The year 1773, to which these experiences in a small part of London relate, was one of high febrile mortality, according to the Bills. Two years after, Dr William Grant was moved to write an ‘Essay on the Pestilential Fever of Sydenham, commonly called Gaol, Hospital, Ship and Camp Fever[244],’ which, as he said in his preface, “I often see in this city: and though so common and fatal, appears not at present to be generally understood.” It was, he says, “an indigenous plant, frequent in this city, being produced by close confinement; but it often passes unnoticed, because unknown.” The deaths by “fever” in the London Bills were as follows until the end of the century:
Deaths from Fever and from all causes in London.
| Year | Fever deaths | All deaths | ||
| 1771 | 2273 | 21780 | ||
| 1772 | 3207 | 26053 | ||
| 1773 | 3608 | 21656 | ||
| 1774 | 2607 | 20884 | ||
| 1775 | 2244 | 20514 | ||
| 1776 | 1893 | 19048 | ||
| 1777 | 2760 | 23334 | ||
| 1778 | 2647 | 20399 | ||
| 1779 | 2336 | 20420 | ||
| 1780 | 2316 | 20517 | ||
| 1781 | 2249 | 20719 | ||
| 1782 | 2552 | 17918 | ||
| 1783 | 2313 | 19029 | ||
| 1784 | 1973 | 17828 | ||
| 1785 | 2310 | 18919 | ||
| 1786 | 2981 | 20454 | ||
| 1787 | 2887 | 19349 | ||
| 1788 | 2769 | 19697 | ||
| 1789 | 2380 | 20749 | ||
| 1790 | 2185 | 18038 | ||
| 1791 | 2013 | 18760 | ||
| 1792 | 2236 | 20213 | ||
| 1793 | 2426 | 21749 | ||
| 1794 | 1935 | 19241 | ||
| 1795 | 1947 | 21179 | ||
| 1796 | 1547 | 19288 | ||
| 1797 | 1526 | 17014 | ||
| 1798 | 1754 | 18155 | ||
| 1799 | 1784 | 18134 | ||
| 1800 | 2712 | 23068 |
There were higher figures in the years immediately before 1771, the years to which the generalities of Fordyce and Armstrong relate. There is a decline in the fever-mortality towards the end of the century; but it is just from the years 1799-1800 that we have an account by Willan of the prevalence and conditions of London typhus, than which nothing can well be imagined worse. The intermediate glimpses we get of typhus in London in the writings of Dr Hunter, physician, and of Dr James Sims, show that the disease was perennial.
“In the month of February, 1779,” says Hunter[245], “I met with two examples of fever in the lodgings of some poor people whom I visited that resembled in their symptoms the distemper which is called the jail or hospital fever. It appeared singular that this disease should show itself after three months of cold weather. Being therefore desirous of learning the circumstances upon which this depended I neglected no opportunity of attending to similar cases. I soon found a sufficient number of them for the purpose of further information. It appeared that the fever began in all in the same way and originated from the same causes. A poor family, consisting of the husband, the wife, and one or more children, were lodged in a small apartment not exceeding twelve or fourteen feet in length, and as much in breadth. The support of them depended on the industry and daily labour of the husband, who with difficulty could earn enough to purchase food necessary for their existence, without being able to provide sufficient clothing or fuel against the inclemencies of the season. In order therefore to defend themselves against the cold of the winter, their small apartment was closely shut up, and the air excluded by every possible means. They did not remain long in this situation before the air became so vitiated as to affect their health and produce a fever in some one of the miserable family. The fever was not violent at first, but generally crept on gradually ... soon after the first a second was seized with the fever, and in a few days more the whole family perhaps were attacked, one after another, with the same distemper. I have oftener than once seen four of a family ill at one time and sometimes all lying on the same bed. The fever appeared sooner or later as the winter was more or less inclement, as the family was greater or smaller, as they were worse or better provided with clothes for their persons and beds, and with fuel, and as their apartment was more or less confined. The slow approach of the fever, the great loss of strength, the quickness of the pulse with little hardness or fulness, the tremors of the hands, and the petechiae or brown spots upon the skin, to which may be added the infectious nature of the distemper, left no doubt of its being the same with what is usually called the jail or hospital-fever.”
Dr James Sims, who had seen much of Irish typhus in Tyrone in his earlier years, and had removed to London, wrote of typhus among the poor there in 1786, ten years before the more systematic and more circumstantial descriptions by Willan[246].
This fever was exceedingly mortal, several medical men, he had reason to believe, falling sacrifices to it. Sims never saw the cases till the 7th or 8th day, when they were desipient, insensible, with pulse scarcely to be felt and not to be counted, all having petechiae. None had scarlet rash or sore-throat. They sank and died quietly; the strongest cordials did not produce the smallest effect, and blisters in many did not even raise the skin[247].
It is in the year 1796 that we begin to have the full and accurate records by Willan of the prevailing diseases of London month by month as he saw them at the Carey Street Dispensary, situated in the crowded quarter between Holborn and the Strand[248]. His first reference to typhus is as follows:
“In September, also, fevers usually appear which from their commencement exhibit symptoms of malignancy; being attended with a brown dry tongue, violent pain of the head, delirium, or coma, deep-seated pains of the limbs, petechial spots and haemorrhagy. These fevers become highly contagious, especially when they occur in close, confined situations, and in houses where little attention is paid to ventilation or cleanliness. The disease is extended by infection during the months of October and November, but its progress is generally stopped by the frosts of December.”
Willan says little more of fever in London until September, 1798, when these contagious malignant fevers became more numerous, both in the city and adjacent villages, than had been known for many years before; also the fever was more fatal than usual, one in five or six dying, whereas one in seven was formerly a very unfavourable death-rate, and one in twenty not unknown. Haemorrhages, aphthae, diarrhoea, starting of the tendons, picking the bedclothes, violent delirium, ending in deafness, stupor, hiccough and involuntary evacuations, were the usual accompaniments of this fever. In the corresponding months of 1799 he recurs to the symptoms of this “malignant contagious fever,” and depicts typhus as clearly as may be. In September, 1799, it was “attended with a dull pain of the head, great debility or sense of lassitude and pains referred to the bones, tremblings, restlessness with slight delirium, a querulous tone of voice, a small and frequent pulse, heat of the skin, thirst and a fur upon the tongue, first of a dirty white colour, but turning in the latter stage of the disease to a yellowish brown. In this form the fever continued thirteen days without any dangerous symptoms, and then suddenly disappeared, leaving the patient, for some time after, languid and dispirited. All the individuals of a family were successively affected with the same train of symptoms; many of them so slightly as not to be much confined to their beds.” In October and November he describes the symptoms of the disease in a more dangerous form. By this fever, he was informed, some houses of the poor had been almost depopulated, the infection having extended to every inmate. “The rumour of a plague was totally devoid of foundation.”