ordinary business for some days, had a dreadful relapse which nearly destroyed her. It was during my attendance on this case that the venomed arrow wounded me.... Like Mrs Jenner’s fever, at an early period there was a clear intermission for four days.... On the eighth day after the first seizure it again set in, in good earnest, and continued one-and-twenty days.... Dr Parry was with me from Bath five times, Dr Hicks and Dr Ludlow as many, and my friend George was never absent from my bedside.... But, to return to that mansion of melancholy, Henry’s. His infant girl has now the fever; a servant maid in the house is dying with it; and to complete this tragical narrative, about five days ago fell poor Henry himself. His symptoms at present are such as one might expect: violent pain in the head, vertigo, debility, transient shiverings.... His pulse this evening is sunk from 125 to 100. The stench from the poor girl is so great as to fill the house with putrid vapour; and I shall remove him this morning by means of a sedan-chair to a cottage near my own house[285].”

This is a tolerably clear picture of a short-period fever with relapses, or of relapsing fever strictly so-called; the stench, also, of one patient is characteristic. Barker, of Coleshill or Birmingham, has much to say under the same year 1794, of a slow, tedious fever, marked by “sluggish action and comatose symptoms,” and much subject to relapses; but he does not give the duration of the first or subsequent paroxysms, as Jenner does, or the usual length of the clear intervals, his most definite case being of a young woman who died in twenty-four hours from a relapse which came on about three weeks after the fever had left her[286].

It was the access of fever in 1794-5, and the alarm that it caused among the richer classes, that led to the opening of the Manchester House of Recovery in 1796. In certain streets in the neighbourhood chosen for the hospital, Portland Street, Silver Street and others in the same block, the cases of contagious fever for nearly three years before the hospital was opened are given by Ferriar as follows:

Sept. 1793 to Sept. 1794, cases of fever, 400

Sept. 1794 to Sept. 1795, " " " 389

Sept. 1795 to May 1796, " " " 267

The cases began to be sent to the hospital on the 27th May, 1796, and an attempt was made to extinguish contagion in the houses, by white-washing, disinfecting and the like; so that in the same group of streets there were only 25 cases of fever from 13 July, 1794 to 13 March, 1797. Meanwhile the admissions to the hospital were few until the dearth of 1799-1802. One of the manufacturing towns which is known to have shared in the epidemic fever of 1794-96 was Ashton-under-Lyne, where upwards of three hundred cases (with few deaths) occurred in less than three months at the end of 1795. This epidemic must have been somewhat special to Ashton, for it produced much alarm in neighbouring places and caused Ashton to be avoided from fear of infection.

Shortly after 1796, Ferriar made an inquiry into an epidemic of fever at a village within a mile of Manchester; the houses were many of them new, built for the convenience of a large cotton mill; but even the new houses were offensive, with cellars occupied by lodgers, and almost every house overcrowded. This was the first fever in the village, and it was traced to a family who had come from Manchester with infected clothes. Stockport about the same time erected a House of Recovery, having “the same general causes of fever which render the disease so common in Manchester”; and Ferriar adds: “I believe there is not a town in the kingdom containing four thousand inhabitants which would not be greatly benefited by similar establishments.”

The bad harvest of 1794 raised the price of wheat to 55s. 7d. on 1 January, 1795, and the prospect of another short harvest to 77s. 2d. on 1 July. A famine being threatened, the Government caused neutral ships bound to French ports with corn to be seized, and brought into English ports, the owners receiving an ample profit. Agents were also sent to the Baltic to buy corn. By these means the price of wheat, which had risen in August to 108s. 4d., fell in October to 76s. 9d. Parliament met on the 29th October, and various measures were taken[287]. In the spring of 1796, the climax of distress was reached, wheat being at 100s. per quarter. The harvest of 1796 was abundant and wheat fell to 57s. 3d. The harvests of 1797 and 1798 were not equally good, but they were not altogether bad, and the price of wheat kept about 50s. for nearly three years, which were years of comparative comfort between the dearth of 1794-96 and the dearth of 1799-1802.

Fevers in the Dearth of 1799-1802.

Although Willan chooses the end of the year 1799 to enlarge upon the London fever, he does not connect it with the dearth that was already beginning to be felt (soup kitchens having been opened in various parts of London). The price of wheat, which had been steadily about 50s. in 1797 and 1798, rose in May, 1799 to 61s. 8d., after a hard winter which had probably injured the autumn-sown corn. The harvest turned out ill, and the price of wheat rose in December, 1799, to 94s. 2d. Bounties were offered on imported foreign grain, but in June, 1800, the price was 134s. 5d., falling in August to 96s. 2d. on the crops promising well. The latter end of harvest proved wet, much of the grain being lost, so that the price per quarter of wheat rose to 133s. in December. There was much suffering, and some rioting. Parliament met on the 11th November, 1800, on account of the dearth, the opinions of the members being much divided as to the causes of the high prices. In March, 1801, wheat was at 156s. 2d. per quarter, beef from 10d. to 10½d. per pound, mutton 11d. to 12d. per pound. It is to this year, when the quartern loaf was at one-and-eightpence, that a comparison by Arthur Young belongs, showing the great change in the purchasing power of wages[288]. By the end of summer, 1801, wheat rose to 180s., and the quartern loaf was for four weeks at 1s. 10½d.

Whatever statistics were then kept of fever-cases, show a decided rise in the years 1800 and 1801:

Year Manchester House of Recovery (fever-cases) Glasgow Royal Infirmary (fever-cases) Newcastle Dispensary (fever-cases) London Bills of Mortality (fever-deaths)

1796 371 43 201 1547

1797 339 83 65 1526

1798 398 45 67 1754

1799 364 128 — 1784

1800 747 104 — 2712

1801 1070 63 425 2908

1802 601 104 — 2201

1803 256 85 352 2326

1804 184 97 255 1702

1805 268 99 74 1307

The London Fever Hospital was not opened until February, 1802, a small house in Gray’s Inn Lane containing sixteen beds. It came at the end of the epidemic, and was in small request during the next fifteen years. The same epidemic at Leeds was the occasion of opening a House of Recovery there in 1804, twenty-five years after Lucas had first called for it. The state of affairs in Leeds, which at length moved the richer classes to that step, is thus described by Whitaker[289]:

“In the years 1801 and 1802 an alarming epidemic fever spread in Leeds and the neighbourhood. The contagion extended so rapidly and proved so fatal that some hundreds were affected at the same time, and two medical gentlemen, with several nurses, fell victims to the disease.... In 1802 whole streets were infected house by house; in one court, of crowded population, typhus raged for four months successively.”

One of the Leeds physicians, Dr Thorp, seized the occasion to urge the need of a fever hospital, in a pamphlet written in 1802, in which he said:

“In a visit made a few days ago to those abodes of misery, I saw in one particular district upwards of twenty-five families ill in contagious fever. In some houses two, in others six or seven [families] were confined, many of whom appeared to be in extreme danger.” The superintendent of the sick poor stated to Dr Thorp “that sixty families in epidemic fever are under his care at this time. New applications are making daily. In some families three, in others six or seven, are in the disease. Forty persons in fever have applied to him for medical aid within the present week[290].”

The wonder is that, with the enormous prices of food, things were not worse. At the time when provisions were dearest, work was slack in several industries. A commercial report of 1 April, 1801, speaks of the trade of Birmingham as very distressed, a large proportion of the men being out of work; the ribbon trade of Coventry was deplorable, and the woollen trade of Yorkshire still worse. Evidence of epidemic typhus in various parts of England came out in connexion with the reports on influenza in 1803. Holywell, in Flintshire, with a large cotton-making industry, had not been free from a bad kind of typhus for two years previous to the influenza of 1803[291]. In Bristol there was a good deal of fever in 1802-3, which found its way, through domestic servants, into good houses in Clifton, “and proved fatal in some instances[292].” It is probable that these are only samples, the writings on epidemics being singularly defective at this period. The following, dated 10th April, 1802, by a surgeon at Earlsoham, near Framlingham, Suffolk, gives us a glimpse of malignant contagious fever in a farm-house:

“The most prevailing epidemics for the last twelve months have been typhus maligna and mitior, scarlatina anginosa, measles, and mumps. Many of the former have proved alarmingly fatal in several of our villages, whilst those of the second class of typhoid fevers have put on the appearance of the low nervous kind attended with great prostration of strength, depression of spirits, loss of appetite, etc., which frequently continue many weeks before a compleat recovery ensues.” Five cases, of “the most malignant kind of typhus,” occurred in a farmer’s family: one of the sons, aged eighteen, died in a few days with delirium, and black sordes of the mouth, tongue and throat; then the father, two daughters, and another son, took the infection but all escaped with their lives. Of four persons who nursed them, one caught the fever, and died. Four persons in a neighbouring family, who visited them, took infection, of whom two died[293].

There was perhaps nothing very unusual in such instances of country fevers at the beginning of the century. The incident is exactly in the manner of one that figures prominently in a story of Scottish life and customs at the same period, which long passed current as a faithful picture and as enforcing a much-needed moral[294].

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

From 1803 to 1816 there was comparatively little fever in this country. This was notably the case in London, but it was also true of all the larger towns where fever-hospitals had been established, and it was as true of Ireland as of England. This was, indeed, a time of great prosperity, which reached to all classes, the permanent rise of wages having more than balanced the increased cost of the necessaries of life. The following prices of wheat will show that a dear loaf did not necessarily mean distress while the war-expenditure lasted:

Prices of wheat (from Tooke).

s. d.

1802 57 1

1803 52 3

1804 Lady Day 49 6

Dec. 86 2

1805 Aug. 98 4

Dec. 74 5

1806 73 5

1807 Nov. 66

1808 May 73 6

Dec. 92

1809 March 95

July 86 6

Dec. 102 6

1810 June 113 5

Dec. 94 7

1811 June 86 11

Nov. 101 6

1812 Aug. 155

Nov. 113 6

1813 Aug. 112

Dec. 73 6

1814 July 66 5

1815 Dec. 53 7

1816 May 74

Dec. 103

1817 June 111 6

1817 Sept. 77 7

1818 Dec. 78 10

1819 Aug. 75

1820 72

1821 July 51

Dec. 50

1822 42

1823 Feb. 40 8

June 62 5

Oct. 46 5

Dec. 50 8

1824 65

The only years in the period from 1803 to 1816 in which there was some slight increase of fever were about 1811-12. There was undoubtedly some distress in the manufacturing districts at that time, owing to the much talked-of Orders in Council, which had the effect of closing American markets to British manufactures[295].

The small amount of fever in London between the year 1803 and the beginning of the epidemic of 1817-19 rests on the testimony of Bateman[296], who in 1804 took up Willan’s task of keeping a systematic record of the cases at the Carey Street Dispensary. He has only two special entries relating to typhus: one in the autumn of 1811, when some cases occurred in the uncleanly parts of Clerkenwell and St Luke’s (“but I have not learned that it has existed in any other districts of London”); the other in October and November 1813, when there was more typhus among the Irish in some of the filthy courts of Saffron Hill, near Hatton Garden, than for several years past, the infection having spread rapidly and fatally in several houses. The best evidence of this lull in typhus in London is the almost empty state of the new fever-hospital:

Year Admissions

1802 164

1803 176

1804 80

1805 66

1806 93

1807 63

1808 69

1809 29

1810 52

1811 43

1812 61

1813 85

1814 59

1815 80

1816 118

1817 760

Until it was removed to Pancras Road, in September, 1816, the London fever-hospital had only sixteen beds. But Bateman says that no one was refused admission, and that for several years the house was frequently empty three or four weeks together. Also at the Dispensary, in Carey Street, he had an opportunity during the period 1804-1816,

“Of observing the entire freedom from fevers enjoyed by the inhabitants of the numerous crowded courts and alleys within the extensive district comprehended in our visits from that charity.” And again, writing in the winter of 1814-15, Bateman says: “To those who recollect the numerous cases of typhoid fevers [this term did not then mean enteric] which called for the relief of dispensaries twelve or fourteen years ago, and the contagion of which was often with great difficulty eradicated from the apartments where it raged, and even seized the same individuals again and again when they escaped its fatal influences, the great freedom from these fevers which now exists, even in the most close and filthy alleys in London, is the ground of some surprise.” And once more, in the summer of 1816, just as the new epidemic period was about to begin, he says: “The extraordinary disappearance of contagious fever from every part of this crowded metropolis during the long period comprehended by these Reports [since 1804], cannot fail to have attracted the attention of the reader.”

Bateman concluded, not without reason, that this immunity of London from fever was due to the high degree of well-being among the poorer classes in times of plenty; and although he made out that the poor of Dublin, Cork and some Scotch towns did not profit by times of plenty so much as those in London, yet his reason for the abeyance of fever from 1804 to 1816 applied to England, Ireland and Scotland at large, and was doubtless the true reason.

The following figures from Manchester[297], Leeds[298] and Glasgow[299] hospitals, as well as the Irish statistics elsewhere given, are closely parallel with those of London:

Manchester House of Recovery.

Year Cases Deaths

1796-7 371 40

1797-8 339 16

1798-9 398 27

1799-1800 364 41

1800-1 747 63

1801-2 1070 84

1802-3 601 53

1803-4 256 33

1804-5 184 34

1805-6 268 29

1806-7 311 33

1807-8 208 15

1808-9 260 21

1809-10 278 30

1810-11 172 15

1811-12 140 18

1812-13 126 13

1813-14 226 17

1814-15 379 29

1815-16 185 14

1816-17 172 6

Leeds House of Recovery.

Year Cases Deaths

1804 (2 mo.) 10 0

1805 66 6

1806 75 2

1807 35 1

1808 80 3

1809 93 8

1810 75 14

1811 92 4

1812 80 12

1813 137 11

1814 79 4

1815 146 15

1816 121 13

1817 178 8

1818 (10 mo.) 254 20

Glasgow Royal Infirmary (Fever Wards).

Year Cases

1795 18

1796 43

1797 83

1798 45

1799 128

1800 104

1801 63

1802 104

1803 85

1804 97

1805 99

1806 75

1807 25

1808 27

1809 76

1810 82

1811 45