The epidemic fever of 1685-86.

A letter of 12 March, 1685, says: “Sir R. Mason died this morning in his lodging at Whitehall. A fever rages that proves very mortal, and gives great apprehensions of a plague[32].” Sydenham also was reminded of the circumstances preceding the Great Plague of London in 1665. In his first account of the epidemic of fever in 1685[33], which began with a thaw in February, he points out that the thaw in March, 1665, had been followed by pestilential fever and thereafter by the plague proper. In a later reference, when the epidemic of fever was in its second year (1686) he says: “How long it may last I shall not guess; nor do I quite know whether it may not be a certain more spirituous, subtle beginning, and as if primordium, of the former depuratory fever (1661-64) which was followed by the most terrible plague. There are some phenomena which so far incline me to that belief[34].” However, no plague followed the malignant, if not pestilential, fever of 1685-86. The reign of plague, as the event showed, was over; the fever which had been on former occasions its portent and satellite, came into the place of reigning disease. It is true that Sydenham does not identify the fever of 1685-86 by name as pestilential fever; on the contrary, he entitles his essay “De Novae Febris Ingressu.” But the novelty of type was partly in contrast to the fevers immediately preceding, which admitted treatment by bark, and its principal difference from the pestilential fever of former occasions seems to have been that it was not followed by plague[35]. Its antecedents and circumstances were very much those of plague itself. Its mortality was greatest in the old plague-seasons of summer and autumn, it had slight relation to famine or scarcity, or to other obvious cause of domestic typhus. Sydenham can find no explanation of the new constitution but “some secret and recondite change in the bowels of the earth pervading the whole atmosphere, or some influence of the celestial bodies.” He enlarges, however, on the character of the seasons preceding, which would have affected the surface, if not the bowels, of the earth, and the levels of the ground-water.

The winter of 1683-84 was one of intense frost; an ice-carnival was held on the Thames during the whole of January. The long dry frost of winter was followed by an excessively hot and dry summer, the drought being such as Evelyn did not remember, and as “no man in England had known.” For eight or nine months there had not been above one or two considerable showers, which came in storms. The winter of 1684-85 set in early, and became “a long and cruel frost,” more interrupted, however, than that of the year before. The spring was again dry, and it was not until the end of May 1685 that “we had plentiful rain after two years’ excessive drought and severe winters[36].”

The two years of excessive drought, with severe winters, had their effect upon the public health, as will appear from Short’s abstracts of parish registers in town and country[37]; the years 1683-85 being conspicuous for the excess of burials over baptisms:

Country Parishes.

Year Registers
examined		 Registers with
excess of death		 Deaths in
them		 Births in
them
1683 140 37 923 685
1684 140 31 900 629
1685 140 19 574 478
1686 140 16 419 301
1687 143 19 522 427
1688 143 11 327 267
Towns.
1683 25 8 1398 1169
1684 25 8 1243 865
1685 25 4 1191 741
1686 25 2 555 418
1687 25 1 313 269
1688 25 2 191 146

There is no clue to the forms of sickness that caused the excessive mortality in country parishes and provincial towns. But in London it appears from the Bills that the one great cause of the unusual excess of deaths in 1684 was an enormous mortality from infantile diarrhoea, from the end of July to the middle of September, during the weather which Evelyn describes as excessively hot and dry with occasional storms of rain.

It was in the second year of the long drought, February, 1685, that Sydenham dated the beginning of his new febrile constitutions. The mortality of 1685 was just twenty deaths more than in 1684 (23,222); but fever (with spotted fever) and smallpox had each a thousand more out of the total than in the year before. Sydenham says that the fever did not spare children, which might be alleged of typhus at all times; but a fever of the kind, even if it ran through the children of a household, seldom cut off the very young, the mortality being in greatest part of adults and adolescents. Excepting smallpox for the year 1685, infantile and children’s maladies were not prominent during the constitution of the “new fever;” the usual items of high infantile mortality, such as convulsions and “griping in the guts” or infantile diarrhoea, were moderate and even low. Hence, although the weekly fever-deaths in the following Table may not appear sufficient for the professional and other interest that they excited, it is to be kept in mind that they had been mostly of adult lives. It is probable also that a good many of them had been among the well-to-do, and perhaps at first in the West End; for there is nothing in the height of the weekly bills for all London to bear out the remark of the letter of 12 March, already quoted, “A fever rages that proves very mortal and gives apprehensions of a plague.”

Weekly Mortalities in London.

1685.

Week
ending		 Dead Of fever Of spotted
fever		 Of
smallpox		 Of griping
in the guts
March3 376 49 0 11 35
10 458 73 2 30 31
17 367 53 1 25 17
24 441 63 3 33 27
31 366 53 5 24 36
April7 421 47 10 28 30
14 433 64 8 32 27
21 473 66 6 47 45
28 470 68 3 49 45
May5 385 50 6 35 39
12 447 75 3 59 41
19 437 79 4 58 43
26 452 61 2 74 39
June2 469 65 8 65 36
9 521 88 14 62 41
16 499 91 9 66 34
23 478 76 12 71 53
30 526 82 13 84 45
July7 497 81 8 87 53
14 478 82 11 78 51
21 464 79 11 87 47
28 488 62 6 68 54
Aug.4 493 82 5 86 51
11 529 109 13 89 47
18 580 74 13 99 71
25 536 91 7 67 85
Sept.1 556 94 13 53 104
8 539 82 10 81 77
15 485 90 7 63 70
22 459 90 10 37 51
29 502 114 3 58 53
Oct.6 444 108 11 40 54
13 445 89 13 61 38
20 369 86 5 40 28
27 379 73 7 29 45
Nov.3 443 96 8 55 43
10 410 84 7 26 35
17 432 103 8 35 39
24 471 107 6 56 31
Dec.1 384 87 4 36 24
8 452 98 8 49 24
15 403 69 3 29 47
22 438 99 2 34 27
29 432 80 9 28 28

Weekly Mortalities in London.

1686.

Week
ending		 Dead Of fever Of spotted
fever		 Of
smallpox		 Of griping
in the guts
Jan.5 394 80 5 28 29
12 400 80 3 27 48
19 396 67 5 36 32
26 366 76 2 21 30
Feb.2 452 87 8 16 30
9 416 78 5 37 30
16 405 94 9 20 25
23 419 74 7 16 40
March2 417 84 1 20 37
9 455 95 6 18 30
16 415 71 10 31 21
23 453 78 11 22 46
30 372 58 8 17 35
April6 392 80 11 13 27
13 393 72 7 21 29
20 420 61 10 26 37
27 471 99 9 27 22
May4 429 78 21 28 46
11 374 71 6 16 22
18 395 69 5 17 3 (sic)
25 395 66 11 24 36
June1 383 63 4 15 49
8 404 66 6 26 38
15 523 88 9 43 64
22 503 99 9 25 73
29 473 90 10 31 62
July6 430 71 6 18 62
13 401 76 2 19 56
20 464 87 14 24 74
27 508 99 3 23 76
Aug.3 506 86 9 14 90
10 493 74 7 14 104
17 522 99 7 26 101
24 536 115 5 18 104
31 520 90 8 22 93
Sept.7 531 94 4 21 104
14 498 84 6 18 110
21 540 100 3 17 101
28 443 90 5 13 67
Oct.5 425 81 4 13 60
12 432 96 2 9 56
19 391 73 1 9 33
26 402 79 3 11 43
Nov.2 373 64 1 23 39
9 456 85 1 19 31
16 401 73 2 9 23
23 359 61 4 10 54
30 397 68 1 7 34
Dec.7 359 76 0 9 21
14 438 60 0 8 46
21 354 49 1 8 39
28 356 53 2 9 32

Sydenham says that he regarded the new fever at first as nothing more than the “bastard peripneumony” which he had described for previous seasons; but he had soon cause to see that it wanted the violent cough, the racking pain in the head during coughing, the giddiness caused by the slightest movement, and the excessive dyspnoea of the latter (Huxham likewise distinguished typhus from “bastard peripneumony”). The early symptoms of the “new fever” were alternating chills and flushings, pain in the head and limbs, a cough, which might go off soon, with pain in the neck and throat. The fever was a continued one, with exacerbation towards evening; it was apt to change into a phrensy, with tranquil or muttering delirium; petechiae and livid blotches were brought out in some cases (Sydenham thought they were caused by cordials and a heating regimen), and there were occasional eruptions of miliary vesicles. The tongue might be moist and white at the edges for a time, latterly brown and dry. Clammy sweats were apt to break out, especially from the head. If the brain became the organ most touched, the fever-heat declined, the pulse became irregular, and jerking of the limbs came on before death.

Later writers, for example those who described the great epidemic fever of 1741, have identified the fever of 1685-86 with the contagious malignant fever afterwards called typhus, and Murchison, in his brief retrospect of typhus in Britain, has included it under that name. Sydenham mentions petechiae and livid blotches in some cases, and the Bills give a good many of the deaths in the worst weeks of the epidemic under the head of “spotted fever.” It is not at first easy to understand why Sydenham should have written an essay specially upon it, in September, 1686, to claim it as a new fever[38] and not rather as the old pestilential fever—“populares meos admonens de subingressu novae cujusdam Constitutionis, a qua pendet Febris nova species, a nuper grassantibus multum abludens.” It should be kept in mind that his motive was correct treatment, and that the fashionable treatment of the day by Peruvian bark was, in his judgment, unsuited to this fever, however much it may have suited the epidemical intermittents of 1678-79 and the “depuratory” dregs of them for several years after. Physicians, he says, had learned to drive off by bark the fevers of the former constitution, from 1677 to the beginning of 1685, even when the fever intermitted little and sometimes when it intermitted not at all; and they saw an indication for bark in the nocturnal exacerbations of the new fever. Sydenham found that even large doses of bark did not free the patient from fever, and that restoration to health under treatment with the bark was due “magis fortunato alicui morbi eventu quam corticis viribus.” He seeks to establish the indications for another treatment by setting forth the symptoms minutely; and as the question of bark in fevers was the great medical question of the time, this may well have been Sydenham’s motive for discovering in the epidemic of 1685-6 a “new fever” although he does not say so in as many words. We have a good instance of how the bark-craze was at this time influencing the very highest circles of practice in the case of Lord Keeper Guildford, in July, 1685, as related in another chapter.

It will be seen from the table of weekly deaths that the second of the two hard winters was over before the fever began to attract notice. Sydenham compares its beginning after the thaw in February, 1685, to the beginning of the plague when the frost broke in March, 1665.

If it had been merely the typhus of a hard winter, of overcrowding indoors, of work and wages stopped by the frost, and of want of fuel (which things Evelyn mentions as matters of fact), it would have come sooner than the spring of 1685. The Bills for years before have regularly a good many deaths from fever, and always some from spotted fever; but these may have come from parishes wholly beyond the range of Sydenham’s practice. The fever began definitely for him in February, 1685, and was at its worst in the old plague-seasons of summer and autumn. If the seasons had any relation at all to it, the epidemic was a late effect of the long drought, an effect which was manifested most when the rain came, in the summer of 1685 and throughout the mild winter and normal summer of 1685-86. It must have been for that reason that Sydenham traced the source of it to “some secret and recondite change in the bowels of the earth,” rather than to a change in the sensible qualities of the air. One must ever bear in mind that the physicians of the Restoration gave no thought to insanitary conditions of living; in that respect the later Stuart period seems to have been behind the Elizabethan or even the medieval; we cannot err in assuming, behind all Sydenham’s speculative causes, a great deal of unwholesomeness indoors. Sydenham’s fullest reference to the subterranean sources of poisonous miasmata occurs in his tractate on Gout:

“Whether it be that the bowels of the earth, if one may so speak, undergo various changes, so that by the accession of vapours exhaled therefrom the air is disturbed, or that the whole atmosphere is infected by a change which some peculiar conjunction of certain of the heavenly bodies induces in it;—the matter so falls out that at this or that time the air is furnished with particles that are adverse to the economy of the human body, just as at another time it is impregnated with particles of a like kind that agree ill with the bodies of some species of brute animals. At these times, as often as by inspiration we draw into the naked blood miasmata of this kind, noxious and inimical to nature, and we fall into those epidemical diseases which they are apt to produce, Nature raises a fever,—her accustomed means of vindicating the blood from some hostile matter. And such diseases are commonly called epidemical; and they are short and sharp because they have thus a quick and violent movement[39].”

It was Sydenham’s intimate friend Robert Boyle who worked out the hypothesis of subterraneous miasmata as a cause of epidemic (and endemic) diseases. An account of his theory will be found in the chapter on Influenzas and Epidemic Agues. It may be said here that it needs only a few changes, especially the substitution of organic for inorganic matters in the soil, to bring it into line with the modern doctrine of miasmatic infective disease as expounded by the Munich school.

It has not been usual to think of spotted fever, (or of influenzas), in that connexion; but a telluric source of the epidemic constitution of 1685-86 was clearly Sydenham’s view; and as the fever came in circumstances like those of the last great plague, and was thought at the time to be the forerunner of another great plague, its connexion with recondite decompositions in the soil, dependent on the phenomenal drought of two whole years before, cannot be set aside as a possibility, the less so that the fever, although of the type of typhus, was not a fever of cold, hunger, and domestic distress, but mainly of the warm, or mild, or soft weather following the long drought, and of many well-to-do-people, as in the great Netherlands fever of 1669. My view of it is that it was the modified successor of plague, the pestis mitior, which used to precede and accompany the plague, now become the dominant constitution. The authentic figures of its mortality come from London; but Sydenham says that its “effects were felt far more in other places”; although Short’s abstracts of parish registers, given above, do not indicate excessive mortality throughout England.