Summer Diarrhoea of Infants in London, 17th century.

In the period of twenty-five years which Sydenham’s epidemic constitutions cover (1661-1686), the first distinctively choleraic season was the late summer and autumn of 1669. It was the first of a series of such seasons, in one or more of which there occurred dysentery, cholera morbus and bilious colic. In the context of the bilious colic of the years 1670-72, Sydenham remarks that this was a disease which attacked chiefly the young of a hot and bilious temperament, and was most rife in the summer season[1389]. It is in connexion with the smallpox of 1667-69 that he speaks of diarrhoea in infants; in that malady, he says, diarrhoea is as natural to infants as salivation to adults, and he blames the imprudent efforts of nurses to check the diarrhoea for the deaths of “many thousands of infants[1390].” This is perhaps all that can be found in Sydenham to show that infants did in fact suffer from diarrhoea, and that it was fatal to them in large numbers. Equally indirect is the testimony of Willis. Speaking of convulsions, he says they occur at two special periods of life,—within one month of birth (the “fits of the mother” of 18th century writers), and during teething; and with reference to the cause he says: “As often as the cause of the convulsive distemper seems to be in the viscera, either worms or sharp humours, stirring up to torments of the belly, are understood to be at fault[1391].” It may be thought singular that Sydenham and Willis should not have enlarged upon the infantile age at which the summer diarrhoea of London mostly proved fatal, or that Sydenham should not have elucidated by some comment the enormous weekly totals of deaths by “griping in the guts” in the Parish Clerks’ bills during many of the summers and autumns that came within the period of his epidemic constitutions.

It should be kept in mind, however, that it was from the populous liberties and outparishes occupied by the working class,—from Cripplegate, Shoreditch, Spitalfields, Whitechapel, St Olave’s, Southwark, Newington and Lambeth,—that the largest totals in the bills came. Sydenham in Pall Mall, Willis in St Martin’s Lane, and Morton in Newgate Street, were not likely to see much of the maladies of the poorest class, least of all the infantile part of these; and the fact that their illustrative cases of choleraic disease are mostly of adults should not mean that the age of infancy did not then furnish most of the deaths, as it certainly did in later times.

Whatever may have been the reason of their saying so little of infantile diarrhoea, its great frequency or fatality in London in the end of the 17th century rests upon the explicit testimony of Doctor Walter Harris, in his book on the Acute Diseases of Infants, written in 1689[1392]: “From the middle of July to the middle of September these epidemic gripes of infants are so common (being the annual heat of the season doth entirely exhaust their strength) that more infants, affected with these, do die in one month than in other three that are gentle.” It was probably this remarkable fatality of the summer diarrhoea of infants that led Sydenham to say that the cholera morbus of August differed toto caelo from the disease with the same symptoms at any other time of the year[1393].

The summer of 1669 was excessively hot; it was a season of enormous mortality from fevers in Holland, of a type very difficult to understand, and in New England it was remarkable for fluxes, agues and other fevers. In that summer, as well as in the following, Sydenham lays stress upon the amount of choleraic and dysenteric sickness, without saying that it was specially fatal to children. The following Tables, compiled from the weekly bills of the Parish Clerks for each of the two summers, show the enormous rise of the total deaths in August and September, “griping in the guts” accounting for almost the whole of the increase.

Weekly Mortalities supposed of Infantile Diarrhoea in London.

Summer and Autumn of 1669

Week
ending		 Convulsions Griping in
the guts		 All
causes
June29 30 42 283
July6 49 74 365
13 48 105 391
20 53 119 389
27 36 122 368
Aug.3 28 96 340
10 22 129 437
17 43 173 510
24 31 182 482
31 42 269 665
Sept.7 45 318 707
14 34 277 619
21 33 231 524
28 29 232 570
Oct.5 38 185 553
12 30 172 518
19 25 156 473
26 16 146 421
Nov.2 14 89 372

Summer and Autumn of 1670

Week
ending		 Convulsions Griping in
the guts		 All
causes
July5 37 41 318
12 40 51 320
19 43 76 351
26 40 77 372
Aug.2 49 113 470
9 38 160 485
16 44 189 555
23 47 222 629
30 42 250 629
Sept.6 31 253 617
13 24 239 586
20 38 225 575
27 27 150 474
Oct.4 16 130 401
11 13 104 376
18 17 78 325
25 15 75 336
Nov.1 19 46 283

These are the characteristic London bills of a hot autumn; they recur sometimes two or three years in succession, and on an average perhaps once or twice in a decennium. Any year with an unusually high total of deaths from all causes is almost certain to show a large part of its excess of deaths in the weekly bills of summer and autumn. The proof that these enormous weekly totals under the head of “griping in the guts” were infantile deaths lies in the fact that they were gradually transferred to “convulsions,” as will appear in the tables of future autumnal epidemics showing the transference half made and wholly made. The transference to “convulsions” was almost complete before the year 1728, when the ages at deaths from all causes were first published in the weekly bills. After that year it is obvious that any excessive mortality of the six or eight hot weeks of late summer or autumn corresponds to a great increase of the deaths under two years, which is also the increase of deaths from convulsions. But those were the “convulsions” of a particular season, occupying exactly the place which “griping in the guts” held in the weekly bills of certain years in the earlier period. As most of the deaths from infantile diarrhoea are really from convulsions, it is easy to see that high weekly totals of deaths under that generic name must have been from infantile diarrhoea—when they began to rise in August far above the ordinary level of convulsions to fall to the level again in October. It is by precisely the same reading between the lines that we discover, under the head of “diarrhoea and dysentery” in the modern registration returns, that there is hardly any fatal dysentery, not much fatal diarrhoea of adults, but an enormous fatality from the diarrhoea of infants, especially in summer.

The sickness of the latter half of 1669, and of the years following to 1672, which we know from Sydenham and Morton to have been choleraic and dysenteric, was not special to London. The following abstracts of the burial registers of country parishes,

Deaths in Country Parishes of England.

Years Registers
examined		 With excess of
burials over baptisms		 Baptisms
in these		 Burials
in these
1669 118 33 685 878
1670 119 53 781 1403
1671 121 36 668 1051
1672 121 28 555 741
1673 124 16 365 487

by Short, show an excessive mortality in those years, which would have been in part caused by bowel complaints, as in the general “choleric lasks” of the 16th century.

In the summers of 1671 and 1672 the article of “griping in the guts” continues high in the London bills. It rises again decidedly in the summer of 1675, reaching a maximum of 129 deaths in the week ending 24 August, the deaths from all causes being 460. In the summer of 1676 it almost equals the high mortality of 1669 and 1670, reaching a maximum of 238 deaths in the week ending 22 August, the deaths from all causes being 607. In 1678 and 1679 there were epidemic agues, complicated with choleraic flux and gripes, which undoubtedly affected many adults[1394]. The deaths from “griping in the guts” continue high in the summers of 1680 and 1681. But by that time the article “convulsions” had steadily increased in the bills; and in the next great season of bowel complaint, the excessively hot and dry summer of 1684, the high mortality of the season is divided more equally between “griping in the guts” and “convulsions,” a sufficient indication of the age-incidence of the former:

London Weekly Mortalities.

1684

Week
ending		 Griping in
the guts		 Convulsions All
deaths
July1 56 98 454
8 71 92 404
15 65 79 364
22 74 89 420
29 116 84 503
Aug.5 154 180 720
12 — — —
19 186 100 609
26 — — —
Sept.2 171 95 585
9 144 82 564
16 103 58 471
23 91 59 464

The summers and autumns of 1688 and 1689 were again characteristic seasons of infantile diarrhoea. The deaths rose in August and September almost as in 1669 and 1670; but now the article of convulsions has actually more of the mortality of the season assigned to it than the original article of “griping in the guts.”

London Weekly Mortalities.

Summer and Autumn of 1688

Week
ending		 Convulsions Griping in
the guts		 All
causes
July10 84 28 353
17 94 35 388
24 90 80 491
31 108 86 510
Aug.7 122 119 557
14 141 136 630
21 130 113 518
28 120 90 483
Sept.4 109 98 532
11 112 119 547
18 90 102 474
25 102 76 476
Oct.2 71 65 380
9 67 43 362

Summer and Autumn of 1689

Week
ending		 Convulsions Griping in
the guts		 All
causes
July16 108 60 486
23 109 65 463
30 121 69 504
Aug.6 147 102 576
13 121 130 631
20 140 150 662
27 150 190 726
Sept.3 150 170 733
10 108 156 693
17 110 117 630
24 95 90 558
Oct.1 104 89 540
9 76 78 486

The following table from the annual bills will serve to show the summers most fatal to infants in London, and at the same time the gradual usurpation of the place of “griping in the guts” by “convulsions.”

Annual deaths from Infantile Diarrhoea, etc., in London.

Griping in
the guts		 Convulsions
1667 2108 1210
1668 2415 1417
1669 4385 1730
1670 3690 1695
1671 2537 1650
1672 2645 1965
1673 2624 1761
1674 1777 2256
1675 3231 1961
1676 2083 2363
1677 2602 2357
1678 3150 2525
1679 2996 2837
1680 3271 3055
1681 2827 3270
1682 2631 3404
1683 2438 3235
1684 2981 3772
1685 2203 3420
1686 2605 3731
1687 2542 3967
1688 2393 4438
1689 2804 4452
1690 2269 3830
1691 2511 4132
1692 1756 3942
1693 1871 4218
1694 1443 5024
1695 1115 4496
1696 1187 4480
1697 1136 4944
1698 1165 4480
1699 1225 4513
1700 1004 4631
1701 1136 5532
1702 1189 5639
1703 985 5493
1704 1134 5987
1705 1021 6248
1706 948 5961
1707 883 5948
1708 768 5902
1709 812 5892
1710 707 6046
1711 614 5516
1712 575 6156
1713 581 5779
1714 670 7161
1715 589 6818
1716 709 7114
1717 653 7147
1718 801 8055
1719 826 7690
1720 731 6787