CONTENTS.

PAGE
[CHAPTER I.]
TYPHUS AND OTHER CONTINUED FEVERS.
The Epidemic Fever of 1661, according to Willis[4]
Sydenham’s epidemic Constitutions[9]
Typhus Fever perennial in London[13]
The Epidemic Constitutions following the Great Plague[17]
The Epidemic Fever of 1685-86[22]
Retrospect of the great Fever of 1623-25[30]
The extinction of Plague in Britain[34]
Fevers to the end of the 17th Century[43]
Fevers of the seven ill years in Scotland[47]
The London Fever of 1709-10[54]
Prosperity of Britain, 1715-65[60]
The Epidemic Fevers of 1718-19[63]
The Epidemic Fevers of 1726-29: evidence of Relapsing Fever[66]
The Epidemic Fever of 1741-42[78]
Sanitary Condition of London under George II.[84]
The Window-Tax[88]
Gaol-Fever[90]
Circumstances of severe and mild Typhus[98]
Ship-Fever[102]
Fever and Dysentery of Campaigns: War Typhus, 1742-63[107]
Ship-Fever in the Seven Years’ War and American War[111]
The “Putrid Constitution” of Fevers in the middle third of the 18th Century[120]
Miliary Fever[128]
Typhus Fever in London, 1770-1800[133]
Typhus in Liverpool, Newcastle and Chester in the last quarter of the 18th century[140]
Fever in the Northern Manufacturing Towns, 1770-1800[144]
Typhus in England and Scotland generally, in the end of the 18th century[151]
Fevers in the Dearth of 1799-1802[159]
Comparative immunity from Fevers during the War and high prices of 1803-15[162]
The Distress and Epidemic Fever (Relapsing) following the Peace of 1815 and the fall of wages[167]
The Epidemic of 1817-19 in Scotland: Relapsing Fever[174]
The Relapsing Fever of 1827-28[181]
Typhoid or Enteric Fever in London, 1826[183]
Return of Spotted Typhus after 1831: “Change of Type.” Distress of the Working Class[188]
Enteric Fever mixed with the prevailing Typhus, 1831-42[198]
Relapsing Fever in Scotland, 1842-44[203]
The “Irish Fever” of 1847 in England and Scotland[205]
Subsequent Epidemics of Typhus and Relapsing Fevers[208]
Relative prevalence of Typhus and Enteric Fevers since 1869[211]
Circumstances of Enteric Fever[216]
[CHAPTER II.]
FEVER AND DYSENTERY IN IRELAND.
Dysentery and Fever at Londonderry and Dundalk, 1689[229]
A generation of Fevers in Cork[234]
Famine and Fevers in Ireland in 1718 and 1728[236]
The Famine and Fever of 1740-41[240]
The Epidemic Fevers of 1799-1801[248]
The Growth of Population in Ireland[250]
The Famine and Fevers of 1817-18[256]
Famine and Fever in the West of Ireland, 1821-22[268]
Dysentery and Relapsing Fever, 1826-27[271]
Perennial Distress and Fever[274]
The Great Famine and Epidemic Sicknesses of 1846-49[279]
Decrease of Typhus and Dysentery after 1849[295]
[CHAPTER III.]
INFLUENZAS AND EPIDEMIC AGUES.
Retrospect of Influenzas and Epidemic Agues in the 16th and 17th centuries[306]
The Ague-Curers of the 17th Century[315]
The Peruvian Bark Controversy[320]
The Influenza of 1675[326]
The Influenza of 1679[328]
The Epidemic Agues of 1678-80[329]
The Influenza of 1688[335]
The Influenza of 1693[337]
The Influenza of 1712[339]
Epidemic Agues and Influenzas, 1727-29[341]
The Influenza of 1733[346]
The Influenza of 1737[348]
The Influenza of 1743[349]
Some Localized Influenzas and Horse-colds[352]
The Influenza of 1762[356]
The Influenza of 1767[358]
The Influenza of 1775[359]
The Influenza of 1782[362]
The Epidemic Agues of 1780-85[366]
The Influenza of 1788[370]
The Influenza of 1803[374]
The Influenza of 1831[379]
The Influenza of 1833[380]
The Influenza of 1837[383]
The Influenza of 1847-48[389]
The Influenzas of 1889-94[393]
The Theory of Influenza[398]
Influenza at Sea[425]
The Influenzas of Remote Islands[431]
[CHAPTER IV.]
SMALLPOX.
Retrospect of earlier epidemics[434]
Smallpox after the Restoration[437]
Sydenham’s Practice in Smallpox[445]
Causes of Mild or Severe Smallpox[450]
Pockmarked Faces in the 17th Century[453]
The Epidemiology continued to the end of the 17th century[456]
Smallpox in London in 1694: the death of the Queen[458]
Circumstances of the great Epidemic in 1710[461]
Inoculation brought into England[463]
The popular Origins of Inoculation[471]
Results of the first Inoculations; the Controversy in England[477]
Revival of Inoculation in 1740: a New Method[489]
The Suttonian Inoculation[495]
Extent of Inoculation in Britain to the end of the 18th Century[504]
The Epidemiology continued from 1721[517]
Smallpox in London in the middle of the 18th century[529]
The Epidemiology continued to the end of the 18th century[535]
The range of severity in Smallpox, and its circumstances[544]
Cowpox[557]
Chronology of epidemics resumed from 1801[567]
The Smallpox Epidemic of 1817-19[571]
Extent of Inoculation with Cowpox or Smallpox, 1801-1825[582]
The Smallpox Epidemic of 1825-26[593]
A generation of Smallpox in Glasgow[597]
Smallpox in Ireland, 1830-40[601]
The Epidemic of 1837-40 in England[604]
Legislation for Smallpox after the Epidemic of 1837-40[606]
Other effects of the epidemic of 1837-40 on medical opinion[610]
The age-incidence of Smallpox in various periods of history[622]
[CHAPTER V.]
MEASLES.
Derivation and early uses of the name[632]
Sydenham’s description of Measles in London, 1670 and 1674[635]
Measles in the 18th century[641]
Increasing mortality from Measles at the end of the 18th century[647]
Measles in Glasgow in 1808 and 1811-12: Researches of Watt[652]
Measles in the Period of Statistics[660]
[CHAPTER VI.]
WHOOPING-COUGH.
Earliest references to whooping-cough[666]
Whooping-cough in Modern Times[671]
Whooping-cough as a Sequel of other Maladies[674]
[CHAPTER VII.]
SCARLATINA AND DIPHTHERIA.
Nosological difficulties in the earlier history[678]
The Throat-distemper of New England, 1735-36[685]
Angina maligna in England from 1739[691]
An epidemic of Throat-disease in Ireland, 1743[693]
Malignant Sore-throat in Cornwall, 1748[694]
Fothergill’s Sore-throat with Ulcers, 1746-48[696]
“Scarlet Fever” at St Albans, 1748[698]
Epidemics of Sore-throat with Scarlet rash in the period between Fothergill and Withering[699]
Scarlatina anginosa in its modern form, 1777-78[708]
History of Scarlatina after the Epidemic of 1778[713]
Scarlatina (1788) and Diphtheria (1793-94) described by the same observer[715]
Scarlatinal Epidemics, 1796-1805[719]
Scarlatina since the beginning of Registration, 1837[726]
Reappearance of Diphtheria in 1856-59[736]
Conditions favouring Diphtheria[744]
[CHAPTER VIII.]
INFANTILE DIARRHOEA, CHOLERA NOSTRAS, AND DYSENTERY.
Summer Diarrhoea of Infants in London, 17th century[748]
Summer Diarrhoea of Infants, 18th century[754]
Modern Statistics of Infantile Diarrhoea[758]
Causes of the high Death-rates from Infantile Diarrhoea[763]
Cholera Nostras[768]
Dysentery in the 17th and 18th centuries[774]
Dysentery in the 19th century[785]
[CHAPTER IX.]
ASIATIC CHOLERA.
Asiatic Cholera at Sunderland in October, 1831[796]
Extension of Cholera to the Tyne, December, 1831[802]
The Cholera of 1832 in Scotland[805]
The Cholera of 1832 in Ireland[816]
The Cholera of 1832 in England[820]
The Cholera of 1848-49 in Scotland[835]
The Cholera of 1849 Ireland[839]
The Cholera of 1849 in England[840]
The Cholera of 1853 at Newcastle and Gateshead[849]
The Cholera of 1854 in England[851]
The Cholera of 1853-54 in Scotland and Ireland[855]
The Cholera of 1865-66[856]
The Antecedents of Epidemic Cholera in India[860]
Note on Cerebro-Spinal Fever[863]

CHAPTER I.

TYPHUS AND OTHER CONTINUED FEVERS.

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

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

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

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

“I am far from taking upon myself the credit of exhausting my subject in the present observations. It is highly probable that I may fail even in the full enumeration of the epidemics. Still less do I warrant that the diseases which during the years in question have succeeded each other in the sequence about to be exhibited shall remain the same in all future years. One thing most especially do I aim at. It is my wish to state how things have gone lately; how they have been in this country, and how they have been in this the city which we live in. The observations of some years form my ground-work. It is thus that I would add my mite, such as it is, towards the foundation of a work that, in my humble judgment, shall be beneficial to the human race. Posterity will complete it, since to them it shall be given to take the full view of the whole cycle of epidemics in their mutual sequences for years yet to come[4].”