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.