The following is the abstract of “contagious fever cases” from the records of the Whitehaven Dispensary from 30 June, 1783, to 9 June, 1800[272]:

The year 1790 is indicated as an unhealthy one, by the excess of burials over christenings, also at Macclesfield, where there were 316 christenings to 380 burials, the proportion being usually the other way[273].

Dr John Alderson of Hull wrote in 1788 an essay on the contagion of fever, in which there are no authentic details for Hull: “The calamity itself is the constant complaint of every neighbourhood, and almost every newspaper presents us with an example of the direful consequences of infection”—the reference being to gaols more particularly[274]. Whatever was the reason, there was undoubtedly a great deal of typhus in England in the eighties of the eighteenth century. Oxfordshire, Gloucestershire, Worcestershire, Wiltshire and Buckinghamshire experienced much typhus from 1782 to 1785, although we have few particulars. “The remembrance of its ravages at Gloucester, Worcester and Marlborough,” says Dr Wall of Oxford, “is still fresh in every mind, where its virulence proved so peculiarly fatal to the medical world.” At Aylesbury, Dr Kennedy survived an attack of the “contagious fever,” to write an account (1785) of the epidemic, which he traced to the gaol (the date, be it observed, is subsequent to Howard’s visitations)[275]. At Maidstone, also, in 1785, the gaol fever was the subject of a special account[276].

At Worcester in 1783 the younger Dr Johnstone caught typhus while visiting the gaol, which was thereafter rebuilt at great expense. A prisoner took it to Droitwich where 14 died[277].

Dr Wall gives clinical details of fifteen cases of typhus treated by him in private practice at Oxford in 1785; one of his patients was an apothecary whose business had exposed him very much to the influence of contagion, as he was much employed amongst the poor in the suburbs of the town and neighbouring villages and in the House of Industry[278]. In the year 1783-85, much of the epidemic fever was of the nature of ague, as described in another chapter. It is not always easy to separate it from typhus; but there is no doubt that both were prevalent together. Thus in the parish of Painswick, Gloucestershire, in the spring of 1785 there occurred both “a contagious fever” and an “epidemic ague,” the latter having left a good many persons dropsical and cachectic[279]. This had been part of an epidemical fever which had raged for some time in the county of Gloucestershire, and is said to have lately carried off a great number of poor. At Norton, within five miles of Gloucester, there lived in two adjoining tenements two families: in one a man and his wife and three children, in the other a man and his wife, of whom only one remained alive on the 1st of March, 1785[280].

The extraordinary failure of the harvest in Scotland in 1782 produced much distress, and with it fever, in the winter following. The Glasgow and Edinburgh municipalities imported grain for the public benefit. Various traces of the scarcity and fever appear in the Statistical Account written a few years after. Thus, in Holywood parish, Dumfriesshire, some fevers were wont to appear in February and March among people of low circumstances living in a narrow valley; and the unusual mortality in the dear year 1782 was owing to an infectious fever in the same cottages. In the regular bills of mortality of Torthorwald parish, Dumfriesshire, the deaths from “fever” fall in the dear years, 1782-3, 1785, &c. In Dunscore parish, in the same county, the burials of 1782 rose to the most unusual figure of 30 (the baptisms being 17), “owing to a malignant fever[281].”

But Scotland was now past the danger of actual famine from even a total failure of the harvest. Some farmers were ruined, and many more were unable to pay the year’s rent; but the very poorest were enabled to find food, one source being “the importation of white pease from America.” From Delting, in Shetland, one of the poorest parishes, the report is: “There is reason to believe that none died from mere want; but there is no doubt that many, from the unwholesome food, contracted diseases that brought them to their graves.”

The following relating to the parishes of Keithhall and Kinkell, Aberdeenshire, in the scarcity following the lost harvest of 1782, is a curiously detailed glimpse of the time:

We hear most of fevers in the Highland parishes, with their subdivisions of holdings and an excess of population. Thus of Gairloch, Ross-shire, it is said: “Fevers are frequent, sometimes they are of a favourable kind, at other times they continue long and carry off great numbers”—the poor in this parish, upon the Kirk Session roll, numbering 84 in the year 1792, and the aggregate money paid to the whole number averaging £6. 7s. in a year, whereas the fertile parish of Ellon, Aberdeenshire, with 40 on the poor’s roll, paid them £43 per annum.

Again, of the fishing village of Eyemouth, it is said: “The only complaints that prove mortal in this place are different kinds of fevers and consumptions; and these are mostly confined to the poorest class of people, and ascribed to their scanty diet.” And of another fishing parish, in Banffshire, Fordyce, including Portsoy, it is said: “The most prevalent distemper is a fever, and that for the most part not universal, but confined to particular districts. It is sometimes thought to arise from infection and communication with other parts of the country; at other times from local situations and circumstances of the people’s houses and habits of living in particular districts[283].”

The beginning of the great French war was the occasion of a considerable increase of fever; although no records make it appear so fatal a time as the years 1783-86. The commercial distress and want of work which began in the autumn of 1792, were intensified by the bad harvests of 1794 and 1795, which followed two harvests also deficient. This was the period of distress and of epidemic fever to which Wordsworth referred in the passage in the first book of the ‘Excursion,’ where he is relating the story of Margaret’s ruined cottage[284].

There is little medical writing upon the epidemic fever of 1794-95; and, in the very district of Wordsworth’s story, the records of the Whitehaven Dispensary bear no traces of a great concourse of patients. There is reason to think that the fever, if slow and weakening, was seldom fatal, that it was typhus mitior, and that it was sometimes, perhaps often, relapsing. One glimpse we get of it in the family of the afterwards celebrated Dr Edward Jenner of Berkeley, in the winter of 1794-95. He thus writes to a friend about the visitation of “grim-visaged typhus:”

This is a tolerably clear picture of a short-period fever with relapses, or of relapsing fever strictly so-called; the stench, also, of one patient is characteristic. Barker, of Coleshill or Birmingham, has much to say under the same year 1794, of a slow, tedious fever, marked by “sluggish action and comatose symptoms,” and much subject to relapses; but he does not give the duration of the first or subsequent paroxysms, as Jenner does, or the usual length of the clear intervals, his most definite case being of a young woman who died in twenty-four hours from a relapse which came on about three weeks after the fever had left her[286].

It was the access of fever in 1794-5, and the alarm that it caused among the richer classes, that led to the opening of the Manchester House of Recovery in 1796. In certain streets in the neighbourhood chosen for the hospital, Portland Street, Silver Street and others in the same block, the cases of contagious fever for nearly three years before the hospital was opened are given by Ferriar as follows:

The cases began to be sent to the hospital on the 27th May, 1796, and an attempt was made to extinguish contagion in the houses, by white-washing, disinfecting and the like; so that in the same group of streets there were only 25 cases of fever from 13 July, 1794 to 13 March, 1797. Meanwhile the admissions to the hospital were few until the dearth of 1799-1802. One of the manufacturing towns which is known to have shared in the epidemic fever of 1794-96 was Ashton-under-Lyne, where upwards of three hundred cases (with few deaths) occurred in less than three months at the end of 1795. This epidemic must have been somewhat special to Ashton, for it produced much alarm in neighbouring places and caused Ashton to be avoided from fear of infection.

Shortly after 1796, Ferriar made an inquiry into an epidemic of fever at a village within a mile of Manchester; the houses were many of them new, built for the convenience of a large cotton mill; but even the new houses were offensive, with cellars occupied by lodgers, and almost every house overcrowded. This was the first fever in the village, and it was traced to a family who had come from Manchester with infected clothes. Stockport about the same time erected a House of Recovery, having “the same general causes of fever which render the disease so common in Manchester”; and Ferriar adds: “I believe there is not a town in the kingdom containing four thousand inhabitants which would not be greatly benefited by similar establishments.”

The bad harvest of 1794 raised the price of wheat to 55s. 7d. on 1 January, 1795, and the prospect of another short harvest to 77s. 2d. on 1 July. A famine being threatened, the Government caused neutral ships bound to French ports with corn to be seized, and brought into English ports, the owners receiving an ample profit. Agents were also sent to the Baltic to buy corn. By these means the price of wheat, which had risen in August to 108s. 4d., fell in October to 76s. 9d. Parliament met on the 29th October, and various measures were taken[287]. In the spring of 1796, the climax of distress was reached, wheat being at 100s. per quarter. The harvest of 1796 was abundant and wheat fell to 57s. 3d. The harvests of 1797 and 1798 were not equally good, but they were not altogether bad, and the price of wheat kept about 50s. for nearly three years, which were years of comparative comfort between the dearth of 1794-96 and the dearth of 1799-1802.

Fevers in the Dearth of 1799-1802.

Although Willan chooses the end of the year 1799 to enlarge upon the London fever, he does not connect it with the dearth that was already beginning to be felt (soup kitchens having been opened in various parts of London). The price of wheat, which had been steadily about 50s. in 1797 and 1798, rose in May, 1799 to 61s. 8d., after a hard winter which had probably injured the autumn-sown corn. The harvest turned out ill, and the price of wheat rose in December, 1799, to 94s. 2d. Bounties were offered on imported foreign grain, but in June, 1800, the price was 134s. 5d., falling in August to 96s. 2d. on the crops promising well. The latter end of harvest proved wet, much of the grain being lost, so that the price per quarter of wheat rose to 133s. in December. There was much suffering, and some rioting. Parliament met on the 11th November, 1800, on account of the dearth, the opinions of the members being much divided as to the causes of the high prices. In March, 1801, wheat was at 156s. 2d. per quarter, beef from 10d. to 10½d. per pound, mutton 11d. to 12d. per pound. It is to this year, when the quartern loaf was at one-and-eightpence, that a comparison by Arthur Young belongs, showing the great change in the purchasing power of wages[288]. By the end of summer, 1801, wheat rose to 180s., and the quartern loaf was for four weeks at 1s. 10½d.

Whatever statistics were then kept of fever-cases, show a decided rise in the years 1800 and 1801:

The London Fever Hospital was not opened until February, 1802, a small house in Gray’s Inn Lane containing sixteen beds. It came at the end of the epidemic, and was in small request during the next fifteen years. The same epidemic at Leeds was the occasion of opening a House of Recovery there in 1804, twenty-five years after Lucas had first called for it. The state of affairs in Leeds, which at length moved the richer classes to that step, is thus described by Whitaker[289]:

One of the Leeds physicians, Dr Thorp, seized the occasion to urge the need of a fever hospital, in a pamphlet written in 1802, in which he said:

The wonder is that, with the enormous prices of food, things were not worse. At the time when provisions were dearest, work was slack in several industries. A commercial report of 1 April, 1801, speaks of the trade of Birmingham as very distressed, a large proportion of the men being out of work; the ribbon trade of Coventry was deplorable, and the woollen trade of Yorkshire still worse. Evidence of epidemic typhus in various parts of England came out in connexion with the reports on influenza in 1803. Holywell, in Flintshire, with a large cotton-making industry, had not been free from a bad kind of typhus for two years previous to the influenza of 1803[291]. In Bristol there was a good deal of fever in 1802-3, which found its way, through domestic servants, into good houses in Clifton, “and proved fatal in some instances[292].” It is probable that these are only samples, the writings on epidemics being singularly defective at this period. The following, dated 10th April, 1802, by a surgeon at Earlsoham, near Framlingham, Suffolk, gives us a glimpse of malignant contagious fever in a farm-house:

There was perhaps nothing very unusual in such instances of country fevers at the beginning of the century. The incident is exactly in the manner of one that figures prominently in a story of Scottish life and customs at the same period, which long passed current as a faithful picture and as enforcing a much-needed moral[294].

Comparative immunity from Fevers during the War and high prices of 1803-15.

From 1803 to 1816 there was comparatively little fever in this country. This was notably the case in London, but it was also true of all the larger towns where fever-hospitals had been established, and it was as true of Ireland as of England. This was, indeed, a time of great prosperity, which reached to all classes, the permanent rise of wages having more than balanced the increased cost of the necessaries of life. The following prices of wheat will show that a dear loaf did not necessarily mean distress while the war-expenditure lasted:

Prices of wheat (from Tooke).

The only years in the period from 1803 to 1816 in which there was some slight increase of fever were about 1811-12. There was undoubtedly some distress in the manufacturing districts at that time, owing to the much talked-of Orders in Council, which had the effect of closing American markets to British manufactures[295].

The small amount of fever in London between the year 1803 and the beginning of the epidemic of 1817-19 rests on the testimony of Bateman[296], who in 1804 took up Willan’s task of keeping a systematic record of the cases at the Carey Street Dispensary. He has only two special entries relating to typhus: one in the autumn of 1811, when some cases occurred in the uncleanly parts of Clerkenwell and St Luke’s (“but I have not learned that it has existed in any other districts of London”); the other in October and November 1813, when there was more typhus among the Irish in some of the filthy courts of Saffron Hill, near Hatton Garden, than for several years past, the infection having spread rapidly and fatally in several houses. The best evidence of this lull in typhus in London is the almost empty state of the new fever-hospital:

Until it was removed to Pancras Road, in September, 1816, the London fever-hospital had only sixteen beds. But Bateman says that no one was refused admission, and that for several years the house was frequently empty three or four weeks together. Also at the Dispensary, in Carey Street, he had an opportunity during the period 1804-1816,

Bateman concluded, not without reason, that this immunity of London from fever was due to the high degree of well-being among the poorer classes in times of plenty; and although he made out that the poor of Dublin, Cork and some Scotch towns did not profit by times of plenty so much as those in London, yet his reason for the abeyance of fever from 1804 to 1816 applied to England, Ireland and Scotland at large, and was doubtless the true reason.

The following figures from Manchester[297], Leeds[298] and Glasgow[299] hospitals, as well as the Irish statistics elsewhere given, are closely parallel with those of London:

Manchester House of Recovery.

Leeds House of Recovery.

Glasgow Royal Infirmary (Fever Wards).

Even such fever as there was in Britain from 1804 to 1817 was not all certainly typhus. The high death-rates at the Manchester fever-hospital in 1804 and 1805 (1 death in 7·5 cases and 1 death in 5·25 cases) may mean a certain proportion of enteric cases in those years. “From 1804 to 1805,” says Ferriar, “many cases were admitted of a most lingering and dangerous kind.... Many deaths took place from sudden changes in the state of the fever, contrary to the usual course of the disease, and only imputable to the peculiar character of the epidemic. Similar cases occurred at that time in private practice.” Next year, 1806, there was an epidemic among the troops at Deal, described under the name of “remittent fever,” which Murchison claims to have been enteric[300]. In September, 1808, says Bateman, several were admitted into the London House of Recovery, with malignant symptoms; “and some severe and even fatal instances occurred in individuals in respectable rank in life.” He still uses the name of typhus; but he is aware that the cases of continued fever, especially in the summer and autumn of 1810, had often symptoms pointing to a bowel-fever rather than to a head-fever[301].

The years 1807 and 1808 appear to have been the most generally unwholesome during this period of comparative immunity from fever; they were marked by the occurrence of dysenteries, agues, and infantile remittents, as well as of fevers of the “typhus” kind. The chief account comes from Nottingham[302]. The cases of “typhus” there were very tedious, but not violent, nor attended with any unfavourable symptoms, only one case having petechiae, and all having diarrhoea. The following table of admissions for various kinds of fever (as classified by Cullen) at the Nottingham General Hospital, 25 March, 1807, to 25 March, 1808, shows the preponderance of “synochus” and next to it, of infantile remittent:

Admitted to the Nottingham General Hospital, 1807.

The state of war in the Peninsula was favourable to epidemic or spreading diseases, and there is a good deal to show that such diseases did exist among the British troops[303]. But there is only one good instance of England getting a taste of that experience of war-typhus which the Continent had to endure for many years. This was on the return of the remnant of the army after the defeat at Corunna on 16 January, 1809. The troops were crowded pell-mell on board transports, which had a very rough passage home. Dysentery broke out among them, and was the most urgent malady when they landed at Plymouth in a state of filth and rags. Typhus fever followed, but in the first three weeks at Plymouth, to the 18th of February, it was not of a malignant type, only 8 dying of it in the Old Cumberland Square Hospital; in the next three weeks, 28 died of it there. Up to the 27th of March, 1809, the sick at Plymouth from the Corunna army numbered 2432, of whom 241 died. Of 4 medical officers, 3 took the contagion, of 29 orderlies, 25 took it. The fever was in some cases followed by a relapse, which was more often fatal than the original attack[304]. This was a typical instance of typhus bred from dysentery or other incidents of campaigning, a contagion more dangerous to others than to those who had engendered it. “Within a few yards of the spot where I now write,” says Dr James Johnson, of Spring Gardens, London, “the greater part of a family fell sacrifices to the effects of fomites that lurked in a blanket purchased from one of these soldiers after their return from Corunna[305].” In August, 1813, an Irish regiment passing through Leyburn, a small market-town of the West Riding of Yorkshire, in an airy situation, was obliged to leave behind a soldier ill of typhus, who died of the fever after a few days. The infection appeared soon after in the cottages adjoining, and remained in that end of the town for several months, choosing the clean and respectable houses. In a farmer’s family, a son, aged twenty-nine, died of it, while another son and two daughters had a narrow escape. The disease appeared also in the village of Wensby, a mile distant, and in other villages. Few lives were lost[306].

These were, perhaps, not altogether solitary instances in Britain of typhus spread abroad by the movements of troops during the great French war. Let us multiply such instances by hundreds, and we shall vaguely realize the meaning of the statement that the period of the Napoleonic wars, and more particularly the period from the renewal of the war in 1803 until its close in 1815, was one of the worst times of epidemic typhus in the history of modern Europe. It was precisely in those years that England, Scotland and Ireland enjoyed a most remarkable degree of freedom from contagious fever.

The Distress and Epidemic Fever (Relapsing) following the Peace of 1815 and the fall of wages.

The long period of comparative immunity from typhus near the beginning of the 19th century was first broken, both in Great Britain and in Ireland, by the very severe winter of 1814-15; but it was not until the great depression of trade following the peace of 1815 (which made a difference of forty millions sterling a year in the public expenditure) and the bad harvest of 1816 that typhus fever and relapsing fever became truly epidemic, chiefly in Ireland but also in Scotland and England. The lesson of the history is unmistakable: with all the inducements to typhus from neglect of sanitation in the midst of rapidly increasing numbers, there was surprisingly little of the disease so long as trade was brisk and the means of subsistence abundant. The reckoning came in the thirty years following the Peace.

In London, says Bateman[307], the epidemic began in the autumn of 1816, before the influence of scarcity was acutely felt, in the courts about Saffron Hill, the same locality in which he mentioned fever in the winter of 1813-14 among the poor Irish. But this means little more than that the Irish, whether in Ireland or out of it, are the first to feel the effects of scarcity in producing fever. At the very same time that it began among them in Saffron Hill, it began among some young people at a silk factory in Spitalfields. In March, 1817, there was a good deal more of it in Saffron Hill, as well as among the silk-weavers in Essex Street, Whitechapel, in Old Street, in Clerkenwell, and in Shadwell workhouse. Many poor-houses, and especially those of Whitechapel, St Luke’s, St Sepulchre’s and St George’s, Southwark, were getting crowded in 1817 with half-starved persons, among whom fever was rife in the summer and autumn. There was also much of it in the homes of working people in the eastern, north-eastern and Southwark parishes, with more occasional infected households in Shoe Lane, Clare Market, Somers Town and St Giles’s in the Fields (“in the filthy streets between Dyot Street and the end of Oxford Street”)[307]. The hospitals and dispensaries were fully occupied with fever, and the new House of Recovery in Pancras Road, with accommodation for seventy patients, was soon full. At the Guardian Asylum for young women, more than half of the forty inmates were seized with the fever in one week. The cases were on the whole milder than in ordinary years; of 678 admitted to the House of Recovery in 1817, fifty died or 1 in 13·5. In two-thirds of these patients the fever lasted two weeks or to the beginning of the third week; of the remaining third, a few lost the fever on the 7th, 8th or 9th day, a larger number on the 12th to the 14th day, while a considerable number kept it to the end of the third week or beginning of the fourth. Of the whole 678, only 75 had a free perspiration, and in only 19 of these was the perspiration critical so as to end the fever abruptly. The fever relapsed in 54 of the 678, a proportion of relapsing cases which seemed to Bateman to be “remarkably great[308].” In most the symptoms continued without break throughout the illness. Besides other febrile symptoms, there were pains in the limbs and back, aching of the bones, and soreness of the flesh, as if the patients had been beaten. There was a certain proportion of severe complicated cases of typhus. Bateman held that the differences in type depended on the differences of constitution, giving the following reason for and illustration of his opinion: