Fever in London

There ought to have been no difficulty in answering the question. The causes of death in the metropolis had been assigned in the books kept at Parish Clerks’ Hall since 1604, and had been printed since 1629. The printed series was in the hands of Graunt, from 1629 down to the date of his writing, January 1662; and he did abstract the deaths under each head of disease and casualty from 1629 to 1636 inclusive, and again from 1647 to 1661; but the ten years from 1637 to 1646 inclusive, he omitted as presenting nothing of importance and as being “inconsistent with the capacity” of his sheet of paper[1057]. All the original documents prior to 1658 appear to have been lost in the fire of 1666, so that Graunt’s omission cannot now be made good. One could wish that the worthy citizen had made no difficulty about the size of his paper. The omitted years are not only those of great political revolution, which may have had an effect upon the public health, but they are of special interest for the beginning of that great period of fever and smallpox in London which continued all through the 18th century.

The following section of London mortality, down to the end of our present period, will show, by reference to the total deaths, how important the omitted years are for the epidemiological history.

Year Plague Fever Smallpox Total
deaths

1629 0 956 72 8771

1630 1317 1091 40 10554

31 274 1115 58 8562

32 8 1108 531 9535

33 0 953 72 8393

34 1 1279 1354 10400

35 0 1622 293 10651

36 10400 2360 127 23359

37 3082 — — 11763

38 363 — — 13624

39 314 — — 9862

1640 1450 — — 12771

41 1375 — — 13142

42 1274 — — 13273

43 996 — — 13212

44 1492 — — 10933

45 1871 — — 11479

46 2365 — — 12780

47 3597 1260 139 14059

48 611 884 401 9894

49 67 751 1190 10566

1650 15 970 184 8754

51 23 1038 525 10827

52 16 1212 1279 12569

53 6 282 139 10087

54 16 1371 832 13247

55 9 689 1294 11357

56 6 875 823 13921

57 4 999 835 12434

58 14 1800 409 14993

59 36 2303 1523 14756

1660 13 2148 354 12681

61 20 3490 1246 16665

62 12 2601 768 13664

63 9 2107 411 12741

64 5 2258 1233 15453

65 68596 5257 655 97306

1666 1998 741 38 12738

The year 1638, and the four successive years 1640-43, have exceptional mortalities, which plague alone can by no means account for. In one of those years, 1641, we know that smallpox was rife, along with plague, in the autumn; in the third week of August there were 118 deaths from smallpox (133 from plague), and in the second week of September 101 from smallpox (185 from plague), the plague continuing at even higher figures all through September and October, while smallpox ceases to be mentioned in the letters of the time[1058]. According to earlier and later experience, the epidemic of smallpox would have been followed by a quiet interval of that disease; so that the high mortality, beyond what plague could account for, would have been due to some other epidemic type. There is little doubt that that type was fever, less heard of in letters of the society people because it was, in its steady prevalence from year to year, an infection of the crowded quarters of the poor.

We begin about this period to find fever, or typhus fever, taking that place in the medical history of England which it continued to hold down to the generation before our own. What remains of the history of plague until its extinction in 1665-66, is so closely interwoven with the history of malignant fever, that it will be more convenient to carry the latter on side by side with it instead of in a separate chapter.

The first medical essay upon the malignant fever which got the name of typhus at the beginning of the 19th century, was that of a physician, Sir Edward Greaves, published at Oxford in 1643 in connexion with the sickness in that city while the king and the Royalist army lay there, and with the sickness in the Parliamentary army of the earl of Essex which lay at Reading. Greaves describes the unmistakable characters of spotted fever or typhus, and calls it, in his title “Morbus Epidemicus Anni 1643, or the New Disease.” In his text he speaks of “this so frequently termed the New Disease.” The name of “New Disease” was used also for influenza; but there can be no doubt that typhus did become common in England during the Civil Wars, between the Royalists and the Parliamentarians, which were the first and also the only sieges and campaigns on English soil that really touched the life of the nation.

The continent of Europe had been familiar with the same type of fever ever since the beginning of the 16th century, now in Italy, now in Spain, another time in the Low Countries, or in Hungary, or in Germany in the Thirty Years’ War. Greaves, our first writer on epidemic typhus, had been preceded a whole century by Fracastori, whose description of the fever at Verona in 1505 is perhaps the first account of epidemic sickness free from subservience to ancient or medieval authority, and based upon direct observations made in modern Europe. At the same time typhus or spotted fever was not new to England in 1643. There is always the difficulty whether some epidemics of fever should be called influenza or typhus; but the fever of the Black Assizes, as well as the standing “sickness of the house,” was certainly typhus, and so probably was the “new disease” in 1612.

The history of fever in England has been partly traced in the chapter on gaol-fevers in the Tudor period and on the Protean “hot agues,” “new sickness,” “strange fevers” or influenzas of 1540, 1557-8 and 1580. At a much earlier period, fevers of the same type (with dysenteries, lienteries, and pestilent sore throats) have been described, with whatever details there are, in connexion with the periodic famines, especially since the Conquest. But we are now come to a time in the history when typhus fevers appeared in the country unconnected with gaols or with famines. We are come, indeed, to the new era of epidemics, which is revealed more clearly after the plague was extinguished for good, but was really concurrent with the last half-century of plague, preparing, as it were, to succeed the long reign of that infection. The Civil Wars may be admitted to have given the new types of sickness an impulse, but the wars did not originate them, nor did they serve in any way to establish them as the predominant forms of epidemic sickness for nearly two centuries. Whatever it was in the condition of England that favoured the prevalence of fevers, fluxes, and smallpox, that factor was beginning to make itself felt shortly after the Tudor period ended: it continued in operation through all political changes of Restoration, Revolution, and Georgian rule; and if the conditions at length changed, largely for the better so far as the adult population is concerned, and for the better even as regards infancy, there has followed the “nova cohors febrium” of our own time, appropriate to its own state of society, as was the old troop before it. This theme is really the subject with which a new volume should open; but as the plague-period overlaps its successor the fever-period by half a century, and as one must pay heed to the chronology, it remains to insert some facts about fevers in this place.