Sydenham says that he regarded the new fever at first as nothing more than the “bastard peripneumony” which he had described for previous seasons; but he had soon cause to see that it wanted the violent cough, the racking pain in the head during coughing, the giddiness caused by the slightest movement, and the excessive dyspnoea of the latter (Huxham likewise distinguished typhus from “bastard peripneumony”). The early symptoms of the “new fever” were alternating chills and flushings, pain in the head and limbs, a cough, which might go off soon, with pain in the neck and throat. The fever was a continued one, with exacerbation towards evening; it was apt to change into a phrensy, with tranquil or muttering delirium; petechiae and livid blotches were brought out in some cases (Sydenham thought they were caused by cordials and a heating regimen), and there were occasional eruptions of miliary vesicles. The tongue might be moist and white at the edges for a time, latterly brown and dry. Clammy sweats were apt to break out, especially from the head. If the brain became the organ most touched, the fever-heat declined, the pulse became irregular, and jerking of the limbs came on before death.

Later writers, for example those who described the great epidemic fever of 1741, have identified the fever of 1685-86 with the contagious malignant fever afterwards called typhus, and Murchison, in his brief retrospect of typhus in Britain, has included it under that name. Sydenham mentions petechiae and livid blotches in some cases, and the Bills give a good many of the deaths in the worst weeks of the epidemic under the head of “spotted fever.” It is not at first easy to understand why Sydenham should have written an essay specially upon it, in September, 1686, to claim it as a new fever[38] and not rather as the old pestilential fever—“populares meos admonens de subingressu novae cujusdam Constitutionis, a qua pendet Febris nova species, a nuper grassantibus multum abludens.” It should be kept in mind that his motive was correct treatment, and that the fashionable treatment of the day by Peruvian bark was, in his judgment, unsuited to this fever, however much it may have suited the epidemical intermittents of 1678-79 and the “depuratory” dregs of them for several years after. Physicians, he says, had learned to drive off by bark the fevers of the former constitution, from 1677 to the beginning of 1685, even when the fever intermitted little and sometimes when it intermitted not at all; and they saw an indication for bark in the nocturnal exacerbations of the new fever. Sydenham found that even large doses of bark did not free the patient from fever, and that restoration to health under treatment with the bark was due “magis fortunato alicui morbi eventu quam corticis viribus.” He seeks to establish the indications for another treatment by setting forth the symptoms minutely; and as the question of bark in fevers was the great medical question of the time, this may well have been Sydenham’s motive for discovering in the epidemic of 1685-6 a “new fever” although he does not say so in as many words. We have a good instance of how the bark-craze was at this time influencing the very highest circles of practice in the case of Lord Keeper Guildford, in July, 1685, as related in another chapter.

It will be seen from the table of weekly deaths that the second of the two hard winters was over before the fever began to attract notice. Sydenham compares its beginning after the thaw in February, 1685, to the beginning of the plague when the frost broke in March, 1665.

If it had been merely the typhus of a hard winter, of overcrowding indoors, of work and wages stopped by the frost, and of want of fuel (which things Evelyn mentions as matters of fact), it would have come sooner than the spring of 1685. The Bills for years before have regularly a good many deaths from fever, and always some from spotted fever; but these may have come from parishes wholly beyond the range of Sydenham’s practice. The fever began definitely for him in February, 1685, and was at its worst in the old plague-seasons of summer and autumn. If the seasons had any relation at all to it, the epidemic was a late effect of the long drought, an effect which was manifested most when the rain came, in the summer of 1685 and throughout the mild winter and normal summer of 1685-86. It must have been for that reason that Sydenham traced the source of it to “some secret and recondite change in the bowels of the earth,” rather than to a change in the sensible qualities of the air. One must ever bear in mind that the physicians of the Restoration gave no thought to insanitary conditions of living; in that respect the later Stuart period seems to have been behind the Elizabethan or even the medieval; we cannot err in assuming, behind all Sydenham’s speculative causes, a great deal of unwholesomeness indoors. Sydenham’s fullest reference to the subterranean sources of poisonous miasmata occurs in his tractate on Gout:

It was Sydenham’s intimate friend Robert Boyle who worked out the hypothesis of subterraneous miasmata as a cause of epidemic (and endemic) diseases. An account of his theory will be found in the chapter on Influenzas and Epidemic Agues. It may be said here that it needs only a few changes, especially the substitution of organic for inorganic matters in the soil, to bring it into line with the modern doctrine of miasmatic infective disease as expounded by the Munich school.

It has not been usual to think of spotted fever, (or of influenzas), in that connexion; but a telluric source of the epidemic constitution of 1685-86 was clearly Sydenham’s view; and as the fever came in circumstances like those of the last great plague, and was thought at the time to be the forerunner of another great plague, its connexion with recondite decompositions in the soil, dependent on the phenomenal drought of two whole years before, cannot be set aside as a possibility, the less so that the fever, although of the type of typhus, was not a fever of cold, hunger, and domestic distress, but mainly of the warm, or mild, or soft weather following the long drought, and of many well-to-do-people, as in the great Netherlands fever of 1669. My view of it is that it was the modified successor of plague, the pestis mitior, which used to precede and accompany the plague, now become the dominant constitution. The authentic figures of its mortality come from London; but Sydenham says that its “effects were felt far more in other places”; although Short’s abstracts of parish registers, given above, do not indicate excessive mortality throughout England.

Retrospect of the great Fever of 1623-25.

The most instructive instance of pestis mitior in Britain is not the pestilential fever which led up to the last plague (1665-6), but the great epidemic of fever all over England and Scotland which reigned for two or three years before the great outburst of plague in 1625. I go back to this because it was not wholly or even mainly a famine fever (although it was as general as one of the medieval famine-fevers), and because in that respect it furnishes a close parallel to the fever of 1685-86, which I regard as the successor of the plague. After this interlude in the history, we shall proceed to consider the question of the final extinction of plague.

The spotted fever or spotted ague of 1623-24, the plague of 1625, and the country agues of the same autumn make really a more instructive series of epidemic constitutions than any that fell under Sydenham’s observation, so instructive, indeed, that it has seemed worth while to revert to it for the sake of illustrating the doctrine of epidemics then in vogue. That doctrine made little of contagion from person to person; yet the idea of contagion was familiar, and had been so since medieval times. If we might assume contagion to explain such cases as those that occurred in the houses of squires and nobles, we might find a source of it either in the famine-fever of Scotland or in the war-fever of the Palatinate. But the teaching of the time was that it was in the air; and if the infective principle had been generated either in Scotland or on the upper Rhine it had diffused itself in some inscrutable way. The doctrine of epidemic constitutions seems strange to us; but some of the facts that it was meant to embrace are also strange to us. Were it not for an occasional reminder from influenza, we should hardly believe that any fevers could have travelled as the Hungarian fevers, the spotted fevers or “spotted agues” of former times are said to have done.

On the other hand, we have now a scientific doctrine of the effects of great fluctuations of the ground-water upon the production of telluric miasmata, which may be used to rationalize the theory of emanations adopted by Sydenham and Boyle. From this modern point of view the remarkable droughts preceding the pestilential fevers and plagues of 1624-25 and 1665, and preceding the fever of 1685-86, which is the one that immediately concerns us, may be not without significance.

The London fever of 1685-86 having been suspected at the time to be the forerunner of a plague, as other such fevers in the earlier part of the century had been, and no plague having ensued, the question arises most naturally at this stage, why the plague should have never come back in London or elsewhere in Britain after the great outbreak of 1665-66.

The extinction of Plague in Britain.

Plague had been the grand infective disease of Britain from the year of the Black Death, 1348-9, for more than three centuries, down to 1666. The last of plague in Scotland was in 1647-8, in the west and north-west of England about 1650 (in Wales probably in 1636-8), in Ireland in 1650, and in all other parts of the kingdom including London in 1666, the absolute last of its provincial prevalence having been at Peterborough in the first months of 1667[53], while two or three occasional deaths continued to occur annually in London down to 1679. False reports of plague, contradicted by public advertisement, were circulated for Bath in 1675[54], and for Newcastle in 1710[55]; while in London as late as 1799, during a bad time of typhus fever, the occurrence of plague was alleged[56].

It is not easy to say why the plague should have died out. It had been continuous in England from 1348, at first in general epidemics, all over the country in certain years, thereafter mostly in the towns, either in great explosions at long intervals or at a moderate level for years together. The final outburst in 1665, which was one of the most severe in its whole history, had followed an unusually long period of freedom from plague in London, and was followed, as it were, by a still longer period of freedom until at last it could be said that the plague was extinct. In some large towns it had been extinct, as the event showed, at a much earlier date; thus at York the last known epidemic was in 1604, and it can hardly be doubted that many other towns in England, Scotland and Ireland would have closed their records of plague earlier than they did had not the sieges and military occupations of the Civil Wars given especial occasion for the seeds of the infection to spring into life. Plague seemed to be dying out all over England and Scotland (in Ireland it is little heard of except in connexion with the Elizabethan and Cromwellian conquests) for some time before its final grand explosion in London in 1665.

In seeking for the causes of its decline and extinction we must keep prominently in view the fact that the virus was brought into the country from abroad as the Black Death of 1348-9. But for that importation it is conceivable that there would have been no signal history of plague in Britain. Its original prevalence was on a great scale, and there were several other widespread epidemics throughout the rest of the 14th century. In the first volume of this history I have collected evidence that plague was endemic or steady for long periods of the 15th and 16th centuries in London, with greater outbursts at intervals, and that in the 17th century it came chiefly in great explosions. Something must have served to keep the virus in the country, and more especially in the towns, until at length it was exhausted. An exotic infection, or one that had not arisen from indigenous conditions, and would probably never have so arisen, does not remain indefinitely in the country to which it is imported. Thus Asiatic cholera, imported into Europe on six, or perhaps five, occasions in the 19th century, has never become domesticated; and yellow fever had a career in the southern provinces of Spain during some twenty years only. Plague did become domesticated for about three centuries in England, and for longer in some other countries of Europe; but it died out at length, and it would almost certainly have died out sooner had it not found in all European countries some conditions not altogether unsuited to it. What were the favouring conditions?

If, as I believe, the virus of plague had its habitat in the soil, from which it rose in emanations, and if it depended therein, both remotely for its origin in some distant country, as well as immediately for its continuance in all countries, upon the decomposition of human bodies, then it is easy to understand that the immense mortalities caused by each epidemic would preserve the seeds of the disease, or the crude matters of the disease, in the soil. Buried plague-bodies would be the most obvious sources of future plagues. But if the theory given of the Black Death be correct, bodies dead of famine or famine-fever would also favour in an especial way the continuance of the plague-virus in certain spots of ground, although they would probably never have originated it in this country. Moreover, the products of ordinary cadaveric decomposition would be so much pabulum or nutriment for the continuance of the virus. But all those things being constant, the continuance of plague would largely depend upon the manner in which the dead, after plague, or after famine and fever, or in general, were disposed of. The soil of all England in 1348-9 was filled with multitudes of the dead laid in trenches, and there were several general revivals of plague in the fifty or sixty years following. In London there were plague-pits opened in the suburbs in many great epidemics during three centuries. Even when there was no epidemic the dead were laid in the ground in such a manner that their resolution was speedy, and the diffusion of the products unchecked. But it is undoubted that greater care in the disposal of the dead did at length come into vogue. Thus, in the Black Book of the Corporation of Tewkesbury there is an entry under the year 1603, that all those dead of plague, “to avoid the perill, were buried in coffins of bourde,” the disease having carried off no fewer than 560 the year before (1602) and being then in its second season.[57]. The reason given is “to avoid the peril,” and it is beyond question that burial in a coffin did in fact delay decomposition (unless in peculiar circumstances which need not be particularized), and kept the cadaveric products from passing quickly and freely into the pores of the ground. Again, if the burial were in such coffins as the Chinese commonly use, the decomposition would proceed almost as slowly as if the body had been embalmed, and with as little risk of befouling the soil. For a long time in England such burials were the privilege only of the rich; but as wealth increased by commerce they became the privilege of all classes; and in the last great plague of London, as I said in my former volume, “even at the worst time coffins would seem to have been got for most.” Defoe’s account of the burials in heaps in plague-pits is so exactly like that of Dekker for the plague of 1603, and of other contemporaries for the plague of 1625, that one may reasonably suspect him to have used these earlier accounts as his authority for the practice in 1665, which he had no direct knowledge of. However, I do not contend that there were no such burials in 1665; just as one learns from Dekker that the coffin-makers in 1603 were busily employed and grew rich, although he also describes how a husband “saw his wife and his deadly enemy whom he hated” launched into the pit “within a pair of sheets.” In ordinary times, as we learn from the tables of burial-dues, there were poorer interments without coffins as late as 1628, according to a document printed by Spelman, the name of the parish being withheld, and even as late as 1672 in the parish of St Giles’s, Cripplegate. Spelman’s object in writing in 1641 was to protest against the mercenary practices of the clergy in the matter of burial, recalling the numerous canons of the medieval Church directed against all such forms of simony; and incidentally he mentions that it was testified before the Commissioners that a certain parson “had made forty pound of one grave in ten yeeres, by ten pounds at a time”[58]—a “tenancy of the soil” short enough to satisfy even the so-called Church of England Burial Reform Association. The use of coffins in the burial of the very poorest is now so universal that we hardly realize how gradually it was introduced. I am unable to say when burial in a sheet or cerecloth ceased; but it became less and less the rule for the poorer classes throughout the 17th century. In 1666 was passed the Act for burial in woollen, which was re-enacted more strictly in 1678[59]. The motive of it was to encourage the native woollen manufactures, or to prevent the money of the country from being expended on foreign-made linen; and its clauses ordained that woollen should be substituted for linen in the lining of the coffin and in the shrouding of the corpse, but that no penalty should be exacted for burying in linen any that shall die of the plague. Whether it prohibited in effect the use of linen cerecloths to enshroud corpses where no coffin was used does not appear clearly from the terms of the Act; but, as the intention was to discourage the use of linen, and to bring in the use of woollen, for all purposes of burial, it is probable that it served to put an end to coffinless burials altogether, wherever it was enforced, inasmuch as the prescribed material was wholly unsuited for the purpose of a cerecloth.

The history of the London plague-pit between Soho and the present Regent Street shows that, after the last great plague of 1665-66, more caution was used against infection from the buried plague-bodies. Macaulay says it was popularly believed that the earth was deeply tainted with infection, and could not be disturbed without imminent risk to human life; and he asserts that no foundations were laid in the pest-field till two generations had passed and till the spot had long been surrounded with buildings, the space being left blank in maps of London as late as the end of George I.’s reign[60].

After 1666 the old churchyards were not less crowded than before, but more crowded, perhaps because coffined corpses occupied more space and decayed more slowly. On 17 October, 1672, Evelyn paid a visit to Norwich: “I observed that most of the churchyards (tho’ some of them large enough) were filled up with earth, or rather the congestion of dead bodys one upon another, for want of earth, even to the very top of the walls, and some above the walls, so as the churches seemed to be built in pitts.” The same day he had visited Sir Thomas Browne, the author of the famous essay on urn burial or cremation, (suggested to him by the digging up of forty or fifty funeral urns in a field at Old Walsingham). The essay is full of curious learning and equally curious moralizing. But Sir Thomas, though a physician, has not a word to say on so proximate a topic as the state of the Norwich churchyards, which came under his eyes and perhaps under his nose every day of his life[61].

The practice of burying in coffins, which came at length within the means of all classes, may seem too paltry a cause to assign, even in part, for so remarkable an effect as the absolute disappearance of plague after a duration of more than three centuries. My view of the matter is that the virus would have died out of itself had it not been continually augmented, or fed by its appropriate pabulum, and that the gradual change in the mode of interment helped to check such augmentation or feeding.

But the more elaborate interment of the dead was itself an index of the greater spending power of the community, and it may be said that it was the better condition of the people, and not this one particular thing in it, which put an end to the periodical recurrences of plague. In all but its earliest outbursts in the fourteenth, and perhaps the fifteenth century, plague had been peculiarly an infection of the poor, being known as “the poor’s plague.” Perhaps the chief reason why the richer classes usually escaped it was that they fled from the plague-tainted place, leaving the poorer classes unable to stir from their homes, exposed to the infectious air, and all the more exposed that their habitual employments and wages would cease, their sustenance become precarious, their condition lowered, and their manners reckless. Again, it was not unusual for the plague to break out in a season of famine or scarcity, during which the ordinary risks of the labouring class would be aggravated. Famines ceased (except in Ireland, where there had been comparatively little plague), and scarcities became less common. The sieges and occupations of the Civil Wars in the middle of the 17th century, which undoubtedly were the occasion of the last outbursts of plague in many of the towns, were a brief experience, followed by unbroken tranquillity. Whatever things were tending to the removal of plague in all its old seats had free course thereafter.

On the other hand, one may make too much of the increase of well-being among the labouring class which coincided with the cessation of plague. As a check upon population plague worked in a very remarkable way. In London, as well as in towns like Newcastle and Chester, plague towards the end of its reign arose perhaps once in a generation and made a clean sweep of a fifth or a fourth part of the inhabitants, including hardly any of the well-to-do. It destroyed, of course, many bread-winners and many that were not absolutely sunk in poverty; but its broad effect was to cut off the margin of poverty as if by a periodical process of pruning. The Lord Mayor of London wrote to the Privy Council at the end of the great plague of 1625: “The great mortality, although it had taken many poor people away, yet had made more poverty by decay of tradesmen”—a decay of trade which they might reasonably expect to recover from before long. No such ruthless shears was ever applied at intervals to the growing fringe of poverty in after times. The poor were a more permanent residue, pressing more upon each other; but they did not press more upon the rich, except through the poor rate; on the contrary, the separation of classes became more marked.

Perhaps I ought to give an illustration of this, so as not to leave so radical a change in the vague and disputable form of a generality. I shall take the instance of Chester; its circuit of walls, remaining from the Roman conquest, is something fixed for the imagination to rest upon amidst changes within and without them.

The case of Chester shows by broader contrasts than anywhere else the change from the public health of plague-times to that of more modern times. But it can hardly be said to show the populace better off than before; it shows them changed into a proletariat, and separated from the richer classes by walls several feet thick. Such, at least, was the result after four generations of immunity from plague, a result which indicates, as I have said, that we may easily make too much of the improved well-being of the poorer classes as a cause of the cessation of plague.

An easy explanation of plague ceasing in London has long been current, and just because it is an easy explanation it will probably hold the field for many years to come. It is that the fire of 1666 burnt out the seeds of plague. Defoe, writing in 1723, ascribed this opinion to certain “quacking philosophers,” but he would hardly have said so if he could have foreseen the respectable authority for it in after times. The plague had ceased in most of its provincial centres after the Civil Wars, and in some of them, such as York, from as early a date as 1604. It ceased in all the principal cities of Western Europe within a few years of its cessation in London. In London itself it ceased after 1666, not only in the City which was the part burned down in September of that year, but in St Giles’s, where the Great Plague began, in Cripplegate, Whitechapel and Stepney, where it was always worst, in Southwark, Bermondsey and Newington, in Lambeth and Westminster. Nor can it be said that the City was the source from which the infection used to spread to the Liberties and out-parishes. All the later plagues of London, perhaps even that of 1563, began in the Liberties or out-parishes and at length invaded the City. The part of London that was rebuilt after 1666 contained many finer dwelling-houses than before, built of stone, with substantial carpentry, and elegantly finished in fine and rare woods. The fronts of the new houses did not overhang so as to obstruct the ventilation of the streets and lanes; but the streets, lanes, alleys and courts were somewhat closely reproduced on the old foundations. A side walk in some streets was secured for foot-passengers by means of massive posts, which, with the projecting signs of houses and shops, were at length removed in 1766. The improvements in the City after the fire were mostly in the houses of the richer citizens. The City was the place of residence of the rich, with perhaps as many poorer purlieus in close proximity as the residential districts of London now have. But four-fifths of London at the time of the fire were beyond the walls of the City. It is in these extramural regions that the interest mostly lies for epidemical diseases. They remain, says Defoe in 1723, “still in the same condition they were in before.” Unfortunately we know little of their condition, whether in the 17th century or in the 18th. But there must have been something in it most unfavourable to health; for we find from the Bills of Mortality that the cessation of plague made hardly any difference to the annual average of deaths, the increase of population being allowed for. This fact makes the disappearance of plague all the more remarkable.

Fevers to the end of the 17th century.

The epidemical seasons of 1685-86 were the last that Sydenham recorded; he was shortly after laid aside from active work by gout, and died in 1689. Morton, who made notes of fevers and smallpox until 1694, is more a clinical observer than a student of “epidemic constitutions”; and although his writings are of value to the epidemiologist, he does not help us to understand the circumstances in which epidemic diseases prevailed more at one time than another. To the end of the century there is no other medical source of information, and little besides generalities to be collected from any source. It is known that the years from 1693 to 1699 were years of scarcity all over the kingdom, that the fever-deaths in London reached the high figure of 5036 in 1694, and that there was a high mortality in many country parishes and market towns during the scarcity. But there are few particular illustrations of the type of epidemic sickness. There is, therefore, little left to do but to give the figures, and to add some remarks.

Fever Deaths in the London Bills, 1687-1700.

Tables from Short’s Abstracts of Parish Registers.

In the London figures the year 1694 stands out conspicuous by its deaths from all causes, and by its high total of fevers. The fever-deaths began to rise from their steady weekly level a little before Christmas, 1693, and remained high all through the year 1694, with a good many deaths from “spotted fever” in the worst weeks. Among the victims in London in February was Sir William Phipps, Governor of New England: his illness appeared at first to be a cold, which obliged him to keep his chamber; but it proved “a sort of malignant fever, whereof many about this time died in the city[65].” Pepys, writing to Evelyn on 10 August, 1694, calls it “the fever of the season,” three being down with it at his house, but well advanced in their recovery. In that week and in the week following, the deaths in London from all causes touched the highest points of the year, the deaths from fever and spotted fever being a full quarter of them. Fever at its worst in London never made more than a quarter of the annual deaths from all causes; so that, if we take it to have been the successor of the plague, it operated in a very different way—with a greatly lessened fatality of all that were attacked, with only a reminder of the old special incidence upon the summer and autumn seasons, but with a steadiness from year to year, and throughout each year, that made the fever-deaths of a generation little short of one of those enormous totals of plague-deaths that were rapidly piled up during a few months, perhaps once or twice in a generation.

The following table from the London weekly Bills shows the progress of the fever from the end of April, 1694, with the number of deaths specially assigned to “spotted fever”:—

London: Weekly Mortalities from fever and all causes, epidemic of 1694.

The year 1694, to which the epidemic of malignant fever (as well as malignant smallpox) belongs, was one of the series of “seven ill years” at the end of the 17th century (1693-99). They were long noted, says Thorold Rogers, “for the distress of the people and for the exalted profits of the farmer.” The price of wheat in the autumn and winter of 1693 was the highest since the famine of 1661. In 1697-8 corn was again dear and much of it was spoilt. At Norwich in 1698 wheat was sold at 44s. a comb.

Harvests spoiled by wet weather or unseasonable cold appear to have been the most general cause of the high prices of food. In London there was no unusual sickness except in 1694; indeed the other years to the end of the century show a somewhat low mortality, the year 1696, which Macaulay marks as a time of severe distress among the common people owing to the calling in of the debased coinage[66], had the smallest number of deaths from all causes (18,638) since many years before, and for a century after allowing for the increase of population. But the deaths from “fever” were some three thousand every year, and the births, so far as registered, were, as usual, far below the deaths.

It was in the country at large that the effects of the “seven ill years” were chiefly felt. According to Short’s abstracts of parish registers, there was unusual mortality at the beginning of the period and at the end of it; in his Chronology he mentions spotted fever, bloody flux and agues in 1693 (besides an influenza or universal slight fever recorded by Molyneux of Dublin), and again in 1697 and 1698 “purples, quinsies, Hungarian and spotted fever, universal pestilential spotted fever,” from famine and bad food.

When we look for the evidence of this in England we shall have difficulty in finding it. Short’s own abstracts give almost no colour to it; but there are other figures from the parish registers, scattered through the county histories and statistical works, which prove that the seven ill years must have checked population. Thus at Sheffield in the ten years 1691-1700 there was the greatest excess of burials over baptisms in the whole history of the town from 1561—namely, 2856 burials to 2221 baptisms (688 marriages). At Minehead, Somerset, a parish of some 1200 people occupied in weaving, the deaths and births were as follows in four years of the decennium:

A glimpse of spotted or pestilential fever in Bristol during the years of distress at the end of the 17th century comes from Dr Dover, a man of no academical repute, but at all events an articulate voice. Passing from an account of the spotted pestilential fever at Guayaquil, “when I took it by storm,” he goes on[67]: