His account of the epidemic of 1674 is still more important to be set beside the figures in the bills; for the type, according to Sydenham, was anomalous, and the total of deaths entered by the Parish Clerks (795) is exceptionally large. Like the epidemic four years before, it began in January, came to a height about the vernal equinox, and was nearly over at the summer solstice[1189].
Weekly Deaths in London in the first six months of 1674. (Epidemic of Measles.)
1674
| Week ending | Fever | Smallpox | Griping in the guts | Measles | Convulsions | Teeth | Consumption | All causes | |||||||||
| Jan. | 6 | 35 | 13 | 35 | 0 | 37 | 15 | 78 | 332 | ||||||||
| 13 | 35 | 19 | 32 | 1 | 32 | 22 | 65 | 369 | |||||||||
| 20 | 37 | 12 | 29 | 0 | 39 | 18 | 65 | 327 | |||||||||
| 27 | 34 | 15 | 38 | 0 | 38 | 17 | 68 | 354 | |||||||||
| Feb. | 3 | 32 | 23 | 39 | 7 | 45 | 26 | 75 | 418 | ||||||||
| 10 | 47 | 18 | 35 | 4 | 48 | 35 | 86 | 430 | |||||||||
| 17 | 55 | 21 | 46 | 15 | 70 | 38 | 98 | 537 | |||||||||
| 24 | 62 | 17 | 45 | 28 | 54 | 44 | 97 | 510 | |||||||||
| March | 3 | 58 | 31 | 28 | 59 | 48 | 49 | 87 | 547 | ||||||||
| 10 | 55 | 22 | 31 | 87 | 85 | 58 | 122 | 688 | |||||||||
| 17 | 63 | 15 | 46 | 95 | 79 | 57 | 113 | 695 | |||||||||
| 24 | 59 | 23 | 44 | 65 | 57 | 39 | 96 | 568 | |||||||||
| 31 | 51 | 19 | 49 | 60 | 77 | 51 | 105 | 622 | |||||||||
| April | 7 | 44 | 13 | 40 | 43 | 65 | 48 | 118 | 547 | ||||||||
| 14 | 53 | 20 | 32 | 31 | 60 | 50 | 98 | 535 | |||||||||
| 21 | 40 | 17 | 43 | 38 | 55 | 42 | 106 | 517 | |||||||||
| 28 | 50 | 17 | 44 | 53 | 67 | 34 | 87 | 520 | |||||||||
| May | 5 | 51 | 31 | 28 | 30 | 56 | 24 | 75 | 452 | ||||||||
| 12 | 38 | 26 | 47 | 30 | 54 | 37 | 79 | 479 | |||||||||
| 19 | 50 | 35 | 33 | 26 | 47 | 28 | 82 | 461 | |||||||||
| 26 | 67 | 27 | 33 | 13 | 45 | 28 | 63 | 415 | |||||||||
| June | 2 | 48 | 24 | 28 | 14 | 41 | 26 | 77 | 365 | ||||||||
| 9 | 35 | 26 | 38 | 15 | 48 | 27 | 66 | 369 | |||||||||
| 16 | 64 | 34 | 38 | 19 | 38 | 22 | 70 | 419 | |||||||||
| 23 | 34 | 33 | 34 | 9 | 52 | 15 | 71 | 368 | |||||||||
| 30 | 37 | 39 | 30 | 9 | 30 | 21 | 59 | 343 | |||||||||
It will be seen that the highest weekly mortality from measles is only 95, in the week ending 17th May. But in that week the deaths from all causes reached the enormous total of 695, which was nearly three hundred above the weekly average of the time. This appears to have been the epidemic of measles which Morton declares to have destroyed three hundred in a week, a mode of reckoning which would claim for measles, directly or indirectly, the excess of mortality from all causes during the height of the epidemic[1190].
These high weekly mortalities in February, March, April and May are remarkable for the season of the year. Usually when the weekly figures reach six or seven hundred, it is in a hot autumn, and the cause is infantile diarrhoea, represented in the bills by the excessive number of deaths from “griping in the guts” and “convulsions;” more rarely, and then only for three or four weeks, correspondingly high figures are reached in a season of influenza. But in this case the epidemic measles is the only relevant thing. The measles deaths by themselves do by no means account for the enormous weekly totals; but two of the three columns of figures which help them, and indeed keep pace with the rise of the measles deaths, namely, “convulsions” and “teeth,” are infantile deaths obviously related to the prevailing epidemic; while the third column, “consumption,” which contributes most of all, did not in the London bills mean pulmonary consumption exclusively, but also the wasting or marasmus which followed or attended acute fevers in general, and was specially apt to follow or attend measles[1191].
Sydenham gives no indication that the spring of 1674 was unusually productive of pneumonia or pleurisy among adults; the winter, he says, was unusually warm, the weather in spring turning colder. But, as to the measles, he does say that the epidemic was anomalous or irregular; while both he and Morton refer the fatalities more especially to the sequelae of measles,—to the “suffocation” of infants and children by the bronchitis or peripneumonia, or to “angina,” as Morton says, meaning perhaps the same as in Scotland was understood by “closing” in infants. Measles itself was a milder disease than smallpox, according to the experience of all times; and yet, by its sequelae (bronchitis, capillary bronchitis and pneumonia, including what Morton calls “angina,” and excluding, for the present, whooping-cough), it raised the weekly mortalities of February, March, April and May, 1674, to far above the average. Sydenham said, with reference to the much milder epidemic of 1670, that these after-effects of measles “destroyed more than even smallpox itself” (quae [peripneumonia] plures jugulat quam aut variolae ipsae). We shall not correctly understand the part played by measles among the infective maladies of children unless we keep that grand character of it in mind—that its effects upon the mortality of infancy and childhood are only in part expressed by the deaths actually appearing under its name.
The London bills for 1674 afford us the opportunity of testing Sydenham’s paradox that measles, by its after-effects, destroyed more than smallpox itself. The epidemic of measles was nearly over in June; and immediately thereafter an epidemic of smallpox began (not of course from zero but from the usual level of the disease), which reached a maximum of 122 deaths in the week ending 20th October. The second half of the year was thus marked by a sharp outburst of smallpox, as the first half was marked by a sharp outburst of measles; and those two diseases were the only epidemic maladies that gave character to the respective seasons, each being in its proper season, according to Sydenham—measles in the spring, smallpox in the autumn. Although the measles deaths were only 795 for the whole year, the smallpox deaths being 2507, yet the former epidemic was attended by so great an excess of deaths under various other heads that the half of the year in which it fell was far more unhealthy than the succeeding half in which the smallpox mainly fell, the weekly average of the first six months having been 468 deaths, and of the second six months 349 deaths. The following table shows the weekly mortalities for the second half of the year; it will be observed that no column of figures keeps pace with the rise of the smallpox deaths, as three columns had kept pace with the rise of the measles deaths in the first six months of the year.
Weekly Deaths in London in the last six months of 1674. (Epidemic of Smallpox.)
1674