| Week ending | Convulsions | All deaths under two | All deaths from two to five | Total of deaths at all ages | |||||
| Aug. | 13 | 218 | 240 | 71 | 558 | ||||
| 20 | 217 | 284 | 76 | 547 | |||||
| 27 | 240 | 297 | 80 | 573 | |||||
| Sept. | 3 | 260 | 331 | 59 | 638 | ||||
| 10 | 226 | 283 | 61 | 593 | |||||
| 17 | 209 | 253 | 43 | 528 | |||||
| 24 | 169 | 225 | 46 | 515 | |||||
| Oct. | 1 | 158 | 224 | 59 | 510 | ||||
| 8 | 190 | 236 | 61 | 558 | |||||
| 15 | 136 | 172 | 42 | 464 | |||||
In those nine mortal weeks of 1734, it will be seen that the deaths under two years were about 45 per cent. of the deaths at all ages; they were at the same time considerably more than half the recorded births. That was the characteristic mortality of an unhealthy summer and autumn. It was chiefly caused by the same cholera infantum or summer diarrhoea which raises the weekly bills of London in our own time, and the occasions of it recurred in a series of hot summers, or at intervals, just as they do now. I shall not seek to illustrate this point for the rest of the 18th century, and down to the beginning of registration in 1837. The history of infantile diarrhoea is a continuous and uniform one, with indications of greatest severity in the first half of the 18th century. Sir William Fordyce, whose general theme is what he calls the hectic fever of children (rickets), thus reveals some reasons why that should have been the worst period of infantile diarrhoea[1395]:
“I speak within the bounds of truth when, judging from the Bills of Mortality and the numbers in such circumstances who have been brought to my door since the year 1750, I assert that there must be very near 20,000 children in London, and Westminster and the suburbs (if this be questioned, examine the public charity schools and workhouses, the purlieus of St Giles’s and Drury Lane, and satisfy yourselves) ill at this moment of the hectic fever, attended with tun-bellies, swelled wrists and ancles, or crooked limbs, owing to the impure air which they breathe, the improper food on which they live, or the improper manner in which their fond parents or nurses rear them up: for they live in hotbed chambers or nurseries, they are fed even on meat before they have got their teeth, and, what is if possible still worse, on biscuits not fermented, or buttered rolls, or tough muffins floated in oiled butter, or calves-feet jellies, or strong broths yet more calculated to load all their powers of digestion; or are totally neglected.”
Mistaken regimen among the more comfortable, total neglect among the lowest class—these general causes of infantile mortality reached their highest point in London under George I. and George II., at the time of the disastrous mania for spirit-drinking. But the broken constitutions of the parents were probably a more telling thing for the poor stamina of the children than close nurseries, injudicious food or even total neglect[1396].
While the article “Convulsions” in the London bills gradually swallowed up nearly all the deaths of infants under two years, and so far extinguished the article “griping in the guts” that the latter in the year 1739 had fallen to the merely nominal figure of 280 deaths in the year, yet it should be borne in mind that there must have been in the same period an excessive mortality from convulsions not specially related to cholera infantum. For example, the kind of convulsions in new-born infants which nurses called the “nine-day fits,” produced the following mortalities in the Lying-in Hospital of Dublin: Of 17,650 infants born alive in the hospital from 8 Dec. 1757 to 31 Dec. 1782, there died 2944 within a fortnight of birth, or 17 per cent. The disease of perhaps nineteen in twenty was “general convulsions, or what our nurses have been long in the habit of calling the nine-day fits[1397].” Corresponding deaths in London would have been included under “chrisoms and infants” in the earlier period; but as that article gradually ceased, they were naturally transferred to the article “convulsions.”
The sacrifice of infants’ lives in London by the diarrhoea of summer having been so enormous as the preceding tables show, the question arises whether the same disease was a chief factor in the mortality of provincial cities and towns. There is little positive evidence for, and there is a good deal of probability against, its having been so important anywhere as in London. In the second quarter of the 18th century, when London had 700,000 inhabitants, the larger provincial towns such as Edinburgh, Glasgow, Manchester, Newcastle had not more than 30,000 to 40,000. A Liverpool writer in 1784, by which time the population had grown much, does indeed say that young children in large towns during the hot summer months are apt to be fretful and peevish, and that they should have a change to the air of the country[1398]. But it is inconceivable that Manchester, with such vital statistics as are shown at p. 644 could have had the same death-rates from convulsions in general or from the summer-diarrhoea kind of them in particular, that London then had. Still it had at least a local predisposition, then as now, to epidemic diarrhoea. Thus Ferriar, having described certain flagrant nuisances in the town, goes on to say that the burning summer of 1794 was followed by wet warm weather, that a bilious colic raged among all ranks of the people, and that thereafter “the usual epidemic fever” became very prevalent among the poor[1399].
The bills of mortality for occasional years at Chester, Warrington, Northampton, Carlisle and Edinburgh, which have been cited before in various contexts, throw hardly any light upon this question of infantile diarrhoea. The records of the Newcastle dispensary in the end of the 18th century do show a good many cases of diarrhoea to have been attended, with a proportion of fatalities which suggests that some, at least, were in infants. Newcastle, as will appear in the sequel, was certainly much subject to dysentery and the diarrhoea of adults in the 18th century, and was as likely a place as any in England for cholera infantum. In the records of two towns of Scotland it seems probable that a good deal of infantile diarrhoea had been entered in the burial registers under the name of “bowel-hive.” At Kilmarnock, from 1728 to 1764, and at Glasgow from 1783 to 1800, the principal causes of death in infancy had the following annual average ratios per cent. of the deaths from all causes:
| Kilmarnock 1728-64 | Glasgow 1783-1800 | |||||
| Smallpox | 16 | per cent. | 18·8 | per cent. | ||
| Bowel-hive | 7·0 | " | 6·5 | " | ||
| Chincough | 3·0 | " | 5·0 | " | ||
| Closing | 2·8 | " | 2·7 | " | ||
| Measles | 2·4 | " | 1·3 | " | ||
| Teething | 1·4 | " | 3·5 | " | ||
The article “bowel-hive” has a somewhat higher ratio of the deaths from all causes at Kilmarnock, with about 4000 population, than at Glasgow with some 80,000, and was probably a very comprehensive term[1400].
So far as concerns systematic medical description, an article by Dr Benjamin Rush, of Philadelphia, written in 1773, is the first expressly on the theme of cholera infantum or the summer diarrhoea of children; but, as Hirsch correctly remarks, the popular names of the disease then current in American towns, such as “disease of the season,” “summer complaint,” or “April-and-May disease” (Southern States), indicate that it was well known before the profession began to write upon it[1401]. So far as concerns London, I am disposed to infer that it was more common, relatively to the population, in the end of the 17th century and throughout the 18th than in our own time. I shall come back to that after giving the modern statistics of the malady for the capital and other English towns.