Return of Spotted Typhus after 1831: “Change of Type.” Distress of the Working Class

A fever with relapses, and a fever with sloughing of the follicles and lymph glands of the intestine, were not the only novelties in the first thirty or forty years of the 19th century. Relapsing fever and enteric or typhoid fever were each clearly separated, at a later date, from typhus fever. But what was the “typhus fever” from which they were at length separated? It was a fever which came prominently into notice after the “constitution” of 1826-29 was ended—a fever with a mottled, measly, or rubeoloid rash, and with various other spots, on account of which it was described by Dr Roupell in 1831, in a lecture before the College of Physicians of London, as a “new fever.” It was a new fever only in the sense in which each new febrile “constitution,” whether it were an influenza, an epidemic ague, or a malignant typhus, was apt to be called popularly “the new fever,” in the 16th and 17th centuries. There were, of course, erudite men at the College of Physicians in 1831 who knew that a fever with a mottled rash, with vibices and petechiae, and with all other symptoms of typhus gravior, had often occurred in England, Scotland and Ireland in former times. The “spotted fever” was perhaps the most familiar name of typhus in the 17th century. The mottled rash, like that of measles, was described for the fever of Cork by Rogers in the beginning of the 18th century, and for various other English and Irish epidemics by Huxham, O’Connell, Rutty and others. But undoubtedly the maculated typhus was somewhat new to the generation who saw it about 1830 and following years, the continued fevers which had prevailed in England, Scotland and Ireland since 1816 having been for the most part the simple continued, or synocha, with or without the relapsing character, and to some extent enteric fever.

It was from 1830 to 1834 that a change in the reigning type of fever began to be remarked in London, Dublin, Edinburgh and Glasgow, the new type becoming more and more evident as fevers became more prevalent in the ‘thirties’ and ‘forties.’ Typhus at length became so much a spotted fever that the question arose whether it should not be classed among the exanthemata. In 1840, Dr Charles West, having observed “the alteration in character which fever has undergone within the last few years,” went over the history (but more the foreign than the English) with a view “to illustrate the question whether typhus ought not to be classed among the exanthematous fevers:” of course he found many old descriptions of a mottled rash or other spots, but saw no reason to make spotted typhus one of the exanthemata. Dr Kilgour, of Aberdeen, who treated more than a thousand cases in his fever-ward at the infirmary there from 1838 to 1840, wrote in 1841, “I am perfectly satisfied that this fever, call it by what name we will, is truly an exanthematous fever.” Previous to 1835, the spots of fever-cases in the Glasgow Infirmary had hardly been remarked; but after that date all cases were classed either as spotted or not, the spotted cases being three-fourths of the whole. Besides being spotted, the fever of the new constitution was insidious in its approach and low in its reaction, very unlike the sthenic, militant, inflammatory synocha of the generation before. The blood-letting which had been all but universally used in the fever from 1816 to 1828, and had seemed to answer well, was continued for a time in the fever of the ‘thirties.’ But it was soon found to be injurious: the patients in the new fever were apt to faint when only a few ounces of blood (four or six) had been drawn, whereas in the other fever (whether relapsing or simple continued) they had often lost thirty ounces before deliquium was reached. It was found, on the other hand, that fever-cases in the ‘thirties’ needed wine and other cordial regimen. There was nothing new in these revolutions, whether of the fevers themselves, or of the opinions as to their treatment. Sydenham’s method of taking his cue for treatment from the “constitution” of the season, which was the method of Hippocrates, appeared to be once more the best suited to the circumstances.

It is not easy to make out what were the circumstances of the time that led to the supersession of simple continued fever (or relapsing fever in Ireland and Scotland), by spotted fever or typhus gravior in all parts of the kingdom. Sydenham would have looked, among other things, to the weather and the character of seasons; but from 1830 onwards there was no season so notable as the dry and hot summer of 1826, although the end of the year 1836 was remarkably wet. The period of typhus gravior was a time of much sickness of other kinds—the Asiatic cholera of 1831-32, the influenza of 1831, 1833, and 1836-37, and the general unhealthiness of the year 1837. This was also the decade when the “condition-of-England question” was a common topic, a time of strikes and of much distress among the working classes, as shown in the reports of the Poor Law Commission.

In Glasgow there was a considerable prevalence of fevers year after year from the relapsing-fever epidemic of 1827-29, according to the following table of admissions for fever to the Royal Infirmary and the special fever-hospitals:

Admissions for Fever, Glasgow.

Year Fever cases

1827 1084

1828 1511

1829 865

1830 729

1831 1657

1832 1589 }

1148

1833 1288

1834 2003

1835 1359

1836 3125

1837 5387

1838 2047

1839 1529

The worst year of the series for fever was 1837, and the worst month of that year was May, when the fever-deaths were 1 in 3·22 of the mortality from all causes. That great access of fever in Glasgow followed immediately upon the great strike of the cotton-spinners, on 8th April, 1837, by which eight thousand persons, mostly women, were thrown out of work. The death-rate in Glasgow was in those years as high as anywhere in the kingdom, and was higher in the nine years from 1831 than in the nine years preceding. The population of Glasgow, says Cowan, had increased on the industrial side, out of proportion to its middle and wealthiest class; and to that he would attribute the higher death-rates in the second period (right-hand side), of the following table:

Glasgow Death-rates.

1822-1830 1831-1839

Year Death-rate
over all.
One in Death-rate
under five.
One in Year Death-rate
over all.
One in Death-rate
under five.
One in

1822 44·4 101 1831 33·8 79

1823 36·4 78 1832 21·67 63

1824 37·0 81 1833 35·7 77

1825 36·3 81 1834 36·3 81

1826 40·6 105 1835 32·6 67

1827 37·0 84 1836 28·9 62

1828 33·0 79 1837 24·6 65

1829 37·9 100 1838 37·9 83

1830 41·5 97 1839 36·1 72

The high death-rates in some of the years in the second column were owing to special causes—Asiatic cholera in 1832, smallpox of children in 1835 and 1836, and to influenza, as well as to typhus, in 1831, 1833 and 1837. As to the fever which prevailed from 1831 to 1836, as it was not relapsing in type, so it was not associated with scarcity.

“The increase of fever in Glasgow,” says Cowan, “during the seven years prior to 1837, had taken place, not in years of famine or distress, but during a period of unexampled prosperity, when every individual able and willing to work was secure of steady and remunerating employment. From the close of 1836, one of those periodical depressions in trade, arising from the state of our monetary system, had visited this city, and deprived a large proportion of the population of the means of subsistence.”

It was then that the cases of typhus trebled in number.

The epidemic of fever reached its height in Dundee about the same time as in Glasgow, and in both towns sooner than anywhere else in Scotland or England. One reason of this was the labour-troubles culminating in strikes. In the twelvemonth from 15 June, 1836, to 12 June, 1837, more than three-fourths of all the admissions to the Dundee Infirmary on the medical side were for fever (700 cases). After the wet autumn of 1836 there were a good many cases of dysentery, of which 22 were treated in the infirmary, with two deaths.

At Edinburgh, as at Glasgow, there had been an unusual amount of fever in 1831 and 1832, and a steady prevalence of it thereafter. The epidemic of 1836-39 was for the most part typhus of the winter seasons, declining each spring and disappearing each summer, except in the summer of 1836, when many cases came in June, July and August from airy parts of the town. The climax of the epidemic was in 1838, a year later than in Glasgow and Dundee, according to the admissions to the fever-wards of the infirmary:

Admissions for Fever, Edinburgh Infirmary.

Year Cases

1831 758

1832 1394

1833 878

1834 690

1835 826

1836 652

1837 1224

1838 2244

1839 1235

1840 782

At Aberdeen the epidemic appears to have been later even than at Edinburgh, if the following admissions to one of the two fever-wards (Dr Kilgour’s) may be taken as a fair measure of it:

Admissions for Fever, Aberdeen.

Year Cases Deaths

1838 (March to December) 189 26

1839 286 29

1840 534 53

In all these large towns of Scotland, the fever was purely typhus. The various observers all describe the fever as of the spotted kind, the proportion of cases with spots varying somewhat.

Thus, at Glasgow Infirmary, from 1835 to 1839, there were 4202 cases with eruption, 1270 without eruption, and 143 doubtful. And, that the cases without eruption were not cases of enteric or typhoid, is probable from the record kept of the fatalities in Dr Anderson’s fever-wards:

In 1885 cases with eruption, 275 deaths, or 14·58 per cent.

" 324 cases without eruption, 11 deaths, or 3·33 per cent.

" 143 cases doubtful, 7 deaths, or 4·89 per cent.

At Aberdeen, Kilgour counted 59 cases spotted in a total of 189 in 1838, 96 in a total of 286 in 1839, and 278 in a total of 534 in 1840, all the cases, whether spotted or not, being of the same fever, which he considered an exanthematous malady as a whole. Of 169 cases tabulated by Craigie at Edinburgh, from 28 June, 1836, to 12 February, 1837, there were 79 with an eruption, which was usually the mottled or rubeoloid rash.

The fatalities were relatively more in Edinburgh than in Dundee, comparing two periods which were not the same. Of 700 cases at Dundee, from June, 1836, to June, 1837, only 50 died, or 1 in 14, notwithstanding a good many complications from chest complaints and bowel complaints. At Edinburgh during fifteen months of 1838-39, there died 276 in 2037 cases, or 1 in 7·3; of those cases, 1075 were in females, with 116 deaths, or 1 in 9, and 962 males, with 160 deaths, or 1 in 6. The most common age for the fever at Dundee was from twenty to forty years (416 out of 700 cases, with 26 deaths, or 1 in 16), while the most fatal age, as usual, was from forty to sixty years, at which one person died of three attacked. At Aberdeen, in the last year of the epidemic, the years of life from ten to twenty had more cases (233 in a total of 657) than any other decade of life. The average stay of a patient in the Aberdeen fever-wards was 18·67 days. The great preponderance of deaths in adolescents or adults was clearly shown in the Glasgow fever-statistics, 1835-39.

Deaths from
typhus fever Under
ten years Over
ten years Fever-deaths per cent.
of deaths from
all causes

4788 752 4036 11·57

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. 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.”

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:

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

From nearly all the registration districts of England and Wales, deaths from fever were returned in 1837-39, so that the contagion must have been very widely spread in town and country. In London the epidemic declined greatly in 1839, but in many parts of England the deaths registered as “typhus” were hardly less numerous than in 1838, and in some country divisions they were more, as if the contagion had taken longer to reach the villages. One village epidemic in North Devon in the latter half of the year 1839 had been observed by Dr W. Budd, afterwards of Bristol:

The first case in the village (North Tawton, 1100 to 1200 inhabitants) was of a young woman in a poor and crowded cottage, who sickened on 11 July, 1839; her mother, brother, and sister sickened in succession, her father and a young infant escaping the infection. In another cottage, four out of six were ill of fever, in another, three persons had it, and so on, the whole number of cases treated by Dr Budd in the village until the beginning of November being about eighty. It was carried from North Tawton to neighbouring hamlets: thus, a sawyer who lodged next door to the first infected cottage sickened of the fever and, on 2 August, returned to his home in the hamlet of Morchard. As he lay there, he was visited by a friend, who assisted to raise him in bed: “While thus employed, the friend was quite overpowered by the smell from the sick man’s body,” and on the tenth day thereafter sickened of fever, which spread to two of his children and to a brother who came from a distance to see him. Another sawyer who lodged with the former left North Tawton ill a week after him (9 August) for his home, also at Morchard, where he died after a period not stated; ten days after his death his two children took the fever, his widow escaping it. In a third instance, a widow L—— left North Tawton on 21 August to visit her brother, a farmer in the hamlet of Chaffcombe, seven miles distant. Two days after her arrival she fell ill of fever and recovered slowly. In the same farmhouse the mistress caught it a month or two later and died on 4 November; the farmer himself took to bed with the fever on the day his wife died, and came safe through the attack. Three weeks after, an apprentice on the farm sickened, then a lad (the fifth in order) in the end of December, then the farmer’s sister, then another apprentice, then a serving-man, then a maidservant, and lastly the daughter of the widow L—— from North Tawton, who had been the first case in the house months before. This farmhouse at Chaffcombe sent off two distinct offshoots of contagion. The lad, who was fifth in the above series, was sent home ill to his mother’s cottage, between Bow and North Tawton, in the end of December. His mother sickened on 24 January, 1840, and died on 2 February. Next door to her lived a married daughter, whose whole household were attacked. Another married daughter, who came from a distance to visit the sick, took the infection on her return home, and so started a new focus. From the same farm at Chaffcombe, the maid, who was ninth in order in the above series, was sent home to her father’s cottage in the hamlet of Loosebeare, four miles away; her father caught the fever from her, and a farmer K——, who lived across the road, having visited this man several times in his illness, took the fever next, other cases following under farmer K’s. roof, and thereafter throughout the whole hamlet of Loosebeare.

This was doubtless the way the epidemic spread in all the country districts of England, the unwholesome state of labourers’ cottages, as revealed in the reports of the Poor Law Commission, favouring it. In the chapter on the fevers of Ireland we shall find that the contagion of typhus and relapsing fever was dispersed in the same way, but to a much greater extent, owing to the amount of vagrancy.

In the manufacturing towns of the North of England the fever continued at a somewhat steady epidemic level for several years. The pathetic scenes of typhus among the poor of Manchester in Mrs Gaskell’s famous tale of Mary Barton belong to the early part of the year 1839; but they might have been drawn from almost any months of the two or three years following, according to the passage cited below from the same work. In 1839 the Lancashire deaths from typhus were 1343; in Wales, Monmouth and Herefordshire they were 1548. There is, indeed, little improvement in the statistical returns as late as 1842. The deaths from “typhus” were as follows in all England and Wales:

1838 1839 1840 1841 1842

18,775 15,666 17,177 14,846 16,201

The deaths from the epidemic maladies of infants and children during the same five years were also very high.

1838 1839 1840 1841 1842

Smallpox 16,268 9,131 10,434 6,368 2,715

Measles 6,514 10,937 9,326 6,894 8,742

Hooping cough 9,107 8,165 6,132 8,099 8,091

Scarlatina 5,802 10,325 19,816 14,161 12,807

Croup 4,463 4,192 4,336 4,177 4,457

Diarrhoea 2,482 2,562 3,469 3,240 5,241

The epidemic of smallpox corresponded closely to the epidemic of fever, the former being fatal chiefly to infants and young children, the latter fatal chiefly to adults. Before the smallpox epidemic had subsided scarlet fever became unusually mortal, especially in 1840, and kept its higher level of deaths for a generation after. The epidemic of fever, although it affected the mortality of the young comparatively little, was indirectly a reason why many of them died of other diseases; for the prostration of the parents, the impoverishment, and all the other troubles associated with an epidemic of typhus, led to inevitable sufferings among the young, which weakened their power of resistance.

The registration returns were not tabulated (except for London) from the end of 1842 to the beginning of 1847, but there is reason to think that the epidemic fever was not active in the interval. It is undoubted that the enormous construction of railroads in England during those years gave employment and wages to multitudes, and ended the distress the sooner. This effect of railroad-making in England was so obvious that Lord George Bentinck desired to relieve the distress in Ireland in 1846-47 by the same means.