The corresponding epidemic of typhus in England had the fortune to be recorded in great part under the new system of Registration, which came into force on the 1st of July, 1837. At the beginning of registration of the causes of death, and until a good many years after, no distinction was made in the published tables between typhus fever and enteric fever. But we happen to know that the epidemic of 1837-38 was in London almost wholly typhus, just as it was in the large towns of Scotland. Of sixty cases in 1837-38, of which notes were kept by West, under Latham at St Bartholomew’s Hospital, none that died and were examined post-mortem had ulcerations, although some had congestion, of Peyer’s patches, the cases being all reckoned typhus exanthematicus[372]. Sir Thomas Watson, who was then physician to the Middlesex Hospital, says of the ulceration of Peyer’s patches in continued fever:

“Since attention has been drawn to the subject, the patches of glands, and the whole tract of mucous membrane, from the stomach to the rectum, have been diligently explored, and the result seems to be that, at certain times and places (in other words, in certain epidemics), the ulceration of the inner surface of the intestine is far less common than at others. It was comparatively rare in an epidemic of which I witnessed some part in Edinburgh [1827-29]. Then I came to London; and for several years I never saw a body opened after death by continued fever without finding ulcers of the bowels. More recently, however, and especially during the present epidemic (1838), I have looked for them carefully, in many cases that have proved fatal in the Middlesex Hospital, and have discovered neither ulceration nor any other apparent change in the follicles of the intestines.” And elsewhere he confirms the purely typhus character of the epidemic of 1838: “Our wards at the Middlesex are full of it, and scarcely a case presents itself without these spots. We speak of it familiarly as the spotted fever; or, from the resemblance which the rash bears to that of measles, as the rubeoloid fever[373].”

From which it would appear that not even the ordinary average number of endemic cases of enteric fever, such as might have been expected at a hospital in the west end of London, were forthcoming in the epidemic of 1837-38, so purely was the type of fever typhus.

The deaths from this epidemic in London, from the 1st of July, 1837, to the 31st of December, 1838, were as follows[374]:

1837 1838
3rd Quarter 4th Quarter 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
826 1107 1285 1176 829 788

—a total of 6011 deaths from fever, nearly all typhus, in eighteen months. The worst London parishes were Whitechapel and St Pancras, in which latter the fever-hospital was situated. The high mortality from fever, which had begun before the 1st of July, 1837, continued into the year 1839, when the deaths in London (probably including some enteric) were 1819.

Over all England and Wales, including London, the last six months of 1837 produced 9047 deaths from “typhus,” and the twelve months of 1838, 18,775 deaths, the winter of 1837-38 having been the most fatal period. After London, the large towns most affected by the epidemic in the latter half of 1837 were as follows:

Deaths from
typhus in
six months
Liverpool 524
Manchester and Salford 274
Birmingham 75
Bolton 75
Sunderland 72
Leeds 71
Sheffield 68
Bradford 65
Stockport 63
Dudley 54
Abergavenny 53
Wolverhampton 45
Newcastle 44
Wigan 43
Chorley 41
Swansea 36
Halifax 33
Macclesfield 33
Norwich 27

In each of the next two years the number of deaths from typhus in the four largest towns was as follows:

Typhus
deaths
in 1838		 Typhus
deaths
in 1839
Manchester and Salford 627 416
Liverpool 573 358
Leeds 245 150
Birmingham 123 141