It was in these circumstances that the most fatal infections of typhus took place. Such extraordinary malignancy of typhus happened often when the type of sickness (if indeed there was definite disease at all) among the originally ailing failed to account for it; it was the great disparity of condition that accounted for it. There were, however, more special occasions when a higher degree of malignancy than ordinary was bred or cultivated among the classes at large who were habitually liable to typhus. But even the old pestilential spotted fever which used to precede, accompany, and follow the plague itself, was fatal to a comparatively small proportion of all who had it. Thus, towards the end of the great London plague of 1625, on 18th October, Sir John Coke writes to Lord Brooke: “In London now the tenth person dieth not of those that are sick, and generally the plague seems changed into an ague[176].” One in ten is probably too small a fatality for the old pestilential fever; but that is the usually accepted proportion of deaths to attacks in the typhus fever of later times. The rate of fatality is got, naturally, by striking an average. But in truth an aggregate of typhus cases, however homogeneous in conventional symptoms or type-characters, was not always really homogeneous. We have seen that ninety cases of typhus could occur in the slums of Manchester with only two deaths. On the other hand there were outbreaks of gaol-fever in which half or more of all that were attacked died; and I suspect that the average fatality in typhus of one in ten was often brought up by an admixture of cases of healthy and well-conditioned people who caught a much more malignant type of fever from their contact with those inured to misery. To strike an average is in many instances a convenience and a help to the apprehension of a truth; but for the average to be instructive, the members of the aggregate must be more or less comparable in their circumstances. It has been truly said that there is no common measure between Lazarus and Dives as regards their subjective views of things; it is not a little strange to find that they are just as incommensurable in their risk of dying from the infection of typhus fever. The rule seems to be that the degree of acuteness or violence of an attack of typhus was inversely as the habitual poor condition of the victim. In adducing evidence of the tragic nature of typhus infection conveyed across the gulf of misery to the other side, I shall endeavour to keep strictly to the scientific facts, leaving the moral, if there be a moral (and it is not always obvious), to point itself.
Let us take first the common case of country-bred people migrating to the towns. Any lodging in a crowded centre of industry and trade would be high-rented compared with the country cottage which they had left, and they would naturally gravitate to the slums of the city.
“Great numbers of the labouring poor,” says Ferriar of Manchester, “who are tempted by the prospect of large wages to flock into the principal manufacturing towns, become diseased by getting into dirty infected houses on their arrival. Others waste their small stock of money without procuring employment, and sink under the pressure of want and despair.... The number of such victims sacrificed to the present abuses is incredible.” And again:
“It must be observed that persons newly arrived from the country are most liable to suffer from these causes, and as they are often taken ill within a few days after entering an infected house, there arises a double injury to the town, from the loss of their labour, and the expense of supporting them in their illness. A great number of the home-patients of the Infirmary are of this description. The horror of these houses cannot easily be described; a lodger fresh from the country often lies down in a bed filled with infection by its last tenant, or from which the corpse of a victim to fever has only been removed a few hours before[177].”
Two instances from the same author will show the severe type of the fever.
The tenant of a house in Manchester, who was herself ill of typhus along with her three children, took in a lodger, a girl named Jane Jones, fresh from the country. The lodger fell ill, but the fact was kept concealed from the visiting physician until her screams discovered her: “She was found delirious, with a black fur on the lips and teeth, her cheeks extremely flushed, and her pulse low, creeping, and scarcely to be counted.” Treatment was of no use; she “passed whole nights in shrieking,” and in her extremity, she was saved, as Ferriar believed, by affusions of cold water. Another case, exactly parallel, proved fatal in three days:
“In 1792 I had two patients ill of typhus in an infected lodging-house. I desired that they might be washed with cold water; and a healthy, ruddy young woman of the neighbourhood undertook the office. Though apparently in perfect health before she went into the sick chamber, she complained of the intolerable smell of the patients, and said she felt a head-ache when she came down stairs. She sickened, and died of the fever in three days[178].”
These are instances of country-bred people, plunging abruptly into the fever-dens of cities and catching a typhus severe in the direct ratio of their ruddy, healthy condition. Another class of cases is that of persons carrying the atmosphere of a gaol into the company of healthy and otherwise favourably situated people. Howard gives a case: at Axminster a prisoner discharged from Exeter gaol in 1755 infected his family with the gaol-distemper, of which two of them died, and many others in that town. The best illustrations of the greater severity and fatality of typhus among the well-to-do come from Ireland, in times of famine, and will be found in another chapter. But it may be said here, so that this point in the natural history of typhus fever may not be suspected of exaggeration, that the enormously greater fatality of typhus (of course, in a smaller number of cases) among the richer classes in the Irish famines, who had exposed themselves in the work of administration, of justice, or of charity, rests upon the unimpeachable authority of such men as Graves, and upon the concurrent evidence of many.
Ship-Fever.
The prevalence of fevers in ships of war and transports from the Restoration onwards can be learned but imperfectly, and learned at all only with much trouble. Sir Gilbert Blane, who was not wanting in aptitude and had the archives of the Navy Office at his service, goes no farther back than 1779, from which date an account was kept of the causes of death in the naval hospitals. But the deaths on board ships of the fleet were not systematically recorded until 1811, when the Board of Admiralty instructed all commanders of ships of war to send to the Naval Office an annual account of all the deaths of men on board[179]. The sources of information for earlier periods are more casual.