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 PUBLIC HEALTH 
 
 POPULAR INTRODUCTION 
 
 TO 
 
 SANITARY SCIENCE. 
 
 BEING A HISTORY OF THE PREVALENT AND FATAL DISEASES OF THE 
 
 ENGLISH POPULATION FROM THE EARLIEST TIMES TO THE 
 
 END OF THE EIGHTEENTH CENTURY. 
 
 WILLIAM A. GUY, 
 
 M.B. CANTAB., F.R.S. 
 
 FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS ; 
 
 PROFESSOR OF FORENSIC MEDICINE AND HYGIENE IN KING's COLLEGE, LONDON. 
 
 &C. &C. &C. 
 
 HENRY RENSHAW, 
 356, STRAND, LONDON. 
 
 1870. 
 
 [-4// rights of Translation reserved.^
 
 LOKDOX : 
 
 EATILL, EDWABDS AST) CO., PBDrUBS, CHAXD08 STBMT, 
 
 COyiST GAEDEX. 
 

 
 H 
 
 FA I 
 
 TO 
 
 ROBERT CHEERE, Esquire, 
 
 MEMBEB OF THE COUlfCIL OF KING'S COLLEGE, LONDON", AND TBEAST7BEB OF 
 king's COLLEGE HOSPITAL. 
 
 THESE LECTURES AKE DEDICATED 
 
 AS A TRIBUTE OF SINCERE ESTEEM AND AFFECTIONATE REGARD 
 
 BY 
 
 THE AUTHOR.
 
 PREFACE. 
 
 The eight lectures I have so recently delivered at King's 
 College are here printed, somewhat condensed, but other- 
 wise little altered. 
 
 In compiling them, as in printing them, I have been 
 actuated by the belief that tlie Science of Hygiene is 
 imperfectly appreciated, because some are ignorant, others 
 unmindful, of the rich benefits it has lavished upon us in 
 times past. I have accordingly endeavoured to remove 
 the existing ignorance or indifference by submitting the 
 facts of the case in such a form that they may commend 
 themselves to the members of my own profession as true 
 and yet not trite j to the public as interesting in themselves,, 
 and supremely important in their practical applications. 
 
 The title I have adopted indicates of itself the wish by 
 which I have been actuated to combine a scientific with a 
 popular treatment of my subject. Whether I have suc- 
 ceeded in so difficult an undertaking must be left to the 
 judgment of others. 
 
 In treating my subject after the historic method, I wish 
 it to be understood that I have chosen rather to present a 
 connected series of faithful abstracts of the chief works of 
 our great sanitary historians and reformers, with facts and
 
 viii Preface. 
 
 figures taken direct from the London Bills of Mortality, 
 than to settle disputed questions by weighing one authority 
 against another. I must also state that, in omitting minute 
 references to authorities, I have been solely influenced by 
 the wish to fit my work for continuous uninterrupted 
 reading. Nevertheless I believe that the chief sources of 
 the information I have brought together and condensed 
 will be found sufficiently indicated for every useful 
 purpose. 
 
 If I may be allowed to commend one lecture rather 
 than another to the attention of philanthropists and states- 
 men, it is the seventh, in which, as I believe, I have 
 rightly estimated the character and works of John 
 Howard. 
 
 Let me add that, for the reasons assigned, I have 
 wished to place in the hands of the public a cheap and 
 attractive volume j and that in that wish I have been well 
 seconded both by publisher and printer. 
 
 26, Gordon Street, 
 May, 1870.
 
 CONTENTS. 
 
 LECTURE I. 
 
 Sanitary Retrospect, i. Social and Political Consequences ot Fatal 
 Epidemics, 4. Aim and Scope of Sanitary Science, 5. Sources 
 of Knowledge, 6. Scientific Methods, 7. Numerical Method, 8. 
 Illustrations — Devonshire Colic, 9. Overcrowding and Madness, 
 12. Hot and Cold Regimens in Small-Pox, 16. Extempore 
 Hospitals, 18. Saving of Infant Life in the Eighteenth Century, 19. 
 Scourges of the Adult Population — Scurvy, Jail-Fever, and Small- 
 Pox, 21. Labours of Baker, Cook, Howard, and Jenner, 25. The 
 Future of Hygiene, 26. 
 
 LECTURE n. 
 
 Sanitary Epochs, 28. Health and Disease, 29. Cost of Disease, 30. 
 Variable Character of all the Elements that afiect Health, 31. 
 Causes of Death, 32. Scrofula, ^^. Consumption, 34. Zymotic 
 Maladies, 35. Epidemics — meaning of the term, 36. Varieties 
 of Epidemics, 37. Cholera, 39. Scarlatina, 41. Cholera and 
 Plague, 43. Bronchitis, 44. Ancient Famines and Pestilences, 46. 
 The Black Death of the Fourteenth Century, 47. Symptoms and 
 Nature, 49. Great Mortality, 50. Consequences and Antecedents^ 
 51. Preventive Measures, 53. Lazarettos and Quarantine, 54. 
 
 LECTURE III. 
 
 Black Death continued, 55. Consequences, Moral and Religious, 56. 
 The Flagellants, 57. Poisoning of Water, and Persecution of the 
 Jews, 58. Habits of the English People — Bad Housing and Gross 
 Feeding, 59. England in the Olden Time, 60. London in the 
 Twelfth Century, 61. Sweating Sickness of the Fifteenth and Six- 
 teenth Centuries, 63. Dr. John Caius, 64. Lord Bacon, 65, 
 b
 
 Contents. 
 
 Nature of the Disease, 66. Sanitary Measures, 68. Medical Treat- 
 ment, 69. Diet of the English, 70. Letters of Erasmus, 71. 
 English Intemperance, 72. The Sweating Sickness, a modified 
 Influenza, 74. Petechial Fever, Brain Fever, Trousse-Galant, 
 Epidemic Flux, Scurvy, and Diphtheria, 76. Atmospheric Dis- 
 turbances, 81. A Sickly Century, 82. 
 
 LECTURE IV. 
 
 The Plague of the Sixteenth and Seventeenth Centuries, 8.^. London 
 Bills of Mortality, 84. The Five Epidemics — their Duration and 
 Mortality, 85. Summary of Facts, 85. Deaths in the Plague of 
 1665, 87. Dr. Nathaniel Hodges — His Account of the Plague of 
 1665, 89. Plague- water of the College of Physicians, 90, Ravages 
 of the Plague, 91. Its Decline, 92. The Plague at Eyam, 93. 
 Mompesson, 94. Frightful Mortality-, 95. Episodes of the Plague 
 at Eyam, 97. Precursors of the Plague in London, 99. Its Cause — 
 Contagion, 99. Symptoms, 100. Blains, Buboes, and Tokens, 
 101. Treatment of the Sick, 103. Preventive Measures, 104. 
 Virtues of Sack, 103, and 105. Amulets, Charms, and Alexi- 
 pharmics, and other strange Remedies, 103-106. Hodges' Treat- 
 ment of Himself, 106. Later Attacks of Plague in other Countries ; 
 at Marseilles, Moscow, and Malta, 107, How to deal with the 
 Plague, 108. 
 
 LECTURE V. 
 
 Third Sanitary Epoch, from the Fire of London in 1666, to the End of 
 the Eighteenth Centurj-, no. London before the Fire, 112. Re- 
 building of London — Plans of Wren and Evelyn, 113. Effects of 
 the Fire, 115. What it did not do, 116. Sanitary Condition of 
 London during the Seventeenth Centur)-, 117. Sydenham, 119. 
 Small-Pox, Measles, Syphilis, and Scuny, 120. The Cool Regimen, 
 123. Causes of Death at the Beginning of the Eighteenth Centurv-, 
 as shown by the London Bills of Mortality-, compared with Earlier 
 and Later Returns, 124. Influenza of 1732-3, 128. Sanitary Im- 
 provements, 130. Ventilation in the First Quarter of the Centuiy 
 by Wren, Desaguliers, Sutton, and Hales, 131. Ventilation of the 
 House of Commons, 131. Of Ships, 132. Of Buildings, 134. 
 Sanitary State of the Last Half of the Century, 135. The De- 
 vonshire Colic, the Jail-Distemper, Scur\y, Dysentery, and Small- 
 Pox, the Fatal Diseases of the Eighteenth Century, 136.
 
 Contents. xi 
 
 LECTURE VI. 
 
 Lead-Colic resumed, Huxham's Account, 137. Requirements of the 
 Eighteenth Century, 139. The Scurvy, 140. Its Prevention and 
 Cure — the Potato, 141. Symptoms of the Disease, 142. Not 
 peculiar to Seamen, 143. The Scurvy on Land, 144. At Quebec, 
 145. At Millbank, 146. Scurvy in the Navy, 148. State of our 
 Ships-of-War a Century ago, 148. Ravages of the Disease, 149. 
 Miscarriage of Warlike Expeditions, 150. Scurvy Prevented and 
 Cured, 152. Anson's Expedition, 155. Cook's First Voyage, 159. 
 Captains McBride and Parry, 160. Sanitary Reforms in the Navy, 
 161. Comparative Mortality of Seamen in the Eighteenth and Nine- 
 teenth Centuries, 162. Increased Efficiency of the Navy, 163. 
 Improved Health of the Army, 164. 
 
 LECTURE VII. 
 
 The Jail-Fever and John Howard, a Romance of History, 165. Its 
 Early History, 165. Black Assizes at Oxford, Exeter, and London, 
 166. A Black Assize in Dublin, 172. The Jail-Distemper Spreads 
 among the People, 172. Conveyed in Clothing, 172. Infects our 
 Armies and Fleets, 173. State of English Prisons and Bridewells, 
 in 1774, 174. Wood Street Compter, 174; The King's Bench, 175. 
 County and Borough Jails; Dartford, Cambridge, Marlborough, 
 and Launceston, 176. Deprivation of Water, Air, and Light, 177. 
 Prison Squalor and Deititution, 178. Prisons private Property, 180. 
 Their Owners, Clerical and Lay, 180. Extensive Prevalence of 
 the Disease, 181. The Jail-Distemper in France, 182. The 
 Disease generally a Form of Typhus, 183. Not always the same 
 Disease, 184. Howard's Precursors, 185. Biography of Howard, 
 186. His Sanitary Improvements at Cardington, 187. Sheriff 
 of Bedford, in 1773, 188. His Prison Inspections, 189. .The 
 Acts of Parliament of 1774, 190. Their immediate Results, 
 190. What our Prisons now are, 190. Howard's Life and Death — 
 His Character, defended against Himself and others, 191. Howard 
 a Man of Genius, 192.
 
 xii Contents. 
 
 LECTURE VIII. 
 
 Small-Pox, 19.1. Small-Pox and Plague Compared — Calculations of 
 Blanc and Black, 194, Its Awful Ravages in all Parts of the World, 
 195. No Respecter of Persons, 196. Its Early History, 197. In 
 Europe in the Sixth Century, 197. Mortality, 198. Mortality in 
 the Army, 199. A Cause of Blindness, 200. Deaths at Different 
 Ages — ver\- Fatal to Children, 200. Inoculation, its History, 201. 
 Introduction into England, 201. Mild Character of the Modified 
 Disease, 202. Successful Inoculators, 203. Estimate of the Value 
 of Inoculation, 204. Its Influence on the Aggregate Mortality by 
 Small- Pox, 205. Small-Poxatthe Closeof the Eighteenth Century, 
 206. Vaccination and Edward Jenner, 207. Character of his Dis- 
 covery, 208. His Perseverance, and Ultimate Success, 209. What 
 Vaccination is, 209. Its Success as Compared with Inoculation, 210. 
 Numerical Statements of Result?, an. Extirpating Power of Vac- 
 cination — Illustrations, 212. Past Sanitary Progress, 213. Health 
 and Civilization, 214. Sanitary Discoveries of the Eighteenth 
 Century, 215. Grounds for Expecting further Sanitary Improve- 
 ments, 215. The Policies of Palliation and Prevention, 216.
 
 LECTURE I. 
 
 IXTRODUCTORY. 
 
 The Council of King's College in the exercise, as I think, 
 of a very wise discretion, have determined that henceforth 
 Hygiene, Public Health, Sanitary Science, shall be duly 
 honoured within these walls. They have accordingly 
 founded a Chair of Hygiene ; and have appointed me their 
 first Professor. I am very sensible of the honour ; I re- 
 cognise the responsibility, and I will strive to justify the 
 choice. 
 
 Need I say that I do not handle this subject now, either 
 as learner or teacher, for the first time. My interest in it 
 dates back more than a quarter of a century. It began at 
 a time when sanitary science, legislation, and organization 
 were in their infancy ; so that if some exotic pestilence 
 (such as the cholera) landed on our shores, or some home- 
 bred epidemic (such as typhus fever) scattered sickness and 
 death among us, we were taken by surprise : we lacked 
 everything needful — legal authority, a centre ofintelligen 
 guidance and control, a staif of officials. But happily, we 
 were not equally destitute of facts; for the Registrar-General 
 had been for some time at work, heaping up materials to 
 serve as the bricks and hewn stones of a scientific edifice, 
 and furnishing periodical returns which had a direct prac- 
 tical value, both through the interest they created and sus- 
 tained, and the wholesome warnings they administered. 
 
 When I say that, at the time to which I refer, the 
 science of Hygiene was in its infancy, I do not mean to
 
 Retrospect. 
 
 assert that we had no knowledge of preventible causes of 
 disease and premature death, or to ignore all that the 
 eighteenth century had taught us about the lead colic, 
 the scurvy, the jail-distemper, and the small-pox. Nor 
 do I overlook the fact that La Medecine Legale, and 
 L'Hygiene Publique, had been treated by Fodere and 
 otliers as parts of one larger and more comprehensive 
 science in which the State had a special interest 3 that 
 Paris and Fonblanque, in treating of Medical Jurispru- 
 dence, had something to say about the *' preservation of 
 public health," about nuisances, plague-police, and bills 
 of mortality 3 and that we were not without able treatises 
 on such special topics as the influence of employments 
 upon health. But Hygiene had not then grown to the 
 perfect shape and full stature of a science. It was not 
 fully displayed in any treatise, or set forth in any recog- 
 nised and authoritative course of lectures. 
 
 Again, I do not speak of sanitary^ legislation as^non- 
 existent, but as inefficient. If a neighbour stopped some 
 " antient light" or corrupted the air "with noisome 
 smells," a man had his remedy in an action at law 3 and 
 from very early times, he had a chance once a year of bring- 
 ing some common nuisance under the notice of the Court- 
 leet. But efficient sanitary legislation there was none. 
 And the same may be said of sanitary organization ; for the 
 officer of health was then known only in Ireland, as the 
 legislative offspring of the inquiries of the Select Commit- 
 tee of the House of Commons " On the State of Disease 
 and Condition of the Labouring Poor in Ireland," embo- 
 died in the Reports of 1819. A quarter of a century was 
 to elapse before the "large towns and populous districts'* 
 of England were to be submitted to a like scrutiny, with 
 a like practical result. It was in 1844 that the Commis- 
 sioners appointed to conduct that inquiry presented their 
 first report : and towards that report (monument as it is
 
 space and Consiiniption. 
 
 of the sagacious and well-directed industry of Mr. Edwin 
 Chadwick) I contributed the results of a laborious inquiry 
 into the health of letter-press printers, and of others fol- 
 lowing in-door occupations. This inquir}'- taught me that 
 a great saving of life might be confidently looked for in an 
 unexpected quarter : that out of 36,000 deaths a year in 
 England and Wales, which I attributed to true pulmonary 
 consumption, 5000 might be saved by increased space 
 and improved ventilation in shops, workshops, and fac- 
 tories 3 that among men doing the same work under the 
 same roof, the liability to consumption was determined by 
 the space j and that this might be narrowed to a point at 
 which men would die as fast as by some contagious malady, 
 so that here, as in Italy, consumption might seem to pass 
 from one person to another. 
 
 Such being the result of my first sanitary inquiry, it was 
 but natural that, without disparaging the art of healing, I 
 should come to think with Fodere, that it is in the power 
 of governments to do more good to mankind than all the 
 books on medicine put together, and be ready to co-operate 
 with those who felt that a "Health of Towns' Associa- 
 tion" ought to spring out of the startling revelations of 
 the " Health of Towns' Commission." Accordingly, from 
 1845 ^^ ^^4^ (when "The Nuisances Removal and Dis- 
 eases Prevention Act " was passed), by lectures, by 
 speeches, by printed appeals, and by all the legitimate 
 machinery of a wholesome and successful agitation, I bore 
 my part in that labour of love. With the first sanitary 
 Act to show as the fruit of its efforts, the Health of Towns' 
 Association soon died a natural death 5 but the interest 
 which it had excited and sustained did not die out. There 
 were still whole bodies of men and women, such as the 
 London bakers and the needlewomen, suffering grievous 
 physical evils which no existing legislation could alleviate 
 or remove 3 and our soldiers were victims of a sanitary
 
 Political Aspect of Plagii^cs. 
 
 neglect both cruel and costly. There was still, therefore,, 
 a work of wholesome agitation to be carried on j and in 
 this, too, I bore a part. The interval between the eventful 
 year 1848 and the present time has been filled by a series 
 of researches on the Influence ot Occupations on Health, 
 tlie Duration of Life among the higher and middle classes, 
 the Dietaries of Prisoners, the Mortality of Hospitals, the 
 Fluctuations of Mortal Maladies, the Relation of Insanity to 
 Crime, and several other topics directly bearing on the 
 Science and Art of Hygiene. 
 
 This brief retrospect will not, I trust, be condemned as- 
 egotistic. It was not unnatural, I think, that tlie first 
 occupant of a new Chair should desire to justify the choice 
 which has placed him in so distinguished a position. 
 
 To these few words which, counting on your indul- 
 gence, I have ventured to say about my own sanitary 
 work, I desire to add, that if at any time during the last 
 quarter of a century — at the beginning of it, when the 
 subject wore the blush of novelty, or, more recently, 
 when that attraction had ceased — I have been impressed 
 with the importance of sanitary science, that feeling has 
 been confirmed and strengthened by every inquiry into 
 which I have been led during the preparation of this 
 course of lectures. 
 
 Brought, so to speak, into close contact with the great 
 pestilences of tlie Middle Ages — with the Black Death of 
 the fourteenth, the Sweating Sickness of the sixteenth, 
 and the Oriental Plague of the seventeenth century — I 
 found the historians who recount their ravages profoundly 
 impressed with their social and political consequences. 
 Hecker, the learned author of the " Epidemics of tlie 
 Middle Ages," finds in the Black Death '' the greatest 
 impediment to civilization within the memory of man" — 
 " One of the most important events which have prepared 
 the way for the present state of Europe 3" our Professor of
 
 Aims of Sanitary Science. 
 
 Economic Science and Statistics attributes to it nothing 
 short of "an economical revolution" here in England 5 
 and historians of repute have attributed the decline and 
 fall of the Roman Empire to the pestilences which swept 
 off the adult male population, and left the then proud 
 mistress of the world an easy prey to the barbarians. 
 
 But these opinions, though they served to confirm my 
 ^rst impressions of the great importance of Sanitary 
 Science, did not take me by surprise, for I called to mind 
 the confident statement of Sir Gilbert Blane, that if the 
 mortality of the British Navy during the war with Ame- 
 rica had obtained throughout the French revolutionary 
 war, our stock of seamen would have been used up, and 
 " men would not have been procurable by any bounties, 
 •however exorbitant." So that it was not the seaman- 
 ship and fighting qualities of our sailors alone that carried 
 lis triumphantly through that terrible contest, but a re- 
 duced mortality due to the sanitary discoveries and reforms 
 which first recruited oar population by saving lives in 
 infancy and childhood, and then cut off from our forces 
 ►by sea and land, the destructive supplies of jail-fever, 
 scurvy, dysentery, and small-pox. 
 
 I feel, then, that we are dealing with a subject, the im- 
 portance of which it is impossible to deny and difficult 
 to exaggerate. Let us look closely into its aims and 
 scope, the sources of the knowledge it accumulates and 
 applies, the scientific methods it employs, its past triumphs, 
 its future prospects. 
 
 The aim of Sanitary Science is to prevent disease, pre- 
 serve health, and prolong life — to maintain the whole 
 people in the highest efficiency for the labours of peace 
 or the struggles of war. If we prefer the term Hygiene, 
 we may divide it into two branches — a private hygiene if 
 we address ourselves to individuals, a putlic hygiene if we 
 deal with nations or communities.
 
 So? trees of our Knowledge. 
 
 It is of public hygiene that I am to speak in this course 
 of lectures J and it is a ver}' large and comprehensive 
 science. It has to do with persons of every rank, of both 
 sexes, of every age. It takes cognizance of the places 
 and houses in which they live ; of their occupations and 
 modes of life ; of the food they eat, the water they drink^ 
 the air they. breathe j it follows the child to school, the 
 labourer and artisan into the field, the mine, the factory, 
 the workshop 5 the sick man into the hospital j the pauper 
 into the workhouse 3 the lunatic to the asylum 3 the thief 
 to the prison. It is with the sailor in his ship, the soldier 
 in his barrack ; and it accompanies the emigrant to his 
 new home beyond the seas. To all of these it makes 
 application of a knowledge remarkable for its amount, 
 and the great variety of sources whence it is derived. To 
 physiology and medicine it is indebted for what it knows 
 of health and disease ; it levies large contributions on 
 chemistry, geology, and meteorology j it co-operates with 
 the architect and engineer j its work commends itself to 
 the morahst and divine. 
 
 The Council of this College have always acknowledged 
 this its moral and religious aspect j and from the first 
 establishment of the Theological Department, have ar- 
 ranged that its pupils should not leave this place ignorant 
 of the fact that the destitution which attracts disease 
 repels religion. 
 
 Among o\xx sources of hnowledge there are two to which 
 I must make special reference. I mean the past history 
 of disease, and its current history as displayed in the 
 periodical returns of the Registrar-General. Of its history 
 in times past, I may observe that it is in many points of 
 view extremely important. It teaches us that several 
 fatal epidemics, some imported, some bred at home, have 
 ceased to afflict us because we have relinquished the habits 
 of life that welcomed or produced them 5 that some en-
 
 Scientific Methods. 
 
 demic maladies have nearly disappeared with a wider and 
 better cultivation of the soil, and others with the spread of 
 commerce, and the increase in the number and variety of 
 our articles of food 3 while, in one instance at least (I 
 speak of the lead colic), much suffering has been averted, 
 and many lives saved, by inquiries conducted on the 
 soundest principles of induction 3 and in one ever-memo- 
 rable case (vaccination), by closely observing nature, and 
 listening to tlie voice of analogy. These historic retro- 
 spects, full, as they are, of instruction and encourage- 
 ment, cannot be disregarded in any systematic course of 
 teaching. 
 
 The current history of disease is equally indispensable, 
 not merely as a means of comparison by which the past 
 becomes more instructive, but as indicating, at short in- 
 tervals of time, the exact state of the pubHc health. Nor 
 must we forget that these very reports, so valuable at the 
 time of their publication, are to become, in their turn, 
 materials of history, and standards of comparison indis- 
 pensable in all inquiries into the sanitary state of any class 
 or group of persons, of any village or district, of men or 
 women following any given occupation. 
 
 And now, having said something of the aim and scope 
 of our science, and something also of our sources of in- 
 formation, I proceed to inquire by what methods of pro- 
 cedure we transmute it into scientific truth ; how we 
 become possessed of those general principles which we 
 hold in reserve, to be applied at a moment's notice to 
 such special cases as may present themselves. 
 
 To answer this question, we must first inquire to what 
 class of sciences this science of ours belongs. Obviously 
 to the same class as medicine itself. Both are pre-emi- 
 nently sciences of observation, with much in common 
 and many points of contact j both make disease their 
 study, but in different ways. With the physician the
 
 TJic Numerical Method. 
 
 question is. What will cure an ague or mitigate a fever ? 
 with the health officer. What will prevent them? If the 
 physician takes cognizance of prevention, it is only to ad- 
 vise the patient and his household what precautions they 
 should adopt j but the care of the officer of health extends 
 to the whole district or community threatened by the 
 disease. The physician may advise a consumptive patient 
 to abandon some unhealthy occupation, damp dwelling, 
 or undrained district 5 the officer of health would render 
 the occupation healthy, or drain the district dry. Medicine 
 studies climate, in order to learn how it may suit a case 
 of asthma or consumption ; hygiene inquires what effect 
 it is likely to have on a fleet or an army. In a word, 
 while cure or palliation is the aim of medicine, prevention 
 is the object of hygiene 3 while the one studies the good 
 of the unit, the other looks to the welfare of the mass. 
 And this consideration leads us straight to the point at 
 which we are aiming — the natureof our scientific methods. 
 As hygiene deals with mankind not one by one, but in 
 masses, its scientific method can be no other than that 
 numerical method so often confounded with its leading 
 application — statistics. If this word now meant what it 
 originally did, and what, I tliink, it ought still to do — the 
 science of States — then hygiene would take rank among 
 its leading subdivisions as applying the great State- 
 policy of prevention to health and disease. 
 
 Of this numerical method which the French physician 
 Louis so largely applied, and Gavarret so ably explained 
 and illustrated, I have now to treat, as it lends itself to 
 the science of hygiene, premising that under the mistaken 
 name of statistics it has been the subject of many a 
 pleasant jest, and freely admitting that it is an instru- 
 ment of danger in the hands of the ignorant, tlie awkward, 
 or the careless, though safe and sure in the grasp of the 
 honest and intelligent. Every honest man finds it a friend ;
 
 TJic DevonsJiire Colic, 
 
 to the man who prefers the triumph of an opinion or a 
 party to the truth, to him alone is it an enemy. 
 
 The precautions to be observed by those who make use 
 of this powerful instrument of research are many, and not 
 always obvious. They do not lie on the surface, but crop 
 up at every turn. With each fresh inquiry they present 
 themselves afresh j with each new science they change their 
 form and character. I will illustrate these precautions and 
 the application of the method as I have found it in the 
 act of giving birth to great hygienic discoveries. Be it, 
 however, well understood that this logic of large numbers 
 is itself subordinate to a universal logical method which 
 deals with sums and averages no otherwise than with in- 
 dividual facts, or with the results of experiment ; indeed 
 with all data, whatever form they assume. So that the 
 instances I am about to adduce must be taken as illustra- 
 tions both of the numerical method and of this more com- 
 prehensive logic. They all belong to the sanitary history of 
 the eighteenth century, and are taken from the works of 
 Sir George Baker, who is not generally numbered among 
 hygienic authorities. 
 
 I. Quite early in the eighteenth century, certainly 
 prior to the year 1703, there prevailed in the county of 
 Devon a disease of which the first and usual manifestation 
 was a painful colic, the second a paralytic dropping of the 
 hands j while, in rare instances, the sufferers became de- 
 lirious or epileptic, and died at length convulsed or coma- 
 tose. Cases of this disease were so numerous in Devon- 
 shire and so rare elsewhere, that both the inhabitants and 
 the physicians who wrote about it agreed in regarding it 
 as an endemic malady. They also saw that a disease so 
 prevalent and yet so local must needs have a cause both 
 widely diffused and limited in the extent of its operation. 
 The cyder made and consumed in the county answered to 
 this description, and was accepted as the true cause. Mus-
 
 lo S/r George Baker, and 
 
 grave, who wrote in 1703, and Huxham in 1739, adopted 
 the popular behef, and differed only as to the particular 
 property in the cyder which gave rise to the disease, the 
 one ascribing it to its crudity and sharpness, the other to 
 the tartar it contained. Huxham's tartar theory was the 
 more plausible of the two, for it seemed to link together, 
 as due to this cause, the colic attributed ahke to the wine 
 of Poictou, the rum of Jamaica, and the cyder of Devon- 
 shire. But Sir Georo^e Baker, who had lons^ doubted this 
 theory, thought he saw, in the symptoms of the Devonshire 
 disease, the working of tlie poison of lead ; and he deemed 
 it eminently improbable that two things so unlike as apple 
 juice and lead could give rise to the same symptoms. Lead, 
 then, being such a poison as would account for all the 
 symptoms of the disease. Sir George will go in search of it^ 
 expecting to find it in some shape or other in the cyder. 
 But first he will do justice to an anonymous French author, 
 who seems to have anticipated him ; and he will also 
 ransack ancient Greek and Latin authors in search of in- 
 formation about lead and its effects. Then, returning to 
 Musgrave and Huxham, he shows that crudity and sharp- 
 ness in liquors is productive rather of diarrhoea than of the 
 constipation that attends the colic j while tartar shares with 
 acid liquors the power of curing it j and that the wines of 
 Poictou, when the disease prevailed in that part of France, 
 were adulterated witli litharge : and he cites a happy illus- 
 tration from Zeller which (like a two-edged sword) cuts 
 both ways, to the effect that the inhabitants of the neigh- 
 bourhood of Tubingen drank with impunity wines as sour 
 as vinegar, till they came to be adulterated with lead, and 
 that then the colic showed itself. Sir George nextshows that 
 the Devonshire colic is most prevalent when cyder is most 
 abundant j that it attacks persons of all ranks who drink 
 it, but that, as Dr. Wall, of Worcester, tells him, the cyder- 
 making and cvder-drinkin^ inhabitants of Hereford, Glou-
 
 The Lead Poison. 1 1 
 
 cester, and Worcester, do not suffer. He now submits 
 several specimens of Devonshire cyder to chemical exami- 
 nation with others from Hereford j and finds lead in the 
 former, not in the latter — indications of lead and the metal 
 itself; lead from cyder in the cask, lead from cyder in 
 bottle. The next step is to discover the source of this 
 lead impregnation ; and he traces it to a practice almost 
 peculiar to the county of Devon, of mending the stones of 
 the presses with iron cramps, fixed by melted lead ; to 
 another practice of lining the presses entirely with lead ; to 
 another of nailing sheet lead over cracks ; to another — 
 namely, the use of leaden pipes to convey the juice from 
 the presses 3 to another, to wit, the putting a leaden weight 
 into the casks to prevent the liquor growing sour ; to still 
 another — namely, boiling the must in vessels deepened by 
 a rim of lead. Add to this employment of lead in the 
 making of cyder, what was probably too largely practised^ 
 the use of it and its salts to correct acidity, and we are at 
 no loss to account for the prevalence of the colic and its 
 attendant paralytic and nervous disorders throughout the 
 length and breadth of the county of Devon. On the other 
 hand, Dr.Wall, of Worcester, alleges that the freedom from 
 colic in the counties of Hereford, Gloucester, and Worces- 
 ter was coincident with the absence of lead from their 
 cyder-making apparatus. 
 
 The number of persons suffering from this unexpected 
 cause must have been considerable ; for in a period of less 
 than five years, ending with 1767, 28^ cases were received 
 into the Devon and Exeter Hospital, of which 209, or 
 about three in four only, were cured. The more obstinate 
 cases were sent to the Bath Hospital, and of these about 
 half were cured. Of the patients, it appears that Devon- 
 shire contributed eight for one from the counties of 
 Hereford, Gloucester, and Worcester. The colic there- 
 fore was not confined to Devon j but existed to a limited
 
 12 A Siiigtdar Disease. 
 
 <?xtent in the other cyder-making counties j and cases are 
 reported by Wall and otliers, to show the exceptional use 
 of lead beyond the limits of Devonshire. One of Dr. 
 Wall's cases is to the following effect : " In a plentiful 
 year of apples, I knew a farmer who, wanting casks, 
 tilled a large leaden cistern with new cyder, and kept it 
 there till he could procure hogsheads sufficient to contain 
 the liquor. The consequence was, that all who drank of 
 it were affected by it as lead workers usually are. We 
 had eleven of them at one time in the intirmary." 
 
 Sir George Baker's masterly demonstration of the 
 true cause of the Devonshire colic is contained in 
 the first of the seven papers which he read at the 
 College of Physicians in 1767. The remainder in part 
 confirm and justify his views, and in part enlarge and 
 complete our knowledge of the poisonous action of lead, 
 and of the many unexpected ways in which it may gain 
 admission into our bodies. It is not possible to read these 
 papers without being struck with the rare union of learn- 
 ing, industr)', candour, and logical acumen which they 
 display 3 and no one who is acquainted with Dr. Wells' 
 Essay on Dew, so generally cited as a model of scientific 
 research, can fail to recognise in Sir George Baker's essays 
 logical illustrations of equal value, with the additional 
 recommendation that they issued in a great discovery by 
 which an immense amount of suffering has been averted 
 from mankind, and no small number of lives saved. 
 
 2. But Sir George's papers on the colic of Devonshire 
 and the poison of lead are not his only claim to a foremost 
 place among sanitary authorities. In the year 1782, he 
 read to the College of Physicians " An Account of a 
 Singular Disease which prevailed among some Poor Chil- 
 dren, maintained by the parish of St. James, in West- 
 minster." This essay, as you will presently see, is not 
 only a most valuable contribution to our knowledge of
 
 Cicrioiis Nervous Symptoms. 13 
 
 the baneful consequences of overcrowding, and of the 
 physical causes of insanity, but also an excellent illustra- 
 tion of the use of the numerical method, and of a mode of 
 discovering truth which confers on observation the force 
 and value of experiment. 
 
 In the autumn of 1782, 73 healthy paupers (46 girl* 
 and 27 boys), from seven to fourteen years of age, were 
 transferred from Wimbledon to King Street, Golden 
 Square. On the fourteenth day after their arrival, a girl, 
 thirteen years old, was suddenly seized with excruciating 
 pain in the stomach and back, soon followed by violent 
 headache, delirium, and convulsions — for which symptoms 
 she obtained temporary relief. After a few days, another 
 and another girl were attacked exactly in the same 
 manner, and at the end of three weeks, the disease had 
 become so prevalent that Sir George was called in. He 
 found nine girls and a woman servant ill j five in "ex- 
 treme pain," three "cruelly convulsed," and two "raving 
 in a fit of delirium.''' Another woman servant "was 
 tormented by a severe colic." He was told that some of 
 these patients had had several attacks, and had been re- 
 lieved by purgatives J but that the last two days the 
 attacks had been more violent, the intervals of ease 
 shorter, and the delirium almost incessant. Sickness was 
 a leading symptom, and constipation general ; and in 
 three cases a spontaneous vomiting and purging had given 
 immediate and permanent relief. The patients some- 
 times lay quiet for one or two hours, and then started up 
 screaming. They themselves stated that their fits began 
 with transient pain of stomach, followed by pain at the 
 back of the head, and this by " total perversion of the 
 understanding." "None of them had any degree of 
 fever." The worst attacks followed sleep. Four or five 
 other girls had complained of pain in the stomach and 
 bowels. This strange malady affected only females, was
 
 J 4 Ozxrcrowdiiig and Insanity. 
 
 confined to those ^vho had slept in the same room, and of 
 these to such as were above thirteen years old. The 
 house, being mostly wainscoted, had been painted a 
 month before the children came to it, and the smell of 
 paint was still very perceptible everywhere. The sleep- 
 ing-room occupied by the sufferers was 8 ft. high, 20 ft. 
 long, and 16 ft. wide, and held 10 beds j 9 for 18 girls, 
 two in a bed, and one for the servant j but being a warm 
 room, it "was generally crowded at night by a much 
 greater number than its just complement." Counting 
 the woman as equivalent to two children, the cubic space 
 per child would be only 128 feet. But, to make tlie 
 matter worse, " the chimney had been stopped up witli 
 bricks," and it was the " constant custom of the servant 
 at night to keep the room shut, and to close the window- 
 shutters." The parish doctor, who often had to visit this 
 room at midnight, found " the smell of paint very dis- 
 agreeable." The three candles and oil-lamp were ob- 
 ser\ed to give a glimmering light, and to be " frequently 
 almost extinguished." A woman who had passed one 
 night only in this room, as nurse to the sick children, had, 
 next morning, a sharp attack of the same pain, delirium^ 
 and convulsions. But, strange to say, of 18 girls who 
 slept in an adjoining room of the same dimensions, 
 painted at the same time, but having an open chimney, 
 not being so closely shut up at night, and not so attractive 
 to outsiders, not one had a symptom of the disease. The 
 diet and treatment of the children was the same through- 
 out the house, and was deemed satisfactory. The patients 
 were removed to a large airy room. They passed a quiet 
 night, but next morning were seized in the usual manner, 
 but the fits were less frequent, less violent, without con- 
 vulsions, and there was an abatement of the delirium in 
 the intervals. Things went on well for four days, but on 
 the morning of the fifth Sir George found all the patients.
 
 0-jcrcroiuding and Insanity. 15 
 
 " after having passed may hours in pain and convulsions, 
 in a most outrageous state of insanity, which continued 
 the whole day." From that time, though all the patients 
 had several returns of pain in the stomach and bowels, 
 it was less severe, was rarely followed by convulsions, and 
 seemed to change its seat to the lower bowel, creating 
 tenesmus and dysuria. During the whole course of the 
 disorder, whilst there was a remission of colic and con- 
 vulsion, there were "pains in the breast, legs, and arms." 
 No fresh seizures took place after the sleeping-room was 
 evacuated. No death happened 3 but in two instances 
 the recovery, though complete, was very slow. 
 
 This case presents us with those conditions of equality 
 (in locahty, in size of apartments, in number of occupants 
 allotted, in the recent use of paint, in diet and general 
 treatment, in the sex and age of the sufferers) for which 
 science is ever on the look out 3 while it brings into bold 
 relief the excess of crowding and exclusion of air as the 
 concomitants, and most probable causes, of the bodily and 
 mental disorders j as either the true and sufficient cause, 
 or as joint causes with the emanations from the painted 
 walls. But on this latter supposition, the paint must 
 have been innocuous under the less unwholesome condi- 
 tion of the room, the occupants of which remained un- 
 affected. 
 
 But whether this most curious combination of intestinal, 
 nervous, and mental disorder is to be regarded as the result 
 of intense pollution of the air from overcrowding and 
 utter absence of ventilation, or of these co-operating with 
 the emanations from the walls, I esteem it one of the most 
 instructive contributions yet made to hygiene on the one 
 hand, and to psychology on the other j and withal as an 
 admirable example of the most fruitful in good results of 
 all our logical methods. 
 
 3. I take my last illustration from Sir George Baker's
 
 i6 Sinall'pox at Blaitdford, 
 
 " Observations on the modem Method of Inoculating the 
 Small-pox," read to the College of Physicians in 1 771. It 
 is very interesting at the present time, when the question 
 Where shall we treat patients suffering from contagious 
 maladies ? is exciting so much interest. 
 
 I may remind you tliat when our great physician Syden- 
 ham began to practise, more than two centuries ago, the 
 medical world was divided into two parties, of which the 
 one advocated bleeding and lowering remedies, " to check 
 the too great ebullition of the blood," the other "as 
 strenuously insisting on the necessity of cordial medicines, 
 and a very warm regimen, in order to imitate nature, and 
 to expel the malignity of the disease from the centre of the 
 body to the circumference." "Sydenham was persuaded 
 that a great number of patients had fallen victims to both 
 heresies." But that which he attacked with the greatest 
 success was the last 3 and after a hard fight with doctors 
 and nurses, he dealt a deathblow to the stifling system. 
 But there is a strange vitality about great errors j and so 
 this false theory of the seventeenth century survives in 
 this enlightened nineteenth, under the modified form of a 
 partiality for close-fitting doors and windows, a horror of 
 drafts, and a proneness to attribute every natural change 
 for the worse in the condition of a patient to some inno- 
 cent movement of fresh air. Dr. Pultney, of Blandford, 
 whom Sir George, in the language of his time, styles " a 
 very ingenious physician," relates " a fact notorious in that 
 place," which ought to ser\e as a corrective of such no- 
 tions. 
 
 On the fourth of June, 1731, a fire broke out at 
 Blandford, when 150 persons were ill of the natural 
 small-pox. All these were carried instantly into tlie fields, 
 where many remained several days and nights. Beds were 
 laid for them on the dry ground under hedges, and the 
 arches of bridges ; " yet notwithstanding this sudden ex-
 
 The Hot Regimen. 1 7 
 
 posurc to the air, it is a fact which many people will 
 remember andean testify, that one person only died — viz., 
 a young woman who was almost expiring at the time 
 when she was removed." 
 
 These 150 cases, be it recollected, were cases of natural, 
 not of inoculated small-pox, and that of a severe type ; for 
 we learn from Dr. Pultney's letter that small-pox of so 
 malignant and destructive a kind was then prevailing in 
 the West of England, that Dr. Andrew of Exeter 
 h)st in eight months 25 patients in 44 from the natu- 
 ral disease confluent with purple spots ; and he was 
 credibly informed that at Lyme 60 deaths at least had 
 occurred among about 250 people : also that of the few 
 seized at Blandford before inoculation a great proportion 
 died under very malignant symptoms. Now the natural 
 small-pox of which these patients died under very malig- 
 nant symptoms, the small-pox which at Exeter had killed 
 more than half whom it attacked, and at Lyme nearly one 
 in four, broke out in Blandford the first week in April, at 
 which time there were at least 700 inhabitants who had 
 not been inoculated, and such '' a perfect rage for inocula- 
 tion seized the whole town and neighbourhood," that by 
 the 1 6th of the month about 300 had been operated upon, 
 and that without any preparation. Now the mortality 
 from the inoculated small-pox, when imparted to persons 
 of all ages without special preparation, amounted to about 
 I in 500; and Sir George tells us that, according to the 
 best information he could procure, about 17,000 persons 
 had been inoculated after proper preparation, and with 
 subsequent free exposure to the air, and that of this num- 
 ber only five or six died. Such being the favourable rate 
 of mortality in inoculated small-pox, let us see what hap- 
 pened to the inoculated at Blandford. We are told that 
 there were in the town many advocates for the warm regi- 
 men among all ranks ; that " the hot regimen was too
 
 i8 Extempore Hospitals. 
 
 much practised in several instances," and that when Dr. 
 Pnltney "was called to some of the people," and wit- 
 nessed the giving of "hot things" during the eruptive 
 fever, but especially " the pernicious custom of depriving 
 the sick of the benefit of fresh and cool air, he did not 
 wonder that miscarriages should happen". — the miscar- 
 riages in question being thirteen deaths in 384 cases! 
 
 Here then we have the inoculated small-pox (naturally 
 a mild and tractable disorder) claiming thirteen victims 
 out of 384, or more than one in thirty, under the hot 
 regimen J while, in the same town, the natural small-pox, 
 of a severe type, and elsewhere killing from a fourth to a 
 half of all whom it attacked, destroying only one person in 
 Tjo, and that one already on the point of death, under the 
 very cool regimen of hedges and dry arches. 
 
 I may take this opportunity of stating that, about a 
 centur}^ ago. Dr. Brocklesby, an army surgeon, showed the 
 advantage of treating typhus fever in rude temporary- 
 structures, such as we may bum down when they have 
 done their work without scandalizing the most rigid eco- 
 nomist. But my present object being to show the ap- 
 plication of the numerical method and the all-embracing 
 rules of logic to the discovery of truth in Hygienic Science, 
 T rest content with these illustrations from the works of 
 Sir George Baker, and pass on to consider past sanitar}- 
 triumphs, and the hopes they seem to justify of progress in 
 the future. 
 
 Now there are three diseases which no longer, under 
 any name, figure on our registers of death : I mean the 
 Black Death of the fourteenth centur}', the Sweating 
 Sickness of the sixteenth, and the Plague of the seven- 
 teenth. For the disappearance of these diseases neither 
 science nor the labours of individuals, nor such local occur- 
 rences as the Great Fire of London, can claim any credit. 
 AVe must attribute the happy result to the natural progress
 
 British Lying-in Hospital. 19 
 
 of society from barbarism to civilization, to the onward 
 march of the peaceful arts, and to the growth of habits of 
 decency and cleanliness. 
 
 But there were still in existence, in the first year of the 
 eighteenth century, several fatal maladies destined to be- 
 come extinct, or to suffer material reduction in the num- 
 ber of their victims, by discov^eries and successful sanitary 
 labours made and undertaken in the next hundred years, — 
 diseases of the earliest infancy, which I shall not stop 
 to particularize j diseases of childhood, divided into 
 two groups of infectious disorders and wasting maladies j 
 and those of manhood, divided into the same two 
 groups. 
 
 Of the first class I will simply observe that they cer- 
 tainly destroyed fewer lives at the end than at the begin- 
 ning of the century. If I were asked for a rough estimate, 
 I should say that for 3 deaths of infants at the beginning 
 of the century there were 2 at the end 5 and this improve- 
 ment too, like the passing away of our early epidemics, I 
 attribute to progressive civilization, more skilful medical 
 treatment, and less ignorant nursing. Perhaps I cannot 
 better exhibit the improvement that took place in the 
 second half of the century than by giving you the figures 
 of the British Lying-in Hospital for the first and last 
 twelve years of that period of fifty years. There died in 
 the first twelve years more than i in 15 : in the last 
 twelve, less than i in 82 ! And, as I have before me the 
 deaths of the mothers for the same years, I may state that, 
 while the death-rate for the first twelve years was i in 38,. 
 it was only i in 318 for the last twelve. These figures 
 show a reduction of mortality in an institution which must 
 have commanded the best medical skill and best nursing 
 of the whole period under review, of more than fivefold 
 for children, and more than eightfold for their mothers. 
 In this reduction sanitary improvements in space, ventila- 
 c 2
 
 20 Fatal Diseases of A didts. 
 
 tion, and cleanliness must have borne a very considerable 
 part. 
 
 Respecting the infectious diseases of childhood — scarla- 
 tina, measles, whooping-cough, diphtheria, to which I may 
 add small-pox, as less exclusively a disease of childhood — 
 I must speak with some hesitation, as the old London 
 bills of mortality do not admit even of a rough comparison 
 with the reports of the Registrar-General under this head. 
 But that there was a great falling-olf in the deaths from 
 the chronic wasting maladies of children during the eigh- 
 teenth century admits of no manner of doubt. Heberden, 
 comparing the tigures of the London bills for the begin- 
 ning, middle, and end of the century, shows that out of 
 about 21,000 deaths at each of the three periods^ scrofula, 
 or the evil, occasioned 70 in the first, 15 in the second, 
 and 8 in the third j and rickets 380 in the tirst, 11 in the 
 second, and i only in the third. 
 
 Turning now to the adult population, and to the 
 diseases most amenable to hygienic treatment, we find un- 
 mistakeable evidence of improvement. Fevers, which are 
 held to be specially open to the attacks of the sanitary re- 
 former, are set down by Heberden as destroying 3000 per- 
 sons, most of them probably young adults, in the begin- 
 ning, 3000 in the middle, and only 2000 at the end of the 
 century: and dysentery as falling from iioo to 135, 
 and from i^,^ to 20 ! I find too that from 1701 to 
 1758, the entries in the bills under the head of sores and 
 ulcers and imposthumes fell from 113 to 23. I mention 
 these three entries — fever, dysentery, and ulcers — because 
 these, with scurvy and small-pox, were the scourges of 
 our seafaring population in the times to which I am refer- 
 ring. Of the small-pox, let me add that it was credited 
 with 1600, 2000, and 2000 deaths in the beginning, 
 middle, and end of the century. 
 
 Among the diseases that destroy the young adult popula-
 
 The Sacrzy. 21 
 
 tion, pulmonary consumption must always hold the tirst 
 place J and this disease is set down in Heberden's tables as 
 the cause of 3000 deaths at the beginning, 4000 in the 
 middle, and 5000 at the end of the i8th century. I can- 
 not now discuss the causes of this increase 3 but must de- 
 vote what remains of this lecture to a short notice of the 
 three diseases to which the events of the iSth century 
 have imparted a special interest — scurvy, jail-fever, and 
 small-pox. 
 
 The history of the scurvy is a history also of scanty or 
 improper supplies of food. In early times it followed as 
 a mortal epidemic in the footsteps of famine, being pro- 
 moted, but not caused, by cold damp seasons, and by 
 squalor and filth. It is commonly found associated with 
 dysentery, fever, and foul ulcers, and has certainly contri- 
 buted largely to the fatality of our great epidemics. The 
 progress of agriculture and horticulture, our enlarged com- 
 merce in fruit and vegetables, the abundance and cheap- 
 ness of the potato, and improved habits of life, have done 
 much to root out this destructive disease from among the 
 civil population. 
 
 Through the combined operation of these causes the 
 scurvy long since ceased as an epidemic, to reappear in con- 
 nexion with such visitations as the potato rot in Ireland ; 
 in young communities, such as California, before the in- 
 troduction of a due supply of vegetables and fruits ; in 
 workhouses and prisons whenever the potato (the only or 
 chief vegetable element in their dietaries) is omitted. But 
 when the scurvy had ceased to afflict nations and commu- 
 nities as an epidemic, it did not cease to scourge their 
 armies and fleets if their supplies of food fell short, or the 
 essential element of fruit and vegetables was cut off from 
 theii- dietaries. In earlier times it was but natural to sup- 
 pose that the disease was occasioned solely by want of food, 
 and not by the absence from such food as starving people
 
 Voyages of Anson and Cook. 
 
 could obtain of the vegetable element. At what period 
 the truth dawned upon men's minds we do not know j 
 but certainly as early as 1617, John Woodall, Master in 
 Surger}', knew that lemon-juice was the best of all remedies 
 for the scur\-y, and commended it accordingly. But strange 
 to say, this important fact was forgotten or overlooked for 
 more than a hundred years. About 1770 Lind revived and 
 dilfused a knowledge of it. But nearly another quarter of 
 a century was to elapse before our navy was supphed with 
 it. This important step was taken in 1796, and was pro- 
 bably determined by a fact that occurred about two years 
 previously. The Suffolk, of 74 guns, sailed from England 
 the 2nd April, 1794, with a supply of lemon-juice, of 
 which two-thirds of an ounce was given every day to every 
 man on board. This ship was 162 days without commu- 
 nicating with tlie land, and reached Madras without losing 
 a man, with only fifteen slight cases on tlie sick list, and 
 no case of scur\y. 
 
 In my sixth lecture I shall give you in detail the facts 
 of Anson's disastrous voyage, that you may be able to ap- 
 preciate the possible ravages of the scurvy 5 and, by way 
 of contrast, some particulars of Captain Cook's first voyage 
 round the world. In this place I must content myself 
 with stating that in less than nine mondis Anson lost 626 
 out of 961 men, chiefly by scur\y, being nearly 2 in 3 ; 
 while Captain Cook, about thirty years later, sailed round 
 the world, and returned in three years with the loss of four 
 men by accident and one by disease, out of a crew of i j8. 
 Again, in Pany^'s three Polar voyages, of a year and a half 
 and two years' duration, only 7 men died out of 334. 
 
 ^Making the largest allowances for the diff'erence be- 
 tween the man-of-war and the exploring vessel, and 
 between the modes of recruiting in the two cases, we have 
 yet an excess of mortality in Anson's vessels which proves 
 the great efficacy of the measures for preserAing health
 
 The Jail-Distemper. 
 
 for which Captains Cook and Parry were so justly renowned. 
 The demonstration of the possibility of preserving the 
 health of seamen in long voyages is an honour which has 
 been specially ascribed to Captain Cook, for reasons which 
 I shall explain in my sixth lecture. 
 
 The jail-distemper is an old offender. The famous Black 
 Assize was held at Oxford in 1^77. In those early times 
 it was known as the Sickness of the House. I think I 
 recognise it in the London bills from 1606 to 1665 as the 
 Parish bifectioji. It was still at home in the prisons of 
 England during the first three-quarters of the eighteenth 
 century, and John Howard, in 1774, found their inmates 
 expiring in loathsome cells of pestilential fevers and the 
 confluent small-pox. It was one of the most loathsome, 
 infectious, and fatal diseases of which we have any know- 
 ledge. A prisoner might carry it about vt^ith him in his 
 clothes, and," invulnerable in his ownmephitic atmosphere," 
 infect the whole court convened to try him 5 might convey 
 it, if discharged, to his own family, or to the population of 
 a village or town 5 might become a terrible focus of infec- 
 tion to armies or fleets. It originated among prison scenes 
 in which it is hard to say which was most conspicuous, the 
 disgusting filth, the reckless depravity, the lawless violence, 
 the gross imposition, or the helpless inaction of the State. 
 One cannot think of it without horror, or speak of it 
 without disgust. Such a combination of physical and 
 moral evils, such a seething mass of crime, misfortune (for 
 most prisoners were small debtors), low vice, and debau- 
 chery, the world has never seen beyond the limits of Eng- 
 land. I am speaking of a date as recent as 1774. Then it 
 was that " plain John Howard," " modest, noble Howard," 
 of whose gentleness, courage, and constancy I shall have 
 to speak in ray seventh lecture, finding that, as Sheriff of 
 Bedford, he had a duty to perform, did it, as was his wont ; 
 and after such a fashion, too, that in the self-same year
 
 Sju all-pox. 
 
 J 7 74, he compelled the House of Commons, by the force 
 of his facts, backed by the weight of his personal charac- 
 ter, to release the prisoner from his fetters of physical 
 corruption and illegal extortion. In a few years the jail- 
 distemper died out from English prisons, washed and 
 blown away ; and a fatal source of infection was for ever 
 removed from our civil population, a constantly recurring 
 danger from our army and navy. 
 
 The only remaining disease that I have to notice is the 
 small-pox, a fearfully contagious and most destructive 
 malady, scarring and blinding where it did not kill, the 
 associate of the jail-distemper, one of the many foes of the 
 soldier and sailor. It might be rendered, as we know, a 
 very mild disease by inoculation, introduced into England 
 in 1 72 1 3 but practically the reduction of mortality due 
 to this cause was not very considerable. It was Jenner's 
 discovery of vaccination, about 1796, that gave us the- 
 means, if we had been wise enough to use it, of stamping 
 it out. How much it has already done for us we all 
 know. Its triumphs are inscribed on our mortuary 
 registers, in the small population of our blind asylums, on 
 the unscarred faces of our men and women, in the 
 reduced mortality of our soldiers and sailors. 
 
 If what I have said of the labours of Cook, Howard, 
 and Jenner be true, then it must follow that the joint 
 results of their benevolent and wise exertions may be 
 found inscribed in the plain language of figures on our 
 public records. I take the mortality in the navy as my 
 test, and I find the figures for the two periods 1779 and 
 1813 to stand as follows : — 1779, 123 per 1000 : 1813, I4. 
 per 1000. In 1779, one man sick in ever)- two: in 
 1813, one man sick in ever}' eleven ! These are strange and 
 startling figures J but they do not come by surprise on 
 the minds of those who are familiar with the writings of 
 Pringle and Blane, of Lind and Howard. They know
 
 Great Men of the i^t/i Century. 25 
 
 full well that whereas before the days of Cook, Howard, 
 and Jenner scurvy, jail-fever, and small-pox robbed us of 
 many a victory, and inflicted upon us many a cruel disap- 
 pointment, it was with the soldiers and sailors whose 
 health these men had protected, whose lives these men 
 had saved, that we gained the victories, by sea and land, 
 of the terrible war of the French Revolution. These 
 three men indeed were " more than armies to the public 
 weal." They were our safety in times past 5 they will be 
 our boast, our exemplars, our encouragement, in all times 
 to come. 
 
 If you are not quite weary of figures T will ask you to 
 note and remember these dates : — Sir George Baker's de- 
 monstration of the true cause of the Devonshire colic, 
 1767 ; Captain Cook's first voyage, 1772 j John Howard's 
 parliamentary triumph, 1774; Edward Jenner's boon of 
 vaccination, 1 796 ! Is it necessary that I rehearse the names 
 of the great men who were in the prime of their lives in 
 this interval between 1767 and 1796, who were born to us 
 here in England or in our colonies between the birth of 
 Howard in 1726 and that of Jenner in 1749 (or say, the 
 thirty years from 1720 to 1750) j need I specify the names 
 of Clive, Franklin, and Washington 3 of Paley, Blackstone,. 
 and Adam Smith j of Herschel and Arkwrightj of Burke 
 and Fox; of Goldsmith and Cowper^ of Reynolds and 
 Gainsborough ; of Haydn, of Wedgewood — in order that 
 you may feel how glorious, how rich in all that makes a 
 nation great, was this thirty years of the eighteenth cen- 
 tury, in which Baker, Cook, Howard, and Jenner dis- 
 played their talents and their virtues ? It was a grand 
 epoch in a great history j the dawn of practical Hygiene , 
 the sunrise of preventive philanthropy. Am I wrong in 
 thinking that there are many in this room who would like 
 to know more of the sanitary history of this eventful time, 
 more of the men who unconsciously laid the foundations.
 
 ^6 The Futitrc of Hygiene. 
 
 ■of the science and art of hygiene? In the last four lec- 
 tures of this coarse I hope in some degree to gratify this 
 wish j and next year, if life and health are spared me, to 
 treat of the diseases and sanitary discoveries and reforms of 
 this 19th centur)\ 
 
 Time will not permit me to say all I could wish on a 
 part of my programme that is still untouched — I mean the 
 prospects of this our science of hygit-ne. I would not 
 willingly exaggerate them : but when I bear in mind that 
 we have only lately discovered that our drinking-water 
 may become a vehicle for the poison of cholera and 
 typhus, and that pulmonary consumption is amenable to 
 the influence of drainage j when I reflect that there is 
 great room for improvement in the management of all in- 
 fectious maladies 3 that most of our towns and, all our vil- 
 lages are still untouched by the hand of the sanitary en- 
 gineer j that a great work of cleansing has yet to be done in 
 all our rivers and streams 3 that there are swamps and 
 marshes still undrained — when I bear all this in mind, I 
 cannot condemn as extravagant the estimate of those who 
 think that a fourth part of our actual mortality may be 
 ultimately averted. Nor, if the question of ways and 
 means must be entertained, can I overlook the fact that 
 large sums of money are being wasted, and worse than 
 wasted, on wilful destitution, and a vast taxation of some 
 seven millions a year squandered on the ever-recurring, 
 never-ending work of palliation, which sums, if they were 
 devoted to the work of prevention, would soon make Eng- 
 land the healthiest and the happiest, as she is already, in 
 spite of reckless waste, rash speculation, and spasmodic 
 schemes of emigration, the richest country in the world.
 
 27 
 
 LECTURE II. 
 
 THE BLACK DEATH. 
 
 From the tone and tenor of my first lecture I think you 
 will infer that I am deeply impressed with the importance 
 •of my subject, and desire to commend it not merely to my 
 ■own profession, but to all who take an interest in great 
 public questions. I want to realize for myself, and im- 
 part to you, the grand progress we have made in health, 
 and in all the decent and wholesome usages, all the un- 
 obtrusive virtues, which cluster round it, whether as its 
 causes or consequences, from the days when the Black 
 Death, the Sweating Sickness, or the Oriental Plague laid 
 their heavy hands upon us, to the close of the eighteenth 
 century, when Scurvy, Jail-distemper, and Small-pox were 
 added to the list of extinct pestilences. If I wanted any 
 justification for addressing, in this my first course, not my 
 medical brethren only, but that larger public also that 
 takes an interest in great social questions, I should find it 
 in the fact that while we owe the prevention of small- 
 pox to the science of Jenner, we trace the destruction of 
 the jail-fever and the abatement of the scurvy to the shrewd 
 common sense of two men, Howard and Cook, who did 
 not enjoy the advantage of a medical education. 
 
 I think you will also infer, from what has gone before, 
 that I propose to myself an historic treatment of my sub- 
 ject, by which I do not mean a minute quotation of 
 authorities, but rather a series of analytical sketches drawn 
 direct from the works of authors of repute, or based on
 
 28 Sanitary Epochs. 
 
 such data as the London bills of mortahty. And where, 
 as in the case of John Howard, I tiud a great character, as 
 I think, misunderstood, I shall blend biography with 
 history, and present the man himself, attended by his 
 works J nor shall I fail to speak of Captain Cook when I 
 treat of the scur\y, or of Jenner when I discourse of vacci- 
 nation, I need scarcely add that it is of the sanitary 
 history of England that I propose to treat. Of other 
 nations I shall speak only incidentally and briefly. 
 
 In treating a subject historically, it is desirable to divide 
 the whole period under review into shorter periods, de- 
 lined by certain salient events. Now, the health history 
 of England, up to the close of the eighteenth century,, 
 may, I think, be distributed into three periods, as. 
 follows : — 
 
 I. From the earliest time to the middle of the four- 
 teenth century, the epoch of the Black Death. 
 
 II. From tlie middle of the fourteenth century to the 
 year 1666, the date of the Fire of London. 
 
 III. From the year 1666, to the end of the eighteenth 
 century. 
 
 The first period is marked by scanty records of fre- 
 quently recurring epidemics ; the second by the occurrence 
 of the Black Death, Sweating Sickness,and Plague, concern- 
 ing which we possess fuller details ; and the third by the 
 great discoveries and reforms to which I referred in my 
 first lecture, in connexion with the names of Baker, 
 Cook, Howard, and Jenner. 
 
 I shall devote the rest of this lecture to a brief notice 
 of the first period, and to a short account of the Black 
 Death, the first of the three epidemics of the second ; my 
 third lecture chiefly to the Sweating Sickness j my fourtli 
 wholly to the Plague j the last four to the prevalent and 
 fatal diseases of the eighteenth century. 
 
 But before I enter on this retrospect of the first period.
 
 Health and Disease. 29 
 
 I must prepare the way for the better understanding and 
 full appreciation of it by a few observations on Health 
 and Disease 5 on health, that you may feel its importance, 
 on disease, that you may know what I mean when I come 
 to speak of its several forms and varieties. 
 
 I know that I speak the language of commonplace 
 when I say that health is the greatest of blessings, the 
 mainspring of bodily strength and mental efficiency, and 
 the prime source of comfort and enjoyment ; while disease, 
 in proportion to its degree and duration, is synonymous 
 with suffering more or less severe, and failure more or less 
 complete. But I think that I rise above the level of 
 commonplace when I seek to draw some distinction 
 between the value of health to different classes of society. 
 To the rich, who need not work, and to the poor who 
 must, health is equally the source of comfort and enjoy- 
 ment ; but to the man who must labour that he may 
 live, health is this and something more. It is the means 
 by which he earns his living. Disease, and especially such 
 a lingering malady as a fever or a consumption, dries up 
 the sources of his subsistence, exhausts his savings, plunges 
 him into debt, threatens him and his with destitution. If he 
 recover his health, he may have lost his occupation, and 
 must spend his convalescence in a wearisome, perhaps a 
 fruitless, search after work. If disease attacks his family 
 but spares himself, it is still the greatest calamity that can 
 befall him and them. The minor household virtues have 
 no worse foe, education no deadlier enemy, intemperance 
 no more sure ally, than sickness when it invades the 
 humble dwellings of the poor. 
 
 Now let us consider what disease is in its relations to 
 the State. Labour and capital may be said to be the two 
 pillars on which it rests. Disease paralyses labour and 
 wastes capital. In nations that make public provision for 
 the poor, preventible disease and premature death impose
 
 30 Cost of Disease. 
 
 the heaviest taxes on ther ate-payer, so heavy that in one 
 instance, cited by the late Dr. Southwood Smith, no less 
 than 13 out of 15 of those who received relief in one district 
 of the metropolis had been ill of fever, or were pauperized 
 by it. This, in a greater or less degree, is the sure result 
 of all severe and lingering diseases. But this is not all. 
 The State must have soldiers and sailors in peaceful times, 
 and must add largely to their number in time of war. In 
 either condition disease is ver}' costly j but in war, as I 
 showed you in my first lecture, it may be supremely disas- 
 trous. In such facts as tliese we have the strongest motive 
 to study disease, especially in its preventive aspects. 
 
 That we may enter with advantage on this study, we 
 must first realize the complex and variable character of all 
 tlie elements with which w^e have to deal — of the popu- 
 lation subject to disease 5 of the circumstances which pre- 
 pare it to succumb or resist ; of the atmospheric states 
 which favour the rise and spread of it ; and of the causes 
 which directly produce it. 
 
 To make these matters clear, I will suppose that on the 
 first day of some year (say this very year 1870) we have 
 under ob3er\-ation a population of 4000 souls in some 
 district of this great city. This population will consist of 
 men, women, and children of all ages, from the child 
 just born into the world to the centenarian on the point 
 of leaving it 5 of ever)^ constitution and degree of vigour ; 
 of ever}^ grade of mental power from idiocy to genius. 
 All these were but the survivors among many germs of 
 life, of which some had perished prematurely, others in 
 the very birth, and of these sunivors themselves no two 
 were born alike, no two, as they grew up, have proved 
 exact counterparts of each other. 
 
 On this assemblage of living units, of which no two 
 were or are alike, influences for good or evil, of ever}- 
 deoree of power, are brought to bear in infancy, in child-
 
 Epidemic Constitution. 31 
 
 hood, in youth, in manhood ; and modes of life more or 
 less virtuous or vicious, and occupations more or less 
 healthy, counting by hundreds, offer themselves for choice j 
 to say nothing of things over which they can exercise no 
 control, such as the streets and houses in which they live, 
 such as drainage and the supply of water. By such origi- 
 nal and acquired differences, each population of human 
 beings, like each living unit, comes to have a special cha- 
 racter of its own. No other can be like it j nor can it 
 itself remain for any length of time in the same state. 
 Its numbers, and the ages of its living units, are subject to 
 incessant change 5 and if a census w^ere taken every year, 
 these changes would show themselves annually in ever\" 
 column and line of figures. 
 
 Again, on this population is brought to bear every year, 
 every month, every week, every day, some new combina- 
 tion of temperature, moisture, movement, and state of 
 air, wdiich we call weather, or, when we sum up their 
 prevailing character during long periods of time, climate. 
 And every year we have some atmospheric element which 
 neither thermometer nor barometer, neither rain nor wind 
 gauge, nor measure of moisture, nor test of ozone, can 
 reveal to us, but only our records of sickness and death. 
 One year it is such a state as favours small-pox, the next 
 perhaps it w^ill promote scarlet fever, or measles, or 
 whooping-cough, or it wqll, so to speak, select from 
 several forms of fever that one which shall fill the beds of 
 our fever hospitals. This condition of air, of which 
 disease itself is the only test and measure, was once called 
 pestilence, but is now known as its epidemic constitution . 
 And this, whenever it acts on the population with such 
 energy that the disease which it favours affects large 
 numbers of persons, that disease is called an epidemic. 
 But this epidemic constitution, be it understood, is not its 
 true and direct cause, but only its predisposing cause. The
 
 32 Causes of Death. 
 
 exciting cause is some poison taken into the body, of 
 which more presently. 
 
 I now return to my hypothetical case of a population 
 of 4000 souls, which I assumed to exist at the beginning 
 of the year J and I will try to realize what will have 
 happened to it before the year is out. In the first place, 
 some such number as 120 infants will be added to it in the 
 course of the year, and by the end of it 100 out of tlie 
 4120 will have died. 
 
 Of this 100 deaths, about 10 will have happened 
 in early infancy, and 6 in old age 5 and various external 
 causes, some accidental, some intentional, will have swept 
 away 4 more, making 20 in all. Of the 80 that remain, 
 the wasting maladies of childhood, of youth, and of 
 middle age (pulmonary consumption being the most fatal), 
 will account for 18 deaths; various local maladies for 
 iibout 25, and diseases of the lungs, including the bron- 
 chitis so fatal to old age, 16. There remain, as due to 
 the diseases now known as "Zymotic," 21. These are 
 close approximations to the true figures deduced from the 
 mortuary records of London for the year 1850, a healthy 
 year, following the cholera year 1849 J ^"^ ^^^^7 "^^7 be 
 taken as fairly representing the distribution of deaths, in 
 accordance with the causes of them, in healthy years. 
 
 Now let us see what the cholera of 1849 ^^^ ^^ change 
 these figures. Why, it added largely to the figure for the 
 zymotic class 3 in 1850, it was 99803 in 1849 (^^^ 7^^"* 
 of the cholera) it was 28,313, and if we add the deaths 
 in excess from diarrhora and dysentery, we may safely say 
 that even in these days an exotic epidemic may multiply 
 by three the usual mortality of the class of diseases to 
 •which it belongs. This will give you some faint idea of 
 what an imported disease may do to swell our tale of 
 <leaths, and the sickness of which these deaths are but a 
 fraction.
 
 Tubercular Diseases. ^^ 
 
 Among the causes of the loo deaths I have supposed to 
 occur among a population of 4000, there are three leading 
 groups that have a special interest for the student of 
 hygiene : I mean the group of " tubercular diseases," of 
 which pulmonary consumption is the chief j the group of 
 diseases of the organs of respiration, in which bronchitis 
 takes the lead • and the group to which the Registrar- 
 General gives the name of zymotic. By this is meant an 
 action like that of yeast on dough, by which a germ 
 taken into the body multiplies itself indefinitely, and 
 the body, in its turn, throws off and expels these 
 germs, to become for other human beings the source 
 of the self-same disease by which it has suffered. There 
 is no better type of this group than small-pox 3 for you 
 may have a small-pox patient covered from head to foot 
 with tens of thousands of little blisters, you may take 
 from one of these a small fraction of its contents on the 
 point of a needle, and if you prick a healthy man with it, 
 iie will, in his turn, sicken of the disease, and throw out 
 the same huge crop of blisters, and so on, from patient to 
 patient, to the end of time. 
 
 Let us briefly discuss these three groups and their causes. 
 
 I. Tubercular diseases acknowledge as their cause a 
 substance, hard as gristle, or soft as cheese, formed within 
 or upon the textures of the body, inert and harmless for a 
 time, but sooner or later stirring up inflammation, and so 
 causing swellings or tumours, abscesses and open sores. 
 If this intrusive matter occupies such outward parts as the 
 glands of the neck, which it will do in children, it may 
 fret and tease the body for a while, and leave behind it 
 some ugly scar. This is the most common external form 
 of scrofula, struma, or king's evil \ and tliose who suffer 
 in this way, or from this cause, are called scrofulous or 
 strumous. The word scrofula has a fanciful and trivial 
 <lerivation j but struma, which means " a heaping up," 
 
 D
 
 34 Pulmonary CoiisiitJiptiofi. 
 
 indicates the swelling that marks the early and sometimes 
 the advanced stage of these tubercular diseases. This same 
 scrofulous matter invades the bones and johits, and gives 
 rise to tliose "white swellings" for which we have as yet 
 no better cure than the knife of the surgeon. Most of 
 these external diseases, when they prove fatal, are entered 
 in our death-registers as -'scrofula." 
 
 Another favourite seat of this intrusive matter is in 
 those glands which are interposed between the vessels 
 that carry the white nutritious fluid from the alimentary 
 canal and those that circulate the red blood through the 
 body. Here the scrofulous matter is both a mechanical 
 impediment and a source of irritation, and the two 
 together suffice to explain the painful contrast of swollen 
 belly and shrunken limb which marks this, the Tabes 
 mesenterica (the abdominal consumption) of the Registrar- 
 General. Again, this same intrusive matter may thicken 
 the membranes of the brain, and cause hydrocephalus, or 
 water in the head. These wasting forms of scrofula are 
 fatal to about 2500 children a year, here in London. 
 
 The group of tubercular diseases is completed by the one 
 fatal malady of the adult — pulmonary consumption. Here 
 the intrusive matter occupies the texture of tlie lungs, 
 embarrasses the vital function of respiration, and wears 
 life away by many exhausting discharges. It is the 
 chronic plague of the prime of life: and destroys, in 
 London alone, many thousands a year ; often more than i 
 in 7 of the deaths at all ages, and something like i 
 in 3 of all our grown-up people. This is the disease 
 of which I spoke in my first lecture as certainly amenable 
 to the preventive influence of space, air, and ventilation 
 in the places where men and women live, serve, or work ; 
 and also to the drainage and drying of the damp sodden 
 soils of our towns. 
 
 2. The group of diseases of the lungs and organs of
 
 Zymiotic Maladies. 35 
 
 respiration is scarcely less destructive to life than that of 
 Tubercular Diseases 3 and it would head the list of fatal 
 maladies if consumption were transferred to it. Bronchitis 
 and asthma, its two leading constituents, are two of the 
 fatal maladies of the advanced periods of life. They are, 
 in a remarkable degree, dependent on the seasons and 
 weather, and especially on cold; so that four times as 
 many persons may die in the first and fourth quarters of 
 the year as in the third — in the winter, as in the summer. 
 And a disparity nearly as striking has been shown to 
 exist between the colder weeks of one year and the corre- 
 sponding warmer weeks of another. This fact was well 
 shown by the younger Heberden, who compared the 
 mortality from all causes in the first five weeks of 1795 
 with that of the same five weeks in 1796. The tempera- 
 ture in I 795 ranged between 23° and 29°, in 1 796 between 
 43° and 50". In 1795 the total deaths were 2823; in 
 1796, 147 1 3 or nearly twice as many in the cold as in 
 the mild winter. How fatal this cold was to aged persons 
 may be inferred from the fact that while the cold weeks 
 of 1/95 destroyed 617 children under 1 years old, and 
 the warm wrecks of 1796, 506, or 6 deaths in the first to 
 5 in the last, the deaths above 60 were 717 in the 
 cold year, and only 153 in the milder one, or something 
 approaching 5 to i. Comparisons between cold and 
 warmer weeks of the same year yield similar results. 
 
 3. The fatal diseases which the Registrar-General binds 
 up together and labels as Zymotic^ form a large mixed 
 group, having for their common cause some poison, in- 
 serted into the body, or taken in with the air we breathe, 
 or the water we drink 3 but also containing some diseases 
 not due to this cause. This group then lacks the unity of 
 cause which belongs to the other two ^ and looks rather to 
 practical utility than to scientific exactness. 
 
 Of the 80 deaths remaining after subtracting such as 
 D 2
 
 36 Epidemics, 
 
 happen through violence, from old age, or in infancy, 
 55 may be arranged in three large groups, of which 
 one acknowledges as its cause structural degeneracy, 
 another is singularly amenable to atmospheric influences, 
 a third is produced by poison, inserted or inhaled. But 
 the causes of death may, of course, be classified in more 
 ways than one. They may be grouped according to the 
 jores at which the deaths occur, according to the seat of the 
 disease, or according to its presumed cause. The tables 
 of the Registrar-General exhibit a good practical compro- 
 mise between the second and the third, and some of his 
 tables display the ages at death. Let me add that while 
 the first group might be enlarged by many fatal diseases 
 known to be due to a gradual degeneracy, or slow spoiling 
 of the minute textures, the second group might embrace 
 cholera, diarrhoea, and dysentery as diseases that show 
 themselves nearly as sensitive to the heats of summer, as 
 bronchitis to the cold of winter. 
 
 I must now ask your attention to the class of fatal 
 diseases with which we shall have chiefly to deal in this 
 course — I mean Epidemics. 
 
 Now what do we mean by an Epidemic ? Not a disease 
 that kills a great number of people 3 for consumption does 
 that, and yet is never called an epidemic. We always 
 mean a disease that prevails extensively and yet exception- 
 ally. If, for instance, in the winter, a few persons have 
 common colds, we call their complaint a catarrh ; but if 
 our households, most of our neighbours, and almost every- 
 body we meet or talk about have colds, we say they are 
 the subjects of an epidemic catarrh, or influenza. If ague, 
 after being long a stranger, runs through a village, as I 
 have seen it do in Cambridgeshire, seizing one or more 
 persons in almost every cottage, we call that too an epi- 
 demic, though it is common to speak of ague as an en- 
 demic, restricted to some district in which it attacks most
 
 Exotic. Lidio-cnoiis, and N^aturalizcd. 
 
 J I 
 
 of the inhabitants sooner or later, some one year, some 
 another. Again, if one person in a village or town, or 
 town district, has the cholera, and soon after another and 
 another, and if, day by day, attacks multiply till at length 
 people become alarmed, they speak of this too as an epi- 
 demic. It \^ Epidemic Cholera. Bronchitis, in very cold, 
 or diarrhoea in very hot, weather, might also become so 
 prevalent as to be rightly called an epidemic. 
 
 All prevalent diseases, then, are not epidemics, nor all 
 epidemics of the same class. The prevalence must be ex- 
 ceptional. Some epidemics, like the influenza and the 
 attack of ague of which I spoke just now, are borne on 
 the wings of the wind. They make a quick, sharp on- 
 slaught, and pass on. But others make their attack quite 
 differently. First we hear of a single casej then, perhaps, 
 the next week of another ; then for several weeks together 
 of 2, 3, or 4 ; then, for a few weeks more, the cases 
 count by tens 5 then, after another series of weeks, by 
 hundreds, and after another by thousands 3 then the maxi- 
 mum is reached. And now the disease declines by 
 similar easy stages, the downward progress being some- 
 times slower, sometimes quicker, than the upward. This 
 may be going on for the better part of a year, as was the 
 case with the plague of the seventeenth century, and the 
 cholera of our own times. 
 
 An Epidemic, then, being a disease exceptionally preva- 
 lent, whether mild or severe, our own experience in times 
 past teaches us to recognise at least three distinct varieties 
 of it — the exotic, the indigenous, and the naturalized. To 
 the exotic variety belong such diseases as plague and 
 cholera ; to the indigenous, such as ague and scurvyj to 
 the naturalized, such as small-pox and scarlet fever. To 
 these we may add, as sometimes taking on an epidemic 
 character, bronchitis in severe winters, and English cholera 
 in hot summers. It is equally obvious that there arc two
 
 38 Contagion or Infection. 
 
 varieties of epidemic very distinct the one from the other 
 — the non-contagious that do not, and the contagious, or 
 infectious, that do spread from person to person. Ague, 
 scurvy, and influenza are of the first order j plague, small- 
 pox, and scarlet fever, of the second. 
 
 Now, I need not tell you that the medical world has 
 been divided into two hostile camps on the question of 
 the true nature of certain epidemics ; that there have 
 been contacrionists and anti-contaaionists ; the one set 
 alleging that plague, for example, is not, the other that it 
 is, a contagious malady. Or the battle has raged over 
 typhus fever with equal confidence of assertion. And 
 this conflict of opinion will not surprise us if we call to 
 mind the curious fact that Italian physicians look on con- 
 sumption as a contagious disease 3 or have regard to the 
 prejudices and preconceived opinions with which English- 
 men especially must approach this question. To a great 
 mercantile nation like ours, the doctrine of contagion 
 leads straight on to the troublesome restrictions of quaran- 
 tine, and this consideration has certainly blunted the per- 
 ceptive faculties of some. All, again, who are deeply 
 interested in sanitary reform, are apt to imbibe an un- 
 conscious predilection for the doctrine that all diseases 
 which prevail epidemically, are the oftspring of fllth and 
 overcrowding in the worst houses and districts of our 
 towns 5 and so earnest and excited do some advocates of 
 this doctrine become, that they deny the very existence of 
 contagion. This extreme doctrine is rejected by all the 
 best authorities, and the theory of contagion is now more 
 widely and firmly held than ever. Now I think I can 
 throw some new light on this question if I first lay down 
 certain general laws relating to epidemics, and then have 
 recourse to that numerical method which I commended 
 'u my first lecture. 
 
 Taking an epidemic to mean a disease prevailing ex-
 
 Epidemic Cholera. 39 
 
 tensively and exceptionally, it is clear that the question of 
 contagion can have no place in respect of some diseases 
 so defined. There never has been a question about bron- 
 chitis, however exceptionally prevalent it may be in 
 winter, for cold accounts for that j nor of diarrhoea in 
 the summer months, for heat will explain that. Nor has 
 this question arisen in reference to scurvy, for short sup- 
 plies of food, or errors of diet, fully account for it. The 
 •epidemics concerning which this question of contagion 
 has been raised, are such as prevail over large tracts of 
 'Country, invading first one district, or town, or village, 
 then another, passing from one nation to another, travel- 
 ling over vast continents, and crossing wide seas 5 in ex- 
 treme cases, visiting in succession every quarter of the 
 globe. Cholera and influenza, and the black death, of 
 which I am soon to speak, answer fully to this descrip- 
 tion. 
 
 Let us follow one of these epidemics, such as cholera, 
 step by step. It has its birthplace in the East, in the 
 sunderbunds of Bengal j it journeys from country to 
 country, and place to place, by preference along the great 
 lines of intercourse 5 but neither rivers nor seas stop it. 
 Sometimes it is demonstrably contagious 3 sometimes it 
 seems to be borne along in currents of air, so that it will 
 strike down the inhabitants of one side of a street, or one 
 section of a camp, and spare the other. In every spot it 
 visits, it affects the inhabitants much in the same wayj it 
 inflicts its sudden deaths, it stirs up its acute illnesses, some 
 to end in death, some in recovery. It is a poison which 
 can enter the body, either in the air we breathe, or the 
 water we drink 5 and when it has effected an entrance, 
 the body tries to rid itself of it, and the channel it chooses 
 for the purpose, is the alimentary canal j its efforts to free 
 itself being made during what seems to be the prolonged 
 .cold fit of a fever : and it is in this stage that most
 
 40 Epidemic CJwlera. 
 
 cholera-patients die. This disease, too, like others of its 
 class, is most fatal when it iirst breaks out, least fatal whei> 
 it is passing away. How it selects its victims we do not 
 know, and cannot be expected to learn. Some whom it 
 kills quickly seem in the rudest health, others who are 
 longer in dying are obviously less vigorous. Whether a 
 man is to succumb or recover, probably depends in part 
 on the strength of the dose, but in part on his having, or 
 not having, some unsound organ which will not bear the 
 congestion of the cold, or the quickened circulation of 
 the hot, stage. The intemperate man is always taken at 
 a disadvantage, and the chances of escape lessen with age. 
 Another fact must be specially noted, as common to all 
 epidemics — the poison, when it does not kill by sudden 
 shock, remains for a variable period, in some shorter, in 
 others longer, inert. The seed is sown, but takes time to- 
 germinate. The interval of real or apparent inaction is 
 known as the period of biculation. It is not easy to fix 
 the limits in these maladies. In cholera it is thought to 
 extend from three days to a week ; in typhus fever from a 
 few minutes or hours, to a few weeks or months. The 
 fact that there is this period of inaction, or incubation, 
 helps to explain some apparent anomalies. The cholera, 
 considered as a type of the class to which it belongs, has 
 one or two other characters worth noting. It has been 
 more than once preceded by the milder epidemic, in- 
 fluenza ; it has given something of its own character to 
 other diseases prevailing before, during, and after its own. 
 visitations j it has seemed to require time to develop 
 itself in the several places which it attacks, for several 
 weeks will sometimes elapse before the weekly deaths 
 exceed one or two ; and it is certainly, as a general rule, 
 fostered and promoted by overcrowding and uncleanli- 
 ness. 
 This rude sketch of cholera will apply, with little
 
 Scarlatina. 41 
 
 modification, to all diseases of the epidemic class, which 
 have been imported from abroad, and have not become- 
 naturalized among us. 
 
 Let us now look to our numerical returns, and see 
 what they teach us respecting epidemic maladies j and? 
 what light they throw on the question of contagion in the 
 cases where that question finds place. I will take our 
 annual reports first, and then our weekly ones. For the 
 annual facts 1 refer to a paper of mine published in the 
 "Statistical Journal," in i8^^, in which I reduced the 
 figures for London, during the fifteen years from 1840 to- 
 1854, to a common scale of the deaths per million in a 
 year of 2,^^ days. I will take the figures relating to the 
 second cholera epidemic first, premising that there is a 
 disease known as English cholera, but set down by the 
 Registrar-General simply as cholera, which, in the fifteen 
 years in question, never caused less than 15 deaths, and 
 in more than one non-epidemic year, upwards of 60. 
 Well! in 1847, ^^^^ deaths were ^2 j in 1848, 292 (marking 
 the beginning of an epidemic) 3 in 1849, ^^^^X ^°^^ ^^*^ 
 6209 3 and in the following year fell to 55. Again, the 
 influenza, which, in 1845, occasioned only 35 deaths, and 
 in 1846, 55, is credited with 5O2 in 1847, and 295 in 
 1848; and it fell to 56 again in the great cholera year, 
 1849. Now these figures are in harmony with the notion 
 of an imported pestilence, and with all that I have been 
 saying about cholera as a good example of a pestilence 
 imported, but not naturalized. In the first year, its victims- 
 are comparatively few 3 in the second, very numerous j 
 and the influenza, its forerunner, closely resembles it. 
 
 Let us now turn to Scarlatina, the most fatal of our 
 naturalized epidemics. In no year of the fifteen did it 
 cause less than 354 deaths 3 but in 1848, it occasioned 
 2132. To this number it rose from 643 in 1847, ^"*^ 
 from it, it fell to 943 in 1849. In 1850 the deaths were
 
 42 Is Consimiptioii Contagious f 
 
 507. The figures harmonize completely with the notion 
 of a disease always active, sometimes raging with epide- 
 mic violence. 
 
 Let us now see how the ligures stand for some one epi- 
 demic of the Plague, say for 1665. -^^^ ^^^^^ X^^'' ^^ 
 deaths were upwards of 68,000 j the year previous only 63 
 the year following, 1998 3 and the year after that, 0^^. So 
 that, just as now we have an English cholera and an im- 
 ported Asiatic epidemic cholera, in more remote times we 
 had an English disease entered on the Bills of Mortality 
 as plague, and an imported Oriental plague 3 and in both 
 cases the figures are consistent with the idea of an im- 
 ported pestilence, not naturalized among us. 
 
 Next let us take Bronchitis. In no year of the fifteen 
 did it cause fewer than 271 deatliS3 but in 1853 it 
 destroyed 2083. But, inasmuch as it occasioned 1552 
 deaths in 1852, and 1814 in 1854, it is obvious that 
 we have to do with a disease which may be rendered 
 more fatal one year than another by such a cause as a cold 
 season, but which lacks the strong numerical contrasts of 
 an imported epidemic 3 as, indeed, do our naturalized pesti- 
 lences. 
 
 And lastly, let us take the eminently fatal disease. Pul- 
 monary' Consumption. The lowest figure for the million 
 inhabitants of London in any year is 2645, ^"^ ^^ highest 
 3941 3 and the fluctuation from year to year is very slight. 
 I will give you the figures for three consecutive years : — 
 
 1849, -777 3 ^^5°» ^^45 5 ^^5^* -97°- ^^> then, any one 
 were to assert that this disease is contagious, which is tanta- 
 mount to saying that it may be epidemic, the figures I have 
 quoted would in themselves furnish an answer in the 
 negative. They are suggestive of a domestic disease in- 
 fluenced, as is bronchitis, by the seasons and weather. 
 
 Let us now look at the weekly returns for the six 
 diseases of which I have been speaking — cholera, plague.
 
 Cholera and Plague. 43 
 
 influenza, scarlatina, bronchitis, and pulmonary consump- 
 tion. As I have the figures at hand, I will take the cholera 
 epidemic of 1854. Now, for more than half a }'ear (till 
 the middle of July) no weekly entry of deaths from cholera 
 exceeded 2, and more than once, for many successive 
 weeks, no death by cholera w^as reported. But for tlie 
 week ending July i (J, there was an entry of 5 deaths 5 and 
 now the epidemic seems to have set in, for the next week 
 the deaths were 265 the next, 133 j the next to that, 399 3 
 then 644, and so the disease went on increasing week by 
 week, till in the eighth week it reached its maximum mor- 
 tality of 2050. It took thirteen weeks to fall again to 5, 
 and the next week to that the deaths were 2. It may be 
 said to have prevailed twenty- one weeks, during eight of 
 which it rose progressively, and during thirteen fell. 
 There was no fluctuation. I now take a year of the 
 plague, 1625. From the first week in January there were 
 •entries of deaths varying from i to 5, with more than one 
 blank week; then on March 14, we have the first of a 
 series of unbroken entries, 4, 8, 11, 10, 24, 25, 26,30, 45, 
 and so on, till, after twenty-two weeks, the maximum 
 -entry of 4463 is attained, and then, in seventeen weeks 
 more, the deaths have fallen to zero. The epidemic has 
 passed away. 
 
 Now, between these epidemics of cholera and plague 
 there is an unmistakable resemblance. They are evi- 
 dently diseases of the same class. The figures on the 
 <leath registers rise to an unwonted height in certain years 
 only. They harmonize with the theory of an imported 
 disease. But there is this difference. The cholera of 
 i8j4 attained its maximum in eight weeks, and subsided 
 in thirteen J while the plague took twenty-two weeks and 
 seventeen weeks to accomplish the same feats. The 
 figures for the cholera are suggestive of a disease carried 
 -chiefly in currents of air; those for the plague of one
 
 44 Bronchitis. 
 
 spreading more slowly by direct contact and exposure of 
 the healthy to the sick. 
 
 The influenza of 1847-8 had obviously more affinity 
 with cholera than with plague. Like the cholera, it 
 quickly attained its maximum, but showed a more gradual 
 decline. From October 30, 1847, "^'^^^ri one death was 
 reported, it took seven weeks to reach its climax; but 
 twenty-one weeks elapsed before the mortality fell to 
 zero. 
 
 In reference to Scarlatina, I take the figures of the year 
 1854, in which it may be said to have been epidemic, as 
 the cholera was. There was no week in the year without 
 deaths from this cause, 22 being the lowest ligure in the 
 early part, and 118 the highest towards the end, and 
 there were constant fluctuations ; so that there seemed to 
 be rather a series of short epidemics than one long one. 
 Thus the last eight weeks of the year showed the figures 
 loi, 106, 118, 90, 100, 95, 79, 82. The weekly returns 
 for the year exhibit a disease little influenced by weather, 
 naturalized, always active, sometimes epidemic. 
 
 Bronchitis, again, is a disease of a diflereut order. 1 
 will take the weekly figures for the fatal year 1853. Now 
 the first leading fact that shows itself in the weekly re- 
 turns is that the high figures belong to the beginning and 
 end of the year ; the low ones to the intermediate period 
 — the high to the winter, the low to the summer. The 
 next fact is that, whether the figures are high or lov/, they 
 are subject to a constant fluctuation, obviously connected 
 with the temperature, though not exactly dependent on it. 
 Thus, for six weeks in succession, the thermometer falls 
 from 43^ to 30°, and the death-rate rises steadily from 67 
 to 184; but now, for three other weeks, the deaths rise 
 steadily to their maximum for the year, though the tem- 
 perature rises too. It is clear, then, that we have more 
 than one cause in operation besides the temperature ; but
 
 Ancient Plagues. 45 
 
 we have not the progressive rise to a maximum and pro- 
 gressive fall of the cholera or the plague. 
 
 Lastly, the weekly entries of deaths from consumption in 
 this same year, 1853, fluctuate between 104 and 179, show- 
 ing remarkable steadiness, distinctly influenced by tem- 
 perature, but in a less degree than bronchitis. The disease 
 is evidently not imported, not contagious, nor epidemic. 
 
 I have placed these ligures before you at the risk of 
 seeming tedious, because I wish to show what assistance 
 they may be made to aftbrd in the solution of difficult 
 questions of causation. 
 
 And now I pass on without further delay to speak of 
 the epidemics which occurred in England up to the middle 
 of the fourteenth century, when the black death appeared, 
 remarking, however, by way of preface, that no age or 
 country of the world seems to have been free from severe 
 epidemic visitations^ or from those calamities which so 
 often precede, accompany, or follow them. The sacred 
 history of the Jews, for instance, contains references to 
 Ave famines and ten plagues ; and the history of Rome 
 before the Christian era, to thirty-two plagues, of which 
 four were associated with famine, two with earthquakes, 
 and one with both. The early history of Greece, too, 
 bears evidence of the frequent visitations of drought, 
 famine, flood, and earthquake, with epidemics of great 
 severity. The plague of Athens, in the year 428 e.g., was 
 one of these. Again, in the early centuries of the Chris- 
 tian era, we have notices of many plagues among all the 
 nations of which we possess any historic records , and the 
 whole Roman empire was devastated by mortal epidemics 
 in the second and third centuries, and by the Egyptian 
 plague twice about the middle of the sixth century. 
 
 Of the epidemics which visited our own country in the 
 earlier periods of our history, I observe, by way of preface, 
 that the accounts we have of them are few in number, and
 
 46 Famines and Pestilences. 
 
 that, when they become more numerous, they are mixed 
 up not merely with incredible, but with impossible tales of 
 storms, earthquakes, inundations, meteors, showers and 
 streams of blood, and armies lighting in the clouds. The 
 tirst famines that befell our ancestors are set down for 
 the years 272, 306, and 310J and the first plague for 
 430. One famine is assigned to the sixth century (^I4)j. 
 one plague (558). In the seventh century, we have notices 
 of I famine, 2 epidemics, and i coincidence of 
 drought, famine, and pestilence. In the eighth century 
 mention is made of 2 famines, i drought, and i epi- 
 demic very fatal at Chichester ; in the ninth, of a famine, 
 a pestilence, and 3 winters of extreme severit)^j and 
 in the tenth, of 3 famines, 4 severe winters, and 2 
 plagues affecting man and beast, of which one was a 
 bloody flux. From this time forth our notices become 
 much more numerous and much fuller. The first year of 
 the eleventli century is marked by a bloody flux and hot 
 burning aguej and the year 1087 by an epidemic er)'sipelas ;. 
 and we have notices of 1 1 plagues associated with famines, 
 epizootics, or both. In the twelfth centur}' 15 epidemics, 
 among which 2 of erysipelas, i of bloody flux, and i of 
 burning ague, with many famines, and several epizootics 
 are mentioned J and in the thirteenth, 12 epidemics, 8 
 epizootics, and 19 famines, the human epidemics being 
 several times associated with cattle-plagues, with famines, 
 or with both. Ague is specified as epidemic in 1236.. 
 The notices of plagues, epizootics, and famines in the first 
 half of the fourteenth century are not so numerous as in 
 the centuries preceding. We have notices of 4 epidemics 
 (i dysenteric), as many epizootics, and more famines. 
 
 And now we come to the fatal year 1348, which forms 
 the boundary line between the first and second of the 
 three epochs into which I have distributed the health- 
 history of England up to the end of the eighteenth
 
 The Black Death. 47 
 
 century. It is the year of the Black Death, or Great Mor- 
 tality. 
 
 The Black Death, though usually treated as an aggra- 
 vated outbreak of the Oriental Plague, which is, by very 
 general consent, traced to Egypt as its birthplace, has had 
 assigned to it an origin more remote. Hecker fancies he 
 tinds the source of it in China in 1333, fifteen years before 
 it showed itself in Europe ; and Anglada, in his " Etude 
 sur les Maladies eteintes," traces it by three distinct routes 
 from Black Cathay ; the northern route, by Bokhara and 
 Tartary, the Black Sea and Constantinople, having brought 
 it by the Bosphorus into the Mediterranean, and so into 
 Europe. In the interval between 1333 and 1347, China 
 was visited with drought, famines, torrents of rain, floods, 
 earthquakes, swarms of locusts, and pestilence 3 and at 
 length, in 1348, Europe began to suffer by the same visi- 
 tations. The island of Cyprus was converted into a desert 
 by a frightful earthquake, hurricane, and inundation, fol- 
 lowing the outbreak of the plague 3 and there was observed 
 what was noticed in many countries and cities afterwards 
 — a peculiarly offensive state of the air, sometimes spoken 
 of as a stinking mist, possibly due to the dead locusts 
 which had " never perhaps darkened the sun in thicker 
 swarms," and by countless unburied bodies of men and 
 beasts. On the 25th of January, of this same year 1348, 
 an unexampled earthquake lasting several days, visited 
 Greece, Italy, and the neighbouring countries, shaking- 
 down, or swallowing up, whole villages, and inflicting 
 severe injury on every large city. Others occurred from 
 time to time in all parts of the continent of Europe, and 
 in England, up to the year 1360. 
 
 The Black Death reached England in August, 1348, ap- 
 pearing first in the county of Dorset, thence spreading 
 through Devon and Somerset, to Bristol, Gloucester, Ox- 
 ford, and London 3 in fact, through the whole country.
 
 4«S Guy de C/iaicliac. 
 
 It took three months to reach London j few places are 
 believed to have escaped, and only a tenth part of 
 the inhabitants were thought to have remained alive. 
 There is no room to doubt that the symptoms of this 
 Black Death were those I shall, by-and-by, have to de- 
 scribe as belonging to the Oriental plague. All the accounts 
 that have come down to us, from the imperial author, 
 Kantakusenos, who saw the disease in Constantinople 3 from 
 Boccacio, who witnessed it at Florence ; from the scholar 
 Raymond Chalin de Vinario, and from the " brave" Guy 
 >de Chauliac, who practised at Avignon — all the accounts 
 conspire to justify Hecker's statement, that " It was an 
 •Oriental plague, marked by inflammatory boils, and 
 tumours of the glands, such as break out in no other febrile 
 disease;" to which I must add that it often proved fatal 
 on the second and third day, in the midst of profuse dis- 
 •charges of otfensive smelling blood from the lungs, such 
 discharsres as we now know to attend and characterize ofan- 
 grene of those organs. Guy de Chauliac, than whom we 
 can have no better authority, divides tlie whole epidemic 
 of seven months into two stages of two and five months, 
 respectively, of which the flrst was characterized by the 
 i)loody discharges from the lungs, the second by the charac- 
 teristic plague-tumours. I shall condense de Chauliac's 
 account, as quoted by Anglada, with the pref^ice he so well 
 •deserved. 
 
 " I speak of Guy de Chauliac, one of the glories of 
 -our school" (Montpellier), "one of the great medical 
 characters of his age. Attached to Pope Clement VI, , 
 he had himself an attack of the prevailing malady, which, 
 by a happy exception, spared his life. Slave to his noble 
 duties, he remained immovable at his post, in the midst 
 of the universal panic, while his colleagues meanly sought 
 safety in flight." This is the brave doctor's account of 
 the disease : —
 
 and the Black Death. 4^ 
 
 The mortality set in in the month of Januar}', 1348, 
 and lasted seven months. It was of two kinds : the first 
 lasted two months, with continued fever and spitting of 
 blood, and people died of it in three days 5 the second 
 lasted live months, also with continued fever, and apos- 
 thumes and carbuncles on the external parts, and chiefly 
 in the armpits and groins, and people died of it in five 
 days. The disease (especially that form of it attended by 
 spitting of blood) was so contagious that not only by 
 being with the sick, but by looking at them, one took it 
 of another 3 so that people died without servants, and 
 were buried without priests. The father did not visit his 
 son, nor the son his father. Charity was dead, and hope 
 extinguished. The disease was so fatal that it scarcely 
 left a fourth part of the people alive. Medical, treatment 
 was useless, for all the sick died, except a few at the end, 
 who escaped with ripe buboes. For preservation there 
 was nothing better than flight. Aloetic pills • letting of 
 blood 3 purification of the air by fire 3 comforting the 
 heart by theriaca, apples, and things of good odour 3 con- 
 soling the humours by bole armeniac, and resisting putre- 
 faction by acid things, were recommended as preservatives. 
 For the cure, bleeding and evacuations, electuaries and 
 cordial syrups 3 tigs and cooked onions mixed with plan- 
 tain and butter, to ripen the swellings, followed by inci- 
 sions and the usual treatment of open sores. The car- 
 buncles to be cupped, scarified, and cauterized. " And T," 
 says the good doctor, " to avoid shame, dared not absent 
 myself, but, in constant dread, preser^'ed myself as well as 
 I could by means of the remedies above described 3 but, 
 nevertheless, towards the end of the mortality, I fell into 
 a continued fever, with a swelling in the groin, and was 
 ill more than six weeks, in such great danger that all my 
 friends thought that I should die. But the swelling 
 
 E
 
 ^o Mortality. 
 
 ripening under the treatment I have described, I escaped 
 by the mercy of God." 
 
 The mortahty due to the disease cannot be exactly 
 ascertained for want of censuses and registers of death ; 
 but doubtless it was on a grand scale. We infer this 
 partly from numerical statements and partly from more 
 general accounts. Let us take them by cities, communi- 
 ties, and nations. 
 
 Aleppo lost 500 a day, Gaza 22,000 in all, and Cairo 
 15,000. Genoa lost 40,000, Parma the same number, 
 Naples 60,000, Siena ^0,000, Rome an incalculable 
 number. Venice, out of a population of 200,000, lost 
 70,000, saw 90 patrician families extinguished, and its 
 grand council of 1250 reduced to 380. In Florence, 
 100,000 perished between the months of March and July. 
 In Spain, Valencia lost 300 a day, and many districts of 
 Barcelona were depopulated. In Germany, at Vienna, 
 the deaths were 1800 in one day, and 40,000 in all. 
 At Erfurt 12,000 were interred in one cemetery. In 
 France, at Avignon, 1800 died in the first tliree 
 days, 150,000 in the city and its environs, and at the 
 very first, 6^ monks in a Carmelite monastery 5 there, too, 
 died Petrarch's Laura. Montpellier was very nearly de- 
 populated, 10 out of 12 consuls dijd, not a monk survived, 
 and few medical men. Marseilles lost in one month 
 36,000, and the bishop and his chapter all died. Nar- 
 bonne suffered a loss of 30,000, from which it never 
 recovered. Paris lost 50,000, and Saint Denis 16,000; 
 and for many days together the Hotel Dieu sent 500 
 corpses to the cemetery of the Innocents. We lost here 
 in London 100,000. 
 
 Passing from cities to nations, we find the mortality in 
 China, whence the plague is supposed to have sprung, set 
 down at thirteen millions j in Germany it was 1,244,434 j 
 Europe is supposed to have lost an aggregate of forty
 
 Consequences. 
 
 millions, and Asia and Africa (exclusive of China) 
 twenty-four millions. 
 
 If we take classes of persons, we lind the order of 
 Minorites in Italy credited with 30,000 deatlis, and the 
 iFranciscan Friars in Germany with 124,434, 
 
 We have, Hecker says, *'more exact accounts of 
 England," and he specifies Yarmouth, Norwich, Bristol, 
 Oxford, Leicester, York, and London as cities that 
 suffered *' incredible losses." In Yarmouth 7052 died, in 
 Norwich, 51,100, in London 100,000, a number in some 
 sense confirmed by the statement that, " in one burial 
 ground alone, there were interred upwards of 50,000 
 corpses, arranged in layers, in large pits." 
 
 That a truly frightful mortality did prevail over the 
 whole of Europe may be inferred from such statements as 
 these : — " Cyprus lost almost all its inhabitants 3 and .ships 
 without crows were often seen in the Mediterranean, as 
 afterwards in the North Sea, driving about, and S2)reading 
 the plague wherever they went ashore." Speaking of 
 France, Hecker says that, in many places, *' not more 
 than two out of twenty of the inhabitants were left alive," 
 and of Paris that " more than 500 a day died in the Hotel 
 Dieu, under the faithful care of the sisters of charity," to 
 -whom he ])ays a deserved tribute of praise. At Avignon, 
 we are told, that " the Pope found ir necessary to 
 consecrate the Rhone, that bodies might be thrown into 
 the river without delay, as the church-yards would no 
 longer hold them." Such was the fearful loss of life 
 which entitled this pestilence to the name of the Great 
 Mortality. 
 
 Here in England the pestilence had consequences worth 
 noting. It found us with " a superabundance of all the 
 necessaries of life," but it was followed by a " fatal murrain 
 ■among the cattle," and this, with the lack of labourers to 
 gather what was a plentiful harvest from the fields, led to 
 
 E 2
 
 Antecedents. 
 
 a great rise in the price of food. Hecker's history, as it 
 relates to England, ends thus : — " For a whole year, until 
 it terminated in August, 1349, ^^ Black Death prevailed 
 in this beautiful island, and everywhere poisoned the 
 springs of comfort and prosperity." 
 
 But here, as throughout Europe, the pestilence had also 
 antecedents worth noting. The times were very barbarous. 
 Kings were in constant conflict with powerful subjects, or 
 engaged in external wars 3 cities were fortresses j the 
 roads were beset with marauders 3 the husbandman was a 
 serf 3 human life was of little account 3 witches and 
 heretics were burned alive, and the Jews subject to cruel 
 tortures 3 " wild passions, severity and cruelty, ever}'where 
 predominated3" and (what is more to our present purpose) 
 the cities were " with few exceptions, narrowly built, 
 kept in a tilthy state, and surrounded with stagnant 
 ditches." These conditions, even in those early times, 
 Mere recognised as favourable to the spread of pestilence, 
 as were personal uncleanliness and intemperate habits. 
 
 The cities in tliose days were so built as to be eminently 
 favourable to that overcrowding now so universally recog- 
 nised as a most efficient cause of disease. Armies also,, 
 which are crowds in the worst form, were in constant 
 motion. We had a deadly feud with France, and Calais, 
 surrendered to Edward III. in 1347 5 ^"^ ^'^ \\2i\'Q an 
 excellent illustration of the mischievous agency of armies- 
 in spreading contagious maladies in the fate that befel the 
 Scots. They are stated to have been free from the pesti- 
 lence till they made an irruption into our territory. This 
 issued in the destruction of their army by the sword and 
 the plague together, *' and the extension of the pestilence 
 through tliose who escaped, over the whole country." 
 On the continent of Europe, the crowds that followed 
 the processions of tne Flagellants certainly promoted the 
 spread of the Plague.
 
 Prcvcniive Measures. 53 
 
 Of the treatment of the Black Death I have nothing 
 interesting or instructive to tell you. But something may 
 be said with advantage of preventive measures. Hecker 
 tells us that the first public measures of defence against 
 the Plague were adopted within a few years after the 
 passing away of the Black Death ; and he cites as the first 
 sanitary code certain regulations of Viscount Bernabo, 
 dated 17th January, 1374. " Every plague-patient was to 
 be taken out of the city into the fields, there to die or to 
 recover. Those who attended upon the plague-patient 
 were to remain apart for ten days." " The priests were 
 to examine the diseased, and point out to special commis- 
 sioners the persons infected, under punishment of the con- 
 fiscation of their goods, and of being burned alive. Who- 
 ever imported the plague, the State condemned his goods 
 to confiscation. Finally, none except those who were ap- 
 pointed for that purpose, were to attend plague-patients, 
 ■under penalty of death and confiscation." 
 
 Viscount John, the successor of Bernabo, in the year 
 1399, when the P^^g^^e broke out in Italy for the sixteenth 
 time (to say nothing of frequent visitations of measles and 
 small-pox), enforced measures which would do no dis- 
 credit to a sound sanitary reformer of our own time. He 
 " ordered that no stranger should be admitted from infected 
 places, and that the city gates should be strictly guarded. 
 •Infected houses were to be ventilated for at least eight or 
 ten days, and purified from noxious vapours by fires, and 
 by fumigations with balsamic and aromatic substances. 
 Straw, rags, and the like were to be burned 3 and the bed- 
 steads which had been used, set out for four days in the 
 Tain or the sunshine, so that, by means of the one or other, 
 the morbific vapour might be destroyed. No one was to 
 venture to make use of clothes or beds out of infected 
 dwellings, unless they had been washed and dried either 
 at the fire or in the sun. People were, likewise, to avoid.
 
 54 Lazarettos and Ouaraiitiiic. 
 
 as long as possible, occupying houses which had beeir 
 frequented by plague-patients." 
 
 These regulations go far to show what was then 
 thought by learned physicians of the nature of the disease ; 
 and I cannot do better than quote Hecker's summary of 
 the prevailing notions and views : — That the pestilence, 
 OY epidemic constitution, is the parent of various kinds of 
 disease 7 that the plague sometimes, but not always, 
 originates from it ; that in modern language the penti/ence 
 bears the same relation to contagion that a predisposing 
 does to an occasional cause, and that the conviction of the 
 contagious power of the disease was universal. 
 
 This persuasion of the contagious character of the Plague 
 bore fruit in later times in Italy. In 1485, a special 
 council of health was appointed in Milan, and lazarettos- 
 were established on islands at some distance from the city. 
 Somewhat later (in 1504) this council had conferred upon 
 it the power of life and death 3 and later still (in 1527)' 
 bills of health were introduced. The lazarettos on the 
 islands were for the detention of strangers coming from 
 suspected places. But when the plague appeared in the 
 city itself, the sick with their families were sent to the 
 *'old lazaretto," where they w^ere furnished with provi- 
 sions and medicines j and when cured were despatched 
 to another island lazaretto, where they, and all who had 
 intercourse with them, were detained 40 daysj hence the 
 word quarantine. 
 
 I have some obser\-ations to make on the moral, 
 religious, and political consequences of this great mortality j 
 but these I reserve for the beginning of my next lecture, 
 in connexion with the subject of mental epidemics of 
 which the most remarkable outbreak signalized the epoch 
 of the Black Death.
 
 55 
 
 LECTURE III. 
 
 THE SWEATING SICKNESS. 
 
 Ix my last lecture I described the Black Death of the four- 
 teenth century in its physical aspects, with its antecedents 
 and accompaniments of terrestrial and atmospheric distur- 
 bances, the barbarous and unsettled life of the people, and 
 the filthy and unwholesome state of the great centres of po- 
 pulation. I have now to treat of what I may call its mental 
 aspects ', and this I shall do under the distinct heads of moral, 
 religious, and political. This done, I shall notice briefly 
 those strange outbreaks of nervous disorder which in a 
 remarkable degree characterized the epoch of the Black 
 Death, though they were by no means peculiar to it, I 
 shall then say a few words about the Black Death as it 
 affected us in England, and pass on to the sweating sick- 
 ness. Of the mental effects of the Black Death, it has been 
 said that it gave to all nations a shock '' without parallel, 
 and beyond description." 
 
 Its effects on morals, by which I mean the actions 
 prompted by the natural emotions and passions of man- 
 kind, other than those that flow from religion, must have 
 been of a mixed character. The kind and generous, always 
 a small minority, were doubtless moved to acts of heroic 
 self-sacrifice ; but the indifferent and selfish (a far more 
 numerous class) were guilty of acts of base desertion ; the 
 harsh and unfeeling grew cruel j the criminal class found 
 rare opportunities for the indulgence of their predatory 
 habits ; and those addicted to the worst forms of dissipa-
 
 5^ Religions and Political Co)iscqncnccs. 
 
 tion sinned under the pretence that the natural result of 
 
 their vicious practices would prove a safeguard against the 
 more fatal infection of the plague. AVe read therefore, 
 without surprise, that "parents abandoned their infected 
 children, and all the ties of kindred were dissolved;" 
 that " morals . were deteriorated everywhere;" that at 
 Florence, as elsewhere, " the influence and authority of 
 every law, human and divine, vanished ;" that, in a word, 
 selfishness assumed such gross forms that it became a 
 common practice " to barricade the doors and windows of 
 houses infected with the plague, and to suffer the inhabi- 
 tants to perish without mercy." 
 
 The religious efl:ect of the black death in those super- 
 stitious ages was to intensify every prejudice and heighten 
 every dislike. The Jews were accused of poisoning the 
 wells and streams, and were burnt, banished, or forcibly 
 baptized by thousands and tens of thousands ; or driven to 
 wholesale acts of suicide : while the processions of the 
 Flagellants exhibited a ghastly spectacle of nervous dis- 
 order, debasing superstition, and vicious self-indulgence. 
 These scenes of cruelty and horror were not, however, 
 quite unrelieved. History records acts of devotion on the 
 part of some of the monastic orders ; and we read of the 
 sisters of mercy in the Hotel Dieu dying at their posts, 
 their places at once filled up by willing and devoted 
 women, " strangers to the unchristian fear of death :" so 
 that even to the dark religious aspects of the pestilence 
 there was a silver side. 
 
 The political consequences of the black death are be- 
 lieved to have been very important. Hecker traces to it 
 an immense accession of wealth to the clergy, and Leek}- 
 a sudden taste for luxurious living among all classes. It 
 certainly raised the wages of labour everywhere, and added 
 weight and importance to the working class. As a class 
 it suflfered frightfully ; as a class it obtained this compensa-
 
 Pi'occssiojis of the Flagellants. .57 
 
 tion. In my first lecture I quoted other passages in proof 
 of the profound social and political consequences which 
 the pestilence produced. 
 
 When speaking of the religious effects of the black 
 death I might have noticed with propriety the proceedings 
 of the Brotherhood of the Flagellants, Brethren of the 
 Cross, or Cross Bearers, which took its rise in 1349, when 
 200 of them made their appearance at Strasburg, were 
 joyfully received and hospitably lodged 3 soon grew to a 
 multitude j spread themselves over Germany, Hungary, 
 Poland, Bohemia, Silesia, and Flanders j and moved from 
 place to place, inflicting on themselves their strange 
 penances. How the movement, at first superstitious, 
 degenerated into a mixed mob of ignorant and mischievous 
 fanatics opposed to the Church and hostile to the State j 
 how the Pope put a stop to the pilgrimages by threats of 
 excommunication 5 how kings resisted them j and how, at 
 last, they became objects of bitter persecution, you will 
 find set forth in the pages of Hecker, which also contain 
 learned notices of similar processions of Flagellants in the 
 eleventh, thirteenth, and earlier part of the fourteenth 
 centuries. I may also refer you to Hecker's work for a 
 very complete account of the Dancing Mania, which, 
 beginning in the thirteenth century, showed itself at in- 
 tervals in the fourteenth and fifteenth centuries. Dr. 
 Babington's translation is enriched by interesting notices of 
 similar convulsive diseases occurring in later times in Scot- 
 land. 
 
 The processions of the Flagellants form part of the sani- 
 tary history of the Continent, and especially of Germany, 
 where they took their rise. I shall not, therefore, consider 
 them as belonging to my subject, or discuss, as I am 
 tempted to do, the interesting question whether these 
 manifestations of a disordered mind and nervous system 
 may be directly attributed to the same atmospheric con-
 
 Poisoned Water. 
 
 ditions that so fatally affected the body, but shall resume 
 the subject of the Black Death as it relates to England. 
 
 The accounts of the disease in England are in harmony 
 with those which have come to us from Italy and other 
 parts of the Continent. 'vVe read of the same atmo- 
 spheric disturbances, with the addition that its advent was 
 preceded by great floods. " It rained from Christmas to 
 Midsummer, without one fair day 3" and when it left us 
 " there followed a great dearth of cattle j after that a 
 dearth and scarcity of corn." We read of 5000 cattle 
 dying in one pasture, of beasts and sheep going wild 
 through fields and ''corns," and dying in holes, furrows, 
 and ditches, in innumerable multitudes over the whole 
 kingdom, for want of keepers j of the scarcity and inso- 
 lence of servants, and consequently, the next harvest, 
 of corn rotting in the fields for want of hands. Short, 
 from whose compilation I take these particulars, fixes 
 the date of the arrival of the pestilence on the coast of 
 Dorsetshire as September 28, 1347. -^^ ^^7-^ ^^^^ '^ 
 reached Scotland and Ireland in '50 or '51, and that it did 
 not finish its "perambulation over the world" before 
 '60 or '62. He tells us that " if it was so favourable as to 
 leave a third part of men alive in some few places, in 
 others it took 15 out of 16 j" and that " in more it utterly 
 extirpated the human race." He gives the deaths for 
 Yarmouth at 7052 j for Norwich in six months, at 
 57,000 5 for London during three months, at 2000 a week. 
 " It is said at a medium, to have killed 9 out of every 10." 
 In England, as elsewhere, the Jews were accused of 
 poisoning the springs 5 and this accusation Short traces 
 to the fact that the water was pestilential even to the fishes. 
 Of this wide-spread belief in the poisoning of wells and 
 springs of water, not in the time of the Black Death only, 
 but during all great epidemics, I may obser\'e once for all, 
 that recent discoveries have rendered it highly probable-
 
 Bad Hoiis'uig- and Gross Feeding. 59 
 
 that the people were not always mistaken as to the fact 
 of the poisoning, but only as to its nature and the persons 
 who caused it. In those remote times, the state of the 
 places in which men lived, and their habits of life, 
 rendered the pollution of drinking waters by human 
 excreta inevitable, and so secured the rapid spread of any 
 contagious disease that happened to prevail. 
 
 One curious ^statement, which is made by the same 
 author, without any direct reference to his authority for 
 it, is to the effect that "Tanners, curriers, such as cleansed 
 bog-houses, servants in hospitals, and others employed in 
 other nasty stinking businesses, all escaped infection." 
 
 Of course^ in those remote times, there must have 
 been the strangest misconceptions, the grossest exaggera- 
 tions, the roughest guesses at truth 3 but in the midst of 
 much that is false in degree if not in essence, there stands 
 out in bold relief the great central fact, that in the middle 
 of the fourteenth century, a pestilence not surpassed by 
 any recorded in history, for the ground it covered^ or the 
 destruction of life it occasioned, came to us from the East: 
 that it had the characters of the bubo plague with spitting 
 of blood superadded j that it attacked a large proportion 
 of the population, and destroyed an equally large propor- 
 tion of those whom it seized j that it disorganized society, 
 inaugurated a reign of terror, gave free scope to ever)' 
 vile passion and unworthy prejudice, and if it in any degree 
 promoted religion and stirred up repentance and amend- 
 ment of life, it was at the cost of a speedy and lamentable 
 reaction. The dwellings and personal habits of the 
 English people in town and country were such as to 
 encourage to the utmost the pestilences we bred or im- 
 ported. Judging from the descriptions of foreigners 
 we were characterized by bad housing and gross feeding. 
 The state of things is not likely to have been better in 
 any respect, it was probably worse in all, than when in
 
 •^o Encrland in the Olden Time. 
 
 'the sixteenth century the Dutch scholar Erasmus wrote 
 the letter which I am to quote when I treat of the Sweat- 
 ing Sickness. Nor, on the other hand, was it likely to 
 have been very different from the account given us by the 
 •old chroniclers, Holinshed, Stow, Baker, and Martin. 
 After careful perusal of the extracts which I have made 
 from their works, and reference to Pearson, Rogers, and 
 <ithers who have written about the Middle Ages and the 
 twelfth and subsequent centuries in particular, I imagine 
 the people to have lived somewhat after this fashion : — 
 Their houses, and most of their buildings of every kind, 
 were of timber, the houses " slightly set up with a few 
 posts and many radels," " cast all over with thick clay to 
 keep out the wind," with sundry rooms above and beneath 
 ■"' covered with straw, sedge, or reed, and rarely \\ ith tiles 
 or slate," and with floors of mud. In the country parts, 
 houses, stables, and oflices were under one roof. The 
 lires were lighted against a rere-dos, and the smoke 
 <?scaped as best it could, without the help of chimneys, 
 for these, though introduced in the twelfth centur}% were 
 but slowly acclimatized. The people lay on straw pallets 
 or rough mats, with a log for a pillow ; and the man who 
 contrived to buy a flock bed, and a sack of chaft' for his 
 head to rest upon " thought himself as well lodged as the 
 lord of the town." Servants were lucky if they had a 
 ^heet above them : they had none beneath. The sheep's 
 skin was in common use as clothing. The poor, wanting 
 water, built at the river's edge. The Spaniards, in Queen 
 !Man,''s day, wondered " when they saw what large diet 
 was used in many of these so homely cottages," and one 
 of no small reputation among them is credited with tlie 
 not very complimentary remark that, '' The English have 
 their houses made of sticks and dirt, but they fare com- 
 monly so well as the king." The poor are believed to 
 have lived well, in good years, on barley or oaten bread.
 
 London ill the Tivelfth Centtiry. 6i 
 
 beer and pork ; but to have been subject to famines fre- 
 quent and terrible. There was an abundant supply offish^ 
 both from sea and river. Pearson tells us that " the 
 vineyards the Romans had planted survived Saxon and 
 Danej" that " Gloucestershire was famous for them, and 
 Smithfield was once ruddy with grapes. But gardens 
 were of slow growth, and comparatively few fruits and 
 vegetables had been naturalized." It is likely, therefore, 
 that many of the people living of necessity, or through 
 ignorance, on a diet from which the vegetable element 
 was excluded, suffered the more severely in times of pesti- 
 lence. And thus it happened, that " poisoned by marsh 
 exhalations, wasted by ague and skin diseases, huddled 
 together in cabins, smoke dried, gross eaters and un- 
 cleanly livers," the peasants suffered terribly during ever^ 
 epidemic visitation. Within our walled and fortiiied 
 towns, the state of things was not likely to be much better. 
 Thus I glean from a passage in Stow's Chronicles that 
 even capital cities were unpaved till towards the end of 
 the twelfth century. "This year, 1246," he says, '* the 
 city of Lubeck was destroyed and consumed by fire," " and 
 from that time it was ordered that they should not cover 
 their houses any more with thatch or straw, but with tiles or 
 such like :" the very same common danger caused London 
 to tile all its houses shortly after, especially such as stood 
 close together in a high street. '* Neither were there 
 then but few streets in London paved, nor in 200 year;> 
 after this, except Thames Street, and from Ludgate to 
 Charing Cross, neither was the great City of Paris paved until 
 the year 1186." London, therefore, in the middle of the 
 fourteenth century was almost wholly unpaved. In the 
 middle of the twelfth century, if we may credit the monk, 
 William Fitzstephen, who died in 1191, London consisted 
 of two long narrow tracts of land, separated by the 
 Thames, which then abounded in fish. It was surrounded
 
 6z London ill the Tzuclftli Century. 
 
 with hisli ^valls, strenoftbened with towers and double 
 inites, with a " tower palatine " on the east, and two castles 
 on the west, and the king's palace in the same quarter on 
 the river, with its walls and bulwarks, separated by two 
 miles from the city. The suburbs were studded with the 
 houses of the citizens, with their gardens and orchards. 
 On the north, there were pastures, and meadows, and 
 plentiful corn lields ; and near at hand was a large forest, 
 with wild beasts, bucks and does, boars and bulls. Here, 
 too, were flowing waters, and busy water-wheels and foun- 
 tains, sweet, wholesome, and clear, welling forth among 
 the glistening pebbles. There was Holywell, and Clerken- 
 well, and St. Clement's well, the resorts of scholars and 
 youths on summer evenings. Without one of the gates 
 was a certain Smoothfield (now Smithfield), where horses 
 were sold. In the city there were common sewers, and 
 conveyances for water in the streets. For amusements 
 there were miracle-plays, land-fights and water-lights, 
 leaping, shooting, wrestling, ball and stone-throwing, 
 casting the javeline, cock-fighting and baiting of boars, 
 bulls, and bears. The city mustered the improbable 
 number of 80,000 armed men (20,000 horse and 60,000 
 foot). Its citizens were distinguished "for their civil 
 demeanour, tlieir good apparel, their table, and their dis- 
 course," and its matrons might compare with the Sabine 
 women. There was abundance of provisions and good 
 cooking, and " the only plagues of London are, immo- 
 derate drinking of idle fellows, and often fires." Two 
 centuries later this pleasant city was still unpaved, and 
 even two centuries after that very filthy and unsavoury 
 in-doors and out. 
 
 Between the epoch of the Black Death and that of our 
 next great Pestilence — the sweating sickness — in other 
 words from 1347 to J 485, a period of nearly 140 years, 
 England suffered something like a score of epidemics.
 
 The Sweating Sickness, 6 3 
 
 with their accompaniments of famine and cattle plague. 
 Among these I note one of influenza, one of small-pox^ 
 one of puerperal fever, two of bloody flux, and two of 
 epidemic madness ! I must not stop to comment upon 
 these, tempting as some of them are : but in reference to 
 the last, I may raise the question whether the narrative 
 given at page 12 of my first lecture does not justify the 
 belief that the physical causes which usually give rise to 
 bodily disease sometimes act directly on the mind. 
 
 The Sweating Sickness, Pestilent Sweat, or English 
 Ephemera (for by all these expressive names docs Dr. 
 John Caius call it)^ has a special interest attaching to it, 
 and, considering the remoteness of the period, our infor- 
 mation about it is satisfactory and tolerably complete. 
 It occurred once at the end of the fifteenth century, anil 
 no less than four times during the first half of the six- 
 teenth, or five times in all. Now the Oriental plague 
 attacked London and England five times, once in 1593, 
 and four times in the first 6^ years of the seventeenth 
 century. Of the Plague, then, there were 5 epidemics in 
 72 years 3 of the sweating sickness, 5 in 66 years. But 
 with this coincidence all analogy ceases. The 5 outbreaks 
 of plague were not the only ones ; but the sweating sick- 
 ness does not seem to have occurred in England before or 
 since 5 certainly not as a highly mortal pestilence. 
 
 This sweating sickness of the sixteenth century w.is 
 quite a different disease from the black death of the 
 fourteenth, and the Oriental plague of the seventeenth, 
 between which it was, so to speak, interposed. It did 
 not originate in a foreign country, thence to be conveyed 
 by sea, after attacking other countries and cities, to this ; 
 but it sprang into existence within our own limits (here 
 in England), did not extend to Scotland or Ireland j and 
 when it showed itself abroad, is alleged (with very rare 
 exceptions) to have attacked only our own people. Nor
 
 64 Dr. yoJin Cains. 
 
 was it a contagious disease, in the sense in which the 
 plague was contagious ; it did not develope any distinct 
 cutaneous rash, no blains, boils, or carbuncles, no blood- 
 spots, or large haemorrhages under the skin ; its victims 
 were not indifferently men, women, and children, as were 
 those of the Plague^ but mainly robust men in the prime 
 of life ; its onset, unlike that of the Plague, was, witli 
 the rarest exceptions, sharp and quick, and the mortal 
 struggle which lasted for many days in most cases of 
 Plague, was mostly an affair of less than four-and-twenty 
 hours. Then, again, while the Plague consumed two or 
 three years, and never, I believe, less than one, in its 
 progress through the country which it attacked, and spent 
 the greater part of a year, at least, in any great city which 
 it assaulted, this sweating sickness would do its work of 
 destruction, and sweep over a nation in some five months 
 at the outside, and enter and quit a great city like London 
 in as short a space of time as three weeks. 
 
 The sweating sickness was not limited to England. It 
 appeared in 1529 in Germany, Holland, Denmark, Swe- 
 den, and Norway. But as tlie sickness of 1528 passed 
 away (according to Caius) in July, and did not show 
 itself in Germany till tlie same month of the year follo\^- 
 ing, it is obvious that, on the Continent, it was due to the 
 same atmospheric causes and personal habits as here in 
 England : not to contagion. 
 
 In giving you an account of this disease, I shall follow 
 the course which I shall adopt in tlie case of the Plague, 
 and which I prefer wherever I find it practicable. I shall 
 deal with Dr. Caius as with Dr. Hodges j and having 
 extracted from his *' Boke, or Counseill against the Disease 
 commonly called the Sweate or Sweatyng Sicknesse," 
 all the good metal it contains, turn to Hecker's and 
 Anglada's account of the disease as it occurred on the 
 Continent, for supplementary information.
 
 Lord Bacon. 6^ 
 
 But as Lord Bacon, in his " History of Henry VII.," 
 gives a very clear account of the first attack, in 1485, I 
 will make a short abstract of it as a preface to the whole 
 subject. Toward the end of September there began and 
 reigned in the city, and other parts of the kingdom, a 
 disease then new — this sweating sickness. It had a swift 
 course, both in the persons attacked and the time it lasted ; 
 for after 24 hours, patients were deemed nearly safej and 
 it began September 21st, to end before the month of 
 October was over. It was a pestilent fever, but not fol- 
 lowed by carbuncle, or by purple or livid spots, and it 
 terminated by an extreme sweat. It was "rather a sur- 
 prise of nature than obstinate to remedies," for if it was 
 treated as we should now nurse a common cold, people 
 commonly recovered. But infinite persons died suddenly 
 of it, before the manner of the cure and attendance was 
 known. It was conceived not to be an epidemic disease, 
 but to proceed from " a malignity in the constitution of 
 the air, gathered by the predispositions of seasons j and 
 the speedy cessation declared as much." 
 
 The sweating sickness showed itself for the first time in 
 the year 1485, soon after August 7th, when Henry VII. 
 arrived at Milford Haven from France ; and it continued 
 during the remainder of the month, and through all 
 September. Caius gives us a vivid notion of its severity, 
 when he says of those whom it attacked that it fearfully 
 invaded them, furiously handled them, speedily oppressed 
 them, unmercifully choked them ; and that in no small 
 numbers, many of them being persons of rank and mark. 
 It immediately killed some in opening their windows, 
 some in playing with children in street-doors, some in on*.* 
 hour, many in two, and, at the longest, ** to them that 
 merrily dined, it gave a sorrowful supper." " As it found 
 them, so it took them," some sleeping, some waking, 
 some in mirth, some in care, some fasting, some full, 
 
 F
 
 66 Nature of the Disease. 
 
 some busy, some idle, and in one house, three, five, seven, 
 eight, or more, or all. So that if the half in any town 
 escaped, it was thought great favour. 
 
 This is the account which Caius gives of the disease at 
 its first appearance in 1485. He then gives us the dates 
 and brief particulars of the other attacks. The second 
 was in 1506, the third in 151 7, the fourth in 1528, the 
 fifth in 1 55 1. It is this last which doubtless supplied him 
 with the best materials for his book published in 1552. 
 
 In this, its fifth visit, it showed itself successively at 
 Shrewsbury, in the middle of April, at Ludlow and other 
 places in Wales, at Coventry and other towns in the 
 south, and at places in and about the way to London. It 
 reached London July 7th, and from the 9th to the i6th, 
 killed 761 persons, and from the i6th to the 30th, 143 
 more ; making in all, 904 deaths, exclusive of deaths not 
 registered on the 7th and 8tli. From London the sick- 
 ness passed on to the East, and then to the North, of 
 England, where it raged till the end of August, when it 
 abated, and at the end of September ceased. 
 
 The disease was a fever, followed by a sweat. It set in 
 with pains in the back or shoulder, and in the limbs -, 
 w ith flushes, oppression at the liver and stomach, pain in 
 the head, delirium, and palpitation, followed by a man^el- 
 lous heaviness and desire for sleep. Then (but this is not 
 very distinctly stated) occurred the profuse offensive 
 sweats, from which tlie disease derives its name. I infer 
 from the treatment being directed mainly to two points — 
 the promotion of perspiration, and the prevention of sleep 
 — that the natural cure was free action of the skin, the 
 common mode of death by coma. Patients suffering 
 from this disease were very subject to relapses. They had 
 them for the third, or fourth, and even as often as the 
 twelfth time. 
 
 And now as to the cause, or causes, of tliis sweating
 
 Peculiar to the English, 6-j 
 
 sickness. We have to explain, if we can, the curicjus, 
 but apparently well-ascertained fact, that this disease was 
 limited to England and to Englishmen living abroad, in 
 four out of the live epidemics ; also that other fact, equally 
 strange, that the victims of the disease were not old men 
 or children, bu^ robust middle-aged adults, of what Caius 
 calls 'Miot and moist complexions j" wealthy men living 
 in ease and comfort, or, if of the poorer sort, " idle per- 
 sons, good ale drinkers, and tavern-haunters." ''The 
 laborious, and thin-dieted people," the respectable poor, 
 ^s we should call them, did not take the disease, or had it 
 tavourably. 
 
 "The intemperance, or excessive diet of England," 
 which was a scandal to the French, and a reproach among 
 the nations generally, was, in the judgment of our author, 
 the predisposing cause of the disease, by bringing about a 
 state of body favourable to the operation of the exciting 
 cause, whatever that might be. Nor does the fact that 
 the disease did once (in the year 1529) extend to Bra- 
 bant and parts adjacent, shake his belief j for he groups 
 together England, Holland, and Germany, as countries 
 addicted to an "evil diet," "destroying more meats and 
 drinks, without all order, convenient time, reason, or 
 necessity, than either Scotland, or all other countries under 
 the sun." So powerful and effective was this dietetic 
 predisposition, that neither absence nor flight could pre- 
 serve our countrymen ; for in Calais, Antwerp, and other 
 places in Brabant, it was only Englishmen and persons 
 using the English diet who fell sick. " This disease then, 
 is almost peculiar to us Englishmen, and not common to 
 all men, following us, as the shadow the body, in all 
 countries, albeit not at all times." For such strong and 
 reiterated statements, there must have been some founda- 
 tion of fact. Gluttony and intemperance, then, as now, 
 were powerful predisposing causes of disease. 
 F 2
 
 68 Sanitary PrecaiUions. 
 
 Among a people addicted to such excesses we should 
 scarcely expect anything approaching to effeminacy. But 
 yet, Caius accuses his contemporaries of being ''unwisely 
 fine and womanly delicate." He complains that " the old 
 manly hardness, stout courage, and painfulness of Eng- 
 land," were utterly driven away, and that, in their stead, 
 men had become effeminate, and nice, and not able to 
 withstand a blast of wind j while children, *'if they were 
 not all day by the fire with toast and butter, and in their 
 furs, they were straight sick." 
 
 Concerning the exciting cause of the disease Caius has 
 little information to give us. He sees that it must be in 
 the air, and he alludes to stinking mists seen to fly from 
 town to town, so offensive morning and evening that men 
 could scarcely abide them. 
 
 When he comes to the question of preservation, or, as 
 we should now call it, prevention, our author prescribes 
 moderation in diet, with details as to fruits and vegetables 
 which may be taken to prove that such wholesome things 
 were at that time in common use j and also measures 
 tending to insure purity of air inside and outside the dwell- 
 ing. He would make a " sweet house " by means of 
 sundry odours and perfumes, after having made it clean 
 by removing the rushes and dust, with which, as we know, 
 the floors of the best houses, and even of palaces, were 
 strewn. Juniper berries, or a mixture of myrrh, rose- 
 leaves, and frankincense, were also to be burnt on the 
 coals. 
 
 Outside the houses the air was to be improved by filling 
 up ditches, removing carrion, mending with earth muddy 
 and rotten grounds, burying the dead, keeping gutters 
 clean, and sinks and easing places sweet, removing dung- 
 hills and ill-smelling things, drying moist air with fires, 
 and so forth. 
 
 Personal cleanliness and well-washed hands and faces
 
 Medical Treatment. 69 
 
 are also commended as great aids to health, and clean 
 clothes and suitable exercises. Men should not go out in 
 the morning tasting j they should smell to scented hand- 
 kerchiefs, and take, the first thing in the morning, a little 
 mithridatum, or some other harmless and useless confec- 
 tion. Of quack medicines and charlatans from every nation 
 under the sun, of remedies so filthy that he was ashamed 
 to mention them, of the aurum poiabile, and waters the 
 products of six months' continuous distillation, costly in 
 proportion, Caius gives us examples more than enough. 
 
 The cure or remedy for the sweating sickness consisted 
 in a four-and-twenty hours' rest, the patients being all the 
 time guaranteed against the slightest exposure of the body 
 or any part of it to the air, and the sweat being rather en- 
 couraged than forced. They were to have no food for 
 twenty-four hours, and no drink for five; and special care 
 was to be taken in the 4th, 7th, 9th, nth, and 14th 
 hours. Clarified ale, with a little sugar, might be 
 given the 5tli hour, and sweating, if not sufificient, was 
 to be encouraged by frictions and warm drinks. For de- 
 lirium he prescribed rose water and vinegar to the nose; 
 and if the patient slept or fainted he was to be beaten, 
 scolded, and pulled by the ears, nose, or hair. He was 
 .not to be allowed to sleep till he had no desire to do so : 
 this rule to be broken only under the advice of a learned 
 man in physic. This strange treatment we shall see was 
 adopted by Hodges in the Plague. 
 
 I have not, I believe, omitted anything interesting or 
 important from this book of Dr. Caius. You have before 
 you a rude and imperfect sketch of a disease wholly unlike 
 the Oriental Plague, and yet having all the attributes of a 
 great epidemic. Bred in England, nursed by English 
 habits and modes of life, largely prevailing among the 
 .adult population, and destroying many of those whom it 
 .attacked in an incredibly short space of time, making but
 
 The Diet of the English. 
 
 a short stay in any one place ; such is the sweating sick- 
 ness of the sixteenth century. Caius's account I have 
 said is imperfect 3 but Hecker is able to supply its de- 
 fects from other sources, English and German, 
 
 Among the symptoms he mentions a livid and bloated 
 countenance, great difficulty of breathing, vomiting, intense 
 thirst, convulsions, and a whining and sighing voice 5 and 
 diarrhoea in some cases after the worst symptoms had sub- 
 sided. The occasional occurrence of death before the ap- 
 pearance of the characteristic sweat, as sometimes happens 
 in plague and cholera, is also noted j and we are told too 
 that convalescent patients remained very feeble for a week 
 or so, and that few stirred out till the second or third 
 day. 
 
 Of the antecedents and causes of the disease Hecker 
 gives an abundance of details. We learn that the first,, 
 third, fourth, and fifth attacks were all very severe ; the 
 second exceptionally mild 3 that the first, fourth, and 
 fifth were preceded by great inundations, and the fourth 
 attended with great scarcity of provisions ; that as the 
 first outbreak of 1485 was traceable to the army of free- 
 booters and mercenaries who fought at Bosworth, so the 
 third of 1517 took place in London, crowded with foreign 
 artisans from every country in Europe ; while the fourth 
 of 1528 coincided in point of time with the great military 
 operations of Francis L, and his allies in Italy and before 
 Naples. Nor were there wanting in these epidemics, and 
 especially in the last of them, atmospheric disturbances, and 
 unusual developments of the lowest forms of life. There 
 were floods and storms 3 and in Germany mould-spots 
 reappeared on clothes, and red discolorations of water. 
 
 Among the predisposing causes, in other words, the con- 
 ditions that had prepared the bodies of men to receive this 
 peculiar infection from the air, tlie diet and mode of life 
 of the robust adult population of England receive, at the
 
 Letters of Erasmus. 
 
 hands of Hecker, as of Caius, due attention. J will follow 
 their example, and will Xxy to represent to you the English 
 as they then lived. I will first read an abstract of the 
 often quoted letter of Erasmus to the physician of Cardi- 
 nal Wolsey. He grieves and wonders that Britain had for 
 so many years been afflicted with a continual plague, and 
 chiefly with the sweating-sickness^ a malady that seemed 
 almost peculiar to it ; and he thinks that it might be freed 
 from the disease by reforming its buildings. He finds 
 fault with the aspects of the houses, and the construction 
 of the sitting-rooms, in which great parts of the walls were 
 filled with plates of glass that admitted hght but excluded 
 air. He tells us that the streets were generally co- 
 vered with clay and rushes, which sometimes remained 
 undisturbed for twenty years, concealing a mass of filth not 
 fit to mention, and exhaling a vapour not wholesome for 
 the human body. This ancient collection of filth was 
 doubtless nothing less than the successive contributions 
 made by the houses themselves ) for from another letter 
 by the same hand we learn that "the floors of the houses 
 generally were made of loam strewed with rushes, con- 
 stantly put on fresh, without removing the old, lying there 
 in some cases for twenty years, concealing fish-bones, 
 broken victuals, and other filth, and impregnated with the 
 urine of dogs and men. The existence of this nauseous 
 state of things is confirmed by Caius's directions for fumi- 
 gating rooms, which were to be put in practice after the 
 removal of rushes and dust. It is easy, therefore, to credit 
 Erasmus when he says, " If, even twenty years ago, I had 
 entered into a chamber which had been uninhabited for 
 some months, I was immediately seized with a fever." 
 Erasmus then notices the fact that many parts of England 
 N\Tre marshy and intersected by salt streams, and that the 
 common people were amazingly fond of salt food. To 
 make our island and people healthy he recommended the
 
 /- 
 
 English Intemperance. 
 
 disuse of rushes, the building of chambers so as to be ex- 
 posed to the heavens on two or three sides, glass windows 
 made to open and shut, a more sparing diet, and more 
 moderate use of salt provisions, and the appointment of 
 officers to keep the roads more free from nuisances. All 
 this Erasmus writes in no carping spirit, for he loved the 
 country that had so long given him an hospitable abode ; 
 and would willingly spend the remainder of his life there. 
 But this letter of Erasmus gives us only an imperfect 
 idea of the Scythian tilth of human dwellings, and the 
 coarse, unwholesome habits of life among our ancestors 
 at the time that the sweating sickness prevailed amongst 
 them. The tributaries of the Thames were large filthy 
 streams, bearing boats, ships, and even " navies " on their 
 foul, reeking bosoms. What their condition must have 
 been at that time, we may infer from the well-known lines 
 in the Dunciad, written early in the eighteentli century : — 
 
 " To where Fleet ditch, with disemboguing streams. 
 Rolls the large tribute of dead dogs to Thames, 
 The King of Dykes ! than whom no sluice of mud. 
 With deeper sable blots the silver flood." 
 
 These tributaries of the Thames were, I should think, 
 much in the state of the water surrounding the noto- 
 rious Jacob's Island, in the middle of this nineteenth cen- 
 tury, when the same filthy stream served tlie common 
 purpose of sewer and water-supply j and so prepared its 
 wretched neighbours for the visitation of the cholera. 
 
 As to diet and clothing, we are able to collect this 
 additional information. Both high and low were ad- 
 dicted to intemperance J and this English vice passed into 
 a proverb in foreign parts, as appears from a passage in 
 Milton's Areopagitica, in which he speaks of " household 
 gluttony" as a ^Miational corruption, for which England 
 hears ill abroad." Flesh meats, highly seasoned with 
 spices, were eaten to excess, strong wine was drunk early
 
 What the Sweatijig Sickness was. 73 
 
 in the morning, and noisy nocturnal carousings were 
 customary. English cookery was wholly wanting in re- 
 finer»ent, and pot-herbs were scarce. The clothing of the 
 period was immoderately warm, and the head was covered 
 with thick caps, of which the inner one, of velvet or 
 satin, was close fitting. Hot baths also were much in 
 vogue, and diaphoretic medicines were prescribed in most 
 disorders. Soap was little used, and linen was dear. 
 
 It was by such habits and customs that our ancestors 
 prepared themselves as fitting victims of a disease charac- 
 terized by profuse sweating. We have but to suppose 
 exceptional weather, heavy falls of rain and consequent 
 inundations J a certain '^ epidemic constitution" of the air, 
 large gatherings of soldiers or civilians, and a nation of 
 gluttons and drunkards living in filthy, unventilated 
 houses in squalid, noisome streets, with their persons 
 steaming in hot and uncleanly clothing, to be prepared 
 for any conceivable amount of sickness and mortality. 
 
 And now we come to ask ourselves this question — was the 
 sweating sickness that visited us five times in the fifteenth 
 and sixteenth centuries, a disease sid generis, or was it only 
 an extreme degree of an epidemic with which in still earlier 
 and in later times, we have been familiar ? Hecker 
 discusses this question in a chapter headed, " Form of the 
 Disease j" and he arrives at the conclusion that the Eng- 
 lish sweating sickness was " a rheumatic fever in the most 
 exquisite form that has ever yet been seen in the worlciy 
 If Hecker means by this word rheumatic what we mean 
 by the word catarrhal (as I have no doubt he does) he is 
 probably right. I may add, that Mead, writing in 1722 
 of " the same kind of fever," as it occurred in 1713, when 
 it was known as the " Dunkirk Fever," from being 
 brought by our soldiers from that place, describes it as 
 beginning with a pain in the head, and going off in 
 large sweats, usually after a day's confinement.
 
 74 ^ Alodijicd Influenza. 
 
 For my own part, if I were asked to what disease 
 this sweating sickness bears the nearest resemblance, I 
 should say, either to an ague, with a short and faintly 
 marked lirst and second stage, proving fatal in its first 
 paroxysm, and, if not, running on to three, four, or 
 twelve relapses j or to a modified and specially severe 
 form of influenza, which, when it did not prove fatal, 
 left behind it for some days a state of extreme weakness. 
 
 Let us now see whether the second of tliese alterna- 
 tives, to which I incline, is borne out by the account 
 which Hecker gives us of the sweating sickness as it 
 showed itself in Germany, Holland, Denmark, Sweden, 
 and Norway in 1529. 
 
 One feature of the Influenza, by which it is distin- 
 guished from the Plague, and from all contagious epide- 
 mics, is the short sojourn it makes in the places it attacks. 
 Now we learn that the sweat continued in Hamburgh 
 only nine days, in Stettin little more than a week, in 
 Dantzig five days, in Augsburg six, in Amsterdam five. 
 Taking what we call sporadic cases into account, it was 
 an aflair, at the most, of a fortnight or three weeks. 
 
 Anotlier feature of the influenza which the sweating 
 sickness displayed is the simultaneous, or nearly simul- 
 taneous, outbreak of the disease over a wade region or cir- 
 cuit of cities. Now, the Sweating Fever broke out at the 
 same time (in the beginning of September) at Stettin,. 
 Dantzig, and other Prussian cities ; at Augsburg, far to the 
 ^lOUth on the other side of the Danube j at Cologne on the 
 Rhine J at Strasbourg, at Frankfort-on-the Maine, at Mar- 
 burg, at Gijttingen, and at Hanover. It took possession 
 of these cities " as it were by a magic stroke," " like a 
 violent conflagration, which spread in all directions," the 
 flames " rising up everywhere, as if self- ignited," and 
 while this occurred in Germany and Prussia, tlie same 
 thing was happening in Denmark, Norway, and Sweden,
 
 Other European Epidemics. 
 
 K) 
 
 perhaps also Lithuania, Poland, and Prussia. As to the 
 period during which this disease continued to attack the 
 nations of the Continent, we have reason to beheve that 
 it did not exceed three months. It then " disappeared 
 everywhere without leaving behind it any sign of its exis- 
 tence, or giving rise to the development of any other 
 disease." And it did not interfere with the "French 
 Hunger Fever," or the " Italian Petechial Fever." 
 
 If then the two characteristics of shortness of sojourn 
 and simultaneous attack may be said to belong to the 
 influenza, they certainly did belong equally to this sweat- 
 ing sickness j and I may add that the small aggregate of 
 deaths (probably not exceeding 1200, or, at the outside, 
 1500, in London during three weeks) — small when we 
 consider the violent way in which it seized many of its. 
 victims — is quite in harmony with what we know of the 
 disease in our own day. 
 
 The influenza, I may add, was one among the many 
 epidemics that have made the sixteenth century memo- 
 rable in the history of disease. ''It was," to use Hecker's 
 words, " a century of putrid malignant affections 5 a cen- 
 tury replete with grand phenomena affecting human life." 
 So that what the same author says of the English Sweat- 
 ing Sickness of 1^17 and 1551 — namely, that it "made 
 its appearance, not alone, but surrounded by a whole 
 group of epidemics, called forth by general morbific influ- 
 ences of an unknown nature," is certainly true of the 
 three other visitations, and notably so of the epidemic of 
 1528. 
 
 The principal epidemics to which allusion is thus made 
 were the Influenza 3 the Petechial Fevers of Italy, France, 
 and Hungary- the Hauptkrankheit or Encephalitis of 
 France and Germany 3 the Trousse-Galant of France 5 the 
 epidemic flux, the epidemic scurvy, and the diphtheria. 
 
 I shall ofive such a brief account of each of these as.
 
 76 The Influenza. 
 
 may sene to fill up the epidemic history of the sixteentli 
 centur}'. 
 
 Of the hijiuenxa I shall have to speak more at large on 
 a future occasion. It is fully treated of in the " Annals of 
 Influenza," edited by Dr. Theophilus Thompson for the 
 lirst Sydenham Society, by Dr. Robert Williams, in his 
 Avork on Morbid Poisons, and by Hecker, It has a special 
 interest for the reason that influenzas are usually only 
 *'fhejirst manifestations, liit sometimes also the last remains 
 of extensive epidem ics. 
 
 By a curious coincidence, there occurred in the course 
 of this sixteenth centur}', 5 notable epidemics of influenza, 
 as there were 5 of sweating sickness in the fifteenth and 
 sixteentli, and 5 of plague in the sixteenth and seventeenth. 
 The dates of the outbreaks are 1510, 1551, 1557^ 1564, 
 and 1580. But w^e have notices of the same disease as 
 ■occurring in the fifteenth centur}' — in France in 141 1 and 
 1414 J also in Ireland at a period not stated. It was in 
 T414 that the French christened this disease Co(jueluche, or 
 -the Monk's hood, from the head-gear to which it com- 
 pelled tlie people to resort. The symptoms were those of 
 a common cold — pains in the head, back, and loins 5 fever, 
 often attended with delirium; nausea and loathing of 
 food ; watering at the eyes ; hoarseness and cough ; and at 
 last disagreeable eruptions about the mouth and nostrils, 
 ■or bleeding from the nose, profuse perspiration, or diarrhoea. 
 The disease was more remarkable for the number whom 
 it attacked than for the deaths it occasioned. But it is 
 probably an exaggeration to say that it was "unattended 
 with danger." It prevailed in tliose earlier, as in these 
 later times over an immense extent of territory. The 
 Annals of hjliienxa contain notices and detailed accounts 
 of epidemics, twenty in number, from the year 15 10 to the 
 year 1837. 
 
 This is all that I deem it necessar}'- to say at present of
 
 Petechial Fever. 77 
 
 this disease, which links together in so interesting a 
 manner, the past and present of epidemic history. 
 
 Petechial Fever. — This epidemic seems to have been 
 first seen in Spain in 1490. It broke out in Granada, 
 *' where it threatened to annihilate the army of Ferdinand 
 the Catholic." But the first epidemic of which we have 
 a good description, occurred in Italy, in 1505, nearly 
 simultaneously with the second sweating sickness here in 
 England. Fracastoro, an eminent Italian physician, de- 
 scribes it as a contagious disease, less readily communi- 
 cated by the person, and by clothes, than the bubo- 
 plague, and chiefly to those in immediate attendance on 
 the sick. The early symptoms were slight and obscure. 
 There was weariness, as after great exertion, but not 
 much heat of surface. The patients lay on their backs, 
 with cerebral oppression, and blunted sensibility j and in 
 most cases muttering delirium, with bloodshot eyes, set 
 in from the fourth to the seventh day. The urine, clear 
 and copious at first, became red and turbid j the evacua- 
 tions were putrid and offensive ; the pulse was slow and 
 small ; there was little thirst, but a loaded tongue ; a 
 lethargic state in some, great restlessness in others. On 
 the fourth day, or on the seventh, red or purple spots, 
 like flea-bites, or lentils, broke out on the arms, back, 
 and breast J and on the seventh or fourteenth, and in 
 some cases later, the disease came to its height. It was 
 most fatal to children and young people, especially among 
 the higher ranks. This same fever, in a very malignant 
 form, in the year 1528, the date of our third outbreak of 
 the sweating sickness, extended throughout Italy, and 
 followed Italians abroad ; and there is reason to believe 
 that it attacked the troops of the French and their allies 
 at the disastrous siege of Naples. 
 
 And lastly, in the years succeeding the fifth outbreak 
 of the sweating sickness, in 1 551, as well as in the years
 
 Troussc-galant of France. 
 
 preceding it, this petechial fever seems to have prevailed 
 in the armies of the Continent. It is thought to have 
 attacked the imperial troops in 1547, and the Hungarians 
 in their camp near Komorn, in 1566. 
 
 This fever seems to have been much mixed up with the 
 Oriental Plague, and often confounded with it in the six- 
 teenth century 5 and under the name of " spotted fever," 
 figures in our London Bills of Mortality of the seven- 
 teentli century. It has become naturalized in England, 
 as one form of the typhus of modern times. 
 
 The Hauptkrankheit, or Brain Fever, seems to have 
 shown itself both in France and Germany — in France in 
 1482, after a two-years' scarcity j in Germany in [517. 
 The disease, as it occurred in France, was an inflamma- 
 tory fever with dehrium, and attended by such intense 
 pain in the head, that many dashed out their brains 
 against the wall, or rushed into the watery while others 
 incessantly rushing to and fro, died in the greatest agony. 
 The same disease scourged the north-west of Germany, 
 as far as the shores of the North Sea, at or about the 
 same date. We have no details by which to judge of its 
 fatahty. 
 
 The Trousse-galant of France, named from the speedy 
 death it inflicted on young and robust men, followed fast 
 upon the disasters of the French army before Naples, in 
 J 5 28 3 and was the contemporary of a long and grievous 
 famine, being carried about from place to place by the 
 starving people in search of food. These people, it is 
 haid, were so saturated with the poison of the disease, 
 that they communicated it to persons in health without 
 being themselves affected ; in this respect reminding us of 
 our own jail fever, and of the fever that followed the 
 Irish Famine. It was very inflammatory, often destroyed 
 its victims in a few hours, and left those who recovered 
 deprived of their hair and nails. The disease returned in
 
 Diplitkcria. 79 
 
 1545-6, and spread over Savoy and the greater part of 
 France. The great French surgeon, Ambrose Pare, wit- 
 nessed this second outbreak. The brain and nervous 
 system were severely attacked, and headache followed by 
 stupor, or extreme restlessness and delirium, were leading 
 symptoms. In most patients, eruptions, not exactly 
 described, but probably petechiae, showed themselves. 
 The disease often terminated on the fourth or the eleventh 
 day. Large quantities of thread-worms were discharged. 
 It was eminently contagious, and was followed soon after 
 by the true bubo-plague. It is thought to have been the 
 same disease as the Dandy Fever, which prevailed in the 
 West India Islands in 18285 and also in recent times, in 
 France. 
 
 The Epidemic Flux, which was probably dysentery, and 
 not cholera, prevailed over great part of Europe in the 
 cold summer of 1538. Scarcely a town escaped. Two 
 years before this date (July 12, 1536), Erasmus died of it. 
 We have no satisfactory account of its symptoms. 
 
 The Epidemic Sciirvi/, so generally associated with epi- 
 demic dysentery in modern times, seems to have been 
 very prevalent in the sixteenth century. It occurred in 
 Germany, Portugal, Ireland, and other countries in 1 496, 
 and in Denmark in 1536, and 1557. I shall have to 
 speak of it again when I come to the prevalent diseases 
 of the eighteenth century. 
 
 Diphtheria or Diphtherite is evidently to be counted 
 among the prevalent and fatal epidemics of the sixteenth 
 century. It broke out in Holland in January, 15 17, and 
 was, therefore, contemporary with our sweating sickness 
 of that date. It was an infectious inflammation of the throat, 
 which often destroyed life in less than twenty-four hours. 
 It set in with symptoms of cold, soon followed by inflam- 
 mation of the air-passages, and this by inflammation of 
 the lungs, with high fever. Those who ultimately
 
 8o Last Half of the Sixteenth Century. 
 
 recovered got well slowly. The disease appears to have 
 made a very sudden onslaught, and to have passed away in 
 the short space of eleven days. But it spread beyond the 
 limits of Holland, and certainly to Basle, in Switzerland, 
 where in the space of eight months, it killed 2000 people. 
 Here its symptoms appear either to have been more 
 strongly marked or better described. For we learn that 
 ^' the tongue and gullet were white, as if covered with 
 mould," and that part of the treatment consisted in re- 
 moving this "viscous white coating" every two hours, 
 and smearing the tongue and fauces with honey of 
 roses. This fatal epidemic broke out again in October, 
 1557, at Alkmaar, where it destroyed 200 people in a few 
 weeks, and laid more than 1000 people on their backs in 
 a single day. It lingered longer than on its first out- 
 break, and was certainly less severe. 
 
 The diseases which I have just passed in review as 
 being prevalent in Europe at or about the times when our 
 Sweating Sickness was afflicting us, — the Influenza, the 
 Petechial or Spotted Fever, the Brain Fever, the Trousse- 
 Galant, the Epidemic Flux and Scurvy, and Diphtheria, 
 were not the only maladies of this pestilential century. 
 Syphilis, which was certainly known in England as early 
 as the middle of the twelfth century, prevailed in the six- 
 teenth to a degree of which we have happily now no 
 experience, and cannot easily form any clear conception. 
 Small-pox, Scarlet Fever, Measles, and Erysipelas were 
 also then in existence, and often contributed their quota 
 to the frightful mortality of the period. 
 
 The last attack of Sweating Sickness in England, in 
 1551, brings us to the middle of the sixteenth century. 
 Towards the end of it we encounter the first of the five 
 epidemics of the Oriental Plague, of which we possess 
 satisfactory accounts. 
 
 The sanitary history of the last half of the centur}' is
 
 Atmospheric Disttir bailees. 8i 
 
 not without its interest. In the year 1555, for instance, 
 we are told of Febrile Diseases as being prevalent among 
 us — " hot, burning fevers," which, with other strange 
 diseases, ran into the year following, consuming " much 
 people in all parts of England," and proving fatal, 
 between the 20th of October and the end of December, 
 to "seven grave aldermen in the City of London, and 
 among them Sir John Gresham." In 1563 famine and 
 disease destroyed 20,000 people in London j 1565 is 
 marked by a succession of diseases. Small-pox, Measles, 
 and Malignant Sore Throat. In 1574 there was a pesti- 
 lence. In 1577, we have the first distinct notice of the 
 Jail Distemper, of which I shall have much to say here- 
 after, in the notorious Black Assize at Oxford. We have 
 earlier notices of it in 1414 and 1512. In 1583, there 
 was an epidemic dysentery. To pass from land to sea : in 
 1585, Sir Francis Drake's expedition lost about 700 men, 
 who, for the most part died of calentures. 1586, again, 
 was the date of a great outbreak of the jail distemper at 
 Exeter. In 1 592, as I have just stated, we were visited by 
 the Plague; and the year 1599, ^^^^ ^^ 1^"^^ ^499 of the 
 previous century, was marked by a bad pestilence, of 
 what kind does not distinctly appear. Thus ended this 
 century of epidemics, with its four attacks of Sweating 
 Sickness, as the central figure among the many pesti- 
 lences which scourged our own and other countries. 
 
 It is impossible to read the history of this eventful 
 •century without being struck with the frequent occur- 
 rence of all those phenomena in the natural world, which 
 tend most to create "distress of nations and perplexity." 
 As we read the pages of Hecker, or such a chronological 
 summary of plagues and pestilences as is to be found in 
 Dr. Short's work, we grow literally bewildered with the 
 repeated references to earthquakes, inundations, droughts, 
 violent storms of rain and hail; comets and fiery meteors j 
 
 G
 
 82 A Sickly Centnry. 
 
 to blights, mould spots, blood-coloured rain, fogs and 
 stinking mists, to hosts of caterpillars and swarms of 
 locusts 3 to inverted and distorted seasons, warm winters 
 and inclement summers ; to famines, murrains, and fish 
 rendered unfit for food. Add to these, diseases in so 
 many forms, strange and terrible, the gathering and dis- 
 banding of hosts of mercenary troops, sieges with their 
 inevitable accompaniments of scarcity and disease, battles, 
 with tlieir slaughter and dispersion of sick soldiers to carry 
 disease with them far and wide, and we have a picture of a 
 state of things hard to parallel in any earher or later times. 
 But we must not forget that this century^ if it scourged us 
 with famine and pestilence, and frightened us with earth- 
 quakes and tempests, gave us our English Reformation, 
 our triumph over Spain, and the great names of the Eliza- 
 bethan age. 
 
 In my next lecture, I shall treat of the Plague.
 
 83 
 
 LECTURE IV. 
 
 THE PLAGUE. 
 
 The Black Death, or great mortality, of the fourteenth 
 century, was undoubtedly the same disease as the Plague 
 of which I am now to speak, differing only in degree, not 
 in kind. They had contagion for their common property, 
 the bubo for their common sign, a frightful mortality for 
 their common consequence. 
 
 But as, in the fourteenth century, we had no Bills of 
 Mortality, and no Census of Population, we know nothing 
 of the progress of the disease from week to week, and 
 little for certain of the destruction of life it occasioned. 
 The epidemic of 1499 found us in the same destitution as 
 to reliable facts, and left us in the same ignorance. But 
 the visits of the Plague in the sixteenth and seventeenth 
 centuries were made under more favourable circumstances. 
 London had its weekly Bills of Mortality, and its estimates 
 of population, and these, though imperfect, were an 
 immense improvement on the guesses of the fourteenth 
 century. I shall not now inquire how far facts collected, 
 compiled, and published, as these weekly bills were, are to 
 be rehed upon. I will take the more practical course of 
 using them only for purposes to which I think they are 
 applicable, merely observing, in passing, that, like many 
 other faulty and defective returns, though they may not be 
 strong enough to bear a superstructure of scientific truths, 
 they may yet do good service if we content ourselves with 
 comparing one return with another. This being under- 
 G 2
 
 84 Plague as Affected by Season. 
 
 stood, I place before me the carefully compiled tables of 
 Mr. Marshall, which present at one view the figures for the 
 five recognised plague-years, 1593, 1603, 1625, 1636, and 
 1665 5 and I will extract from these figures all the gold I 
 can. 
 
 Now the first thing I learn from these figures is that, 
 besides the recognised plague-years, there are many others 
 with entries under the head of plague ranging from 1000 
 to upwards of 4000 in the year j and, in the summer, from 
 100 to nearly 400 in some weeks. I find such figures in 
 each of the five years 1606 to 1610, and in each of the 
 eight years 1640 to 1647. ^ infer, therefore, that the 
 Plague was not only a destructive epidemic in some years, 
 but a leading cause of death in others 5 and I do not doubt 
 that the disease which the female searchers reported as 
 plague in epidemic years was the same which they 
 returned as plague in ordinary years. Captain Graunt, 
 who made a profound study of the facts relating to the 
 Plague, says of the Plague of 1 603 that it lasted eight 
 years, and of the Plague of 1636 that it lasted twelve 
 years. Of the outbreak of 1625, on the other hand, he 
 observed that the year preceding only 11 died of the 
 plague, and the year following, 134. 
 
 This, too, is obvious at a glance, that while the wrecks 
 of the winter quarter present many blanks, and those of 
 the autumn quarter a few, those of the spring quarter have 
 four only, and those of the summer none. And this, 
 again, is easy to perceive, that the figures stand thick in 
 summer and autumn, thin in spring and winter j or, to 
 state the matter more exactly, the seasons, in order of 
 mortality, rank thus : — summer, autumn, spring, winter: 
 and I find the same order to prevail in respect of the fatal 
 disease entered as Parish Infection. If now I turn to the 
 five epidemic years, I find that, in them also, the maximum 
 of deaths invariably took place in the summer quarter, and
 
 Mortality. 85 
 
 in four out of the five towards the end of it j and this is 
 true whether the Plague set in early in the year or later. 
 I now turn to Mr. Marshall's table for information as to 
 the rise, progress, and fall of the five epidemics. In 1593, 
 the first cases (three in number) were registered for the 
 week ending March 14, the maximum (983) was 
 reached in 20 weeks, and in 20 more the number had 
 fallen to 39. The Plague must have reached onward 
 into the following year, but for that we have no returns. 
 
 In 1603 the first return was for the same week, and for 
 the same number of deaths j but the maximum was not 
 attained till the end of 26 weeks j and at the end of the 
 40th week, there was a return of 74 deaths. 
 
 In 1625, the first weekly return was of i death, in the 
 week ending January 3 j the maximum was not reached till 
 the 32nd week ; and, after 18 weeks more, the return was 
 nil. 
 
 In 1636, the first return was for the week ending April 
 4 J the maximum was attained after 25 weeks, and, after 
 
 12 weeks more, the return is ml. 
 
 In 1665, the great and final epidemic, the first return is 
 of 2 deaths for the week ending April 25, the maximum 
 was attained after 2 1 weeks, and at the end of other 
 
 13 weeks, the deaths were still 281 . So that we must look 
 for a continuance of the Plague far into the next year — 
 the year of the great fire. Let us now compare the 
 figures for these five plague years, and see how many 
 deaths occurred within the years in the winters or springs 
 of which they severally set in. These figures are as 
 follows:— 1593, 11,503 ; 1603,36,2695 1625, 35'4i7 7 
 1636, 10,400; 1665, 68,596. 
 
 Hence it appears that the first and fourth outbreaks 
 were the least severe ; the second and third, of about 
 equal, but more than threefold severity, and the fifth and 
 last by far the most fatal. And the five epidemics hold
 
 85 Summary of Facts, 
 
 the same relative position, if we test their severity by their 
 maximum weekly returns. The figures for the five epi- 
 demics are 983, 3035, 4463, 796, 7165. According to 
 both these tests of severity, the fourth attack, in 1636, was 
 the mildest, the fifth attack, in 1665 (thirty years later), of 
 nearly seven-fold severity. The Bill for 1666 has this very 
 significant entry : — 
 
 ''In the 97 parishes within the walls of London, from 
 the 19th of December, i66j, to the 28th of August, j666," 
 deaths by the Plague, 284, *' since which time the late 
 dredful Fire hath consumed and laid waste 81 parishes." 
 
 As up to the end of December the remnant of 16 
 parishes yielded only 4 deaths, 1994 deaths must have all 
 occurred in 14 parishes, out of the 16 without the walls 
 which the fire had spared, in the 12 out-parishes in Middle- 
 sex and Surrey, and the five in the city and liberties of 
 Westminster. But London does not seem to have been 
 absolutely free of the Plague till the year 1680. 
 
 I have just said that the fourth attack of plague was the 
 least, and the fifth tlie most, severe. Let it, however, be 
 understood that I have not taken into account that very 
 necessary element in such comparisons, the number of the 
 population. 
 
 As to the mortality due to the Plague, we must, I believe, 
 rest satisfied with the somewhat rude estimate of Sir Wil- 
 liam Petty, who says " that the plagues of London do 
 commonly kill one-fifth part of its inhabitants." 
 
 There is one feature of the Plague which I have not 
 yet noticed, and that is its occasional strange fluctuations, 
 or, as Graunt calls them, its '' sudden jumps," " leaping in 
 one week from 1 18 to 927 ; and back again from 993 to 
 258 ; and from thence again, the very next week, to 
 852.' 
 
 From our examination of the Bills of Mortality, then, 
 we have learnt : —
 
 Deaths ill the Great Plague of 166^. 87 
 
 That in 72 years (from 1593 to 166^) we had 5 out- 
 breaks of the Plague, or about i every 15 years. 
 
 That these outbreaks continued i, 2, 8, or 12 years. 
 
 That they began in winter or spring, and reached their 
 climax in summer. 
 
 That they attained this climax in from twenty to 
 thirty weeks, and passed away or sensibly abated in from 
 twelve to twenty weeks ; so that, speaking roughly, out 
 of live periods of time, three would be taken up in attain- 
 ing the maximum, and two in the fall. 
 
 That if we place the four seasons in the order of mor- 
 tality, beginning with the highest, they stand thus : — 
 summer, autumn, spring, winter. 
 
 That if we measure the severity of the live outbreaks 
 by the deaths in the year in which they set in, or by the 
 greatest number in any one week, but taking no account 
 of population, the hrst and fourth were least severe, the 
 second and third more severe, and the fifth the most fatal, 
 both absolutely and relatively to any possible increase of 
 population. 
 
 That the mortahty due to the Plague may be taken at 
 one-fifth of the inhabitants. 
 
 Let us now turn to the facts recorded for the year of 
 •the great Plague, 1665, and see whether we can learn any- 
 thing more by studying them. 
 
 We have already seen that the Plague lirst showed 
 itself on the 25th April by two deaths, that it attained 
 its acme, September 19, when it claimed 7165 victims; 
 that by the end of the year the deaths had fallen to 281 ; 
 but that, though the great fire of the year following 
 destroyed no less than 8 1 parishes within the walls and 
 2 without, 1 998 deaths occurred in that year, and that 
 even then it was not extinct. 
 
 If we count all the deaths from its outbreak in 1665 
 to its final disappearance, we have a grand total of 70,676.
 
 88 The Deaths ill \66^ underrated. 
 
 o 
 
 But I believe this by no means represents the fall severity 
 of the epidemic ; for I find that, when the deaths due to- 
 the Plague are taken away from the total deatlis of the 
 year 1665, there remains a number of deaths little short 
 of 10,000 in excess of the deaths for the previous year 
 (itself the most fatal to life of a long series). These 
 deaths in excess I attribute with great confidence to the- 
 Plague J for I see in the way the epidemic was dealt with,, 
 and especially in the harsh measure which caused infected, 
 houses to be shut up, the strongest possible temptation to- 
 set down to other causes the deaths due to the Plague. 
 And this conviction is strengthened if I examine the 
 causes in detail. Thus, I find an excess of 1813 over the 
 previous year under the head of spotted fever, of 1299. 
 under that of ague and fever, and of 130 under sucb 
 headings as imposthume and abscess, sores and ulcers. 
 Then fright and grief figure for 117 deaths. Even con- 
 sumption, a most uniform cause of death, shows an im- 
 possible increase of 1 1 6^,, and surfeit (whatever that may 
 mean) of 1007. Take all the entries in excess under 
 the heads of diseases that attack adult men and women,, 
 and they yield a total of nearly 8500. 
 
 The otlier items of increase are very interesting. More 
 women died in child-bed, or suffered abortion by 469 f. 
 and more children perished by teething, convulsions,.. 
 rickets, and canker, to the number of 1670. This last 
 number in part represents an indirect consequence of 
 plagues and pestilences, and indeed of all deatlis and diseases 
 among young adult women ; I mean the neglect of 
 infants and young children. This is the educational* 
 aspect of Plagues and of Preventible Diseases. 
 
 May we not, then, take credit for something short of 
 1 0,000 extra deatlis ; at least for such a number as will raise 
 the 70,676 deaths by Plague to 80,000? I think we may.- 
 
 I now turn for a more exact account of the Plague of
 
 Rise and Progress of the Plague. 89- 
 
 1665 to the work of Dr. Nathaniel Hodges, a Fellow of 
 the College of Physicians, resident in the City, and as 
 his book shows, in active practice among the victims of 
 the disease. 
 
 Dr. Munk, in his Roll of the Royal College of Physi- 
 cians of London, says that he " acquired a great name, 
 among the citizens of London, that he remained at 
 his post and continued in unremitting attendance on the 
 sick," and that, '^ during the latter part of his life, he 
 received a regular stipend from the City of London, for 
 the performance of his charitable office." 
 
 Dr. Hodges tells us that about the close of 1 664, two 
 or three persons died suddenly with symptoms of the 
 Plague in one family at Westminster, that some timid 
 neighbours of theirs took fright and removed into the 
 City of London, carrying the taint of the pestilence with 
 them J whereby the disease, which existed only in a 
 family or two, gained strength, and spread abroad 3 and 
 '^ for want of confining the persons first seized with it, the 
 whole city was in a little time irrecoverably infected." 
 
 In December a hard frost set in, which lasted three 
 months, and during that time very few died of the plague. 
 But the disease was not extinguished j for in the middle 
 of the Christmas holidays, the doctor was called to a 
 young man in a fever, who after two days '' had two 
 risings about the bigness of a nutmeg," " one on each 
 thigh," with a "black hue " and a *' circle round them." 
 By these and subsequent symptoms, he judged it to be a 
 case of Plague. It did not prove fatal. 
 
 When the frost broke, the disease gained ground, and 
 extended into several parishes ; and the authorities issued 
 an order " to shut up all the infected houses," so as ta 
 prevent ingress and egress. To give effect to this order, 
 the houses of the infected were to be marked with a red 
 cross, and to carry the inscription, " Lord liave mercy upon
 
 •90 The College of Physic ians. 
 
 us ;" and a guard was set, whose duty it was to hand food 
 and medicine to the sick, and to prevent them from going 
 abroad till forty days after their recovery. In spite of these 
 harsh measures, " the Plague more and more increased." 
 Nor will this surprise us if we imagine the frantic and 
 successful etforts that must have been made by the non- 
 infected to escape, and the temptation to servants and 
 nurses to appropriate and remove the property of the 
 dying and dead. Indeed Dr. Hodges accuses the nurses 
 of strangling their patients, and secretly conveying the 
 pestilential taint from sores of the infected to those who 
 were well 3 and he justifies his accusation of " these aban- 
 ■doned miscreants," the Gamps and Prigs of the seven- 
 teenth century, by two instances 3 the one of a nurse who 
 '' as she was leaving the house of a family, all dead, loaded 
 with her robberies, fell down dead under her burden in 
 the streets," the other of a " worthy citizen," " who being 
 suspected dying by his nurse, was before-hand stripped 
 hy her J but recovering again, he came a second time 
 into the world naked." 
 
 In spite of the well intentioned measures of the autho- 
 rities, the Plague continued through May and June with 
 more or less severity, sometimes in one place, sometimes 
 in another, till the people, becoming thoroughly frightened, 
 flocked out of town in crowds. But the disease raged 
 with redoubled fury among those that remained. Then 
 the authorities bestirred themselves to the utmost. They 
 instituted a monthly fast ; and the King commanded the 
 College of Physicians " to write somewhat in English," that 
 might serve as '"a general director)^" The College not 
 only obeyed the royal commands, by inventing a " Plague 
 IVo.ter,'' consisting of a cordial distilled off from a vinous 
 infusion of a score of very harmless roots, leaves, and 
 flowers, but also appointed two of their number to co- 
 operate with two chosen from among the aldermen in at-
 
 Ravages of the Plague. 
 
 tending the intectecl j while Dr. Ghsson, Regius Professor 
 at Cambridge, and Drs. Paget, Wharton, Berwick, and 
 Brookes volunteered their help, with many others who 
 survived, and eight or nine who fell victims to their self- 
 devotion, among whom Dr. Conyers receives honourable 
 mention. 
 
 Still, in the face of every precaution, the Plague con- 
 tinued its work of destruction, especially among the com- 
 mon people, so as to be called the " Poors Plague ;" and, 
 in August and September, completely got the mastery, 
 " so that three, four, or five thousand died in a week, and 
 once 8000." 
 
 And here I will follow Dr. Hodges' example ; and try 
 to give you some idea of the state of things then pre- 
 vailing. But, in doing so, I must shorten and tone down 
 his description. "In some houses," he says, "carcases 
 lay waiting for burial," " in others, persons in their last 
 agonies." " In one room might be heard dying groans, 
 in another the ravings of delirium," and, near at hand, 
 relations and friends bewailing their loss and their own 
 dismal prospects. " Death was the sure midwife to all 
 •children, and infants passed immediately from the womb 
 to the grave." Some of the infected ran about stagger- 
 ing like drunken men, and fell down dead in the streets, 
 or they lay there comatose and half dead j some lay 
 vomiting as if they had drunk poison ; and others fell 
 dead in the market in the act of buying provisions. The 
 plague spared " no order, age, or sex." The divine was 
 taken in the very exercise of his priestly olfice, and the 
 physician while administering his own antidote ; and 
 though the soldiers retreated, and encamped out of the 
 city, the contagion followed, and vanquished them. 
 Many in their old age, others in their prime, most 
 women, and still more children, perished, " and it was 
 not uncommon to see an inheritance pass successively to
 
 92 Decline of the Plague. 
 
 three or four heirs in as many days." There were not 
 sextons enough to bury the dead, the bells ceased tolling, 
 the burying places were full, so that the dead were thrown 
 into large pits, dug in waste ground, in heaps, 30 or 40 
 together j and those who attended the funerals of their 
 friends one evening, were often carried the next to their 
 own long home. 
 
 This is written of a time when the worst had not yet 
 happened. It was about the beginning of September that 
 the disease was at its height. Then fires were ordered to 
 be burnt in the streets for three days together; but, 
 before the time had expired, they were extinguished by 
 heavy rains, which ushered in the most fatal night of all, 
 with its register of more than 4000 deaths. 
 
 From this, its culminating point, the Plague, " by 
 leisurely degrees declined," " and before the number in- 
 fected decreased, its malignity began to relax, inso- 
 much that few died, and those chiefly such as were ill- 
 managed." Dr. Hodges distinctly states that the pesti- 
 lence did not stop for want of subjects, but from the 
 nature of the distemper. "Its decrease was, like its 
 beginning, moderate." Early in November, people grew 
 more healthful, and though the funerals were still fre- 
 quent, " yet many who had made most haste in retiring, 
 made the most to return j" " insomuch that in December, 
 they crowded back as thick as they fled." The houses 
 were again inhabited} the shops re-opened ^ the people 
 went cheerfully to their work 3 the rooms, in which a 
 short time before infected persons had breatlied their last, 
 were peopled afresh, and many went into their beds 
 " before they were even cold, or cleansed from the stench 
 of the diseased.'' " They had the courage now to marry 
 asrain," " and even women, before deemed barren, were 
 said to prove prolific, so that, although the contagion had 
 carried off, as some computed, about 1 00,000, after a few
 
 The Plague at Eyam. 93 
 
 months, their loss was hardly discernable." But the next 
 spring there appeared "some remains of the contagion," 
 which was easily conquered by the physicians ; and the 
 whole malignity ceasing, the city returned to perfect 
 health, as, after the great lire, " a new city suddenly arose 
 out of the ashes of the old, much better able to stand the 
 Jike flames another time." 
 
 So much for the Plague in London. But the city 
 became the focus of " infection to surrounding districts, 
 and, even, as I shall presently show, to remote places. 
 We are told that the citizens who crowded into the 
 adjacent towns, carried the infection with them, so that 
 the Plague reigned over whole counties, leaving hardly 
 any place free, attacking with extreme violence the towns 
 on the Thames, not even sparing places " of the most 
 advantageous situation for a wholesome air." It was not, 
 as Hodges thought, the fault of the moist air of the river, 
 but of the tainted goods that were carried upon it. 
 
 I have just stated that the Plague was conveyed from 
 London even to remote places. I may add that it was 
 not by personal intercourse only, but also by goods and 
 merchandize. Of this latter mode of communication, we 
 have an admirable and most instructive example in what 
 befell the inhabitants of Eyam, in Derbyshire, a place 
 rendered for ever memorable by the heroism of its rector, 
 Mompesson. 
 
 Eyam, a hamlet secluded among the hills of the Peak 
 of Derbyshire, is about 150 miles from London, and had 
 a population of 350 souls. Quite early in the month of 
 September, when the Plague was at its worst in London, 
 there was sent from London to one George Vicars, a 
 tailor, a box of clothes. He opened the box, and hung 
 the clothes to the fire j and, while he watched them, was 
 suddenly seized with violent sickness, and other alarming 
 symptoms. On the second day he was worse 3 was deli-
 
 94 Alovipesson. 
 
 rious at interv als, and large swellings appeared on his neck 
 and groin. On the third day, the plague spot was on his 
 breast, and he died the following night, the 6th of Sep- 
 tember. The disease spread from this centre j by March 
 ist, 1666, had destroyed 58 souls 3 and, by the beginning 
 of June, 77, or more than one in live of the population. 
 About the middle of June, the Plague began to increase j. 
 and then it was that Mrs. Mompesson, the rector's wife, 
 implored her husband to remove, with herself and their 
 two young children, from this doomed village. But he, 
 alleging his duty to his suffering flock, and his responsi- 
 bility to his Maker, and pointing out the stain which 
 would rest on his memory did he desert his post in this 
 hour of danger, determined to remain. He, on his part, 
 tried to persuade his wife to take their children with her 
 to some place of safety till the Plague should be stayed. 
 But she declared that nothing should induce her to leave 
 him alone amidst such ravages of death. Her children, 
 however, she would send away. It was at this time 
 (about mid June) that the inhabitants, wishing to follow 
 the example of the few wealthy who had left early in 
 the spring, and of a few others who had built huts for 
 themselves in the neighbourhood, would have deserted 
 the village en masse. But now Mompesson, with his own 
 example, and that of his wife to back him, pleaded so 
 effectually the selfishness, and the uselessness of such a 
 course, the danger to the neighbourhood, the slight chance 
 of profit to themselves, that the inhabitants were induced 
 to give up all thoughts of flight. Mompesson, then, con- 
 certed measures with the Earl of Devonshire, \\ho re- 
 mained at Chatsworth during the Plague, and with his 
 assistance established and carried out an efficient qua- 
 rantine. 
 
 A circle was drawn round the village, at a distance of 
 about half a mile, bevond which no inhabitant should
 
 Frightful Mortality. 95 
 
 pass ; and to two or three chosen spots_, provisions were 
 brought every morning, by persons from the neighbour- 
 hood, who immediately retired. Men, appointed by the 
 rector, fetched these provisions, and left the purchase- 
 money for the few articles not given by the earl, in 
 troughs of water. 
 
 Tow^ards the end of June, " the plague began to rage 
 even more fearfully." There were so many deaths^ that 
 the passing bell was no longer rung, the churchyard was 
 no longer used for interment, and the church-door was 
 closed. The rector read prayers and preached from an 
 arch in an ivy-mantled rock, in a secluded dingle, to his. 
 people seated on the grass at some distance from each 
 other. 
 
 All this time, though Mompesson had been visiting 
 from house to house, he and his wife had escaped. But 
 on the 22nd of August Mrs. Mompesson was seized, and 
 three days after was at rest in the village churchyard. In 
 this terrible month of August there were 77 deaths out 
 of a population of less than 200 remaining at the begin- 
 ning of the month. At least 2 in ever}' 5 must have 
 died. 
 
 The hot month of September proved less fatal 5 and on 
 the nth of October the Plague, as if exhausted with ex- 
 cessive slaughter, held its hand. It had attacked 76 
 families, and swept avi'ay 267 out of about 350 in- 
 habitants — say 7 in 9. These are the figures taken from 
 the parish register. Mompesson states the deaths at 
 259 ; it is likely, therefore, that 8 died from causes other 
 than plague. The 267 deaths were distributed thus : 
 males, 1365 females, 1265 infants, 5. 
 
 We are not told of the number of attacks that did not 
 prove fatal j but we know that Mompesson's man-servant, 
 and one Marshall Howe, a sturdy daring giant who acted 
 as gravedigger, had the plague and recovered.
 
 <)^ End of the Plague at Eyam. 
 
 In Wood's " History and Antiquities of Eyam," the 
 names and dates are carefully extracted from the register j 
 so that we can follo\\^ the Plague by the month and by 
 the week. It lasted thirteen months, from September 7, 
 166^ to October 5, 1666. In the first month it claimed 
 •6 victims j in the second 23 ; then for seven months, till 
 the end of May, 1666, it never killed more than 9, and in 
 May as few as 4. In June it resumed its activity, claim- 
 ing 19 victims; in July the number rose to 56; and in 
 August, when it reached its chmax, to 77. l\\ September, 
 there was a somewhat abrupt fall to 24 ; and in October 
 {when 10 deaths were entered without dates) to 14. I have 
 extracted the deaths according to the names and order of 
 the deceased, and find under the same names cases of 
 8, 10, II, 13, and 14 deaths; and, as showing their quick 
 succession in some instances, such figures as these : in a 
 family of Rowes, the 41st, 42nd, and 43rd interments. I 
 find, too, that the second death occurred in the family of 
 the reputed landlord of Vicars, and the third in the house 
 of the next neighbour. 
 
 If we count by weeks, we attain the climax about the 
 44lh week, when there were 26 deatlis : but its history, 
 both by weeks and months, is one of slow increase at first, 
 of decided progress during the month of October, of a 
 comparative inactivity during seven months of winter and 
 spring, of progressive and rapid increase in the five 
 months of summer and autumn — evidently at Eyam, as in 
 London, a disease much promoted by heat, and greatly 
 checked by cold. 
 
 Mompesson, the hero of this sad tragedy, left Eyam in 
 1669, three years after the Plague had ceased, for a living 
 in Nottinghamshire, where, so fearful were the people 
 •even then of the Plague in which he had lived and worked 
 so long, that he was obliged to live in a secluded hut till 
 their fears had died away.
 
 Episodes of the Plague. 97 
 
 With this tragedy of Eyam are associated two episodes 
 relating to the Talbots and Hancocks, who found their 
 place of interment in the Riley graves. Riley was in an 
 airy situation, a full quarter of a mile from Eyam. On 
 the 5th of July, after the Plague had been in Eyam ten 
 months, Bridget and Mary, daughters of Richard and Cathe- 
 rine Talbot, died, and were buried by the father close to 
 the house. On the 7th he performed the same sad office 
 for his surviving daughter Ann, and on the i8th for his 
 wife. His son Robert died on the 24th 5 the next day the 
 father followed j and on the 30th another son, the last sur- 
 vivor, who is believed to have been buried by the Han- 
 cocks, whom the pestilence then seized. On the 3rd of 
 August John and Elizabeth Hancock died, and w^ere 
 buried near their cottage by their mother ; four days later 
 she interred her husband and tw^o other sons. Two days 
 more, and she was digging the grave of her daughter 
 Alice ; yet another day, and Ann, her only surviving child 
 left at home, died and was buried. A few days after this 
 Mrs. Hancock left her desolated home to spend the rest of 
 her sorrowful life with her only surviving son. He erected 
 the ''Riley Graves," on which the particulars of this ter- 
 rible history are engraved. 
 
 In Wood's work there is the record of a case very like 
 those of the Talbots and Hancocks. It belongs to the 
 Plague of 1625, and occurred at Bradley, in Cheshire. 
 Thomas Dawson, of Bradley, his wife, brother, three sons, 
 a daughter, a man-servant and a maid-servant, died of 
 the plague brought from London, a distance of 1 70 miles, 
 by one of the sons. The deaths all took place, and the 
 burials are recorded in the parish register, in the interval 
 between July 25 and September 5, a period of forty-two 
 days. These nine persons seem to have made up the 
 whole family. Of Richard Dawson, the uncle, it is 
 alleged that, being a heavy man, and sick of the plague.
 
 98 Antecedents of the Plague. 
 
 he got out of bed, dug his own grave, caused some straw 
 to be thrown in, lay down in it, had his clothes placed 
 over him, and so died. 
 
 The history of the " Plague of Eyam" has pathetic 
 passages and images of horror, such as the last walk of 
 the rector and his wife through the fields, when, talking 
 on their usual theme, their absent children, Mrs. Mom- 
 pesson marks, to the terror of her husband, the sweet 
 smell of the air 3 or that picture of poor Mistress 
 Hancock, dreading to touch the dead bodies of her 
 husband and sons, but tying a towel to their feet, and so 
 dragging them to their last resting place. It is not, how- 
 ever, as a romance of heroic self-devotion that I have been 
 describing the Plague of Eyam, but as an authentic 
 example of plague transported by clothing, infecting a 
 whole village, and being restricted to it and its immediate 
 neighbourhood by judicious and efficient measures of 
 quarantine. 
 
 I may mention, in passing, that Dr. Mead, writing in 
 1722, notices the plague at Eyam, and gives a brief history 
 of it, for which he says that he was indebted to the then 
 rector, the son of Mompesson, and another worthy 
 gentleman. 
 
 From Eyam and Mompesson let us now return to 
 London and Dr. Hodges, and see what he has to teach us 
 about the antecedents of this Plague of 1665. 
 
 Let us first inquire whether there was anything in the 
 year or times preceding the attack to account for the 
 great destruction of hfe it occasioned. Did famine or 
 scarcity, the precursors of so many other pestilences, 
 usher in this also ? Was there such a want of fruit and 
 vegetables as, by inducing scurvy, or a scorbutic condition, 
 would make men easy victims to the disease? The 
 answer is conclusively in the negative 3 for Dr. Hodges 
 tells us that ihe necessities of the poor who were left
 
 Contagion. 99 
 
 behind were relieved " with a profusion of good things 
 from the wealthy, and their poverty was supported with 
 plenty j" that there were open markets and a greater 
 plenty than usual of all provisions, " so that there was the 
 reverse of a famine 3" and we are further told that "this 
 year was luxuriant in most fruits, especially cherries and 
 grapes, which were at so low a price that the common 
 people surfeited with them." Of vegetables no special 
 mention is made. These statements are confirmed and 
 amplified in another passage. ** Had we," he says, " any 
 famine before the last sickness ? or had we portentous 
 swarms of insects like clouds over us ?" No, just the 
 contrary 3 " all things from nature were promising and 
 serene." The only exception I can find to these state- 
 ments is in a passage where the Doctor says that in 
 the year before the Plague "■ there was a great 
 mortality amongst the cattle, from a very wet autumn, 
 whereby their carcases were sold amongst the ordinary 
 people at a very mean price j" but he rightly thinks that 
 a cause so private and particular could not be supposed to 
 extend to so universal an efifect. Of any special over- 
 crowding, or unusual neglect of cleanliness in the time 
 preceding the plague no mention whatever is made. In 
 this great pestilence, therefore, we wholly miss the most 
 common and eflScient predisposing causes. 
 
 As to the exciting proximate cause we are not left in 
 doubt. Dr. Hodges, at least, has no misgiving about it. 
 It was contagion and nothing but contagion. We have it, 
 he tells us, *' from the most irrefragable authority," that 
 the Plague "was imported to us from Holland, in packs of 
 merchandize;" and "by common fame" " it came thither 
 from Turkey in bails of cotton or silk." Dr. Hodges 
 deals with the anti-contagionists of his day in this passage. 
 The plague is communicable by contagion, and in " that 
 way only," "killing most it seizes," and "the infection 
 H 2
 
 loo Syinptojus. 
 
 of the pestilential poison is not only transferable from one 
 subject to another, either by mediate or immediate 
 contact," "but all the conditions hkewise of its exertion are 
 as conspicuous as the noon-day sun j wherefore those 
 arguments to prove the pestilential corruption not to arise 
 from contagion are trifling and not worth notice, aS' 
 altogether disconsonant to reason and experience." 
 
 That our author, though he expresses himself in terms 
 Strange to us, had yet a \try clear view of the whole 
 matter of causation I infer from his enumeration of the 
 four things chiefly necessary to a contagion. There is, 
 first, " an efflux of the contagious seminium/' secondly, 
 " a convenient medium for the contagious particles to move 
 through and be conveyed by 5" thirdly, " a fitness in the 
 subject to receive and cherish tlie contagious f^wi'ia;" and 
 fourthly, **a due stay of this seminium." 
 
 Of the semiiiium, or matter of contagion. Dr. Hodges 
 does not pretend to have any knowledge j but he dis- 
 credits those who allege that the infection resembled 
 *•' the fragrancy of flowers in May," or, " the stench of a 
 rotten carcase." I may, however, remind you that it was 
 his wife's exclamation — "how sweet the air smells" — that 
 struck terror into the heart of the brave Rector of Eyam. 
 Is it not possible that an illusion of the sense of smell may 
 have been sometimes a sign of seizure, as it is occasionally 
 of a fit of epilepsy r 
 
 In describing the symptoms of the Plague, Dr. Hodges 
 distingnishes such as are signs of infection from such as 
 belong to the fully formed disease. 
 
 The early symptoms were shiverings, vomiting, giddiness, 
 headache, delirium, and drowsiness — symptoms common 
 to most severe febrile attacks. 
 
 The more advanced symptoms were fever, restlessness, 
 great heat at the pit of the stomach, palpitation, and 
 bleeding at the nose.
 
 Characteristics of the Plague, ' loi 
 
 The characteristic symptoms were the appearances on 
 the skin, known as Blains, Buboes, Carluncles, and Spots, 
 and certain marks called Tokens. 
 
 The fever, in some cases, was continued, in others, re- 
 mitient, m oth^va, intermittent ; often attended with in- 
 tense thirst, and a dry, black tongue. The matters dis- 
 'Charged by sweat and urine, by vomiting and purging, 
 were often intolerably offensive. Delirium seems to have 
 been very common, for Hodges says, " all the sick," 
 ^'quickly after seizure, grew delirious, running wildly 
 about the streets, if they were not confined by force." 
 A severe dysentery was present in some cases, and blood 
 was poured out under the skin in more. Sudden death 
 without warning, deep sleep passing into death, death in 
 a few hours after the appearance of the characteristic 
 signs — such were some of the exceptions to the rule. 
 
 Our author seems to have been a close observer of 
 the blains, buboes, carbuncles, petechia?, and tokens 
 •which were the outward and visible signs of the 
 Plague. 
 
 The Blains were blisters, from the size of a pea to that 
 •of a nutmeg. They began with a sharp, shooting pain ; 
 contained a thin, straw-coloured liquid j burst and dis- 
 charged a corrosive liquid, yellow or black, and were 
 surrounded by a circle, red at first, variegated afterwards. 
 They appeared in many parts of the body, and their 
 number varied in different cases. One woman was 
 covered all over with them. Sometimes they were the 
 first indications of infection, rarely they became inflamed 
 and turned to carbuncles. 
 
 The Buboes were hard, painful tumours, inflamed and 
 gathering behind the ears and in the armpits or groins j 
 one or two, in favourable cases, very many in unfavour- 
 able ones. There might be one in the right arm-pit, 
 another in the left groin. They would sometimes vanish.
 
 I03 TJie Tokens 
 
 especially during a sweat 3 or they would come and go j. 
 or they would suppurate. 
 
 The Carl'uncle began as a llain, which, when it broke^ 
 became covered with a dead crust, or eschar, round which 
 the skin first grew red, then livid, at last black. They 
 might appear anywhere — breast, finger, armpit, groin > 
 two, three, or more at a time ; and the matter from a 
 carbuncle would produce another on any part that it 
 touched. 
 
 The petechice were little deep-coloured spots on the 
 skin, like flea-bites without the central spot, not removed 
 by pressure, not large and ditfused like scur\'y spots, and 
 showing themselves chiefly on the neck, breast, and back, 
 not on the arms and legs. These spots, too, were few 
 or many 3 might be red, yellow, purple, or black j might 
 cover the whole body 3 might come and go, and be 
 carried otf by a sweat. 
 
 The tokens were deemed the " pledges or forewarnings 
 of Death." They were " minute and distinct blasts,'' or 
 blisters ; but they might look like warts. They might be 
 small as a pin's head, or large as a silver penny. They 
 rose up " with a little pyramidal protuberance," from 
 which they spread 3 appeared on the internal parts as well 
 as on the skin j were sometimes hard, sometimes soft, 
 sometimes sensible to the prick of a needle (a good sign), 
 sometimes insensible (a bad one). They were bad signs 
 even when every other symptom seemed favourable 3 and, 
 especially ivhen deep, were " the sure and speedy messengers 
 of deathy Here are two cases in point : — A girl, when 
 first seized, breathed easily, had a natural warmth of 
 surface, an equal and regular pulse. All things were 
 ''' genuine and well" with her, "as if she had ailed 
 nothing." Dr. Hodges was even inclined to think her 
 shamming, until, on examining her breast, he found " the 
 certain characters of death imprinted in many places,'"
 
 Remedies — Virtues of Sack. 103 
 
 and the following night, ''before she herself, or any 
 person about her, could discern her otherwise out of 
 order," she died. The doctor had seen a widow of sixty 
 eating a hearty dinner of mutton and broth j she said of 
 herself that she had "never been better in her lifej" but 
 he found her pulse to intermit, and, on examining her 
 breast, he found "an abundance of tokens." She died 
 that evening. 
 
 These details will suffice, I think, to give to all men, 
 but especially to doctors, a lively idea of the fatal pesti- 
 lence of 1665, and of the Plague in all its out- 
 breaks. 
 
 In the matter of treatment^ Dr. Hodges shows himself 
 a man of sense. He speaks doubtfully of bleeding, but 
 denounces large and repeated venaesections, deeming it 
 madness " to sink the necessary strength by a rash effusion 
 of blood," " in order to remove an imaginary fulness," 
 and he says that he had "many times seen the blood and 
 life drawn away together." But he commends the J^ir- 
 ginian Snake Root, and Ginger and Spirits of Hartshorn 
 given in the Plague Water of the College of Physicians 
 (a spirituous cordial, as you may recollect) ; but, above 
 all, he gratefully extols " the virtues of sack,'' in which he 
 seems to have been somewhat of a connoisseur, preferring 
 as best that which is " middle-aged, neat, fine, bright, racy, 
 and of a walnut flavour." This generous liquor is both 
 antidote and remedy, unless for those who use it " too 
 intemperately." 
 
 Of other remedies then in repute he speaks with very 
 creditable reserve. Of the virtue of the powder of an 
 unicorn's horn, he is as doubtful as of the existence of the 
 creature itself 3 but he does not condemn troches of vipers, 
 or their volatile salt ; and he found greater success with 
 troches made of the flesh of the rattlesnake than from 
 the native product. As he commends the native remedy
 
 104 Preservation from a Pestilence. 
 
 for its cheapness, vipers must have abounded in those 
 days. 
 
 But these, as well as the ''manifold compositions,'' 
 which must have indeed consisted of many elements, if 
 they were more complicated than the Plague water of the 
 College, or his own alexipharmick vinegar or anti-pestilen- 
 tial confection, were innocent enough compared to what 
 I may call the regimen of the sick-room j and the same 
 may be said of such local applications as the flesh of 
 pickled herrings to the feet and wrists, and of the bare 
 rump of a fowl, live pigeons, and warm sheep's lights to 
 draw out "the pestilential venom'' from the boils and 
 carbuncles. 
 
 What I have called the regimen of the sick-room 
 consisted in keeping the infected close in their beds the 
 whole time of the disease (tying them in their beds, if 
 delirious) ; keeping the patient forcibly awake, if drowsy ; 
 covering him witli blankets to make him sweat ; scrupu- 
 lously avoiding change of body-linen and bed-clothes, 
 because, forsooth, ''the patient takes harm by clean 
 coverings," and incurs "the approach of air" by tlie 
 shitting, because also the fresh things are apt to be damp. 
 The soap used in washing the clothes he acquits of mis- 
 chief, in which he differs from Diemerbroeck, the Dutch- 
 man. 
 
 In treating of " Preservation fro/n a Pestilence," Hodges 
 also shows himself a man of sense. He would make a 
 timely separation of the infected from the healthy, would 
 forbid public funerals, and all kinds of meetings, and 
 would enjoin quarantine ''according to the custom of 
 trading nations.'' He approved the action of the magis- 
 trates in appointing two in every parish to pay a daily 
 visit to every family and see whether they were free from 
 the infection or not. Having noted the good effect of 
 brisk winds, he would stir the air by " the frequent ex-
 
 Amulets and Charms. 
 
 plosions of great guns, especially morning and evenings" 
 and he thought that the products of combustion of " an 
 intimate combination of nitre and sulphur " greatly 
 altered ''the saline qualities of the pestilential taint." 
 Hence he approved of fumigation with nitre and resinous 
 woods. He most approved the placing of a chafing-dish 
 in the middle of a room, or in the doorways or win- 
 dows, and burning in it what he terms "proper things,^' 
 viz., quick lime thrown into an aromatic liquid, or a pas- 
 tile made of a pound of saltpetre and three ounces of 
 sulphur, melted with benzoin and storax, in quantity 
 sufficient to make, when dried, a suitable mass. This is 
 perhaps his best receipt : " The streets, sinks, and canals 
 should daily be cleared of all filth ; because stench and 
 nastiness are justly reckoned entertainers of infection." 
 "Dogs, cats, and other domestic brutes," as carriers of 
 contagion, should be killed. He also shows a proper 
 respect for cleanliness as a measure of prevention, though 
 his treatment of the infected did not, as I have shown, 
 tend to promote it. He says, " I know not, indeed, a 
 greater neglect than in not keeping the body clean, and 
 keeping at a distance everything superfluous or offensive." 
 Lastly, fasting was to be avoided, a diet nourishing and 
 easy of digestion to be chosen, with pickles and sauces, 
 juice of sorrel, lemons, oranges, pomegranates, barberries, 
 and sack at every meal. Tobacco, much praised by 
 Diemerbroeck and others, he does not approve, alleging 
 against it its narcotic qualities, its poisonous oil, its pro- 
 motion of spittle, and " the irksomeness of its scent." He 
 is its ''professed ewew?/," and preferred sack, in which 
 (though a moderate man myself) I confess that I heartily 
 agree with him. He greatly commends a mixture of 
 which camphor is the active ingredient. 
 
 The common people, in Hodges's day, were much 
 addicted to amulets and charms. They painted their
 
 ic6 Hodges Management of Himself , 
 
 bodies with hieroglyphics, and carried about their persons 
 a walnut filled with mercury, a paste made with arsenic, 
 or a dried toad 3 and some nasty old nurses gave human 
 excreta as antidotes. The arsenical paste, in the case of 
 an elderly lawyer, seems to have determined the spot for 
 a " pestilential carbuncle," and in other instances gave rise 
 to large blisters. 
 
 Dr. Hodges finishes his history with a curious account 
 of the regimen he adopted for himself. He kept open an 
 issue which warned him, by a shooting pain and an ill- 
 conditioned discharge, when he ought to have recourse to 
 alexipliarmics, or poison-antidotes. As soon as he rose in 
 the morning he took his own Antipestilential Electuary 
 (which, like the Plague water of the College, consisted of 
 a score of harmless simples) to the size of a nutmeg. He 
 then despatched his own private concerns -, and this done, 
 went into a large room, where he spent two or three 
 hours, as in an hospital, among crowds of citizens, some 
 with the first symptoms of the Plague, others convales- 
 cent. This work done, he took his breakfast, after which 
 till dinner time, he visited the sick at their own houses. 
 When he entered them, he caused " some proper thing " 
 to be burnt on coals, and kept in his mouth some 
 lozenges while he examined the sick. He took care not 
 to enter the sick-room sweating or panting, and he kept 
 his mind as composed as possible. After some hours he 
 returned home, drank a glass of sack, eat a nutritious 
 meat dinner with pickles, and finished with more wine. 
 Then came many more persons for advice, and further 
 visiting of the sick till eight or nine at night. And he 
 " concluded the evening at home by drinking to cheer- 
 fulness of his old favourite liquor, which encouraged sleep, 
 and an easy breathing through the pores at night." If, 
 in the day-time, he had what he deemed " the least 
 approaches of the infection," such as giddiness, nausea.
 
 Efficacy of Isolation. 107 
 
 and faintness, he immediately had recourse to a glass of 
 sack. Yet, in the whole time of the Plague he found 
 himself ill but twice, and soon got better. He is said 
 (probably on the strength of this statement of his) to have 
 had the plague twice. But this, I think, is a mistake. 
 
 Such, then, is a faithful account of the Plague of 1665, 
 from one who was an eye-witness from hrst to last 3 a well- 
 informed, sensible, industrious, and brave man. 
 
 I should not have allowed a disease that has not been 
 seen in England for two centuries to take up so much of 
 our time were it not that it has visited France, Russia, and 
 our own possession (Malta) in much more recent times. 
 It attacked Marseilles in 1720, Moscow in 1771, Malta 
 so late as 18 13 5 and, in each of these cases, after an in- 
 terval which might well have filled the inhabitants with 
 the confidence that they had seen the last of it. It had not 
 been in Marseilles for 70 years 3 in Moscow for a century 
 and a half 5 in Malta for 137 years. We are not justified, 
 then, in asserting that England and London can never 
 again be visited by this formidable disease. I will there- 
 fore ask you to give such further attention to this subject 
 of the Plague as this consideration seems to warrant. We 
 have in it a good example of a contagious fever, with 
 buboes and carbuncles for its local expression j of a specific 
 poison seeking its elimination from the system in the skin 
 and lymphatic glands. I speak of the disease as contagious 
 because I find the facts conclusive on that point, and the 
 arguments of such men as Gooch and Robert Williams 
 convincing in the face of the few who have broached the 
 opposite doctrine. I adopt as probably true the estimate 
 of Dr. Williams that the infection may lie dormant, or 
 latent, for as many as twenty-one days. I am also con- 
 vinced, by the facts recorded by competent and trustworthy 
 authorities, that whole communities and bodies of men, by 
 perfect measures of isolation, have kept free from the
 
 o8 Sanitary Measures. 
 
 ■disease, or (as in the case of the village of Eyam) have 
 prevented it from spreading to their neighbours. 
 
 These (as I think) are the well-established facts and 
 principles with which sanitary science has to deal j and the 
 question naturally arises, What demand may be made on 
 our knowledge and skill by this or any similarly con- 
 tagious malady ? 
 
 Now, we may have to advise and to act in three diffe- 
 rent contingencies : — i . The Plague may have made its 
 appearance in some city, as in London, in 1665. 2. The 
 Plague may be known to exist in some country with 
 which we have commercial relations. 3. The Plague may 
 have shown itself in Egypt, or some neighbouring country, 
 from which, as in times past, it may threaten to spread. 
 
 I. In the first case — that of the Plague having broken 
 out in some city, such as London — it is evident that we 
 could not recoinmend the cruel expedient of barricading 
 the doors and windows of infected houses, and leaving 
 their inmates to perish j nor could we, in these days, shut 
 up the infected houses, mark them with a red cross and a 
 prayer, confine the healthy in the same atmosphere with 
 the sick, and prevent ingress and egress by a guard, as 
 was done in London in 1665. But what we could do, 
 and what we should be bourd to do, would be to appoint 
 skilful and active persons in every parish or district, as it 
 became infected, charge them to make a daily house to 
 house visitation, to examine the sick, and if they were 
 found with the marks of the plague upon them, isolate 
 them to the utmost practicable extent in the houses in 
 which they had fallen sick, or have them removed to some 
 pest-house j and in any case provide for the destruction or 
 purification of clothing, bedding, furniture, and houses, and 
 the immediate disinfection of every matter discharged 
 from the person. Water supply, ventilation, drainage, 
 and the speedy removal of all offensive matters, should
 
 Quarantine. 109 
 
 receive prompt and special attention j and proper food and 
 medicines should be liberally supplied. In a word, each 
 case as it arose ought to be promptly taken in hand and 
 isolated from the healthy to the utmost extent consistent 
 with the proper treatment of it ; while every known 
 sanitary precaution should be taken to destroy the con- 
 tagious matter as soon as formed. 
 
 2. On the second supposition — that the Plague existed in 
 some countr)-- with which we have commercial relations — 
 we might be required to advise the Government as to the 
 expediency of establishing a quarantine, with its necessarily 
 complicated machinery. At present I will only remark 
 how troublesome and costly an interference with com- 
 merce this measure implies j how sore a temptation there 
 must be to evade it 3 how hard it is to give to it full prac- 
 tical effect. But, on the other hand, how grave a respon- 
 sibility must that government incur which, with the 
 terrible histories of past plagues before it, and the fact of 
 contagion admitted by the best authorities, should deter- 
 mine to abandon so obvious a precautionary measure. Let 
 us hope that the knot of this dilemma, so hard to untie, 
 may some day be cut by our experience of the efficacy of 
 house to house visitation and prompt treatment, sanitary 
 and remedial, of each case as it arises. 
 
 3. On the third supposition — that, namely, of the 
 Plague showing itself in Egypt, or other less common 
 birth-place — it is obvious that the governments of the 
 countries threatened with infection might fairly insist on 
 every known precaution being taken to limit the disease ta 
 the first cases that show themselves 3 and (what is still more 
 important) on the towns and districts where the Plague 
 is known to prevail being brought into and maintained 
 in the best possible sanitary condition, like precautionary 
 measures being adopted in reference to such occasional 
 gatherings of human beings as war and pilgrimages imply.
 
 no 
 
 LECTURE V. 
 
 FROM THE GREAT FIRE TO THE CLOSE OF THE 
 EIGHTEENTH CENTURY. 
 
 We are now come to our third sanitary epoch, extend- 
 ing from the Fire of London in 1666, to the end of the 
 eighteenth century. It may be conveniently subdivided in to 
 three periods, of which the first extends from the Great 
 Fire to the end of the seventeenth century 3 the second 
 and third embracing the first and second halves of the 
 eighteenth. For our knowledge of the prevalent and 
 fatal diseases of this period of nearly a century and a half, 
 we are indebted to the writings of physicians practising 
 in London, and to the London Bills of Mortahty, taken 
 in conjunction with what history teaches us of the results 
 of the Great Fire, and of the progressive changes brought 
 about by increasing wealth, extended commerce, and im- 
 proved habits of living. 
 
 In treating of the first period of thirty-four years we must 
 begin with the Great Fire and the immediate consequences 
 that flowed from it. It broke out on the night of 
 Sunday, September 2nd, 1666. It began on Fish Street 
 Hill and continued to burn " for several days together, 
 till it had consumed everything, from the Tower 
 to Temple Bar." It destroyed 81 out of the 97 
 parishes within the walls, and 2 of the 16 without 
 the walls. It found the Plague still in possession of the 
 city, though in a very subdued form. The year previous 
 it had swept away nearly 70,000 inhabitants, probably
 
 Our Streets and Houses. 1 1 1 
 
 80,000, possibly more. This year of the Fire 288 only 
 died of it in the 97 parishes within the walls, 574 in the 
 16 parishes without the walls, 939 in the 12 out-parishes 
 in Middlesex and Surrey, and 197 in the 5 parishes in the 
 City and Liberties of Westminster 3 in all 1998. Now 
 of this number there died between the Fire in September 
 and the end of the year, 4 in the 16 parishes remaining 
 within the walls, 73 in the 14 left standing without the 
 walls, and a number which I am not able to ascertain in 
 the out-parishes of Middlesex, Surrey, and Westminster. 
 But if the deaths in these out-parishes after the Fire bore 
 to the whole number for the year the same proportion as 
 they did in the parishes without the walls, namely i to 8, 
 we should have to allow about 142 deaths j which, added 
 to the other ligures, would give a total of deaths from the 
 Plague, in the year after the Fire, of 219. At any rate, 
 the Plague must be understood to have survived the Fire 
 in the parts of London which were not burnt. The 
 year following (1667) the Plague is still credited with 
 2,^ deaths, and in the subsequent years with 14, 3, o, 5, 5, 5, 
 3, I, 2, 2, 5, and 2, this being the number for 1 679, the 
 last year in which any entry under this head appears. 
 
 Now let us inquire what sort of a city this was that the 
 Plague haunted and the Great Fire consumed. It con- 
 sisted, as we learn on good authority, of narrow, crooked 
 streets, many of them unpaved, with drains all above 
 ground, and sewers much neglected, with a very insuffi- 
 cient supply of water. The houses were of wood, lofty, 
 dark, and ill-planned, each storey overhanging the one 
 below J at the same time that enormous sign-boards swung 
 across the street. In this way effectual provision was 
 made against the intrusion of two of the great purifiers, 
 fresh air and sunlight. The inside of the houses was in 
 keeping with the out. The floors, often of clay, were 
 strewed with rushes, or in the case of such grand struc-
 
 112 London Improvements. 
 
 tures as the palace at Greenwich, with hay j and we learn 
 from the letter of Erasmus, to which I have already re- 
 ferred, that in the days of Cardinal Wolsey, though fresh 
 rushes were supplied from time to time, there would re- 
 main, sometimes for twenty years together, a substratum 
 of the most nauseous and disgusting description. And it 
 appears from earlier accounts, and from certain civic 
 restrictions and regulations, that this loathsome mess was 
 at length turned out into the narrow streets, to be consumed 
 by dogs, cats, pigs, and poultry, or imperfectly washed 
 away by the rain. That this is no exaggerated statement 
 we may infer from the improvements made and regula- 
 tions issued after the Fire. The streets were widened and 
 levelled for the more free flow of the waters, and the 
 sign-boards were ordered to be fixed against the houses ; 
 proper places were selected for lay-stalls j cess-pools were 
 made at the grates of the sewers to receive sand or gravel 
 and prevent choking j the *' Fellowship of Carmen " were 
 to cleanse the streets from *' dung, soil, filth, and dirt," and 
 persons were forbidden to lay in the streets any dead ani- 
 mals, offal, or " noisome thing," or to feed kine, goats, hogs, 
 or poultry, in the streets, or to cast any carrion, putrid flesh, 
 rotten vegetables, rubbish, or dung, into the ditches or 
 sewers, grates, or "gullets." And lastly, the offensive 
 refuse of the houses was not to be run off into the drains 
 or common sewers. The regulations for street cleansing 
 had been rendered doubly necessary by the destruction 
 of 40,000 dogs and five times as many cats, which 
 had acted the part of scavengers, with the serious draw- 
 back of substituting one set of offensive matters for anotlier. 
 The younger Heberden, after describing these improve- 
 ments, is guilty, I fear, of some exaggeration when he 
 says that " in a few years the new town rose up like a 
 phoenix from the Fire with increased vigour and beauty," 
 producing in the country a spirit of improvement till then
 
 Wren^s Plan. 113 
 
 unknown. Allan Cunningham's picture of Sir Christopher 
 Wren, harassed and disappointed, watching " in silence the 
 new city rising up with streets confined and narrow, and 
 house huddled upon house,mean,or plain, or neat, according 
 to the pleasure or purse of the proprietor," is more in con- 
 formity with the truth. The phcRuix which would have 
 risen from the ashes of the Plague-smitten city, had Sir 
 Christopher been allowed to mould it into shape, would 
 have been a noble assemblage of streets from 90 feet wide 
 down to a minimum of 30, bordered with houses uniform 
 in plan. A spacious street would have stretched from Aid- 
 gate to Temple Bar; a second, starting from the Tower,and 
 meeting it at a sharp angle, enclosed St. Paul's Cathedral, 
 with a piazza to the west. At the river's edge, a broad 
 -quay extended from London Bridge to the Temple, 
 with all the halls of the City Companies, alternating 
 and contrastinor with merchants' warehouses, skirtino^ 
 it throughout its whole length j while piazzas and 
 markets dotted the scene, and the rebuilt city churches, 
 at suitable distances, closed the vistas of houses, and 
 •gave height and beauty to the whole. Add to this 
 tantalizing vision of what might have been, an Exchange 
 standing in the middle of a piazza (a sort of Roman 
 forum with double porticoes), with bank, mint, post- 
 office, excise office, and other public buildings grouped 
 near it — a noble centre whence the streets should 
 radiate to the principal parts of the city — and we 
 have the heau ideal of a metropolis of a great nation, 
 '' the wonder of the world." From this vision of beauty, 
 the wholesome and the useful were not to be shut 
 out. A canal was to be cut 120 feet wide with 
 flushing arrangements at Holborn Bridge, and coal 
 stores on either side 5 and churchyards, and trades 
 requiring great fires, or yielding noisome smells, were to 
 be placed beyond the limits of the city. This was no 
 
 I
 
 ri4 Evelyn's Plan, 
 
 architect's dream, for to use the words of Sir Christophers 
 son, " the practicabihty of this whole scheme, without loss 
 to any man, or infringement of any property, was at that 
 time demonstrated, and all material objections fully 
 weighed and answered." Perhaps it was a further recom- 
 mendation of it that King Charles approved it and pre- 
 sented it to the council. "The ingenious Mr. John 
 Evelyn," too, propounded a plan, with a river-quay, 
 straight wide streets, large open spaces with fountains 
 and conduits, a Royal Exchange well placed on the river, 
 and public buildings judiciously distributed — if I may offer 
 an opinion on such a subject, a good, wholesome, handsome 
 plan, though not equal to that of our great architect. But 
 the citizens did not like either plan or any plan at all. 
 They would not submit to the necessary delay j they had 
 a preference for narrow streets, crooked lanes, and blind 
 courts ; thought a crowded city in itself beautiful ; and 
 did not want their new capital to " look like a city of 
 lords rather than of merchants." And thus was lost 
 this golden opportunity "of making the new city the 
 most magnificent as well as commodious for health and 
 trade of any upon earth." 
 
 London, then, having risen from its ashes witli wider 
 streets, less combustible and more spacious houses, and 
 better sanitary arrangements 3 but with no grand and 
 comprehensive structural improvements, and with its out- 
 lyincr districts unchanged 5 let us try to find out what effect 
 was produced upon the health of the inhabitants in the 
 remaining third of the seventeentli century. 
 
 As the Bills of Mortality, for the two years 1667 and 
 1668 give the returns of births and deaths only for the 
 16 parishes left standing, and not for the 97 parishes 
 within the walls till 1669, it is safe to infer that the city 
 began to be inhabited afresh in this year 1669. It further 
 appears from the figures for subsequent years that the
 
 The Fire and the Plagiic. 115 
 
 work of re-population must have been a gradual one. 
 The number of births shows a progressive increase for 1 2 
 years, and the deaths exhibit the same tendency, with 
 marked fluctuations. Now, during all these years, from 
 1667 to 1679, when the last entry under the head of the 
 Plague occurs, there are recorded no less than 82 deaths 
 from plague, and not one of these took place within 
 the limits of the re-built city, or of the 16 parishes left 
 standing. If then our examination of the Bills of 
 Mortality were restricted to the years following the Great 
 Fire, we should naturally infer that the reconstructed city 
 was proof against the plague that still continued to attack 
 the inhabitants of the out-lying parishes which the fire 
 had spared. But this inference would be unsound 3 for, on 
 examining the Bills for the years 1657 to 1664 preceding 
 the Plague and the Fire, I find that while no less than 
 113 deaths by plague occurred in the out-parishes, only 
 2 took place in those within the walls 3 and that in the 
 five years 1 660 to 1 664, the returns for which include the 
 five Westminster parishes, we have one death only 
 within the walls for 60 without the walls. 
 
 We are justified, therefore, in inferring that, except in 
 years when Plague was epidemic, the city within the 
 walls was very nearly plague-proof 3 and also in disturb- 
 ing the behef generally entertained that the Great Fire 
 gave the coup de grace to the Plague. 
 
 This amended view of the subject receives some support 
 from the fact that the proportion of deaths by plague to 
 deaths from all other causes was always, even in epidemic 
 years, lower in the 97 parishes within, than in those 
 without, the city, or those described as out-parishes. Thus, 
 in 1625, while 64 per cent, of the deaths within the city 
 were set down to plague, and 64 also in the parishes 
 without the walls, 70 per cent, was the ratio for the out- 
 parishes. Again, in 1636, while the ratio of deaths from 
 I 2
 
 I T 6 What the Fire did not do. 
 
 plague was only 30 per cent, within, it was 40 per cent, 
 without, the walls, and 70 per cent, in the out-parishes. 
 And again, in 1665, the deaths by plague within 
 the walls having been 6^ per cent, of the total deaths^ 
 they were 70 per cent, in both groups of out-lying 
 parishes. 
 
 Doubtless the city within the walls was always a 
 superior place of residence. Its Cathedral, its Exchange, 
 and its city companies claimed space for themselves, and 
 its wealthy citizens lived in better houses and wider streets 
 than the people in the out-lying parishes. It was in such 
 labyrinths of narrow and squalid streets, as some of us 
 remember in the **^ rookery" of St. Giles, before New 
 Oxford Street was run through it, that the poverty and 
 crime of London took up their abode 5 and in such dis- 
 tricts the plague was rife in epidemic years, and lingered 
 in the years when the parishes within the walls were free. 
 So that it is not true that the Fire of London, so often 
 spoken of as a blessing in disguise, brought about a state 
 of things which guaranteed us against future epidemics 
 of the Plague; for it left standing not only 16 parishes 
 within, and 14 out of 16 without, the walls, but all the 
 out-lying parishes in which the Plague had always proved 
 most fatal and lingered longest. The peculiar hunting 
 grounds of the pestilence remained intact, and probably 
 underwent little change during the last years of the seven- 
 teenth century. They were far from plague-proof 5 and we 
 must look elsewhere than to the Fire, which did not touch 
 them, for the causes of the immunity from the Plague 
 which, as we know, many cities of the continent did not 
 enjoy. If the Great Fire did give us wider streets, better 
 houses and improved municipal arrangements, it was at 
 the cost of the destruction of many noble buildings we 
 could ill spare, and of more than one library we could not 
 replace. " This blessing in disguise," like the "phoenix"
 
 Health of London in the I'jth Century. 117 
 
 which Heberden imagined, must, I fear, be added to the 
 delusions which a pious fancy has framed but a just 
 criticism dispels. 
 
 What the Fire and the Plague did was to disturb and 
 dislocate the population of London, thus placing a serious 
 obstacle in the way of all comparisons of the numbers and 
 causes of death in the years following. And the same 
 obstacle, though in a minor degree, was created by the 
 plague epidemics of 1603, 1625, and 1636. If, in addition 
 to this disturbing cause, we take into account the unsatis- 
 factory way in which the returns of the causes of death 
 were made, the exclusion of deaths of Jews and Quakers, 
 the changes in the nomenclature, the difficulty of ascer- 
 taining the meaning of terms, the acknowledged defects 
 in the returns of births, the additions so often made of new 
 parishes to those comprised in the returns, and, above 
 all, the want of trustworthy censuses of population, we shall 
 see the necessity of proceeding with great caution in any 
 attempt to ascertain the sanitary condition of the inhabitants 
 of London at different periods of the seventeenth century. 
 The only data which may, I think, be used without much 
 fear of misleading us, are the proportions which certain 
 well defined and easily ascertained causes of death bear 
 to the whole number of deaths, with the proviso that, in 
 making choice of years, or groups of years, to be com- 
 pared with each other, we avoid those in which the 
 Plague was epidemic, and those also in which changes 
 were made in the parishes comprised in the bills. 
 
 Observing these precautions, I am able to select for 
 comparison three periods of five years each, those ending 
 1635, those ending 1664, and those ending 1693. ^^ 
 happens that these dates are separated by intervals of 
 29 years. Now I begin by arranging the causes of death in 
 four groups: — i. Deaths in infancy and childhood j 
 2. Deaths in old age, and from diseases incident to the
 
 ii8 Diseases of the ijih Century. 
 
 aged 3 3. Deaths by zymotic maladies, and 4. deaths by- 
 consumption: and I find that the ratio of deaths in 
 infancy and childhood to deaths from all causes was 
 37 per cent, in the five years ending 1635 '■> ^5 P^'" cent, 
 in those ending 1664; and 32 per cent, in those ending 
 1693. Taking next the deaths in old age, I find that 
 they were for the three periods respectively 8, 8, and 7 per 
 cent. Next come the group of zymotic diseases j and 
 I find that these gave rise to 23 per cent, of the deaths in 
 the first five years, 28 per cent, in the second, and 32 per 
 cent, in the third ; and lastly, consumption proved fatal 
 to life in the ratios of 20, 21, and 17 per cent. You see 
 then that the mortality of infants and children, which fell 
 considerably towards the middle of the century, rose 
 again, though not to the high level of the early years 5 
 that the number who reached old age was less at the end 
 than at the beginning and middle of tlie century j that 
 the deaths from zymotic maladies progressively increased 
 throughout the whole period under review j and that this 
 increase coincided with a marked fall in the deaths from 
 consumption towards the end of the century. 
 
 Let us now see what additional light is thrown on the 
 sanitary state of the last part of the seventeenth century 
 by the figures taken somewhat in detail. 
 
 First, let us take the group of fevers — ague and fever, 
 spotted fever, and plague. Well ! these gave rise to 
 14 per cent, in the five years ending 1635, ^"^ ^^ P^^ 
 cent, in those ending 1664, and 1693 respectively: that 
 is to say, 14, 16, and 16 per cent, of all causes of 
 death put together. 
 
 Let us take next in order small-pox and measles. The 
 ratios for these two diseases are 5, 5, and 5^ per cent, for 
 the three periods. 
 
 Next let us take the several entries which comprise the 
 deaths from dysentery, diarrhoea, and cholera. These
 
 Sydenhavis Observations. 119 
 
 increased in the remarkable ratios of 4, 7 J, and 16 per 
 cent. 
 
 The entries under scurvy and sores and ulcers, which 
 we shall by-and-by find to be closely associated with 
 dysentery in unwholesome ships, destroyed life in the 
 ratios of 3, 8, and 5 per thousand. 
 
 Syphilis increased at the rate of i, 3, and 4 per 
 thousand. 
 
 King's evil remained stationary at 3 per thousand ; 
 while this and other diseases implying slow deaths in 
 childhood, taken together, account for i per cent, of the 
 deaths in the first period, 3 in the second, and 2 in the 
 third. 
 
 In these numerical statements, I take no account ot 
 the estimated population at the three periods referred to j 
 but only of the proportion of deaths from special causes 
 to total deaths; and partly for this reason, that the 
 limits of the Bills of Mortality were extended by succes- 
 sive additions, seven parishes having been added between 
 1636 and 1664, and four between 1664 and 1693. 
 
 I will finish what I have to say on the sanitary state 
 of London in the last 30 years or so of the seventeenth 
 century by stating my impression that there was an / 
 increased mortality from fevers, from small-pox and I 
 measles, from dysentery and bowel complaints, and from 
 syphilis 3 that scrofula remained stationary ; that the ; 
 diseases of children, at their worst about the middle of the , 
 century, improved towards the end of it ; that the same 
 is true of scorbutic maladies ; but that, on the whole, the 
 health of London experienced no change for the better 
 during the seventeenth century, except in the ^relief 
 obtained from the incursions of the Plague. 
 
 This inference from the Bills of Mortality is confirmed 
 by a perusal of Sydenham's " Medical Observations con- 
 cerning the History and Cure of Acute Diseases," sup-
 
 1 20 Small'pox and Measles. 
 
 plemented by his "Epistles," which works contain an 
 account of the epidemic diseases of London, extending, 
 over the 25 years from 1661 to 1685. 
 
 I will briefly state what I glean from these works. In 
 the first place, I learn that autumnal intermittents,. 
 severe and very fatal, which had been on the increase for 
 some years previous to 1661, broke out about the begin- 
 ning of July of that year, and by August " were doing 
 fearful mischief," causing excessive mortality, and carry- 
 ing off whole families, and that these agues continued 
 to prevail till 1665, ^^ 7^^^ °* ^^^^ Plague. After 
 that they became of " exceeding rarity " till the year 
 1678. This statement agrees well with the entries in. 
 the London Bills, which indicate 1661 to 1665, and 
 also 1685-86, as well marked epidemic years for ague 
 and fever. 
 
 Continued fever prevailed in many different forms j at 
 one time (as from 1661 to 1665) a miniature of the inter- 
 mittent j at another (as in 1667) a sort of small-pox. 
 without a rash 5 at another (as in 1 669) a kind of dysen- 
 teric fever 3 at another (as in 1685) complicated with 
 cough : always, as Sydenham thought, modelled some- 
 what after the fashion of the prev^ailing epidemic, what- 
 ever that might be, whether ague, small-pox, or dysentery. 
 In 1685-86 this continued fever, complicated with cough, 
 was epidemic not in London only, but in all England^ 
 There was a like epidemic in 1679 j and if we retrace 
 our steps to the great plague year 1665, we find the long, 
 cold, dry winter very productive of bronchitis, pleurisy^, 
 and quinsey. 
 
 Small-pox, in some years " favourable and of regular 
 type," in others "anomalous," "black," "irregular," was 
 epidemic about once in three years, and measles, of 
 extreme severity in 1674, and less fatal in 1664 and 1670.,
 
 Syphilis. 121 
 
 about once in two years. Measles more than once proved, 
 the epidemic forerunner of the small-pox. 
 
 Dysentery, very severe and fatal in 1669, was seen in 
 form of epidemic every three or four years ; and the 
 cholera morbus of Sydenham (the English cholera of our 
 own day in an aggravated form) sometimes, as in 1669;, 
 associated with coHc and dysentery, paid our London 
 ancestors a visit of five or six weeks in the months of 
 August and September of more than one of the years- 
 under review. The disease we now call bronchitis, with 
 pleurisy and quinsey, were epidemic in the seventeenth 
 century as they are now, whenever a long, cold, dry 
 winter occurred to test the vital powders of the aged, the 
 weak, and the intemperate: 1665 and 1683 were such 
 winters, and had such consequences. It was in 1683 that, 
 as Sydenham states, " the cold was more severe than it 
 had ever been within the memory of man. So cold was 
 it that the noble river Thames was frozen up, so that 
 carriages could pass upon it, and shops be opened, and 
 business done just as in a street," the people *' walking on 
 the solid ice as on a pavement." The next year was 
 not "much below it," but the cold did not last so long. 
 There is one disease described by Sydenham which I 
 have not yet noticed j the lues venerea. I find it credited 
 in the Bills with a number of deaths increasing towards 
 the end of the century. In 1675 ^^ caused 97 deaths, in 
 1680, 1 14 J in J 694, 104. What a terrible scourge it 
 was may be inferred from Sydenham's description of it. 
 After enumerating its ravages among the several textures 
 and organs of the body — ravages which w^e, in these days,, 
 witness rarely in the worst cases — he describes the un- 
 happy patient as wasting away in " continual torture," 
 dragging on an existence which " pain, foetor, caries, and 
 shame," make w^orse than any death, till *^ at length.
 
 7 22 yohn Woodall and the Scurvy. 
 
 limb by limb perishing away, the lacerated body, a burden 
 to earth, finds ease only in the grave." Sydenham has 
 no difficulty in fixing on 1493 as the date of the introduc- 
 tion of this scourge into Europe, and on the coast of Guinea 
 as its birth-place. If so, it may be added to the long list 
 of injuries which the slave trade inflicted upon us. 
 
 This brief reference to the works of our great physician 
 has certainly confirmed the teachings of the Bills of Mor- 
 tality ; and assuredly the w^ords with which he concludes his 
 chapter on the Quinsey do not exaggerate the work the 
 physicians of the last half of the seventeenth century had to 
 do. " A murderous array of diseases " had " to be fought 
 against, and the battle " was ^' not a battle for the slug- 
 gard. Day by day there" was "a combat against the 
 life of man, and there " "was neither truce nor quarter. 
 Many " died " by violent deaths 3 but, with tlie exception 
 of these, two-thirds of our race " died *^ of fevers," making 
 ''^ continuous attacks," and winning "daily victories over 
 strong men in the flower of their age." 
 
 And yet these destructive epidemics, some of which, 
 like plague, are wholly, and some, like ague, nearly 
 extinct, as causes of death j and others, as syphilis, hav^e 
 lost much of their malignity j prevailed in a century by no 
 means wanting in great physiological and medical dis- 
 coveries, or destitute of new and valuable sanitary appli- 
 ances. Early in the second quarter (1628) Harvey made 
 his grand discovery, or rather complete demonstration, of 
 the circulation of the blood. The lacteals had been 
 discovered six years before j and, as early as 161 7, John 
 Woodall, surgeon to St. Bartholomew's, and inventor of 
 the Trephine, in his " Surgeon's Mate, or Military and 
 Domestic Medicine," recommended lemon-juice in scuny, 
 not daring to give it its due praise as a sauce to meat, 
 " lest the chief in the ship should waste it in the great 
 cabin to save vinegar."
 
 The Cool Regimen. 1 23 
 
 The middle of the century witnessed the introduction 
 and sale in London of more than one article of diet, and 
 of one medicine, that must have had some effect on the 
 health of the people. Coffee, chocolate, and tea, were 
 first sold as drinks between the years 1655 ^"^ ^^57» 
 and the Peruvian Bark, a specific for the ague, was sold in 
 I 658, having been introduced in 1 6^^, and firmly estab- 
 lished as a medicine of repute by 1663. Sydenham made 
 free use of it in a regular way, and one Talbor as a secret 
 remedy. Need 1 remind you that tobacco was in common 
 use throughout the whole of the seventeenth century ? that 
 it had the honour of being attacked by James 1., and 
 legally persecuted in 1 604 ? that despotic emperors, infal- 
 lible popes, and intolerant Swiss republics, brought all 
 their artiller)- of punishment to bear on those who used it 
 as snuff, or smoked it 3 and that the irrepressible weed, 
 ** loathsome to the eye, hatefull to the nose, harmefuU to 
 the brain, dangerous to the lungs," still sends up its 
 "blacke stinking fume " — ** its horrible Stygian smoake" 
 — in burning deserts, and wintry solitudes, the seaman's 
 luxury, the prisoner's temptation, the pet weakness of 
 civilized, and the prime enjoyment of savage, men. 
 
 So that, in the "^ daily combat against the life of man," 
 Sydenham was armed with Cinchona Bark, in addition to 
 the old and well tried-remedies — mercury, antimony, opium, 
 and the lancet, all of which he used freely, but with discre- 
 tion. But he armed himself also with something better 
 than these, and especially important in its bearing on the 
 diseases which were the chief objects of his study. He 
 revived, and stamped with the weight of his great authority, 
 the use of that '' cool regimen," of which the value is 
 said to have been first recognised and proved by John 
 Crane, who practised in Cambridge, and died there in 
 1552. If we must affix a date to Sydenham's revival of 
 this method, 1683 will be the year.
 
 1 24 Fatal Diseases 
 
 But what with want of appreciation (the case of lemon- 
 juice) 3 or scarcity, clearness, and adulteration, backed by 
 apparent failure, or worse, in some conspicuous case (as 
 happened with the bark) j or obstinate prejudice (such as 
 the cool regimen had to contend with) 5 or the chronic 
 resistance of old habits (as in the contest of coffee, choco- 
 late, and tea, with beer, spirits, and wine) : the practical 
 effect of these drinks and medicines, like the reforms in 
 medical treatment, and the improvements in the houses, 
 clothing, dietaries, and habits of the people, was not con- 
 siderable J and we arrive at the end of the seventeenth 
 century with anything but a clean bill of health. 
 
 And now I must devote what remains of this Lecture to 
 the prevalent and fatal diseases of the eighteenth century, 
 using for this purpose chiefly the facts relating to the 
 metropolis, and dividing the century, as I said I should do, 
 into two equal halves. I might, indeed, have adopted 
 with great propriety an unequal division at the year 1 774, 
 inasmuch as up to that date the history of the century is 
 marked rather by steady progress towards a better state of 
 things than by any grand sanitary event ; while the year 
 1774, as you must have inferred from -what I said in my 
 lirst Lecture, is a date never to be forgotten by Englishmen 
 so long as they hold in esteem the greatest virtues displayed 
 in the purchase of the greatest blessings. But if I had 
 adopted this division I must have separated the great sani- 
 tary reforms of Sir George Baker and Captain Cook from 
 the still greater ones which we owe to John Howard and 
 Edward Jenner. By dividing the century into two equal 
 halves, I shall be able to bring together, as the work of 
 the last years of the second half, the sanitary labours and 
 reforms of these four men. 
 
 I shall begin my inquiry into the sanitary state of the 
 eighteenth centur}- by comparing the ratios borne by the four 
 leading groups and causes of death — infants and children j
 
 Of the Eighteenth Century. 1 25 
 
 aged, zymotic diseases, and consumption — with deaths 
 from all causes, for each of the years 1700, 1725, 1750, 
 1775, and 1 800 J and to give more value to these figures, 
 I shall compare them with the years 1650 and iSjo. 
 
 I take first in order the deaths of infants and young 
 children, and I find the ratios to be as follows : — 1 700, '^,6 j 
 1725075 1750^35 1775^ 345 1800,26. 
 
 The deaths in old age, and from the chief diseases inci- 
 dent to age, run thus : — i 700, 7 ; i 725, 9 3 i 750, also 9 j 
 1775, 8) 1800, 9. 
 
 Zymotic diseases, which I take next, occasioned the 
 following proportionate numbers of deaths: — 1700,30; 
 1725,29; 1750,25; 1775, also 25; 1800,21. 
 
 And lastly, consumption contributed the quota of deaths 
 shown in these figures: — 1700, 15 ; 1725, also 15; 1750, 
 21; 1775, 26 ; 1800, 29. 
 
 If I read these figures aright, they justify these infe- 
 rences : — That the deaths of infants and young children 
 were less numerous in proportion at the end of the century 
 than at the beginning ; and those in old age somewhat 
 more numerous ; that the deaths by zymotic maladies fell 
 continuously from 30 to 21 ; while those attributed to 
 consumption increased, also continuously, from 15 to 29. 
 If we compare the first with the last year of the century, 
 we find a decrease in the mortality of infants and children 
 of more than one fourth ; an increase in that of old persons 
 of less than one-third; a decrease in that by zymotic 
 maladies of one-third ; an increase in the deaths by con- 
 sumption of nearly 50 per cent. 
 
 Let us now take the figures for the years 1650, i 750, 
 and 1850, and see what they teach us. For infants and 
 young children, they are 32, -^o^, and 13 percent.; for aged 
 persons, 9, 9, and 13; for zymotic maladies, 18, 25, 
 and 2 1; and for consumption, 23, 21, and 14. I infer 
 from these figures that the middle of the eighteenth cen-
 
 126 First Quarter of the Centuiy. 
 
 tury was, on the whole, less favourable to life, and more in- 
 fested by zymotic maladies than the middle of the seven- 
 teenth, and that the middle of the nineteenth century showed 
 a marked improvement over both its predecessors, except in 
 the item of zymotic maladies, in which the middle of the 
 seventeenth century contrasts very favourably with it. 
 
 These figures, which relate to single years, are, of course^ 
 somewhat modified if we substitute periods of five years 
 each. I have made calculations on this basis, and find 
 that the results are in harmony with those for single years j 
 but they give us a less favourable impression of the first 
 25 years of the century, and even of the last 25, while the 
 numbers for the second and third quarters justify the view 
 that those were periods of progressive sanitar}'- improve- 
 ment. At any rate, the figures for the years ending 
 1725 stimulate the curiosity to look somewhat closely at 
 the facts at our disposal relating to this, the first quarter of 
 the century. 
 
 Beginning with the Bills of Mortality, and passing the 
 more fatal maladies in review, I find that there are abrupt 
 transitions in the figures which I do not find in our 
 own times. Thus, to take but one example, there were 
 12 deaths from measles in 1704, 319 the year following, 
 and 361 the year after that. Other figures, which I have 
 before me, display frequent fluctuations eminently charac- 
 teristic of epidemic maladies. Of the 25 years, 11 are 
 remarkable for excess of mortality, and for the number 
 of diseases that contribute to it. 
 
 The inference drawn from the London Bills is amply con- 
 firmed by the facts contained in Dr. Thomas Short's care- 
 ful and learned compilation, in which the weather and 
 diseases in England and on the Continent are recorded 
 year by year. The most notable fact bearing indirectly 
 on our own sanitary history is the prevalence of the Plague 
 among the northern nations of the Continent, from 1702
 
 Second Qicarter of the Century. 127 
 
 to 17163 and it is worthy of remark that a ''malignant 
 fever," "very mortal," raged 'Mn Harwich, Sec," in 1709, 
 "from the communication with foreign parts." In 1710, 
 again, we read of " a catarrhous fever, called the Dunkirk 
 rant, or Dunkirk ague," '' brought by disbanded soldiers 
 into England 3" also of the small-pox and spotted fever, 
 very fatal in Norwich. The two years, i 714 and 1723, 
 are noticed as peculiarly fatal throughout England. This 
 last year (1723), as well as 1710, the influenza was epi- 
 demic j and in 1724 the colic was so general in Devon- 
 shire, as to be called an epidemic. 
 
 Time will not allow me to dwell on the severe winters, 
 storms, droughts, scarcities, atmospheric disturbances, and 
 epizootics of this period. But I may remark that the 
 yearly details remind one of the earlier times when our 
 worst pestilences prevailed. 
 
 Of sanitary inventions and improvements belonging to 
 this first quarter of the eighteenth century, I have also 
 little to say. The most interesting procedure of the kind 
 was the oractice of inoculation, introduced into Ensrland 
 in 1722, of which the history belongs to the last Lecture 
 of this course. Another sanitary procedure belonging to 
 this first half of the century relates to ventilation, of which 
 more presently. 
 
 In treating of the prevalent and fatal diseases of the 
 second quarter of the century, I am still able to avail 
 myself of the London Bills, and of the valuable compila- 
 tion of Dr. Short. I find that the annual fluctuations in 
 the deaths are still very large. I will give a few examples : — 
 Ague, which occasioned 11 deaths in 1727, caused 44 in 
 17285 fevers which destroyed 4003 in 1740, killed 7528 
 the year following 3 small-pox, set down for 1206 deaths 
 in I 745, figures for 3236 in 17463 and measles, which 
 destroyed 30 in 1732, proved fatal to no less that 605 in 
 1733. Quinsey shows a fluctuation from 10 to 31, ery-
 
 128 The hiflnenza of i73:z-3. 
 
 sipelas from i to 5, dysentery from 2 to 15, and English 
 cholera from 22 to 103 in successive years. The largest 
 increase in the aggregate mortality occurred in 1 733. The 
 previous year the deaths exceeded 23,000 : that year they 
 were upwards of 29,000. The years marked by a high 
 mortality were, as in the lirst quarter, 1 1 in number, or 
 little less than one-half. 
 
 I now turn to Dr. Short's pages again, to see how far 
 his statements, based, as they are, partly on his own ex- 
 perience, partly on the facts carefully recorded by Win- 
 tringham, Huxham, Hillary, and others, bear out these 
 inferences from the London Bills. 
 
 From the two together we learn that while the last two 
 years of the first quarter of the century were healthy, the 
 second quarter began with a decided increase of mortality, 
 small-pox being the only one of its class that did not prove 
 unusually fatal. The next was a year of scarcity. Dys- 
 entery prevailed, fever continued common, and small-pox 
 took the place of measles. Passing over the more healthy 
 year, 1728, we come to 1729, a year marked by a high 
 mortality from all the epidemics, except measles, and in 
 September by an attack of influenza. The season was 
 unusually "moist, rainy, cloudy, and foggy," and " of a 
 sudden," there " broke out and raged all over Europe, and 
 perhaps the globe, a most universal epidemic catarrh." 
 *' In London near 1000 died weekly during September." 
 Of the frightful mortahty of the small-pox this year we 
 may form some idea from the fact tliat at Ipswich 13 out 
 of 19 died. 1729, then, was doubtless a very fatal year j 
 and Short says of it, and of some years preceding, " that the 
 insalubrity of the air was universal." The years i 730 and 
 I 73 I were healthy years 3 but the winter of 1732-3 wit- 
 nessed another outbreak of influenza, which Dr. Short 
 characterizes as " the most sudden and universally epidemic 
 catarrh that has been in this age, sparing neither ranks.
 
 Ma lignan i Spotted Feve7' 0/1^4.1. 129 
 
 sexes, ages j" "old or young, weak or strongs" and killing 
 off " many hectic and phthisical people." 
 
 It was a particular attention to this epidemic, and its 
 consequences, that first set Short upon that " quest of 
 epidemics in all agesj" which, as he says, gave him 
 a better acquaintance with physic than all " his former 
 studies 3 and convinced" him, not only of ** the uselessness, 
 but perniciousness, of theories and hypotheses in practice." 
 
 That part of the epidemic influenza of 1732-3 which 
 belonged to 1732 did not tell upon the mortality so as to 
 prevent it from being what Huxham calls it, " the most 
 favourable and kindly season for health that had been 
 above sixty years before." But things were so changed 
 in the early part of 1733, that the deaths which in the 
 first week in February (in London) were 1156, increased 
 to a maximum of 1588, of which ''never happened the 
 like before, since the great Plague." There were two 
 other outbreaks of influenza in this second quarter of the 
 century -, one, described by Huxham, in 1 737, and another, 
 also described by him, in 1743. So that we have in 
 this space of twenty-five years, four well-marked epidemics 
 of influenza 5 in the years 1729, 1733, 1737, and 1743. 
 
 Between 1733 and 1736 two comparatively healthy 
 years were interposed -, and then we come upon two 
 years of higher mortality, in which measles, and small-pox, 
 and quinseys are rife, with much mortality among cattle. 
 Measles were especially fatal. In 1737 influenza pre- 
 vailed. Then, we have two comparatively healthy 
 years, followed by a year of scarcity (i 740) caused by a 
 long, severe winter leading up to a late summer, " a most 
 memorable year in future histories." In 1741, '*a malig- 
 nant spotted fever raged among the poor, who had been 
 half-starved the last two years," — a fever much the same 
 as that which raged in Bristol the year before and in 
 Galvvay this same year, but modified since its importation 
 
 K
 
 130 Early History of Ventilation. 
 
 by two men of war from Gibraltar into Plymouth in 1 740 
 — a fever so bad that it would probably have been " a true 
 plague, had the constitution of the air favoured it" — ''the 
 most general, frightful, and fatal" that Dr. Short "had 
 ever seen." 
 
 From 1742 to 1745, the death-rate in London was, on 
 the whole, favourable; but there was an exception in the 
 case of children J for, in the year 1742, there was a 
 renewal of that " putrid sore throat," that viorlus strangu- 
 latorius, which had been seen in Spain in 1610, and first 
 recognised in England in 1 739, and with which the name 
 of Fothergill is so honourably associated. It seems to 
 have been common in London and near it in 1746, and 
 attained its acme in 1 747-48. It was the scarlet fever of 
 our own day, in its very worst form, eminently contagious, 
 and so fatal that it " carried off whole famihes of children, 
 and seized some of their attendants," and "in one small 
 market-town" 80 out of 90, treated by bleeding, died. 
 The years 1 746 and i 747, but especially the first of these, 
 were years of high mortality. Small-pox, spotted fever, 
 dysenter)% and measles all prevailed, and the death-rate 
 was very high. 
 
 The last three years of the second quarter of the century, 
 were healthy, but measles were very fatal in the first, and 
 dysentery in the last of the triad. 
 
 The sanitary reforms and improvements most deserving 
 of attention in this first half of the century are : i. The 
 progress of Inoculation j 2, The successful attempts made 
 to ventilate our ships and buildings, and 3. The eminently 
 disastrous, and, because disastrous, instructive expedition of 
 Anson in i 740. Of these the subject of Ventilation 
 alone requires to be noticed in this place. The practice 
 of Inoculation will be examined in my eighth Lecture, 
 and Anson's voyage in my next. 
 
 The early history of ventilation is extremely interesting.
 
 Wren and Desaguliers. 131 
 
 It may be said to date from a time when the legislature 
 first felt the want of air in the House of Commons, and 
 called the great architect Sir Christopher Wren to remedy 
 the defect. This he did by making a square hole in the 
 ceiling of the House at each corner, which hole formed the 
 base of a truncated pyramid rising six or eight feet into 
 the room above. Sir Christopher, of course, expected 
 that the air from the House would always rise through 
 these short chimneys, forgetting that air in chimneys is 
 greatly assisted in its upward movement by the tire, and 
 has an awkward habit of passing the other way when there 
 is no fire burning. This was found to happen whenever 
 the air in the room above was colder than that of the 
 house itself. Those members who happened to be near 
 the corners found themselves in the same shower-bath of 
 cold air that I once felt when sitting in the old reading- 
 room of the British Museum under a hole in the ceiling 
 covered by an ornamental patera. At what time Sir 
 Christopher was employed to do this work, I do not 
 know J but it was in 1723 that Desaguliers was asked to 
 remedy the inconvenience. This he did very effectually 
 by closing the four pyramids at the top, and carrying 
 tubes from openings in their sides to fire-places in two 
 closets, so that the air of the House should feed the fires 
 and pass away through the chimneys. The fires were to 
 be lighted before the members met, and when this was 
 done the plan answered completely, and the House was 
 kept very cool. But Desaguliers and his plan had an 
 unexpected difficulty to encounter, Mrs. Smith, the 
 housekeeper, was disturbed in the possession of her rooms, 
 and with skill equal to his own, baffled his designs, and 
 daily stifled the House without incurring its displeasure. 
 Her plan of operation was simple and efl^ectual. Instead 
 of lighting the fires before the House met, she waited 
 till the House was heated. Sir George Beaumont and 
 K 2
 
 132 Mi\ Sainnel S^Uton. 
 
 others " observing that the design of cooling the House 
 was frustrated," but not, I presume, suspecting the wicked 
 housekeeper, applied to the doctor for some contrivance 
 for extracting the hot air which should be under his own 
 control. This was in 1736. The doctor again proved 
 himself equal to the occasion by inventing " a centrifugal 
 or blowing wheel," which was *^ able to suck out the 
 foul air or throw in fresh, or to do botli at once," as the 
 Speaker might be pleased to command. 
 
 But, important as it was to promote the comfort and 
 health of the nation's representatives, there was a class of 
 men who stood much more in need of assistance, and 
 were, in their way, quite as valuable to the nation — I mean 
 our soldiers and sailors. About this time an expedition 
 was being organized against the Spaniards. The troops- 
 had been embarked at Spithead, but numbers of them 
 were obliged to be relanded and sent to hospital j for the 
 ships "stunk to such a degree that they infected one 
 another." The Lords of the Admiralty accordingly ap- 
 plied to Desaguliers, saw his models at work, and, in 
 company with Sir Jacob Ackworth, the surveyor of the 
 Navy, inspected the wheel fixed over the House of 
 Commons. The authorities were satisfied, and ordered 
 a smaller wheel to be tried on board the Kinsale^ at 
 Woolwich. This was done 3 but Sir Jacob contrived to 
 bring the machine into disrepute by a rough and off-hand 
 comparison with the old wind-sail, and dismissed the 
 whole affair, expressing regret at the failure of the doctor's 
 wheel, and saying that " he thought it might be a very 
 pretty thing in a house." 
 
 Sir Jacob was then dealing with a philosopher, and 
 easily contrived to give what was called the " shuffling 
 kick " to the machine and its contriver. But he was 
 soon to encounter a sturdier antagonist in a worthy 
 brewer, Mj. Samuel Sutton, who, touched with compas-
 
 His Ventilation of Ships. 133 
 
 sion for the poor sufferers at Spithead, determined to try 
 "what could be done by fire." He accordingly made a 
 preliminary experiment in a room with three fire-places, 
 and found that, on kindling large fires in two of them, 
 the air that came down the third chimney was able 
 to put out a candle, and that when all the fires were 
 lighted, the air entered the room with such force, *' as to 
 raise a pulley with half a hundred weight." This use of 
 fire to produce a draft was the essence of Desaguliers' 
 first plan for ventilating the House of Commons j but 
 Sutton probably did not know this. Be this as it may, he 
 gave himself very earnestly to the work of ventilating 
 ships on this principle. He made use of the fire or fires 
 already existing on board the ship, and led a pipe from 
 the ship's well, or from any other part of the vessel 
 where change of air was needed, to the ash-pit, and so 
 caused the foul air to blow the fire, and pass away up the 
 •chimney. What steps the sturdy brewer took to com- 
 mend his cheap and simple invention 5 how some prac- 
 tical sailors pitied him, as being mad 3 how Sir Charles 
 Wager gave him a letter of introduction to the redoubt- 
 able Sir Jacob ; how he told him " that no experiment 
 should be made if he could hinder it 3" how he petitioned 
 the Lords of the Admiralty j how they gave orders that 
 were set at nought ; how he commended himself to Dr. 
 Mead, and Martin Folkes, President of the Royal Society j 
 how these gentlemen waited on the Lords of the 
 Admiralty, who again ordered the plan to be tried 3 how 
 it was tried in presence of Mead and Folkes, and several 
 other members, and Sir Jacob Ackworth, who was sorry 
 to see them come " to the trial of such a foolish experi- 
 ment 3" how the experiment answered to the satisfaction 
 of all present 3 how Sir Charles Wager gave a peremp- 
 tory order which was at last carried out on board the 
 Norwich man-of-war 3 how Sutton received from the
 
 3 34 Sutton and the Admiralty. 
 
 Admiralty the magnificent reward of loo/. j and how, 
 after troubles, trials, and disappointments innumerable, he 
 had, at last, the satisfaction of seeing his pipes fixed on 
 board all his Majesty's ships, I have not time to tell you. 
 Nor can I stop to describe Dr. Hales' invention of a 
 species of bellows, his 'Ship's lungs," which had the dis- 
 advantage, in common with Desaguliers' wheel, of not 
 being self-acting. This history must finish for the present 
 with a brief statement that, in spite of the proved efficacy 
 of Sutton's simple and cheap plan, and its power of saving 
 lives so valuable, he was employed only for a brief space 
 in fixing his apparatus in king's ships and Indiamen, and 
 that in a year or two no other method of ventilation was 
 known on board ship but the " old way of wind-sails," 
 which egregiously failed when most wanted, namely in 
 calms and in rough weather. How useless the wind-sail 
 ventilator was in bad weather, Anson's little fleet lying at 
 Spithead when the experiments of Hales and Sutton were 
 in progress, and which left England without any other 
 provision for ventilation, was destined soon to discover by 
 a most bitter experience. 
 
 Sutton successfully applied his plan to buildings, and 
 wished to extend it to Newgate 3 but though he expected 
 to find an unanswerable argument in his favour in the 
 outbreak of jail fever that took place in the last year of 
 the half century (1750), he was disappointed, and the 
 prison was allowed to remain as before. 
 
 I have introduced this subject of ventilation, as belong- 
 ing to the history of sanitary science in the second 
 quarter, or first half, of tlie century, and as a contributory 
 to the improved health of which there are indications. 
 It is true that Desaguliers, Sutton, and Hales were all 
 doomed to disappointment, and that their plans fell into 
 disuse 3 but publicity was secured, and ventilators and 
 schemes of ventilation came into fashion 3 so that, when
 
 Third Quarter of the \^th Century. 135 
 
 the managers of public establishments found their build- 
 ings offensive, and deemed them dangerous, there was 
 always some ingenious person to assist them in the work 
 of improvement. Hence it happened that, in 1784, 
 St. Thomas's Hospital was ventilated by a Mr. White- 
 hurst, of Derby 3 that the year following a contrivance, 
 borrowed from a French frigate, began to be used in 
 English vessels of war 3 and that here and there ventila- 
 tion was brought to bear on the jail fever. 
 
 In what remains of this Lecture, I must treat briefly of 
 the sanitary state of the last half of the eighteenth cen- 
 tury, dividing it for convenience into quarters. And here, 
 as I lose Dr. Short's guidance, and Dr. Fothergill's annual 
 reports of the seasons and sickness only extend to a few 
 years of the third quarter, I will limit myself chiefly to 
 what I can glean from the Bills of Mortality. 
 
 Beginning with the third quarter, I must remind you 
 that the figures already adduced indicate a marked im- 
 provement over the quarter preceding in zymotic, or 
 epidemic maladies. They fell in the ratio of 26 to 20, 
 the mortality of children being stationary, while that of 
 aged persons fell in the ratio of 9 to 8, and deaths from 
 consumption maintained their progressive increase. On 
 the whole, too, the figures show less violent fluctuations 
 from year to year, with the exception of diarrhoea, 
 small-pox, and measles, and which continue very fatal and 
 very fluctuating. Thus small-pox, which killed 38 per- 
 sons in 1766, destroyed 11 96 the year following, and 
 1987 the year after that j and measles credited with 79^^ 
 deaths in 1774, caused 15 the year previous, and only 
 I death the year following. 
 
 The influenza prevailed as an epidemic four times in 
 this third quarter: — in 1758, 1762, 1767, and 1775: and 
 it occurred, as you recollect, four times in the second 
 quarter.
 
 13*5 Last Qiuirter of the \%th Centiu^y. 
 
 The last quarter of the century, which displays a maiked 
 decrease in the mortality of children, and some increase 
 in that of aged persons, shows a reaction, to the amount 
 of one-tenth, in zymotic maladies, and a great increase in 
 deatlis from consumption j and we do not find any case 
 of such extreme annual fluctuation in small-pox and 
 measles as occurred in the previous quarter. The greatest 
 fluctuation in small-pox occurs in the years 1770-72. 
 The deaths were 871 in the first year, 3500 in the 
 second, and 636 in the third. Measles shows its greatest 
 fluctuation in 1 785-86. In the first year it caused 
 20 deaths, in the second 793. Next year the deaths fell to 
 84. Dysentery and diarrhoea show a remarkable increase 
 in 1780 and 1781 5 the entry of *' ague " and "ague and 
 fever" give place during the last ten years of the century 
 to the simple entry " fever," and influenza seems to have 
 attracted attention once only in this quarter, in 1782. 
 Of the quarter generally it may be said that it shows some 
 improvement over its predecessor. But the year 1800 
 was marked by an increase in infantile mortality, in small- 
 pox and measles, and in the death-rate from all causes. 
 
 To what I have said of the prevalent and fatal diseases 
 of the eighteenth century, I will only add that the London 
 Bills for the first quarter of the nineteenth exhibit at a 
 glance a very material improvement in the public health. 
 The figures in the column headed " fever " show a marked 
 railing ofFj small-pox is evidently on the decrease, and the 
 total mortality exhibits both diminished intensity and 
 greater freedom from fluctuation. The great sanitary 
 reforms of the last half of the century had evidently left 
 their mark on the death-registers of the early part of the 
 nineteenth century. 
 
 They are almost summed up in the words, lead colic, 
 scurvy, jail-fever, small-pox : in the honoured names of 
 Baker, Cook, Howard, and Jenner.
 
 ^2>7 
 
 LECTURE VI. 
 
 THE SCURVY. 
 
 I AM now to treat of lead colic and scurvy ; of the first, 
 briefly, of the second more at large. Briefly of the first, 
 because I have already, in my first Lecture, spoken of Sir 
 George Baker's discovery of lead impregnation as the true 
 cause of the colic that seized the drinkers of Dev^onshire 
 cyder. I now revert to the subject as belonging to the 
 sanitary reforms of the eighteenth century, and of the third 
 quarter of it. The date of the discovery is 1767. It is, 
 therefore, the first of that remarkable series of sanitary 
 improvements and reforms which ended with the triumph 
 of vaccination in 1 796. 
 
 In my first Lecture I proved by figures the wide preva- 
 lence of lead poisoning in Devonshire. I will now adduce 
 further proofs of the same sort from the treatise of Hux- 
 ham, who practised at Plymouth, and is in every way a 
 good authority. He tells us that, early ir. the autumn of 
 1724, "a disorder exceedingly epidemical spread itself 
 over all the county of Devon, among the populace espe- 
 cially." It lasted till the following spring. It was so 
 '' vastly common " that there was " scarce a family 
 amongst the lower rank of people that had it not," and he 
 often saw five or six lying ill of it in the same house. Such 
 an epidemic colic was never seen before, unless it were 
 that described by Paulus iEgineta as attacking many parts 
 of Italy and the Roman empire, and which was un- 
 doubtedly the lead colic, attended by palsy and epilepsy, a
 
 138 The Devonshire Colic. 
 
 was this of Devonshire. Huxham traced it to an incredible 
 quantity of apples. No such apple-year had occurred 
 within the memory of man, and the quantity of cyder was 
 in proportion. Huxham recognised the coincidence of 
 much colic and many apples j but he (and Musgrave 
 before him) missed the true cause which Sir George Baker 
 so happily discovered. This same coincidence had struck 
 Huxham in the years 1722, 1728, 1730, and 17355 but 
 in none of these was the disease so prevalent, or the apple- 
 harvest so abundant. Under the year 1735, and the 
 month of January, Short has this brief entry : " A colic 
 with severe rheumatic pains, and sometimes with a palsy 
 of the arms and hands." Sydenham, too, speaking of the 
 Colica Pictonum, says, " this is a sort of colic, which is 
 wont to degenerate into palsy," and *' is extremely common 
 in the West Indies, where it destroys many persons." 
 
 To what extent this lead-colic prevailed in other parts of 
 England to which the cyder was sent, we do not know j 
 but it was certainly largely consumed by " scorbutical 
 sailors," of whom Huxham saw a great many cured by 
 apples and cyder alone, and knew the cyder to prove very 
 salutary to sailors voyaging to the East or West Indies. 
 In his short essay on " A Method for preserving the Health 
 of Seamen in long Cruises and Voyages," he prescribed at 
 least a pint a day of " sound, generous cyder " for every 
 sailor. This advice from so eminent a physician, practising 
 in a great seaport in Devonshire, must, I fear, have often 
 caused the colic while it cured the scurvy. 
 
 I have said enough to show that Sir George Baker 
 would have rendered excellent service if his discovery had 
 benefited only the people of his own county, and the 
 sailors resorting to its ports. But when we reflect how 
 often lead found its way, intentionally or by accident, into 
 other liquids in common use — into drinking water, wine, 
 and spirits — and in how many other ways it gains access
 
 Reqiurements of the i^lk Centitry. 139 
 
 to the system, we can scarcely appreciate too highly the 
 services of the scientific physician, who, while riveting the 
 attention for a time on one notable form of lead poisoning, 
 warns us of the clanger we incur from it in so many other 
 ways. It is a great feat to have detected and disarmed 
 so subtle a foe to health and life — the cause of pain, palsy,, 
 epilepsy, and coma. 
 
 I may here mention the fact that, in i 755, a few years 
 before Baker wrote about the lead coHc, an anonymous 
 writer called the attention of the public to the danger 
 arising from the extensive use then made of copper and 
 brass vessels in washing, brewing, cooking, and preserving, 
 as well as the bad custom of *' the good housewife," who 
 would use copper to colour her pickles. 
 
 Before I proceed to speak of the scurvy, let me remind 
 you of the peculiar character and exigencies of the 
 eighteenth century, of the prevalent and fatal diseases of 
 which I am treating. It was, emphatically, a century of war- 
 like struggles by land and sea, of national aggrandizement, 
 of wonderful energy and activity directed outwards. We 
 had, it is true, rebellions in England, Scotland, and Ireland j 
 but our great work lay beyond our own limits. We had to 
 fight with France, Spain, Holland, and America j and to es- 
 tablish and maintain an empire in India 3 and as the seven- 
 teenth century left us a legacy of war, the nineteenth saw 
 us in the midst of one of the greatest struggles that history 
 records. Taking the whole century into account, war was 
 the rule, peace the rare and short exception. Battles and 
 sieges, captured countries and islands, strong military posi- 
 tions taken and held, hostile fleets encountered and defeated, 
 disasters suffered and retrieved, crowd the canvas. We 
 lost our great American colony, and won an Indian 
 empire. For these gigantic struggles two things at least 
 were needed — money and men. Money we might get in 
 part by borrowing, and of that resource we largely availed
 
 140 The Scurvy . 
 
 ourselves j but men must be forthcoming as they were 
 needed, and they must be mainly the growth of our own 
 soil. Now our English population, at the beginning of 
 the century, little exceeded six miUion souls, and a liberal 
 estimate for Scotland and Ireland would raise it to nine j 
 and out of this nine miUion, and its increase from year to 
 year, the men necessary to supply the cruel waste of war 
 by land and sea had to be taken. And yet, at the end of 
 the centur}', we were richer in men than at the beginning 
 of it. The six millions had grown to nine, and the inexo- 
 rable demands of war had been supplied. If I am asked 
 how this came to pass, I answer in three ways — by tlie 
 simple growth of population, by savings effected in the 
 lives of infants and young children, and by like savings 
 among our adult population, but especially soldiers and 
 sailors. Of the second I spoke in my last Lecture 3 of the 
 third I shall have much to say in what remains of the 
 course : of scurvy and the jail- distemper, in reference to the 
 wars of the eighteenth century, and of small-pox as bear- 
 ing on the early struggles of the nineteenth. 
 
 Of the many maladies known to medical men, scurvy 
 is the one respecting which oar knowledge is most com- 
 plete and satisfactory. We recognise it with ease ; wc 
 understand its nature, we are in no doubt as to its cause ■. 
 we have full knowledge of the diseases with which it 
 associates 3 we know by what atmospheric and other con- 
 ditions it may be promoted, and we have learnt both how 
 to prevent it and how to cure it. We recognise it by the 
 mulberry coloured spots, or blotches, on the extremities, 
 on the trunk, on any and every part of the surface of the 
 body 3 by the dark, swollen, and spongy gums 3 by the 
 bleeding condition of the whole frame ; not of one part, 
 but of all. Its nature, or essential character, then, is the 
 escape of blood from the vessels which in health hold and 
 contain it. Its o.ssociaie diseases are foul ulcers, dysenteries.
 
 The Potato. 141 
 
 and fevers. The conditions wliich promote it are cold and 
 damp, insufficient clothing, foul air, tainted water, over 
 fatigue and exposure, mental listlessness and depression. 
 Its true cause is a diet from which vegetables and fruits 
 have been excluded. Its prevention and its cure alike 
 consist in their supply or restoration. All this was known 
 long ago 3 and I have already stated that, as early as 
 1617, Woodall extolled the virtues of lemon-juice. But 
 in recent times we have been able to give to our know- 
 ledge both of cause and cure greater precision. We have 
 had experience of paupers and prisoners whose dietary 
 contained but one vegetable element — the potato — who 
 became scorbutic when that was struck off^ and reffained 
 their health when it was restored. And I state it as the 
 uniform result of my own experience and study of prison 
 returns, that whenever the potato has been withdrawn by 
 the authorities or refused by the individual, scurvy has- 
 been the result. This important fact, then, may be added 
 in when we sum up the benefits conferred upon us by the 
 culture of the potato. Dr. Paris enumerates among its 
 products '^ cottony flax," sugar, vinegar or spirit, a substi- 
 tute for soap in bleaching, a most wholesome, nutritious, 
 and economical vegetable, a starch no way inferior to 
 Indian arrow-root ; and a valuable anodyne extract. To 
 this catalogue I may add the well-known fact that potato- 
 flour is deemed a necessary constituent of all fermented 
 bread. But Dr. Paris saw in the potato a great political 
 agent. He thought that it raised the population of Ireland 
 from one million to seven millions in a century and a 
 half. The potato famine had not then occurred to teach 
 us that even such a boon as the potato was, and is, cannot 
 be divested of a possible penalty. If Paris was right in 
 ascribing the teeming population of Ireland to the culture 
 of the potato, we cannot be wrong in ascribing this 
 increase in part to its anti-scorbutic properties, by which
 
 143 Symiptoms of the Scurvy. 
 
 scurvy and its allied diseases must have been largely pre- 
 vented J and the same must be true, in its degree, of the 
 inhabitants of England and Scotland. There is a sense, 
 then, in which we may be said to have fought our battles 
 with the potato. Perhaps Louis XV. of France had some 
 suspicion of this its prolific virtue, when he wore a 
 bunch of its flowers among his courtiers on a festive 
 occasion J and so brought fashion to bear with effect 
 where philosophy for more than two centuries had 
 utterly failed. 
 
 Let us now look at this disease, scurvy, a little more 
 closely. In the first place, let us guard against vulgar 
 errors and misconceptions. Let it be well understood that 
 scurv}"- is not a scurf or scab on the outer skin, nor a 
 blush which the pressure of a finger will remove, nor a 
 collection of red or white swellings like the nettle-rash, 
 nor a something limited to the head or to some other part 
 of the body ; but a collection of round spots or irregular 
 stains, for which it is hard to find a better name than the 
 old one of the London Bills, " the Purplesy These spots, 
 or blotches, consist of dark blood poured out beneath the 
 skin. This may be the only outward sign of the disease. 
 But in severe cases the blood escapes into the very flesh 
 of the limbs, making them stiff and painful 3 and the 
 vessels are so weak that the slightest touch breaks them, 
 and gives rise to every appearance of a bruise. The 
 gums become dark, swollen, and spongy j the teeth get loose 
 and fall out of their sockets ; the breath grows v^ery offen- 
 sive J and blood pours from the mouth, nostrils, and eyes, 
 and from every outlet of the body. At length the gums 
 and the skin become the seats of foul ulcers, old wounds 
 break out afresh, fractured bones long since repaired, are 
 disunited ; and the poor sufferer, in full possession of con- 
 sciousness, is reduced to such extremity of weakness that 
 he will faint on the slightest exertion or least change of
 
 A Land and a Sea SciLrvy. 143 
 
 posture, and fall down dead as he is being carried on 
 deck, within sight of the land to which, with its fresh air, 
 fresh meat, fresh vegetables and fruit, he had been looking 
 forward as his certain and speedy cure. To give a per- 
 fect idea of the disease, we should have to add the drop- 
 sical affections which mix with, or take the place of, the 
 out-pourings of blood 3 we must recognise with worthy- 
 John Woodall, the " poor miserable man, coming on land 
 from a long voyage," " at the point of death," '' swollen 
 to an exceeding greatness 5 sometimes not able to lift a 
 \q^ over a straw," nor scarce to breathe, by reason of 
 " strong obstruction." We should also have to note the 
 association of scurvy with fever and dysentery 3 the spots 
 of the spotted fever joined to the purples in the London 
 Bills, and the smaller spots of the petechial fevers, being 
 in a sense the manifestations of the scurvy, just as the 
 dysentery, when it constituted the ''bloody jiux'' of the 
 bills, owed its discharges of blood to the same cause. In 
 a word, the defective diet of our London ancestry did 
 doubtless bring about a scorbutic state which played a pro- 
 minent part in more than one of their diseases. There 
 is still another feature of the scurvy well worth noting. 
 It was a disease especially liable to be aggravated by 
 injudicious treatment. Thus Kramer, as cited by Sir 
 Gilbert Blane (he was physician to the Imperial armies 
 in Hungary from 1720 to 1730) "relates that of 400 men 
 labouring under genuine scurvy, treated by one of the 
 medical officers with mercury, so as to excite salivation, 
 in conformity to the doctrines of his master, Boerhaave, 
 not one survived." 
 
 Now this terrible disease is sometimes looked upon as 
 a sailor's malady j but this is an error. It is a disease of 
 the land as well as the sea ; not the product of sea air or 
 salt provisions. Nor were the diseases associated with it, 
 as scourges of our fleets, peculiar to the sea. The foul
 
 7 44 The Sairvy on Land. 
 
 ulcers, dysentery, and fevers, like the scurvy itself, were 
 all common among landsmen similarly circumstanced 
 in respect of food, clothing, cleanliness, and ventilation. 
 The scurvy was especially a disease of seamen, because, 
 while they shared with soldiers, paupers, prisoners, nuns 
 and monks, and the garrisons and inhabitants of beseiged 
 cities, the evils of overcrowding, impure air, defective 
 means of cleanliness, and scanty and tainted supplies of 
 water, they were more frequently and constantly than 
 landsmen exposed to the action of the true cause, an in- 
 nutritious and otherwise defective dietary. I shall there- 
 fore treat of scurvy, first as a disease of landsmen, then as 
 it affects the sailor. 
 
 Now the scurvy, though it may occur in warm climates 
 is, as a rule, a disease of cold and temperate ones. It is 
 common among the northern nations of the European 
 continent, where the diet is very apt to fall short in vege- 
 table elements, and it is accordingly endemic in Iceland, 
 Greenland, Cronstadt, and the northern parts of Russia. 
 Occasionally it has devastated whole kingdoms, as Bra- 
 bant in the year 1556, and Holland in 1562. It has, 
 doubtless, shown itself as a companion or consequence of 
 famines and scarcities everywhere, especially in cold, 
 damp seasons ; and, in the very nature of things, must 
 have afflicted all nations at that stage of their progress 
 from barbarism to civilization, when gardening and hor- 
 ticulture were little practised, and commerce was in its 
 infancy. In the London Bills, scurvy always found a 
 place as a cause of death, and I think that it is easy to 
 recognise it under the name of ''the purples" (associated 
 with spotted fever prior to 1701, but from that date to 
 J 728, heading a column of its own). In one year I find 
 scurvy set down as the cause of 105 deaths; in another 
 year " the purples " are credited with 56 ; and the 
 diseases so commonly associated with scurvy (I mean
 
 The SciLi'vy at Quebec. 145 
 
 •dysentery and sores and ulcers) are conspicuous causes of 
 •death. The worst form of dysentery, " bloody flux," 
 caused in one year no less than 833 deaths; and sores and 
 ulcers in another, 109. The ^' bloody Jiux'' disappears 
 towards the end of the eighteenth century, being re- 
 placed by simple flux, and it may be said of all the 
 diseases I have just mentioned, that they disappeared from 
 the Bills, or underwent great diminution with the march 
 of time. 
 
 But, as I have said, scurvy is not exclusively a disease 
 of cold or temperate climates : for it occurred in the 
 residency at Lucknow, and it attacked the gold miners 
 of California on the overland journey and at the mines, 
 when the thermometer, in the shade, stood above 100°. 
 But these men, as Dr. Ober tells us, were working hard 
 on a diet of fried bacon or fat pork, with wheaten cakes 
 fried in fat, washed down by brandy or whisky, and 
 copious draughts of strong coffee. 
 
 Nevertheless it is in cold and temperate climates chiefly 
 that the scurvy has appeared in its worst forms j in 
 besieged towns, such as Thorn, Breda, Rochelle, and 
 Stettin, in Gibraltar in 1780, at Kars and Sebastopol in our 
 own times, and in Canadian garrisons. Lind tells us that, 
 during the winter of 1 756, the English garrison at Oswego 
 was so afflicted with scurvy, that among 700 men they 
 often could not muster 80 fit for duty — a number scarcely 
 sufficient to protect them from the Indians, and that 200 
 of the 700 died of the disease. 
 
 Again, in the winter of 1759, ^^^^ scurvy broke out 
 among the garrison of Quebec ; and these are the terms 
 in which General Murray, the officer in command, speaks 
 of the calamity : — " The excessive coldness of the climate, 
 and constant living on salt provisions, without any vege- 
 tables, introduced the scurvy among the troops, which, 
 getting the better of every precaution of the officer, and
 
 146 The Epidemic at Millbank. 
 
 every remedy of the surgeon, became as universal as it was 
 inveterate J insomuch that, before the end of April, a 
 thousand were dead, and above two thousand of what 
 remained totally unfit for any service." 
 
 Sir Gilbert Blane cites Piiny and Tacitus as recording 
 the outbreak of scurvy in tlie Roman armies. 
 
 Thus did the scur\y do its work of destruction among 
 our soldiers. We shall presently see what havoc it wrought 
 among our sailors. 
 
 But I must first give you some account of an out- 
 break of scurvy that took place in the Millbank Peniten- 
 tiary in 1822, though this history properly belongs to the 
 first quarter of the nineteenth century. 
 
 The prison was built on the Thames, on a piece of 
 made ground, saturated with water, and surrounded by 
 a tidal ditch. The river, a little higher up, received 
 two of the largest of its foul tributaries, took in their 
 waters at high tide, and, thus polluted, filled the ditch 
 and soaked the soil. This water, improved by filtration, 
 the prisoners drank. The building was opened for the 
 reception of prisoners in i8i6. Six years later, tlie epi- 
 demic which I am about to describe, occurred 3 but, in 
 the two years and eight months preceding it, 1 1 cases of 
 diarrhoea and dysentery, severe enough to be entered in 
 the monthly sick reports, took place 3 and of these 6 were 
 fatal. The tenants of this damp, foul spot, became, in 
 the years 1822-23, the involuntary subjects of the follow- 
 ing disastrous experiment : — 
 
 Dr. Hutchinson, then medical superintendent, obser\^ing 
 that the prisoners were not merely in high health, but even 
 plethoric, deemed the diet excessive, counselled a reduc- 
 tion, and submitted a reduced scale to the committee. 
 But they foolishly preferred a dietary of their own, which 
 came into operation early in July, 1822. It reduced 
 the solid food from 304 to 168 ounces per week 3 it also
 
 Dysentery, Fever, and Nervo2LS Disorder. 147 
 
 lowered the meat element to i o ounces per week con- 
 tained in the soup j and it struck off the potato element 
 altogether. Now I infer, from a careful comparison of 
 this with other dietaries, both of prisoners and paupers^ 
 that this reduction in quantity, and in the meat element, 
 was not adequate to the production of the epidemic that 
 followed, even if we take into account the unhealthy site, 
 the objectionable water supply, the cold winter that fol- 
 lowed, and the low temperature of the prison cells at 
 night. I believe that I am justified in ascribing the sick- 
 ness that so soon followed the reduction, to the entire 
 omission of the potato. Let us now look at the conse- 
 quences. The new dietary came into use, as I have said, 
 early in July, 18225 i" the autumn following, the 
 prisoners grew feeble and languid, and a few slight cases 
 of scurvy showed themselves j but in the months of 
 February and March, 1823, scurvy, associated with diar- 
 rhoea and dysentery, became so prevalent that more than 
 half the prisoners were attacked, and by April 5th, 
 6 died of dysentery. All these diseases were cured by a 
 reformed diet, and medical treatment 5 but the diarrhof;a 
 and dysentery reappeared with great severity in the 
 summer and autumn of 1823, in company with fever and 
 nervous affections, so that the prison had to be closed for 
 several months, and the prisoners to be removed. The 
 severe nervous and mental maladies to which I have 
 referred add a feature of peculiar interest to Dr. 
 Latham's admirable account of the epidemic. The 
 subject, in all its fulness and completeness, belong.^, 
 as I have said, to the sanitary history of the first quarter 
 of the nineteenth century. I treat it now as part of the 
 history of land scurvy j and as an illustration, supported by 
 many analogous occurrences, of the immense value of the 
 potato as an element of all dietaries from which other 
 vegetables, as well as fruits, are shut out. This simple 
 L 2
 
 148 OiLr Ships a Century ago. 
 
 dietetic principle requires to be specially borne in mind 
 in these days, when large establishments for the custody 
 and care of paupers, prisoners, lunatics, aged persons, 
 children at school, soldiers and sailors, and sick people, are 
 so rapidly on the increase. 
 
 I now proceed to treat of scurvy as it shows itself at 
 sea, and among sailors. 
 
 About a century ago, a vessel of war might seem to 
 have been equipped and provisioned with a view to the 
 production of the greatest possible amount of disease in 
 the shortest possible space of time. Beef badly salted, 
 and often so rotten that, before boiling it, it was necessar}^ 
 *' to tie it round with cords ;" biscuits mouldy and full of 
 " weevels or maggots j" and puddings of salt, suet, and 
 flour, made up the dietary. The water was often so 
 thick and green from decomposition and vegetable 
 growth, and so offensive withal, as to disgust sight, smell, 
 and taste. The ship was damp, filthy, and ill-ventilated, 
 and the air of the wells so foul as often to produce fatal 
 asphyxia. Personal cleanliness was neglected j the cloth- 
 ing was insufficient, and the bedding too, the men having 
 to turn in between blankets unwashed perhaps for a 
 year ; little effort was made to amuse the mind, and none 
 to instruct it ; the sailor's only luxury an exorbitant 
 allowance of spirituous liquors, at sea, as on land, the 
 fruitful source of disease, misery, insubordination, and 
 crime. Add to all these privations and discomforts a dis- 
 cipline not merely strict but severe, and punishment often 
 inflicted at the instigation of momentary passion, and we 
 have a lively and faithful picture of the naval service at 
 the period to which I refer. This state of things was 
 subject to slow and interrupted improvements 3 but Dr. 
 Fletcher, a naval surgeon, writing in 1786, not only con- 
 firms the sketch I have given in every particular, but adds 
 to it some serious aggravations. When these foes of
 
 Ravages of the Scurvy. 149 
 
 health were doing their work, and scurvy, dysentery, and 
 fever were reinforcing the enemy, we might suppose 
 that power would be given to the captain or surgeon to 
 procure a supply of the known remedies. But alas I 
 red tape was as active and efficient in those days as we 
 knew it to be in the Crimean War. Take this case, 
 on Dr. Fletcher's authority, as an illustration : — " When 
 his Majesty's ship the Roebuck, with some others, under 
 the command of Sir Andrew Hammond, refitted at 
 Antigua, there were a number of men attacked with 
 yellow fever, &c.," *^sent to hospital." The doctor "was 
 surprised to find that the sick were not liberally supplied 
 with fruit, especially as oranges were plentiful and very 
 cheap." But they were not given because " Government 
 might possibly think such expense too great." He, there- 
 fore, expended half a dollar a day on oranges for some 
 thirty of the Roeluck's crew, with the happy result of 
 quicker recoveries and fewer deaths than happened among 
 the sick from the other ships. And this was no isolated 
 occurrence 3 for the same authority tells us that a fleet 
 might be stationed three years in the East, without the 
 men being ever able to come at the fruits of the 
 country ; a state of things which he justly compares to 
 the strange practice of the ancients in prohibiting all kinds 
 of drink to patients in ardent fevers. 
 
 The consequences of the state of things I have been 
 describing were, as you may suppose, eminently disastrous. 
 Scurvy, putrid ulcer, malignant dysenter}^, and fever 
 allied to that of jails (indeed, often directly imported 
 from them, as testified by Howard and others) suddenly 
 swept off the greater part of many ships' crews, and well 
 nigh depopulated whole fleets. Scurvy alone, without 
 any aid from the other diseases I have just named, has 
 sufficed to place a well-manned vessel at the mercy of the 
 winds and waves. Witness Anson's own ship, the
 
 150 Warlike Miscarriages. 
 
 CenturioTiy in i 742 ; when the crew were so weakened by 
 it that had the ship been compelled to keep the sea a very 
 few days longer, it could not have been brought to an anchor 
 at Juan Fernandez, but must have gone adrift in the 
 Pacific, the survivors perishing miserably, as once 
 happened to a Spanish ship under the like circumstances ; 
 or take the figures that express the mortality in Anson's 
 fleet : — out of 961 men, 626 deaths in nine months, or very 
 nearly 2 out of 3 ! And this was no rare or exceptional 
 occurrence, for such things had happened in earlier and 
 did happen in later times. Thus Sir Richard Hawkins, 
 the great navigator of the age of Elizabeth and her suc- 
 cessor, said that, in the course of twenty years he "had 
 known of 10,000 seamen having perished by scurvy 
 alone." Even so late as 1780, Sir Gilbert Blane found 
 that a fleet manned with between 70C0 and 8000 
 seamen, had in one year lost one in every seven. Fortu- 
 nately for us, this high mortality was not limited to our 
 own ships ; a Portuguese historian, cited by Sir Gilbert 
 Blane, speaking of the favourable case of an exploring 
 expedition, says that " if the dead who had been thrown 
 overboard between the coast of Guinea and the Cape of 
 Good Hope, and between that Cape and Mozambique, 
 could have had tomb-stones placed for them, each on the 
 spot where he sank, the whole way would have appeared 
 one continued cemetery." 
 
 The disastrous consequences of this excessive sickness 
 and mortality in time of war may be readily imagined, 
 but it may be well to give a few illustrations : — 
 
 I. Sir Francis Wheeler's expedition to the West Indies 
 and North America, in 1693, consisting of two ships of the 
 line and six frigates, miscarried in the attack on Marti- 
 nique, through the force being weakened by diseases 3 and 
 in his return voyage his crews were so reduced by deaths
 
 IlltLstrative Cases. 151 
 
 from scurvy and fever that there were hardly hands enough 
 to bring the ships to anchor. 
 
 2. Admiral Hosier, employed with seven ships of the 
 line in the year 1726, to protect the trade of the West 
 Indies, buried his ships' companies twice over, and in 
 place of quelling and coercing the Spaniards, was defied 
 and insulted by them, and died of a broken heart. 
 
 3. To this excessive sickness and mortality Sir Gilbert 
 attributes the failure of our arms in six general engage- 
 ments of the Seven Years' War, and the American War, 
 every one of which was a drawn battle, through deficiency 
 of hands and want of strength in those who fought, due 
 to excessive sickness and mortality. 
 
 It was to facts such as these that Thomson alludes 
 when he speaks of the diseases that 
 
 "at Carthagena quenched 
 The British fire." 
 
 and pictures the " gallant Vernon" looking on "pitying" 
 but helpless, at the terrible ravages of disease and death. 
 
 And yet, even in those times, when other sanitary 
 measures must have been either neglected or imperfectly 
 carried out, there were not wanting striking examples of 
 single ships and whole fleets maintained in perfect health and 
 complete efficiency by fresh meat, vegetables, and fruit, or 
 by strictly observing some dietetic precaution. I will give 
 you one or two cases: — 
 
 I. Fletcher tells us that he had been in a Channel 
 cruiser when the water for above a week was more foetid 
 than the very worst bilge-water, so that the men were 
 *' obliged to suppress their sense of smeUing" when they 
 used it J and yet their health was never better. They had 
 fresh meat and vegetables. And he adds that when the 
 Swallow was up the Ganges, and her water was taken in
 
 D^ 
 
 Scurvy Prevented. 
 
 under the most unfavourable circumstances, no complaint 
 ensued^ " most assuredly owing to their supply of tea and 
 fresh meat." What these unfavourable circumstances were, 
 we learn from another passage, where he tells us that his 
 ship was ordered three times up the Ganges in the very 
 worst seasons j when the thermometer stood at 89°, when 
 an exposure for a few minutes upon deck wetted them to 
 the skin, when the dead bodies floated on the stream in 
 such numbers that it was difficult to make a passage 
 among them 3 and yet, on all these occasions, they left 
 the river without losing a man j a result which Fletcher 
 attributed solely to the tea and sugar which the men, taught 
 by experience, bought each time they entered the river. 
 
 2. The same author gives us an instance on a larger 
 scale, showing the preservative virtue of fresh provisions. 
 It relates to the victory of Admiral Hawke, in 1747. 
 14,000 men, in 20 ships of the line and 12 frigates, had 
 been pent up in their ships for six or seven months in the 
 Bay of Biscay and on the coast of France j and yet, on the 
 day of the tight there were not 20 sick sailors in the whole 
 fleet J in the Royal George and in the Union, of 770 men, 
 only I man unfit for duty ; and on board the Mars,. 
 of 64 guns, not a sick person. " This most extraordinary 
 degree of health is entirely attributed to the fleet having 
 been well supplied w^ith fresh meat and greens 3" and he 
 adds that, when the victualling transports were detained 
 by contrary winds, and the supplies cut off^, they became 
 very sickly. 
 
 These are cases of scurvy prevented : here are instances 
 of scurvy cured ; the first on the authority of Dr. Mead : — 
 When Sir Charles Wager commanded the Baltic fleet, his 
 sailors were terribly afflicted with the scurvy. But fortu- 
 nately, he had taken in at Leghorn a quantity of lemons 
 and oranges, and recollecting that he had often heard how 
 effectual they were in the cure of the scurvy, he caused a
 
 Scurvy Citrcd. 153. 
 
 chest of each (o be opened every day. The men ate the 
 fruit, mixed the juice with their beer, and reached home 
 in good health. 
 
 Mr. Murray, a naval surgeon of large experience on 
 board ship and in hospital, quoted by Lind, after speak- 
 ing in high commendation of oranges and lemons as an 
 infallible cure in every stage and species of the disease, if 
 there was any natural strength left, and no flux, says 
 that at the Danish island of St. Thomas 120 patients, in all 
 the different stages of this distemper, were cured in little 
 more than 1 2 days by limes alone, little or no other 
 refreshments being obtainable. 
 
 Lind gives us another instructive history, which I will 
 present to you in a condensed form : — In the East India 
 Company's first voyage, four ships were under the 
 command of Captain James Lancaster. His ship had 
 a crew of 202 men ; the three others, among them, 222. 
 They left England about the i8th of April, and in July 
 the scurvy broke out. " By the ist of August all the ships, 
 except the captain's, were so thin of men, that they had 
 scarce enough to hand the sails j and, upon having a con- 
 trary wind for 15 or 16 days, the few who were well 
 before began also to fall sick j" so *^ that the merchants 
 who were sent " with " their caroroes," " were obligfed to 
 take their turn at the helm, and do the sailors' duty, till 
 they arrived at Saldania," where the crews of the three 
 ships were in such a condition that they could hardly let 
 fall an anchor, nor hoist out their boats, without the assis- 
 tance of the captain's crew. And " the reason why his 
 crew was in better health than the rest of the ships, was 
 that, having brought some bottles of lemon-juice to sea, 
 he gave to each sailor, as long as it lasted, three spoonfuls 
 every morning fasting. " By this he cured many of his 
 men, and preserved the rest." 
 
 Having, in my last lecture, spoken of the efforts of
 
 154 Ausons Expedition. 
 
 Sutton and others to introduce fresh air into our ships, I must 
 not omit to cite a fact which I lind in Fletcher's work : — 
 The ships of the line. Prudent and Intrepid, sailed from 
 England for the East Indies at the same time, and under 
 apparently similar circumstances. " The Prudent, how- 
 ever, lost three times as many men as the Intrepid : 
 this at first seemed matter of surprise, till at length it was 
 resolved into its proper cause. The Intrepid had scuttles 
 cut between-decks, and the Prudent none, by which a 
 free circulation of air was maintained in the Intrepid, 
 when the lower deck-ports could not be kept open upon 
 account of bad weather." 
 
 The account I have given you of the scurvy, and the 
 cases I have cited, will have prepared you to appreciate the 
 history of the expedition of Anson, in 1 740, so often 
 brought into comparison with Captain Cook's first voyage, 
 in 1772. I have made a minute and careful analysis of the 
 facts of Anson's expedition as given by Richard Walter, 
 chaplain to the Centurion ; with the result, I am sorry to 
 say, of destroymg another delusion, and compelling a 
 material modification of the views which, in common with 
 Sir John Pringle, Sir Gilbert Blane, and other good sani- 
 tary reformers, I had been led to entertain. 
 
 On the 1 8th of September, 1740, Anson set sail from 
 St. Helen's 5 and, on the 15th of June, 1744, anchored at 
 Spithead, having been absent from England three years 
 and nine months. He left with six vessels of war, and two 
 victuallers, and came back with his spoils, and a reputation 
 richly earned, but with a single ship — his own Centurion. 
 Our interest centres in three of these six ships — the Cen- 
 turion, the Gloucester, and the Tryal, and the 961 men who 
 formed their united crews. Such crews, we may hope, were 
 never, before or since, brought together to tempt Providence 
 and tr}^ the metal of a gallant commander. Of the seamen 
 some were drafted direct from hospital and sick quarters.
 
 CalcfitiLvcs. ' 155 
 
 The land forces were men mostly sixty years old, some up- 
 wards of seventy, the worst half of a batch of invalids, of 
 whom the younger and more active had deserted. In lieu 
 of the deserters, Anson was furnished with 2 10 " raw and 
 undisciplined " marines, with *' scarcely more of the 
 soldier than the regimentals." Some of these, too, had 
 been lately discharged from hospital. I gather from facts 
 stated in the narrative that Anson's own ship, the CejiturioJi, 
 left England with a crew of 506 men ; of whom 79 were 
 raw marines, and ^o aged invalids ; and I infer that the 
 other crews were made up much in the same way. With 
 crews composed in part of this ''aged and diseased detach- 
 ment," "crazy and infirm," ''decrepit and miserable j" in 
 part of raw undisciplined marines, did Anson start on his 
 perilous expedition, at the worst possible season of the 
 year, his ships so deeply laden as to oifer a serious impedi- 
 ment to ventilation ; and with the knowledge that a 
 Spanish fleet of greatly superior force was on the look-out 
 for him. 
 
 Now the part of the expedition in which we are inte- 
 rested may be divided into four sea voyages and three 
 sojourns on land : a run to Madeira, occupying 37 days; 
 thence to St. Catherine's, 47 days ; thence to St. Julian's, 
 30 days ; and from St. Julian's to Juan Fernadez, 105 days 
 — in all, 219 days at sea. Nine days at Madeira, 29 at 
 St. Catherine's, and 10 at St. Julian's, make up a total 
 of 48 days on land. From England to Juan Fernandez 
 the time was 267 days, or somewhat less than 9 months. 
 I will state what took place during this 9 months as 
 briefly as I can. 
 
 The run to Madeira occupied 37 days, instead of the 
 usual lo or 123 and the crews sufl'ered from the fevers 
 then known as Calentures. The Centurion lost two 
 men. The ventilation being recognised as inadequate, 
 6 air-scuttles were ordered to be made in each ship, and a
 
 6 Deaths on Board the Centurion. 
 
 supply of water, wine, and other refreshments was laid 
 in. The 47 days' run to St. Catherine's produced a 
 serious sick-list -. 80 men were landed sick from the 
 Centurion, of whom 28 died; and yet by the time they 
 left the island, the 80 had become 96. These were em- 
 barked, and in 30 days they reached Port St. Julian, which 
 place, after a stay of 10 days, tliey left in good spirits, and, 
 as I gather, in good health. It was the 1 05 days spent 
 between St. Julian and Juan Fernandez, amid storms, 
 cold, frost, and deluges of water, under unparalleled expo- 
 sure, fatigue, and privation, that occasioned the greater 
 part of the sickness and mortality of which I am pre- 
 sently to give the summary. In about 10 days after leav- 
 ing St. Julian the scurvy began to show itself, and in less 
 than two months it had spread to such a degree that there 
 were few on board free from it. Soon after, we read of 
 42 dying on board the Centurion, then in the month fol- 
 lowing, double the number, and by the time the ship 
 arrived at Juan Fernandez there had been a loss of up- 
 wards of 200 men, and they could not '* muster more 
 than six foremast men in a watch capable of duty," and 
 even some of these were lame and unable to go aloft. I 
 must not detain you with further details of the sickness 
 and death on board the Centurion, or with the adventures 
 of the Gloucester and Tryal. Suffice it to say that, in the 
 short space of less than nine months, the time spent 
 between England and Juan Fernandez, the crews of the 
 three ships had lost 626 out of 961. Or, if we limit our- 
 selves to the Centurion and its crew, concerning which we 
 have the most exact information, it appears that, in less 
 than 9 months, her 506 men were reduced to 214, her 50 
 invahds to 4, and her 79 marines to 1 1. Of this frightful 
 mortality, by far tlie greater part occurred in the stormy 
 and ever}^ way inclement weather, encountered in round- 
 ing Cape Horn, in the two months and a half that elapsed
 
 Renewed A ttack of SciLvzy. 157 
 
 between leaving Port St. Julian and arriving at Juan 
 Fernandez. 
 
 It belongs to this sanitary history to state that at 
 Madeira, St. Catherine's, St. Julian, and Juan Fernandez, 
 the foul ships were refitted, cleansed, and purified, and 
 that no sanitary precaution seems to have been neglected. 
 
 Nor were these measures ineffectual, for we are told 
 that for some time after leaving Juan Fernandez, the crews 
 had "enjoyed a most uninterrupted state of health." 
 But on leaving the coast of Mexico, the scurvy again 
 began to show itself, and this time it was not possible to 
 attribute it to the stormy and inclement weather, though 
 that which they soon had to encounter doubtless added 
 much to their sickness and mortality. At this time the 
 crew of the Gloucester was reduced to 77 men and 18 
 boys, of which number only 16 men and 11 boys were 
 able to keep the deck, and of these several were infirm. 
 This ship had to be burnt, and her crew transferred to the 
 Centurion. There were 70 sick among them, of whom 
 '* 3 or 4 " died as they were being hoisted on board. And 
 soon we find that the deaths of the consolidated crews 
 were "extremely alarming," that no day passed that they 
 did not bury 8, 10, or 12, and that "those who had 
 hitherto continued healthy, began to fall down apace." 
 When they were able to land on the island of Tinian, 
 they put on shore 128 sick, many of whom were carried 
 on the backs of the Commodore and his ofiicers. On 
 that and the previous day, they buried 2 1 men, and i o 
 more soon after. Anson himself, as we learn, did not 
 escape the scurvy. 
 
 This new attack of scur\'y occurred under circum- 
 stances so different from the first as to puzzle the surgeon 
 and the chaplain. They had fresh provisions in the 
 shape of hogs and fowls, they caught fish in abundance, 
 they had an ample supply of fresh water j they kept all
 
 158 Fate of Pizarros Squadron. 
 
 their ports open, " and took uncommon pains in cleansing 
 and sweetening the ships." But no mention is made of 
 vegetables or fruits, and they owed their supply of Mater 
 to rains which must have kept the atmosphere moist, and 
 so far unfavourable to them. 
 
 The crews recovered their health at Tinian, and all 
 that now remains of this sanitar}^ histor)'. is the simple 
 statement that, when Anson came to muster the remnant 
 of the united crews of the Centurion, the Gloucester, and 
 the Tryal on board his own ship, prior to his attack on 
 the Manila galeon, he had in all only 227 hands, of whom 
 nearly 30 were boys, and 23 lascars and Dutchmen, 
 besides other recruits picked up here and there. So that, 
 out of the original 961 with which Anson left England, 
 the sur\-ivors probably fell very far short of 200. 
 
 Of the Spanish squadron of Pizarro, all that I have 
 time to say is, that while our men were dying of scurv)', 
 the Spaniards were perishing in large numbers of simple 
 star\ation 3 and that out of a fleet of six vessels, with 
 278 guns, 2700 men, and a regiment of soldiers, the 
 Admiral's vessel, the ^^ifl, alone sur^ ived, with a miserable 
 remnant of 100 men. 
 
 Need I add that all that part of this successful, though 
 disastrous, expedition which does not relate to sanitar}' 
 matters, constitutes a romance of real life which no 
 Englishman should omit to read. It atlbrds a curious 
 illustration throughout, of what skill, courage, and conduct 
 can do to meet and overcome gigantic difficulties ; and, at 
 the same time, it must be confessed, an example of the 
 truth of the proverb which asserts that brave men are 
 fortune's favourites. To pass through a hostile French 
 fleet in a dense fog, with his treasure and remnant of 
 brave men, was the crowning incident of an expedition 
 which had abounded in happy turns of fortune. 
 
 I prefaced this account of Anson's voyage by stating
 
 Captain Cook and the Royal Society. 1 59 
 
 that the close and careful study of it had led me to modify 
 the views which, following the lead of Pringle and Blane, 
 I had once adopted. I must now explain myself 3 and, in 
 order that I may do so, I must remind you of a few facts 
 relating to Cook's first voyage. He left England in 1772, 
 just 32 years after the date of Anson's departure, was 
 absent from England 3 years and 1 8 days, sailed round the 
 world, and returned with the loss of 3 men by accident, 
 and I by pulmonary consumption, out of a crew of 118. 
 This was undoubtedly a most happy and favourable result, 
 and we cannot be surprised that Captain Cook, being a 
 Fellow of the Royal Society, should wish to tell that 
 learned body how it had been brought about. This ac- 
 cordingly he did in a paper addressed to the Society, under 
 date March 5, 1776. This paper the Society honoured 
 with the Copley medal, and Sir John Pringle, the President^ 
 in presenting it (Captain Cook was then absent) pro- 
 nounced upon the author and his work a well-deserved 
 eulogium. In it he gave an excellent summary of Anson's 
 expedition, and did the commander the justice of pointing 
 out that the preparatory arrangements of the voyage were 
 not made by himself j that his ship was so deep in the 
 water that the ports could be opened only in the calmest 
 weather 5 and that he neglected nothing for preserving the 
 health of his men that was then known and practised in 
 the navy. But the other serious drawbacks I have pointed 
 out are not mentioned ; and the subject is so treated as 
 to have led Blane and others to use Anson's disastrous 
 failure as a standard of comparison by which to measure 
 Cook's admitted success. Now the sketch I have just 
 given of Anson's expedition, by showing you that the facts 
 were even worse than they are usually represented to be, 
 and by reducing the time within which the great destruc- 
 tion of life took place, does but serve to strengthen the case 
 as a sanitary lesson. But when all the facts are taken
 
 i5o Captains Mc Bride and Parry. 
 
 together — tlie fact that it was a warhke, not an exploring, 
 expedition j that tlie strange crews were forced upon him 
 instead of being chosen by him ; that his ships were so 
 built and fitted as to render ventilation most difficult j that 
 he was sent out without any special provision being made 
 for the health of his men at the very worst season of the 
 year j that he encountered, in rounding Cape Horn, the 
 ver}'- weather which compelled the greatest amount of 
 exertion and exposure, rendered ventilation for many days 
 together simply impossible, and by the union of cold and 
 moisture was eminently favourable to the production of 
 scuny 5 it must be obvious that we have here no fitting 
 standard of comparison by which to measure Cook's 
 merits and success. This being understood, we may give 
 him all the praise his care and vigilance deser\-e. But, as 
 this did not suffice wholly to prevent the scur\y, though 
 it never failed to cure it, it is easy to imagine how the 
 picture would have been reversed had Cook had to contend 
 with Anson's disadvantages and difficulties. Though I 
 have the most unfeigned admiration for Captain Cook, 
 and am unwilling to say a word in his disparagement, I 
 must observe that there were men before his time, as there 
 have been since, who deserve the credit of the same con- 
 scientious care, with the like happy results. As an instance 
 of the first kind, take Captain McBride in the Jason 
 frigate, supplied with malt as a preventive, and instructed 
 by his brother's writings, two years and more at the Falk- 
 land Islands, and losing only one man by apoplexy from 
 intoxication 5 and, as an example of the second order, the 
 exploring expedition of Captain Parry to the Polar seas. 
 The Tiiry and Hecla, *' with no resources but what they 
 carried with them," were absent from England 27 months, 
 and though both men and officers suffered from scurvy, re- 
 turned with a loss of only 3 men out of their united crews of 
 118 — the exact number of Cook's crew in the Resolution.
 
 Sanitary Reforms in the Navy, i6i 
 
 It was Captain Cook's unquestioned merit, then, that 
 gave him a foremost place among the promoters of sani- 
 tary measures in the navy 5 but it was his connexion with 
 the Royal Society, and the honour he received at its hands, 
 that caused his name to be associated with the Scurvy as 
 the man who, above all others, had illustrated the right 
 methods of preventing and curing it. To have conducted 
 an exploring expedition and 118 men round the world, 
 through every variety of climate, during more than three 
 years, with the loss of only one man by disease, was doubt- 
 less a great achievement, honourable to himself" and the 
 gallant service of which he was so distinguished an orna- 
 ment 5 of a piece with his philanthropic life,, in kee])ing 
 with his noble death. 
 
 Captain Cook's first voyage may be looked upon as 
 -one of those conspicuous illustrations of a great prin- 
 ciple which have more than once given a much needed 
 impulse to some great movement of reform. Such a 
 movement, tending towards the improvement in the health 
 of seamen was in progress through the greater part of the 
 eighteenth century 5 promoted at one time by some fear- 
 ful sacrifice of life, such as that which attended Anson's 
 -expedition, at another by some signal success in preserving 
 health, such as was Cook's first exploring voyage. The 
 work was slow and interrupted 3 the lessons of experience 
 were soon forgotten 5 the ruling powers were hard to move ; 
 ^nd ventilation soon fell into disuse, in spite of all that 
 had been done by DesaguHers, Hales, and Sutton. Lemon- 
 juice, though recommended by Woodall, and actually sup- 
 plied to merchant ships as early as 161 7, was not introduced 
 into our navy till 1796, prior to which date navy surgeons 
 had to supply medicines at their own cost. It was not 
 till 1781 that what were called slop-ships (which may be 
 briefly described as floating baths-and-wash-houses, and 
 •clothing establishments, by which recruits and pressed
 
 i62 Mil and j^tk Centuries compared. 
 
 men might be passed on into the senice in a decent and 
 healthy condition) — it was not till 1781 that these were 
 substituted for small tenders and receiving ships. It was 
 not till late in the century that improvements were made 
 in "the situation, htting, and furniture of the sick-lerthy 
 The separation of the sick from the sound, measures for 
 cleansing and dr}ang ships, the use of preser\ed meats, the 
 substitution of wine and tea for spirits, the employment 
 of quicklime for purifying the water taken on board, the 
 supplemental use of distilled water, the promotion of per- 
 sonal cleanliness by inspection at stated periods — these, and 
 other obvious sanitary ameliorations and precautions, 
 assisted by many improvements in the construction of 
 vessels (such as copper-sheathing, tirst introduced into our 
 nasy in 1 761), came gradually into operation 3 and with 
 vaccination, and the supply of lemon-juice, must have 
 greatly improved the health of our sailors by the end of 
 the eighteenth century. It is the period preceding the 
 end of the eighteenth centur}^ then, that we must bring 
 into comparison with the early years of the nineteenth, 
 when our ships were fully supplied with all the means and 
 appliances of health, if we would understand and appre- 
 ciate the value of sanitar}^ science. These are the facts as 
 given by Sir Gilbert Blane. 
 
 In 1779, 70,000 men were voted for the ser\'ice 
 of the navy 3 of these 28,592 w^ere sent sick to hos- 
 pital, and 1658 died. In 1813, out of just twice the 
 number (140,000), 13,071, were sent to hospital, and 977 
 died. In 1779, therefore, the sick were more than 2 in 
 every 3, and the deaths i in every 42 j while in 1813, 
 the sick were about 2 in 21, and the deaths i in 143, the 
 sickness reduced to a fourth, the deaths to little more than 
 a third ! 
 
 I will give you one other numerical statement. I 
 extract from one of Sir Gilbert Blane's tables all those
 
 Increased Efficiency of the Navy. 163 
 
 years in which the number of seamen and marines 
 voted by Parliament was the same, namely 120,0005 and 
 I give you the sick for those years. They form, as you 
 see, a descending series : — 20,544 in 1797, 15,713 in 1798, 
 14,608 in 1799, 8083 in 1805, 7662 in i8o(5. Or, take 
 a similar comparison where the numbers voted were in 
 each year 100,000 : the years 1782, 1795, and 1804. The 
 figures for the sick are 22,909, 20,579, 7650. 
 
 These figures speak for themselves 5 they are very elo- 
 quent. I will add, from the same authority, a statement 
 of a more general kind. The Channel fleet, in the year 
 1800, kept the sea for four months without one vessel 
 being in port, and brought back only 16 subjects for 
 hospital 3 while only twenty years before, the same fleet 
 was so overrun with scurvy and fever as to be unable to 
 keep the sea for ten weeks together. 
 
 Is it possible to imagine a more conclusive demonstra- 
 tion than these facts afford of the reality and importance 
 of the science and art of hygiene r If it be true, as it 
 undoubtedly is, that by improvements in diet, water- 
 supply, and ventilation 5 in clothing and cleanliness ; 
 aided by superior medical treatment, and especially by 
 vaccination 3 and by an improved discipline, tempered by 
 mental culture and amusement — if it be true that these 
 improvements and reforms have saved life and prevented 
 sickness to such an extent, that the eflfective force of 
 our navy has been more than doubled, that one ship, for 
 every purpose of navigation and warfare, is at least 
 equal to two of the same size and force, that a vessel can 
 now keep the sea for twice or thrice the time that was pos- 
 sible less than a century ago 3 if it be true that, at the old 
 rate of mortality, all Europe could not have furnished the 
 seamen necessary for our defence and safety during the 
 great revolutionary war : then is it a mere waste of word-s 
 to argue that health, which is the strength of all who 
 
 M 2
 
 164 Increased Efficiency of the Army. 
 
 work, is the great source of power to nations in their 
 peaceful labours, as in their warlike struggles. 
 
 I have devoted the greater part of this lecture to the 
 navy, because the facts connected with that branch of the 
 public service are more demonstrative of the efficacy of 
 measures of prevention in rooting out the Scurvy than any 
 which the records of the army afford. But you will 
 infer from what I have said of Scurvy as it shows itself 
 on land, especially in besieged places, that the knowledge 
 we have acquired by the study of the disease as it occurs 
 at sea has not been lost on those whose duty it was to 
 promote tlie health and efficiency of the army. 

 
 163 
 
 LECTURE VII. 
 
 THE JAIL-DISTEMPER, 
 
 This lecture will be, from beginning to end, a Romance 
 of History. I shall first give you some account of a 
 singular disease, fatal to individuals, disastrous to the 
 State, and believed to have been peculiar to the prisons 
 of England. I shall then lay before you a description of 
 the condition of our prisons a century ago, which, if it 
 were not strictly true, would be simply incredible. This 
 done, I shall tell you by whom and by what means that 
 state of things was reformed and amended ; and lastly, I 
 shall give a sketch of the life and acts of John 
 Howard, of which life and acts, as of the abuses he 
 reformed, it may be said that they too, if not true would 
 be incredible. 
 
 The jail-distemper, of which I am to treat in this lecture, 
 is a very ancient malady. Howard, on Stow's authority, 
 traces it as far back as the year 1414, when " the gaolers 
 of Newgate and Ludgate died, and prisoners in Newgate 
 to the number of sixty-four." Dr. Robert Williams, in 
 treating of the typhoid poison, cites a passage from Wood's 
 History and Antiquities of Oxford, to the effect that a 
 contagious fever " broke out at the assize of Cambridge, 
 when held in the castle there, in the time of Lent, 13 
 Henry VHI., 1521-1522. For the justices there, and all 
 the gentlemen, bailives, and others resorting thither, took 
 such an infection that many of them died, and almost all
 
 1 66 The Black Assize at Oxford. 
 
 that were present fell desperately sick, and narrowly 
 escaped with their lives." To these early notices it is 
 usual to add Lord Bacon's testimony that "The most per- 
 nicious infection, next to the plague, is the smell of the 
 jail, when prisoners have been long, and close, and 
 nastily kept j whereof we have had in our time experience 
 twice or thrice ; when both the judges that sat upon the 
 jail, and numbers of those that attended the business or 
 were present, sickened upon it, and died." 
 
 Next in order of time to the outbreaks of 141 4 and 
 1521 comes the notorious Black Assize at Oxford, in 1377. 
 I quote from Holinshed. At the assizes held the 4th, 
 5th, and 6th days of July, one Rowland Jenkes was 
 arraigned and condemned " for his seditious toong," "at 
 which time there arose amidst the people such a dampe" 
 (an old mining expression) " that almost all were 
 smouldered, very few escaping that were not taken at 
 that instant :" " the jurors died presently, shortly after 
 died Sir Robert Bell, Lord Chief Baron," with twelve 
 others whose names are given. There died in the town 
 of Oxford 300 persons, and there sickened there, but died 
 in other places, 200 and odd from the 6th of July to the 
 1 2th of August, after which day there died not one of 
 that sickness, for one of them did not infect another, nor 
 did any one woman or child die of it. We learn further 
 that the disease was attended by haemorrhages ; and " that 
 those that bled till they died, strove so much with their 
 sickness, that the blood issued out of their vents : but yet had 
 perfect memory, even to the yielding of tlieir breath." 
 The account given by William Martin confirms this 3 and 
 he adds, " all that were present, almost every one, within 
 40 hours died, except women and children, and no others 
 were touched with the contagion." This Black Assize 
 occurred, be it recollected, in 15773 and it is to this 
 period that another statement quoted by Howard from
 
 The Black Assize at Exeter, \ 67 
 
 Stow's Survey relates. Speaking of the King's Bench 
 Prison, he tells us '* that in the six years preceding the 
 year 1579, one hundred prisoners died there, and twelve 
 between Michaelmas and March of the last mentioned 
 year," "through a certain contagion called the sick?it'ss of 
 the house.'' 
 
 The jail-distemper must have been very rife in the last 
 quarter of the sixteenth century 5 for it showed itself not 
 only at Oxford and in London, but also at Exeter. The 
 date of its outbreak in this city was March 14, ij86, and 
 the occasion was the city assizes held before Sir Edmund 
 Anderson, Lord Chief Justice of the Common Pleas, and 
 Serjeant Floredaie, a Baron of the Exchequer. Holinshed, 
 from whose chronicles I extract this account, describes it 
 as a very sudden and strange sickness, appearing first 
 among the prisoners of the gaol of the castle of Exon, 
 from whom it was dispersed, upon their trial, among 
 sundry other persons. It was very sharp for the time, 
 and few of those first attacked escaped. It was contagious 
 ajid infectious, but not so violent as the plague commonly 
 is J and there was no outward ulcer or sore. There were 
 various opinions as to the cause of the disease. Some 
 attributed it to the "contagion of the gaol," the " close 
 air" and " filthy stink" of which soon affect most 
 prisoners " newly come out of the fresh air." "This is 
 commonly called the gaole sickenesse, and many die 
 thereof." Others imputed the disease to "certaine poor 
 Portingals," about eight and thirty in number, whom one 
 Barnard Drake had captured at sea, and brought into 
 Dartmouth haven, whence they were sent to the castle 
 gaol, and " cast into the deepe pit and stinking dungeon." 
 These men had been long at sea, in a ship from New- 
 foundland, laden with fish ; without change of apparel, 
 and without beds to lie upon. Most of them were sick, 
 some died, and " some one of them was distracted." This
 
 i68 OtJicr OiUbj'eaks of the jail-Distcmpcj'. 
 
 sickness soon spread among the other prisoners, of whom 
 many died and the rest ^' hardly escaped." 
 
 Many of these prisoners when brought to trial were so 
 weak that they had to be led, or carried from the jail on 
 hand-barrows ; and the sight of them, more like *' hunger- 
 star\-ed than with sickness diseased," moved the Lord 
 Chief Justice and others to pity, and to certain reforms 
 and improvements. 
 
 The prisoners, after being rested and kept for a time in 
 tlie air, were brought into court, when an "infection 
 followed " upon many that were there, and especially 
 upon such as were nearest. The effect was not immediate, 
 for ewevy one went away in as good health as he came ; 
 yet, after a few days, the disease showed itself, and more 
 died than escaped. Many of the sufferers were of ''good 
 account," and the list comprises several names now well 
 known in the county. Of the common people also, 
 many died ; and especially constables, reeves, and tithing- 
 men, and jurors, and ''namely, one jury of twelve, of 
 which there died eleven." 
 
 This sickness was dispersed through the shire, and was 
 not extinguished in October, 1586, when this account was 
 written. The period of incubation, as we should now call 
 it, was fourteen days or more, but some, we infer, must 
 have sickened in "a few days." Its moral effects^ 
 are thus described. At its lirst coming it frightened the 
 people, and led many men to pretend, rather than to 
 perform, amendment of life. " So long as the plague 
 was hot and fervent, so long every man was holy and re- 
 pentant : but with the slaking of the one, followed the 
 forgetfulness of the other." 
 
 Three considerable outbreaks of jail-fever occurred in 
 the eighteenth century — in the interval between the years 
 1730 and 1750. The first at Taunton, in 17.30 j the 
 second at Launceston, in 17425 the third in London, in.
 
 The Black Assize in London. 169. 
 
 1750. The Taunton case is mentioned by Howard, in 
 these words. " At the Lent assizes, in Taunton, in 1730^ 
 some prisoners, who were brought thither from Ivilchester 
 gaol, infected the court; and Lord Chief Baron Pen- 
 gelley. Sir James Sheppard, serjeant 3 John Pigot, Esq., 
 sherift^ and some hundreds besides, died of the gaol dis- 
 temper." Of the outbreak at Launceston, Huxham gives 
 us some interesting particulars in his " Observations on 
 the Air and Epidemic Diseases," for April, 1742. The 
 disease was " a contagious putrid fever," " very pesti- 
 lential," both exhausting and oppressive; attended with 
 tremblings, twitchings, restlessness, delirium ; with early 
 phrensy and lethargy in many instances. The tongue was 
 dry and black, the breath offensive, and the skin spotted 
 with black petechiae. An offensive diarrhcna *' brought 
 numbers to their end." This fever ''took its rise from 
 prisons, was disseminated far and near by the county 
 assizes, occasioned the death of numbers, and foiled 
 frequently the best advice." "Those who bled too pro- 
 fusely killed the patient infallibly, and not the disease." 
 Huxham saw three cases of this fever. One patient, a 
 gentleman, died on the 13th day from his seizure, " stupid, 
 delirious, and covered over with purple spots and livid 
 pustules." 
 
 I take my account of the jail-distemper of 1750 from 
 Sir John Pringle's " Observations on the Jail or Hospital 
 Fever." " Li the year 1750, on the nth of May, the 
 sessions began at the Old Bailey, and continued for some 
 days ; in which time there were more criminals tried, and 
 a greater multitude was present in the court, than usual." 
 The prisoners, about a hundred in number, were crowded 
 into two rooms, measuring 14 feet by j 1, and 7 feet high,, 
 and in the bail-dock (a small corner enclosure, open at the 
 top), into which were put some who had been under the 
 closest confinement. The court itself was about 30 feet
 
 1 70 Other Black Assizes. 
 
 square ; and into this narrow and crowded space the air 
 from the bail-dock and the two small rooms found easy 
 access. An open window, "at the furthest end of the 
 room from the bench/' occasioned a draft in the direction 
 of those who were found to have suffered most. These 
 were the persons on the bench, of whom four were 
 attacked and died, namely. Sir Samuel Pennant, the Lord 
 Mayor 5 Sir Thomas Abney and Baron Clarke, judges j 
 and Sir Daniel Lambert, alderman. The other victims 
 were two or three counsel, an under-sheriff, several of the 
 Middlesex jury, and others, to the amount of above 40. 
 This list is exclusive of persons of a lower rank, and of those 
 who did not sicken within a fortnight. "This sickness, 
 as far as was known, spread no further." Sir John raises 
 the question, " whether the air was most tainted from the 
 bar by some of the prisoners then ill of the jail-distemper, 
 or by the general uncleanliness of such persons?" But 
 bethinks it " probable that both causes concurred." The 
 sufferers are said to have " soon become delirious," and 
 several to have had spots upon the skin. The fever was 
 extremely fatal. "All that were seized with the fever 
 died, excepting two or three at most." Such is Pringle's 
 account of the sixth and last of the Black Assizes. It 
 differs in one or two points from tlie notice of it at p. 102 
 of Murchison's treatise on the " Continued Fevers of 
 Great Britain," to which I refer you 3 but it is all that is 
 needed for my present purpose. 
 
 Now, there is reason to believe that these Black Assizes 
 were a few only of many similar outbreaks of which we 
 have no detailed accounts ; for it is highly improbable that 
 a disease which showed itself thrice in the sixteenth cen- 
 tury and thrice in the eighteenth, should have had no exis- 
 tence in the interv^al between 1586 and 1 730. And this view 
 of the case is confirmed by what Lord Bacon says of the 
 disease. There had been in his day "■ experience twice or
 
 y4 Black Assize in Dublin, 171 
 
 thrice " of this jail-distemper j and Dr. Lettsom, writing 
 in 1774, refers to "some recent instances at the Old 
 Bailey-j and in the last Lent circuity" and to "the fatal 
 transaction at Salt-hill." 
 
 Let me here observe that, though I began this lecture 
 by speaking of the jail-distemper as peculiar to the prisons 
 of England, I did not wish to ignore the fact that it has 
 been known to occur in Ireland too. Thus I find in the 
 '^Gentleman's Magazine" for 1776, that, " In Dublin a 
 malignant fever, occasioned by a criminal infected with the 
 jail-distemper being brought into the Court of Sessions 
 without cleansing, produced very fatal effects, and alarmed 
 the whole city." The names of eight of the victims are 
 given, besides several attorneys and others who had to 
 attend in court. 
 
 The jail-distemper, then, on many occasions, made the 
 legal service of the State a service of danger j bat the mis- 
 chief did not end here: it interfered with the due course 
 of justice by the terror it inspired. Thus, I find it stated 
 in the " London Packet," under date March 25, 1774, that 
 an "invidious report" that " the gaol distemper prevailed 
 at Launceston having been spread abroad, great pains were 
 taken to disabuse the public, and two of the faculty were 
 sent to Exeter to state on oath that no such distemper 
 prevailed there. But the judges were afraid to see them, 
 and the gentlemen of the bar, alarmed by the recent 
 death of Baron Adams, attributed to the fever, retired, 
 some to Bridgwater, others eastward 3 so that Judge Aston 
 had to adjourn the court." 
 
 Thus did the jail-distemper do its work of destruction 
 and disorganization in our courts of law. Let us see how 
 it conducted itself towards the general population of the 
 country. 
 
 I. Howard tells us that " At Axminster, a little town 
 in Devonshire, a prisoner discharged from Exeter Gaol
 
 1J2 J ail' Distemper spreads among tJie People. 
 
 in 1755, infected his family with that disease j of which 
 two of them died, and many others in that town after- 
 w^ards." 
 
 2. At page 26 of the " Medical Memoirs of the Gene- 
 ral Dispensary," it is stated that a prisoner dismissed from 
 Newgate, apparently in tolerable health, in four days 
 afterwards was seized with the symptoms of a mahgnant 
 fever, and infected eleven persons who were attacked by 
 the same disease the next week. He was thought to have 
 received the infection before he left Newgate j but he re- 
 tained the clothes he had worn there. 
 
 3. Mr. Field, chaplain of the Reading County JaiJ, 
 gives the following incident, from the diary of the Rev. T. 
 Scott. In 1780, a baker living at Stoke, in Buckingham- 
 shire, allowed a poor man with a large family, to contract 
 a debt of 10?., and then arrested him, thinking that the 
 overseers would pay the sum rather than let him be thrown 
 into prison. But they disappointed him. The debtor was 
 sent to Aylesbury jail, where the fever then prevailed, 
 and took the disease. His wife went to nurse him j he 
 died. She returned home, sickened, and died. The 
 malady spread in the village, sparing the children, but 
 proving fatal to the parents. Forty children were believed 
 to have been bereft of one parent, and nearly twenty of 
 both. The same fever had broken out at Northampton 
 as well as at Aylesbury. 
 
 4. In these three instances, the jail-distemper was com- 
 municated to the outside population by the discharged 
 prisoner himself. I add one instance in which, like tlie 
 plague of old and the small-pox, the disease was carried in 
 the clothes. A man of the name of Russel, whom Dr. 
 Lettsom attended in Wood Street Compter, died of the 
 gaol fever : he had a large family, who lodged near Fleet 
 Market ; and after his death his widow took his clothes 
 there, and probably used some of them j for, about a week
 
 Infects our Armies and Fleets. 1 73 
 
 after, *' herself and the whole family were attacked with a 
 malignant, or jail fever, and with difficulty survived." 
 
 This jail-distemper, which thus infected our civil popula- 
 tion, was one of the worst scourges of our armies and fleets. 
 
 Pringle tells us that " gaols have often been the cause of 
 malignant fevers," and that, in the rebellion in Scotland, 
 above two hundred men of one regiment were infected 
 by deserters brought from English prisons 5 and this is 
 not the only instance he gives. 
 
 To the same effect is the evidence of Lind as to the 
 importation of the jail -distemper into our fleets. Howard 
 states that he showed him, in a ward of Haslar Hospital, 
 a number of sailors ill of the jail fever, brought on board 
 their ship by a man discharged from a London prison ; and 
 Lind, in his work on the Health of Seamen, asserts that 
 ** the sources of infection to our armies and fleets are un- 
 doubtedly the gaols 5" that the disease could often be 
 traced directly from them 5 and especially in impressing 
 men on the hasty equipment of a fleet. "The first 
 English fleet sent last war to America, lost by it above 
 '2000 menj" and Lind elsewhere assures us that ** the 
 seeds of infection were carried from the guard-ships into 
 our squadrons ; and that the mortality thence occasioned 
 was greater than by all other diseases or means of death 
 put together." 
 
 Howard gives us some cases of destruction of life among 
 soldiers on a smaller scale. In his visit to the county 
 jail, Chester Castle, he inspected some cells, one of which, 
 when the door was shut, brought to his mind the Black 
 Hole at Calcutta. An officer at Worcester told him that 
 having sent a sergeant and two men for two deserters 
 lodged here, three of them died a few days after they 
 came to their quarters. And of the Savoy, in which 
 military prisoners were confined, he reports thus in March, 
 1776: **I saw many sick and dying. The gaol was so
 
 174 TVood Street Covipter, 
 
 infected by them, that the distemper has been caught 
 there by many since." Again, in May of the same year, 
 he says : " Many of them sick of the gaol distemper in the 
 rooms where I saw the sick and dying in March." 
 
 But this is not all. The prison lists, as given by Howard, 
 often contain the significant entr}', '' impressed men." I find 
 it in eleven instances. The number of such prisoners was 77. 
 
 Thus in ever}' possible way was the jail-fever brought 
 to bear on our army and navy. Our soldiers and sailors 
 were taken to it, and it was, in turn, carried to them. 
 
 Having now shown you how the jail-distemper invaded 
 our courts of law, spread among the population of our 
 towns and villages, and infected our armies and fleets, I 
 proceed to describe the places in which the disease was 
 born and bred. 
 
 I must premise that in Howard's time the majority of 
 prisoners were debtors. In 1779 there were 2076 debtors 
 to 804 felons, Sec, 909 petty offenders, and ^26 prisoners 
 in the hulks. In Wood Street Compter, from which I 
 take my first illustration, there were, at that date, 38 
 debtors and 11 described as felons, &c. Of the debtors 
 6 were women. Well ! five years before this date, this 
 prison was in the state I am now to describe. There was 
 a room in it known as "the common side," 12 feet 
 high, '^'^ feet long, and 15 feet wide, within the bare walls. 
 The beds were piled one above another " in little separate- 
 cabins," the access to the uppermost tier being by a ladder. 
 The room had a door, and a chimney, and near the door 
 two windows, usually kept shut, and looking into a dark 
 entrance. The victuals were dressed by a large fire in this 
 room, which is described as " capable of holding above 40 
 prisoners." If we take the number at 40, and make no 
 deduction for the beds, the cubic space per prisoner would 
 be less than 150 feet. Well might Lettsom say that if the 
 projector of this apartment had exerted his utmost ability
 
 The King's Bench. 175 
 
 he " could not have planned a place of the same dimensions 
 more effectually calculated to destroy his fellow-creatures." 
 The City of London had so neglected its duty towards 
 these poor creatures, that when they fell ill not even an 
 apothecary was engaged to attend them. The Governors 
 of the General Dispensary supplied this want 3 and during 
 the year 1773, Lettsom attended eight patients with the 
 jail-fev'er, of whom two died : one of the two being the 
 man Russel whose clothes infected his family. When 
 Howard visited this place, the keeper told him that " in the 
 beginning of the year 177.3 his prisoners were sickly, and 
 II died." 
 
 That this Wood Street Compter was no exceptional 
 case, you will infer from the extracts I have made from 
 the Report of a Parhamentary Committee on the State of 
 the King's Bench, presented to the House in this same year 
 1773 5 you will find the Report in the Commons Journals, 
 13 Geo. HI., p. 123. It states among other things that on 
 account of the number of prisoners being always greatly in 
 excess of the number of rooms, the marshal had permitted 
 many to lie in the chapel, in the tap-room, on the staircases 
 and benches, and other improper places, by which means 
 they contract disorders, which often prove fatal, not only to 
 themselves, but to the prisoners in general 3 that there are 
 no separate apartments for sick prisoners, no place for the 
 confinement of the riotous, nor any stronghold for 
 prisoners committed for capital offences j that the walls 
 of the prison are so low and thin that prisoners often 
 escape over and through them 3 and '' that prisoners have 
 been known to break through in less than half an hour." 
 The petition of Benjamin Thomas states that the prisoners 
 took the rooms by seniority, and had to wait many months 
 for them, during which time they were '' obliged to con- 
 tract with some old indigent prisoner for a lodging at an 
 exorbitant price."
 
 T76 Coiuity and BoroiLgh Jails. 
 
 These two examples will give yon an idea of the state 
 of prisons in London about the year 1 774. I will now give 
 one or two illustrations of the condition of prisons and 
 bridewells in country places from the pen of Howard. 
 
 J . Dartford County Bridewell. — " No chimneys 3 offen- 
 sive sewers j and the rooms dirty ; no water, no straw ; no 
 court." "The keeper told me, they had about two years 
 ago a bad fever, which himself and family and every fresh 
 prisoner caught. Two died of it." 
 
 2. Cambridge Town Bridewell. — ''In the spring ot 
 1779, seventeen women were confined in the daytime, 
 and some of them at night, in a room 19 feet square, 
 which has no fire-place or sewer. This made it extremely 
 offensive, and occasioned a fever or sickness among them 
 which alarmed the Vice-Chancellor, who ordered all of them 
 to be discharged. Two or three died within a few days." 
 
 3. Marlborough County Bridewell. — All the rooms are 
 on the ground-floor j and, by a sewer within doors, are 
 made very offensive, " especially the men's night-room, in 
 which, when I was there first, I saw one dying on the floor 
 of gaol-fever. The keeper told me that, just before, one 
 had died there, and another soon after his discharge." 
 
 4. County Gaol, Launceston. — " The prison is a room 
 or passage 23 1 ft. by 7^^ ft., with only one window, 2 ft. 
 by I J ft., and three dungeons or cages on the side oppo- 
 site the window ; these are about 6 J ft. deep ; one 9 ft. 
 long, one about 8 ft., one not 5 ft. — this last for women. 
 They are all very offensive ; no chimney, no water, no 
 sewers, damp earth floors, no infirmar)^, the court not 
 secure, and prisoners seldom permitted to go out to it. 
 Indeed the whole prison is out of repair, and yet the 
 gaoler lives distant. I once found the prisoners chained 
 two or three together. Their provision was put down to 
 them through a hole (9 in. by 8 in.) in the floor of the 
 room above (used as a chapel), and those who served
 
 Deprivation of Watery Air, Light. 177 
 
 them there, often caught the gaol fever. At my first 
 visit, I found the keeper, his assistant, and all the prisoners 
 but one, sick of it 5 and heard that, a few years before, 
 many prisoners had died of it, and the keeper and his 
 wife, in one night." This is just the sort of place in 
 which the infection of the Black Assize of 1 742, described 
 by Huxham, is likely to have originated. 
 
 And now, having illustrated the state of our prisons, in 
 town and country, I will give you a condensed account of 
 it, taken from the materials so laboriously and conscien- 
 tiously collected by Howard, and chiefly in his own 
 words. 
 
 "Many prisons," he says, "'are scantily supplied, and 
 some almost totally unprovided with the necessaries of 
 life." " Many prisons have no water j" ** in some places, 
 where there is water, prisoners are always locked up 
 within doors, and have no more than the keeper or his 
 servants think fit to bring them j in one place they were 
 limited to three pints a day each — a scanty provision for 
 drink and cleanliness ! " "And as to air . . . given us 
 by Providence quite gratis . . . methods are contrived to 
 rob prisoners of this gtnuine cordial of life, as Dr. Hales 
 ver}^ properly calls it." So foul was the air of the jails, 
 that Howard's clothes, in his^r^^ journeys, were so offen- 
 sive that he could not close the windows of his post- 
 chaise, and was, therefore, often obliged to travel on 
 horseback. And he tells us that the leaves of his memo- 
 randum-book were often so tainted, that he could not use 
 it till after spreading it an hour or two before the fire ; 
 and that even the phial of vinegar, which he thought an 
 antidote, after using it in a few prisons, would become 
 "intolerably disagreeable." He adds, "many gaolers 
 made excuses, and did not go with me into the felons' 
 wards." The supply of light was not more liberal than 
 that of air and water — a circumstance which Howard 
 
 N
 
 1 78 Prison Sipialor and Destitution. 
 
 accounts for by ^' the window-tax which the gaolers have 
 to pay 3 this tempts tliem to stop the windows, and stifle 
 their prisoners." 
 
 Thus scantily supplied with water, air, and light, die 
 prisoners literally rotted in "close rooms, cells, and sub- 
 terranean dungeons," of which this is no exaggerated 
 description : — " In some of these caverns, the floor is very 
 damp J in others, there is sometimes an inch or two of 
 water J and the straw, or bedding, is laid on such floors, 
 seldom on barrack bedsteads. Where prisoners are not 
 kept in underground cells, they are often confined to their 
 rooms, because there is no court belonging to the prison." 
 " In many gaols, and in most bridewells, there is no 
 allowance of bedding or straw for prisoners to sleep on ; 
 and if by any means they get a little, it is not changed 
 for months together, so that it is almost worn to dust. 
 Some lie upon rags, otliers upon the bare floors. When 
 I have complained of this to the keepers, their justifica- 
 tion has been, " the county allows no straw ; the prisoners 
 have none but at my cost." " Some gaols have no 
 3EWERS " (a term used to designate conveniences for the 
 reception and discharge of ofl'ensive matters), " and in 
 those that have, if they be not properly attended to, 
 they are, even to a visitant, ofi^ensive beyond de- 
 scription." 
 
 Then as to food : — It may be said, with truth, that 
 most prisoners were half-starved ; and Howard tells us 
 that in above half the county jailsy the " debtors have no 
 bread, although it is granted to the highwayman, the 
 housebreaker, and the murderer ; and medical assistance, 
 which is provided for the latter, is withheld from the 
 former." But though wholesome food and necessary 
 medicine were withheld from the poor debtor, he might 
 have as much spirituous liquor as he could contrive to 
 earn or beg. And it was a well-known fact that, in most
 
 Prison Danoralization. 
 
 prisons, charitable gifts were expended in this way j while 
 there is good evidence that, in some, the personal doles of 
 the visitors, who were allowed to see the debtors at certain 
 hours on certain days, were intercepted by men and 
 women introduced from without to personate them j and, 
 if the begging was done on the premises by a box for 
 contributions, the few pence collected were distributed 
 among those only who had qualified themselves after sooic 
 such fashion as that in force at Whitechapel prison for 
 debtors. The qualification was an entrance fee to the 
 jailer of is. 6d., and a treat to the prisoners of half a 
 gallon of beer. So that, in those evil days, the gifts in- 
 tended for the poor fell into the hands of the profligate, 
 and money which should have relieved distress, found its 
 way to the prison bar. This cruel farce performed in 
 those times within prison walls, is, in our days, exhibited 
 in the open street. The mendicant-thief intercepts the 
 charity intended for the poor, and spends it in the gin- 
 shop. 
 
 This repulsive picture of prisons and prison-life a cen- 
 tury ago, admits still of some heightening touches. The 
 prisoners, like Goldsmith's " Vicar of Wakefield," were 
 allowed to have their families about them ; for Howard 
 tells us, that " debtors croiud the gaols (especially those in 
 London) with their uives and children. There are often, 
 by this means, ten or twelve people in a middle-sized 
 room J increasing the danger of infection, and corrupting 
 the morals of the children." Elsewhere, Howard com- 
 plains of " the confining all sorts of prisoners together, 
 debtors and felons, men and women ; the young begin- 
 ner and the old offender 3" and, again, of "the number of 
 men in the same room, and of lewd women, admitted 
 under the name of wives j" and of *' lunatics at large in 
 some prisons, disturbing and terrifying the other pri- 
 soners." 
 
 N 2
 
 3 8o Prisons Private Property. 
 
 All these evils and abuses were carried to an extreme in 
 jails that were private property, the keepers being pro- 
 tected by the proprietors, and less subject to the control 
 of the magistrates. Now it is an eminently curious and 
 instructive fact that some of the worst conditioned jails 
 were the property of noblemen and Church dignitaries. 
 Among the noble, reverend, and right reverend pro- 
 prietors, we iind Lords Salisbury, Exeter, Arundel, and 
 Derby ; the Marquis of Carnarv^on j the Earl of Cholmon- 
 delcy ; the Dukes of Portland, Devonshire, Norfolk, and 
 Leeds 5 the Bishops of Salisbury, Ely, and Durham 3 the 
 Dean and Chapter of Westminster j and Christ Church 
 College, Oxford. I subjoin three sketches of these private 
 jails. 
 
 One of them, Howard tells us, " was quite out of repair 
 and unsafe 3 and the proprietor, not choosing to repair it, 
 the gaoler, to confine his prisoners, took a method that, 
 to all who saw it, was really shocking." 
 
 Respecting the second of these jails Howard is more 
 explicit J for he says that some years before that, a 
 prisoner w^as tormented with thumbscrews ; and that one 
 of the grand ]\iry (Howard's informant) remonstrated 
 with the proprietor, but in vain. 
 
 My third illustration is given in greater detail. The 
 prison of Ely was the property of the Bishop, Lord of the 
 Franchise of the Isle of Ely. " It was in part rebuilt by 
 the late bishop, about fourteen years ago ; upon com- 
 plaint of the cruel method which, for want of a safe 
 gaol, the keeper took to secure his prisoners. This was 
 by chaining them down on their backs upon a floor, 
 across which were several iron bars, with an iron collar 
 with spikes about their necks, and a heavy iron bar over 
 their legs. An excellent magistrate, James Collyer, 
 Esq , presented an account of the case, accompanied with 
 a drawing, to tlie King, with which his Majesty was
 
 Extensive Prevalence of the Disease. 1 8 1 
 
 much affected, and gave immediate orders for a proper 
 inquiry and redress." 
 
 I will give you one more illustration of the same class, 
 partly to show that the titled owners of these squalid 
 properties, or those who acted for them, demanded a very 
 handsome rent, and partly for the sake of the complete 
 picture it affords of the consequences, inside and outside 
 the prison, of the then system of imprisonment for debt. 
 The prison in question is Chesterfield jail, the property 
 of the Duke of Portland. It consists of " one room with a 
 cellar under it, and the gaoler pays for it i8/. 125. a year. 
 The cellar has not been cleaned for many months, nor 
 the prison door opened for several weeks. The prisoners 
 occasionally descend to the cellar through a hole in the 
 Hoor. There is no allowance, no straws no firing, and 
 water is put in at the window at the price of a half- 
 penny the three gallons." Howard finds four prisoners 
 here, who tell him that they are half starved, and one of 
 them says that he has not eaten a morsel the whole day, 
 though it is afternoon. Their meagre, sickly countenances 
 confirm what they say. All have wives, and their fa- 
 milies amount to thirteen children, cast on their respective 
 parishes. Two had their groats (the legal allowance) from 
 their creditors, and these relieved the other two. 
 
 Such being the places in which the jail-distemper was 
 bred^ it will be interesting to know in how many of them 
 it was either witnessed or heard of by Howard, when he 
 inspected our prisons in the few years following 1774. 
 By marking those prisons, which he describes with some 
 degree of detail, and noting in which of them he saw the 
 jail-distemper, and in which he heard of its having re- 
 cently prevailed, I find that out of 105 prisons he wit- 
 nessed it in 6, and heard of it in 21. So that, putting 
 the two figures together, we may reasonablv infer that 
 the disease haunted one-fourth at least of orr jails. That
 
 1 82 The y ail'Fever in France : 
 
 destructive diseases, and probably the jail-distemper, pre- 
 vailed ill prisons under direct Government control will be 
 inferred from what Howard says about the hulks on the 
 Thames. It resulted, he says, from a public inquiry, 
 that from August, 1776, to March 26, 1778, out of 632 
 prisoners 1 76 had died. This is much more than i 
 in 4. 
 
 I stated at the beginning of this lecture that the jail- 
 distemper was believed to be peculiar to the prisons of 
 England, and for this statement I had the authority of 
 John Howard, who arrived at that conclusion after visiting 
 the clean prisons of Holland, and the less clean, or emi- 
 nently dirty and offensive prisons of Germany, Italy, 
 Switzerland, Austrian and French Flanders, and France : 
 and receiving from Russia what he deemed trustworth}- 
 information. But Howard was deceived in respect of 
 France, and possibly of some other countries by the misuse 
 of terms. Speaking of the Grand Chatelet in Paris, 
 Howard says that a contagious disease prevailed there 
 which in France they call le scorlut, the scurvy. ''This 
 distemper was found to proceed from the prisons ; and to 
 spread in the Hotel Dieu, whither prisoners that had it 
 were removed. The cause of it was generally thought to 
 be want of cleanliness in prisons, where several of those 
 confined had worn their linen for many months, and in- 
 fected the most healthy new-comers that were put in the 
 room with them. Eight hundred were ill of it at once in 
 the hospital of St. Louis, to which all that were sick of it 
 in the Hotel Dieu had been carried." In the Bicetre, 
 Howard found "' an infirmary for the scorlut, a distemper 
 very common and fatal among them. There were 6^ 
 patients, most of them ill of this disorder. They contract 
 it in a year or two from their confinement, as they are 
 never suffered to go out of their rooms. Many lose the 
 use of their limbs by it. I saw several such miserable ob -
 
 Generally a Form of Typhus. \ 83 
 
 jects at St. Louis's Hospital, where they are often admitted 
 at the expiration of their term at the Bicctre." This 
 must have been a terrible addition to tlie horrors of French 
 hospitals, such as Howard saw them, and Frenchmen 
 themselves have described them. Speaking of St. Louis 
 and L'Hotel Dieu, Howard says that they were the worst 
 hospitals he ever visited, " abominable, and a disgrace to 
 Paris." He had frequently seen five or six in one bed, 
 some of them dying. One shudders as one pictures to 
 oneself the Hotel Dieu with 3655 patients thus packed 
 together ! 
 
 The jail-distemper then was not in Howard's time 
 peculiar to the prisons of England or of the United 
 Kingdom. It certainly did prevail in France, and pro- 
 bably extensively ; for Murchison finds notices of it as 
 occurring in the prisons of Nantes, Auxerre, and Rheims, 
 also in Strasbourg and at Posen, in times comparativel}' 
 recent. 
 
 In place then of describing the jail -distemper as pecu- 
 liar to English prisons, we must treat it henceforth as 
 a disease prevailing in them to an unusual extent, and 
 with extreme severity. 
 
 And now I proceed to ask what this jail-distemper was : 
 to inquire whether it was always one and the same disease, 
 or whether there may not have been more than one fatal 
 malady passing under the same name. 
 
 The answer to these questions, as far as they relate to the 
 jail-distemper of the last century, the disease with which 
 Howard had to do, is very easy. It was evidently that 
 Typhus Fever which our best authorities agree in attri- 
 buting to crowds and overcrowding : to crowded prisons and 
 workhouses, crowded hospitals, camps, barracks, and ships, 
 crowded lodging-houses, crowded dwellings in town and 
 country. Wherever men and children live for some time 
 together in places small in proportion to their numbers.
 
 1 84 Not always the same Disease. 
 
 with neglect of cleanliness and ventilation, surrounded by 
 oftensive effluvia, without proper exercise, and scantily- 
 supplied with food, they incur the risk of this disease, and 
 become centres of infection to others j and it is easy 
 to understand how several persons having led such a 
 life for weeks and months together, wearing the same 
 clothing day and night, should come to be saturated with 
 poison, and should be able to infect healthy persons 
 breathing the same close and tainted air for hours together, 
 as happened in courts of law at our successive Black 
 Assizes. On the other hand, it is equally easy to under- 
 stand how a single person issuing from such an atmosphere 
 with such a taint upon him should be in a condition to 
 infect crowds of persons living in a state not far, if at all, 
 removed from that which had made him what he had 
 come to be. Hence the infection of towns and villages, 
 and of armies and fleets by recruits and pressed men fresh, 
 from their sojourn in prison. 
 
 But if we assume, as we safely may, that the jail-dis- 
 temper of Howard's day was the typhus fever of our own j 
 is it equally sure that our prisons always produced this 
 infection and no other ? I think not. I deem it impro- 
 bable that, in earlier as in later times, the many unwhole- 
 some influences to which prisoners were exposed — want 
 of air, water, food and exercise, cold and damp, and 
 otFensive effluvia of every sort — blended, as they must have 
 been, in every degree of intensity, in every possible com- 
 bination and permutation — should have aKvays given rise 
 to one contagious malady, and to one only. This reason- 
 able expectation is fully justified by a careful comparison 
 of the two Black Assizes of Oxford and Exeter — the one 
 held in 1577, the other in 1586, and both described by 
 Holinshed. At Oxford, there was sudden seizure on the 
 spot of men only, no spread of the disease, bloody flux, 
 and death within forty hours without delirium. At Exeter,
 
 Howard's Precursors. 185 
 
 110 immediate effect, seizure after a few days, " contagion 
 and infection," spread of the disease through the county, 
 and no mention of speedy death, or of bloody flux. The 
 Oxford outbreak may have been a malignant dysentery j 
 that at Exeter, the typhus of our day. 
 
 I leave this curious question for more practical con- 
 siderations, and for that eminently useful inquiry how 
 did this jail-distemper — this prison-typhus of the eighteenth 
 century — this physical expression of manifold prison neglect 
 and mismanagement, cease and determine ? Who is to have 
 the credit of that great reform which brought about the 
 destruction of the destroyer r Hundreds of charitable per- 
 sons, in every part of England, had taken pity on the 
 poor debtor, and had given or bequeathed money for his 
 relief, knowing full well how miserable he was 5 and every 
 now and then, some rich man, or the King himself, would 
 buy some wretched family out of bondage ; but no move- 
 ment of reform came from them. There had been Black 
 Assizes, with their terrible consequences ; and the law had 
 been smitten, over and over again, in the persons of its 
 highest dignitaries : but neither did the lawyers originate 
 any reform. Medical charities had sent skilled physicians 
 to the prisons on their errands of mercy j but they had 
 rested satisfied with the work of palliation. The fever 
 spread into our towns and villages, but neither local 
 authority nor central government interfered to protect the 
 lives of our people. It scourged our armies and fleets j 
 but no word of remonstrance was spoken by Horse Guards 
 or Admiralty. In 1701, the Society for Promoting Chris- 
 tian Knowledge sent a committee to visit Newgate ; they 
 distributed money and tracts, and exposed the gross abuses 
 and immoralities practised there j but there, as in other 
 prisons^ things went on as before. Again, in 1729, General 
 Oglethorpe, and his Committee of the House of Commons, 
 began a laborious incjuiry into the state of the Fleet, the
 
 i86 Biography of Howard. 
 
 Marsbalsea, and the King's Bench, and the crimes and 
 cruelties of the miscreants Bambridge and Acton. Reports 
 were prepared and presented, these wretches were 
 tried and acquitted, the horrors of these prison-houses 
 were revealed to an indignant and disgusted public, 
 their outraged feelings found expression in the verses of 
 Thomson, and full justification in the lively pictures of 
 Fielding, Smollett, and Goldsmith ; but still no reform. 
 Even Oglethorpe, the benevolent and patriotic statesman^ 
 the indefatigable chairman of Committee, the brave sol- 
 dier, the wise administrator, linds no better course open to 
 him than to gather some few debtors from the prisons, 
 and with them and others in want of employment, to go 
 forth and found the colony of Georgia. But the glorj' of 
 reforming the whole system of imprisonment in England, 
 missed by this kindred spirit and worthy forerunner, was 
 reser^-ed for nearly half a centur)-, till, in a happy hour, 
 John Howard was appointed sheriff of Bedford. 
 
 In the year 1774, Howard was 48 years old. He had 
 lost his second wife nine years before. He was a spare man 
 of singularly abstemious habits, far from vigorous or robust ; 
 and there was nothing in his then state of health, or in the 
 histor)' of his ailing childhood and sickly youtli, to detract 
 from the merit of his toilsome travels, and constant expo- 
 sure to infection. He was neither learned nor accom- 
 plished, hardly to be called well-educated 5 but he 
 managed his estates wisely and liberally, and had always 
 the command of money. His matrimonial arrangements 
 and projects gave evidence of a strong will and some- 
 what eccentric disposition. But he was quite as wise in 
 these things as the judicious Hooker, or the devout John 
 Wesley. It is easy to take exception to his management 
 of his only child 5 and an ingenious psychologist might 
 maintain the thesis that what was singularity in the father 
 ripened into madness in the son. He was of active habit-i
 
 Sanitary Refoi'ins at Cai'dington. i'^^ 
 
 and humane disposition 3 and as the one tempted him to 
 travel, the other attracted him to scenes of distress. Thus, 
 when he was thirty years old, in the year after the death 
 of his first wife, he went to the scene of the great earth- 
 quake at Lisbon. On his return he w^as captured by a 
 French privateer, and had his first painful experience of 
 prison life. And then it was that he had his first oppor- 
 tunity of showing the sterling metal of which he was made : 
 for, being Hberated on parole, he first made himself fully 
 acquainted with the cruel treatment to Mhich English 
 captives were being subjected in the prisons of France, and 
 then, armed with facts, addressed himself to -the Commis- 
 sioners of sick and wounded seamen, and not only "^ gained 
 their attention and thanks," but the redress of the wrongs 
 our sailors were enduring. Thus early did John Howard 
 show his sympathy with suffering, his love of truth, his devo- 
 tion to duty : thus early did he display his unconscious 
 originality, his patience in collecting facts, his perseverance 
 in using them, his rare unselfish singleness of purpose. 
 
 The year of Howard's captivity in France (May T3th, 
 1756), the Royal Society did itself the honour of electing 
 him one of its Fellows ; and he must needs justify their 
 choice, by presenting three papers, the first on the degree 
 of cold observed at Cardington in the winter of 1763, 
 the second on the heat of the waters of Bath, the third 
 on the heat of the ground on Mount Vesuvius. At 
 Cardington, we are told, that on the first setting in of 
 frost, he would leave his bed at two o'clock in the morn- 
 ing, to note the state of the thermometer in his garden, at 
 some distance from the house. In this simple trait of 
 Howard the Philosopher, we see, by anticipation, the in- 
 vincible perseverance, and abnegation of personal ease and 
 comfort, of Howard the Philanthropist. 
 
 And now I am to speak of Jolni Howard as Landlord. 
 It was on his estate at Cardington, near Bedford, that.
 
 i88 High Sheriff of Bedford. 1773. 
 
 Howard made his thermometrical observations in 1756. 
 To that estate, enlarged by purchase of an adjoining farm, 
 he brought his second wife, in 17583 there he continued 
 to reside till 1774 5 and there he set an example to the 
 landlords of England, by pulhng down and rebuilding 
 every cottage that he owned or was able to purchase, 
 erecting new ones j and, in a word, transforming the 
 village from damp squalor to wholesome cheerfulness, 
 from sickliness to healthiness, from barbarous neglect to 
 civilized, judicious interference and supervision. Here, 
 again, the work which duty prompted him to do, was 
 done thoroughly and completely. It was, perhaps, our 
 iirst considerable work of sanitary reform. 
 
 The seventeen years that elapsed between the date of 
 Howard's personal experience of prison life, followed by 
 his successful intercession with the Commissioners of sick 
 and wounded seamen, and the event that brought him 
 again into direct contact with the prisoner, were spent 
 mostly at Cardington, or at his house in Old Broad Street ; 
 but he was absent now and then, as once (in 1767) when 
 he gauged the temperature of the Bath waters, and once 
 in Italy (in 1770), where he took the opportunity of ascer- 
 taining the heat of the soil of Vesuvius. 
 
 The event to which I refer, was the appointment of 
 John Howard of Cardington to the office of High Sheriff 
 of the County of Bedford. Xow it was the duty of a 
 high sheriff to inspect the prisons and bridewells ; but 
 this duty had been systematically neglected. But Howard 
 was too careful a man not to ascertain what his duties 
 were, and too conscientious not to perform them. And if 
 any other motive were needed by such a man, there was 
 his own bitter experience of his captivity in France, when 
 he had been made to suffer the *' extremity of thirst," and 
 the pangs of hunger, and had lain six nights together upon 
 straw : and his recollection of the cruel treatment that
 
 Examination of English Pj'isons. 189 
 
 had caused " many hundreds of our prisoners of war to 
 perish, and 36 of them to be buried in a hole at Dinan 
 on one day." There was, also, by way of encourage- 
 ment, the happy consciousness of the reform he had 
 brought about by the simple, though toilsome process of 
 collecting the facts of the case, and placing them, in all 
 simplicity and earnestness, before those who had the 
 power of redressing the wrong. 
 
 Thus moved by that "fellow-feeling" which is apt to 
 make men "wondrous kind," and encouraged by the 
 memory of a great success, Howard was scarcely installed 
 in office before he paid a visit to the prisons of the county 
 town, beginning, as it is alleged, with the cell of John 
 Bunyan. He found in the three prisons of Bedford, the 
 county jail, the town jail, and the county bridewell, 
 good illustrations of the then prevalent abuses, exaction of 
 fees, and utter neglect of health. Of the first of these 
 abuses, Howard says : — 
 
 " The circumstance which excited me to activity in 
 their behalf, was the seeing some who, by the verdict of 
 juries, were declared not guilty ; some on whom the 
 grand jury did not find such an appearance of guilt as 
 subjected them to trial, and some whose prosecutors did ■ 
 not appear against them, after having been confined for 
 months, dragged back to gaol, and locked up again till 
 they should pay sundry fees to the gaoler, the clerk of 
 assize, &c." To the second of these abuses, Howard's 
 attention seems to have been drawn after he had already 
 visited most of the county jails in England. Having 
 seen in two or three of them some poor creatures whose 
 aspect was "singularly deplorable," and being told that 
 they had been brought from the Iridewells, he set out on 
 a new journey into the counties already visited, where he 
 inspected, not only the bridewells, but the houses of cor- 
 rection, and the city and town jails. In these inspec-
 
 190 The Sanitary Act of L'j 'J ^. 
 
 tions he displayed such industry and perseverance, that in 
 the year following his appointment as High Sheriff, he 
 had brought together a mass of materials in illustration of 
 the two grand abuses to which I have referred, of such 
 value tliat, when presented to the House of Commons, 
 they not only gave him a public vote of thanks, but, what 
 was to him infinitely more gratifying, they, with rare 
 promptitude, passed two Acts — the one for the relief of 
 prisoners who should be acquitted, respecting their fees ; 
 the other for preserving the health of prisoners, and pre- 
 venting the jail-distemper. 
 
 This Sanitary Act has many of the properties of sound 
 legislation. It is concise and clear, prescribes what is to 
 be done, insures the requisite publicity, constitutes a body 
 of inspectors (the Justices of the Peace in quarter 
 sessions assembled), and provides a summary punishment 
 for the infringement of its own provisions. But Howard, 
 having reason to believe that the provisions of the Act 
 were being imperfectly and negligently carried out, set out 
 on fresh inspections of Enghsh prisons in 1776 and 1779, 
 and published the results, with an account of some foreign 
 prisons and hospitals, in 1777 and 1780. You will infer 
 that Howard had excellent reasons for what he did when 
 I tell you that, according to a calculation I have made, 
 the prisons in which the law had been strictly obeyed bore 
 to those in which it had been imperfectly carried into 
 ertect the proportion of 15 to 130. 
 
 Nevertheless, the good work was begun, and, gathering 
 strength as time went on, the sanitary measures which 
 the Act of 1774 had inaugurated, gradually drove out 
 the jail-distemper, and at length made the prisons of 
 England to rank among the healthiest of the abodes of 
 men. And when I say this, I s])cak not only of our 
 County and Borough jails, which approach somewhat 
 in the character of their inmates (always excepting
 
 Howard* s Life, Deatk, and Character. \ 9 
 
 the poor debtors and pressed men) to the prisons of 
 Howard's day, but emphatically of our great convict estab- 
 lishments where the extremes of every crime, cruel, 
 revolting, and fraudulent, fnid representatives by the 
 thousand. 
 
 I need not tell you that this great prison reform was 
 wholly and solely due to the initiative of John Howard. 
 I cannot tell you, for want of time, how much more he 
 did for us in the seventeen years that elapsed between 
 his appointment as Sheriff of Bedford, and his death in 
 Russia j what voyages and journeys he made, what per- 
 sonal experiences he gained in the prisons, hospitals, and 
 lazarettos of Europe, what moral courage he displayed in 
 his encounters with fever and plague, what physical 
 courage in his fights with pirates in the Mediterranean and 
 thieves in the Crimea. Nor can I describe his last crown- 
 ing act of self-sacrifice, by which he caught the fever he 
 had escaped so long 3 and '' died a martyr after living an 
 apostle." Had time permitted, I should have wished 
 to lay before you all the facts and incidents which supply 
 the materials for a full estimate of his unique character. I 
 should like to have defended it against his own modest 
 depreciation of himself when he speaks of his work as 
 ** a whim' and himself as a '^ plodder,'' as well as against 
 the strange misconceptions of those who could see in 
 this man of genius (for such Edmund Burke took him to 
 be) " a dull, solid, dreary man," a " beautiful" and 
 ''beatified philanthropist," a sentimental sort of being- 
 possessed of *' a morbid sympathy with scoundrels."' 
 This is the language of indignant reaction against the 
 miserable self-indulgence and misplaced sympathies of the 
 age in which we are living; but it is wholly and ludi- 
 crously inapplicable to John Howard, who, if I read his 
 character aright, had no sort of sympathy with crime or 
 criminals, but a sense of justice, a submission to duty, a
 
 392 Hozuard a Man of Genhis. 
 
 moral and physical courage, an industry and perseverance, 
 a truthfulness, simplicity, and modesty, which never 
 before met in the same man, and probably will never 
 meet again. He was emphatically one of those " English- 
 men" to whom, if I may use the grand patriotic 
 language of Milton, God, when he would work some 
 great reformation, does, " as His manner is," first "reveal 
 Himself." Once more I quote the words of Edmund 
 Burke: " His plan was original, and it was as full of 
 genius as it was of humanity. It was a voyage of dis- 
 coveiy — a circumnavigation of Charity j" in a word, 
 what I began this lecture by calling it, a Romance of 
 History — a romance which shall to the end of time 
 amuse and instruct, reprove and encourage, not those 
 only who speak the language that Howard spoke, but 
 those too, all the world over, who are able to appreciate 
 the magnitude of the evils that he attacked, and the great- 
 ness of the victory which he won.
 
 193 
 
 LECTURE VIII. 
 
 SMALL-POX. 
 
 If I was right in calling my last lecture a Romance of 
 History, I cannot be far wrong if I speak of this as the 
 Romance of Science. For though Science has always 
 been a wonder-worker, and often a dispenser of rare bene- 
 fits to mankind, she never shone forth so brightly in both 
 characters as when she put it into the mind of Edward 
 Jenner to extract from the neglected gossip of the dairy 
 the means of destroying the most loathsome and fatal 
 pestilence that ever afflicted mankind. In so characterizing 
 the small-pox I do not exaggerate. How loathsome it 
 was, and what distressing consequences it entailed, in the 
 shape of blindness, deafness, deformity, and impaired 
 health, you all know. How it was the constant associate 
 of the jail-fever in the prisons of England I have already 
 told you. But I must vindicate by facts and figures 
 its claim to rank as the most destructive of all our pesti- 
 lences. 
 
 We have already had under review, in former lectures, 
 the Black Death, the Sweating Sickness, and the Plague ; 
 the Scurvy, and the Jail-Distemper, Of these the 
 sweating sickness may be set aside, as limited to England 
 and a few nations of the Continent, and after five visita- 
 tions during a short reign of some 66 years, ceasing from 
 among us. Scurvy, too, from the very nature of its cause, 
 and the jail-distemper, from its local character and partial 
 
 o
 
 1 94 Small-pox and Plague compared. 
 
 prevalence, cannot be brought into comparison with the 
 small-pox. The plague alone, by the frequency of its re- 
 currence and the extent of its ravages, may claim to be 
 put into competition with it as a destroyer of life. Let us 
 examine this claim. 
 
 I will first interrogate the London Bills of Mortality, 
 and compare the deaths ascribed to small-pox and plague 
 respectively in the years during which both diseases find 
 a place in their columns. I am able to make this com- 
 parison for the 7 years, 1630 to 16363 and the o^^) years, 
 1 647 to 1 679 : in all 40 years. These years comprise the 
 plague epidemics of 1636 and 166^ 5 and yet while the 
 total for plague is 87, 157, that for small-pox is no less 
 than 34, 302. I cannot compare the deaths by plague 
 and small-pox in any other group of years 5 but I may 
 state that while the total mortality by the plague in 72 
 years, of which five were epidemic, was about 200,000, 
 that by small-pox in 180 years did not fall far short of 
 300,000. The annual deaths from small-pox, witliin the 
 limits of the London Bills, during the first 75 years of 
 the eighteenth centur}', were largely in excess of 2000. 
 
 Small-pox, then, since the time that we began to make 
 a record of deaths here in London, down to the year 
 1820, has destroyed about three lives for every two that 
 the plague destroyed in the 72 years that it was entered 
 on the Bills of Mortality. If we had had a death-register for 
 the whole of England during the same period we should, 
 most probably, have found the deaths from small-pox 
 much more numerous than those from plague. And if 
 we could extend our inquiry to the Continent of Europe, 
 and from that to the whole habitable globe, we might, 
 perhaps, find reason to endorse the estimate of Sir Gilbert 
 Blane, who thought himself " greatly within the truth in 
 asserting tliat small-pox has destroyed a hundred for every 
 one that has perished by the plague." Dr. Black's esti-
 
 Small-pox among Savages. \ 95 
 
 mate of the annual mortality from small-pox in Europe 
 alone, in times preceding vaccination, reaches the high 
 figure of 494,000. 
 
 Among the reasons which may be assigned in favour 
 of the superior mortality of smali-pox, I may mention its 
 universal prevalence in every part of the world, among all 
 races of men, among all ranks of society, in both sexes, at 
 all ages, in all seasons 3 its habit of making itself at home 
 everywhere, not content, like the plague, with occasional 
 visits J the large proportion of the population whom it 
 attacks, and the many among them whom it kills. I 
 speak, of course, of the natural small-pox 3 and I do not 
 hesitate to characterize it as the most frightful and de- 
 structive pestilence that ever existed. 
 
 To form a vivid idea of its horrors, we must see it at 
 work among a tribe of savages, as many travellers and 
 missionaries have done. Here is what Alexander 
 Mackenzie says of the disease as it attacked the North 
 American Indians. It was as a fire consuming the dry 
 grass of the field. The infection spread with a rapidity 
 which no flight could escape, and with a fatal effect which 
 nothing could resist. " It destroyed with its pestilential 
 breath whole families and tribes." After picturing the 
 scene presented by the dead and dying, and the putrid 
 carcases dragged out of the huts by the wolves, or mangled 
 inside by the dogs feasting on the disfigured remains of 
 their masters, he finishes by telling us that it was not "uur 
 common for the father of a family, whom the infection 
 had not reached, to call them around him, to represent 
 the cruel sufferings and horrid fate of their relations from 
 the influence of some evil spirit who was preparing to ex- 
 tirpate their race, and to incite them to bafile death, with 
 all its horrors, by their own poniards. At the same time 
 if their hearts failed them in this necessary act, he was 
 himself ready to perform the deed of mercy with his own 
 o 2
 
 19'^ No Respecter of Persons. 
 
 hand, as the last act of his affection, and instantly to 
 follow them to the common place of rest and refuge from 
 human evil." 
 
 To the same effect is the Rev. Mr. Cordiner's descrip- 
 tion of the ravages of the small-pox in Ceylon, where, 
 according to a very moderate calculation, it carried off a 
 sixth of the inhabitants. We are told that the disease 
 inspired the people with such terror that husbands 
 forsook their wives, and parents their children, leaving 
 them only a little drink and food ; that wild beasts 
 attacked and destroyed the abandoned villages 3 and that 
 not even the bones of the deserted sick were afterwards 
 to be found. 
 
 I will give you one more case of the same class. A 
 Dutch ship, with small-pox on board, put into the Cape of 
 Good Hope, and the captain sent the foul linen ashore to 
 be washed. The small-pox broke out among the Hot- 
 tentots who washed the clothes, and killed most of them. 
 It then spread up the country to such an extent that the 
 native tribes at last drew a cordon round the infected 
 places, and shot all who tried to pass beyond it. This 
 fact, cited from Dr. Mead, affords a good illustration of 
 the liability of the disease to be conveyed in articles of 
 clothing. 
 
 That the small-pox was no respecter of persons appears 
 from the fact that the father, mother, wife, uncle, and 
 two cousins of our William \\\. died of it, and that the 
 king himself suffered from it severely and permanently. 
 Maitland, too, writing in 1772, alludes to " the havoc 
 made in great families, not many months since, by that 
 mighty disease, which seemed then to go forth like a 
 destroying angel, subduing all before it." 
 
 The origin of this destructive pestilence is involved in 
 obscurity. It is said to have been mentioned in very 
 ancient Chinese manuscripts, and in Brahmin records
 
 Its Early History. 197 
 
 '^'^66 years old. But the best authorities point to the fact 
 that a disease so contagious had not been imported from 
 Asia into Europe prior to the sixth century, as throwing dis- 
 credit upon these statements. It is true that some lynx- 
 eyed authors, such as Hahn, have thought that they recog- 
 nised the small-pox in the writings of Greek and Latin 
 physicians 3 but Anglada, ta whose able work on extinct 
 maladies I refer you, proves, I think, that they were mis- 
 taken. We do not touch solid ground in this inquiry till 
 nearly three-fourths of the sixth century had run out. 
 Small-pox certainly attacked the Arabian army at the 
 siege of Mecca in 569, and soon after reached Alexandria. 
 The Saracens carried it with them in their warlike expe- 
 ditions, and by the eighth century all Europe is supposed 
 to have became infected. But Anglada, quoting Marius, 
 Bishop of Avenches, and Gregory of Tours, proves that 
 as early as 570 the disease had shown itself in France and 
 Italy. At what time it reached England w^e do not 
 know. It was once thought to have been brought back 
 to us by the Crusaders in the thirteenth century 5 but 
 Woodville found that distinct mention of it had already 
 been made, as existing both here and on the Continent, 
 prior to the ninth century. 
 
 But whatever the date of its arrival in England, small- 
 pox, here as elsewhere, became a naturalized plague. We 
 have notices of severe epidemics in 1174, 1365, 1440, 1556, 
 1564, and 1613 J and from 1629 to i83i,it is entered 
 on the London Bills of Mortality in larger or smaller 
 numbers ; in higher or lower ratios to the total deaths. 
 In 1796 (the year of the introduction of vaccination) the 
 deaths by small-pox exceeded 18 per cent, of the total 
 ■deaths J and in 1772 they reached the high figure of 
 3992, or 15 per cent, of the deaths of that fatal year. 
 Ihe returns for the eighteenth century show that the 
 •mortality was subject to remarkable fluctuation. In 1702
 
 198 Mortality. 
 
 it was as low as 16, in 1796 as high as 184, per iooo ; 
 and to this high ratio it rose from 50 the year previous, 
 and fell to 30 the year after. If we call those years 
 non-epidenaic in which the death-rate fell below 100 per 
 thousand, and those epidemic in which it rose above it, we 
 have 66 of the one to 34 of the other. So that we may 
 say that small-pox was epidemic once in three years. 
 And if we term those severe epidemic years in which 
 the mortality exceeded 150 in the thousand, we shall 
 have live such, or one year in 20 ; and all of these oc- 
 curred in the last half of the centur)' ; the most severe of 
 all within four years of its close. The years and ratios were 
 as follows:— 1752, 173 J 1757, 1555 1772,1543 1781, 
 170 J 1796, 184. If we take tlie years of the century in 
 groups of 20, the first group exhibits the lowest rate of 
 mortality, the fourth the highest; the figures for the five 
 being 68, 78, 87, 99, 93. I shall give you a fair idea of 
 its relative mortality if I say that in the last ten years of the 
 century it was more than a hundred times as fatal as 
 diarrhoea and its allied diseases; six times as fatal as 
 apoplexy, palsy, and sudden death taken together ; and 
 seven times as fatal as the measles. So much for the 
 prevalence of the disease, and the deaths it caused. Let 
 us now inquire what was tlie rate of mortality among those 
 it attacked, and what the proportion of the whole popu- 
 lation whom, sooner or later, it destroyed. 
 
 The deaths among those attacked by the disease may 
 be taken, perhaps, at a fifth for all ages, and a third for 
 adults. In what is called its confiuent form it killed a 
 half; in \X.%discrete form about i in 25 ; in the intermediate 
 degree, i in 12. But there have been instances of a 
 mortality exceeding the highest ratio, and falling short of 
 the lowest. In my first lecture I gave one instance of 
 2^ deaths in 44 seizures; and in my fifth I instanced a 
 mortality of 13 in 19. The danger was always very
 
 In the Army. 199. 
 
 great at the extremes of life — in infancy and old age. 
 The death-rate among the mixed class of persons received 
 into hospital in all stages of the disease was one in 
 three. 
 
 Of the mortality in middle life, we learn something from 
 the experience of the army. Dr. Brocklesby tells us that 
 about the middle of the century small-pox carried off 
 about I in 4 of those whom it attacked in the natural 
 way in encampments and winter quarters j and that 
 only two out of nine soldiers escaped the disease. It 
 follows, then, that out of 100 soldiers, only. 22 would 
 escape attack, and the same number (22 in every loo, or 
 22 in 88 of all attacked) would die from this cause. 
 The mortality in the navy would, in all probability, be 
 higher still, so that we shall probably be within the mark 
 if we assume that when the small-pox was not in any way 
 modified or restrained by inoculation or vaccination, one- 
 lifth of all the men enlisted in our army and navy died of 
 this disease. I need not add that, as a constant associate 
 of the jail-fever, it passed from our prisons direct to our 
 armies and fleets. How often this happened may be 
 inferred from a fact stated by Sir Gilbert Blane, that, in 
 1800, the small-pox broke out 20 times in our Channel 
 fleet alone. 
 
 The proportion of the whole population which small- 
 pox destroyed may be inferred from the ratio which 
 deaths by small-pox bore to those from all diseases in the 
 eighteenth century. It was about i in 12. Jurin makes 
 it I in 14 for the end of the seventeenth and beginning of 
 the eighteenth century. 
 
 Of the numbers out of the whole community whom 
 sooner or later it attacked, we know nothing certain ; 
 for while, on the one hand, we read that there was no age, 
 however advanced, that the disease respected 5 on the other, 
 we are told of whole families, or family groups,being small-
 
 200 Mortality at different Ages. 
 
 pox proof. Diemerbroeck mentions five octogenarians 
 of his own family, and himself at 70, who had not had the 
 disease j while Anglada, who quotes this fact, cites a fatal 
 case at 70, and cases of recovery at 80 and 94 respectively; 
 also a coincidence of an infant a day old, and a man 
 of 80, at the same time under the care of the same 
 physician. 
 
 I may here state, in reference to its worst secondary con- 
 sequence, blindness, that there is ground for believing 
 that from a half to two-thirds of our blind population 
 formerly owed their sad privation to small-pox. 
 
 Some countenance is oriven to the higher estimates of 
 mortality by a computation made by Dr. Haygarth that at 
 Chester, in 1795, small-pox caused half the deaths of 
 children under 10 years of age. 
 
 From a table founded by Dr. Gregory on the Registrar- 
 General's returns for 1837-38, I calculate the deaths at 
 different ages as follows : — Out of 1000 deaths, 752 took 
 place under 5 years of age; 171 from 5 to 15 ; 54 from 15 
 to 30; 21 from 30 to 70 ; and 2 after 70. These figures 
 do not show the ratio of deaths to the living at the 
 several ages ; but this is not needed for my present pur- 
 pose, which is to illustrate the character of the disease by 
 taking these facts into account in conjunction with what 
 I have already stated respecting the occurrence of a small- 
 pox epidemic every third year. If I read the figures 
 aright, they point to a disease always specially greedy of 
 the blood of children, but sometimes feasting upon them 
 to repletion, and then waiting with cruel patience till the 
 lapse of time had provided a fresh repast. 
 
 Against this loathsome pestilence, so widely diffused, 
 so unsparing, so fatal, so cruel ; blinding, deafening, 
 and scarring many whom it spared, and sowing the 
 seeds of future mischief in more; there arrayed themselves 
 in course of time two champions — the one. Inoculation ;
 
 History of Inoculation. 201 
 
 the other, Vaccination ; the one introduced into England 
 earJy in the eighteenth century ; the other towards its 
 close. 
 
 I shall first treat briefly of inoculation, then more at 
 large of vaccination. 
 
 The discovery and first use of the method of Inoculation 
 is involved in obscurity. "^ Some poor unlearned, but 
 Heaven-taught, mortal," as Kirkpatrick has it 3 some 
 Chinese, Hindoo, or Circassian first hit upon it. Our 
 own earliest information about it came from two Italian 
 physicians, Pylarini and Timoni, referring to the early 
 dates 1701 and 1713. Pylarini thought that it was first 
 practised in Greece and Thessaly, and Timoni that it was 
 introduced into Constantinople, by the Circassians and 
 Georgians, about 1670. There is no doubt that it had 
 been practised by the Brahmins of Hindostan from a very 
 remote period, and that the Chinese have long " sown" the 
 small-pox by inserting a crust into the nose. And, strange 
 to say, a method of inoculation known as buying the small- 
 pox had been practised in parts of Wales for at least a 
 century before the introduction of inoculation from 
 Turkey. Be this as it may, it was from Constantinople 
 that inoculation came to us. About the year 1717, Lady 
 Mary Wortley Montague, wife of the English Ambassador 
 to the Turk, had her son, six years old, inoculated there ; 
 and in April, 1722, her daughter, about the same age, here 
 in England. This "charming and accomplished woman," 
 in one of her playful letters, dated Adrianople, 17 17, thus 
 justifies the step she was then contemplating. " Every 
 year thousands undergo this operation, and the French 
 ambassador pleasantly says, that they take the small-pox 
 here by way of diversion, as they take waters in other 
 countries. There is no example of any one having died of 
 it, and you may believe I am well satisfied of the safety of 
 this experiment, since I intend to try it on my dear little
 
 202 Moj'tality from Inoadated Small-pox. 
 
 son." Then followed, under the sanction of the Royal 
 Society, six condemned criminals 5 next five pauper 
 children of St. James's j then the children of a few families 
 of distinction j and to crown all, their Majesties, acting on 
 the cautious advice of Sir Hans Sloane, had all the Royal 
 children submitted to the operation. Mr. Maitland, 
 surgeon to the embassy, was the operator in these cases, 
 and in some ten others in the same year. Naturally 
 enough, though the success of the plan in commu- 
 nicating a mild form of the disease was fully esta- 
 blished by these early cases, the objection that the disease 
 so imparted was the contagious small-pox, soon made 
 itself felt. Indeed, Maitland himself had to deplore a ver}- 
 convincing and sad proof that it was so j for having 
 inoculated the child of a Mr. Batt, in Hertfordshire, six 
 of his serv^ants, who had intercourse with the child, " were 
 all seized at once with the natural disease, of which one 
 died." The practice of inoculation, checked by this 
 consideration, made its way very slowly j for Dr. Jurin, 
 an industrious collector of facts, reports the total for 1722 
 to have been 182 3 and Kirkpatrick, adding together the 
 cases brought together by Jurin and Scheuchzer for the 
 first eight years after its introduction, obtains a total of 
 only 897, of which 39 failed, and 17, at the ver}' outside, 
 died. 
 
 The rate of mortality incident to inoculation was cer- 
 tainly very favourable when compared to that of the 
 natural small-pox. This I will show by comparisons 
 relating to the same time and place. The deaths follow- 
 ing inoculation in 1722, and rightly or wrongly ascribed 
 to it, were at the rate of i in 91, at the very time that 
 Dr. Nettleton reported from many towns in Yorkshire a 
 mortality from the natural small-pox of 19 out of 100, or 
 ver}^ nearly i in 5. The first eight years of the practice 
 yield an average of i in 50 at the outside, against a mor-
 
 Sue cess fid Inoctdators. 203 
 
 tality from the natural disease that certainly did not fall 
 short of I in 5. I add a few facts relating to the early 
 ])eriods : — In 172 1-2, while the small-pox in New Eng- 
 land was killing more than a seventh of those whom it 
 attacked, inoculation proved fatal to only i in 51. In 
 South Carohna, in 1738, while i in 5 died of natural 
 small-pox, only i in 100 fell victims to inoculation. Some 
 inoculators, dealing with a few cases, were unfortunate. 
 Thus, out of a batch of 25 inoculated at Dublin, there 
 were 3 deaths, being the high ratio of nearly one-eighth. 
 But this is quite exceptional ; and, as a set-off, I can cite 
 from Kirkpatrick's work ratios after inoculation in Eng- 
 land of I in 134, 186, 300, 370, 400, 425, 500, and 1000. 
 But this is not all. Instances are cited by the same 
 author of 134, 300, and even 1000 inoculated without a 
 single death j and according to the statement quoted on 
 the authority of Sir George Baker, at p. 17 of this work, 
 the mortality might be reduced to something like i in 
 3000, 
 
 x\s the numbers just given relate to persons of every 
 age, and of mixed ages, to private persons, and children 
 and adults in public institutions, the demonstration of the 
 general safety and slight risk of inoculation may be taken 
 to be complete. Without taking up your time longer 
 with this part of my subject, I will state, as the result of 
 my own reading and reflection, that while, soon after the 
 introduction of the practice the mortality might be as 
 high as I in ^o, it ultimately declined, as the result of 
 growing experience, increasing care, and the progressive 
 abandonment of the stifling system of treatment, to i in 
 -;oo at the most, while the natural small-pox continued 
 even to comparatively recent times to claim some such 
 ratio of victims as i in 4, 5, or 6. The most successful 
 inoculator (;[uoted by Kirkpatrick was a Serjeant Ranby. 
 The Suttons also were noted for their success : but Dr.
 
 204 Estimate of the value of Inocidation. 
 
 Gregory gives much more credit to " diet and exposure to 
 the open air." than to the antimonial and mercurial 
 medicines which they extolled. 
 
 Before I proceed to vaccination, I must examine a 
 question full of interest in the last centur}^, and which 
 has not yet lost its interest for us. I mean the real value 
 of inoculation as a sanitary measure. If I have approxi- 
 mated to the truth in the tigures submitted to you, we 
 have, as it were, face to face, the natural small-pox with 
 a mortality of, say, i in 5, and the inoculated disease with 
 a mortality at the outset of i in 50, at length reduced to 
 I in 500. So that if we suppose 1000 persons seized 
 with the natural disease, something like 200 of them 
 would die of it j but out of the same number submitted 
 to inoculation, the deaths would not exceed 20 when the 
 practice was in its infancy, and 2 when it had grown 
 common, and prevailed largely. This saving of 180 lives 
 in the 1000 on the least favourable supposition, and of 
 198 on the most favourable, will have to be set off against 
 the deaths that may have taken place among the inocu- 
 lated wdio, but for the operation, might never have caught 
 the natural disease, added to the deatlis occurrinor amongr 
 those who caught the infection from the inoculated, but 
 who would not have taken it had the small-pox been left 
 to itself. Hence we may infer that, if the natural small- 
 pox spared only some small fraction of the population, 
 inoculation could not have added largely to the infection 
 and consequent mortality j but if, on the other hand, the 
 natural disease did, sooner or later, attack only a moderate 
 proportion of the entire population, inoculation might, in 
 the long run, cause more deaths indirectly than it saved 
 directly. Now I believe that the first supposition is the 
 one which experience supports : I think that the small- 
 pox did not spare any considerable fraction of the people ; 
 but that, sooner or later, favourably or unfavourably, it
 
 Its effect on the Mortality by S^nall-pox. 205 
 
 infected the greater part of them. I should, therefore,, 
 expect to find that a favourable. impression was made on 
 the total mortality from small-pox by the introduction 
 and spread of inoculation. Such, however, was not the 
 opinion of Sir Gilbert Blane. He alleged that inocula- 
 tion had been mischievous, inasmuch as the proportion 
 borne by deaths from small-pox to the total mortality had 
 increased during the last century from 78 to 94 per 1000 
 — figures which correspond very nearly to those I have 
 already given. But Dr. Gregory, by dividing the last 
 ninety years of the century into three periods of 29 each — 
 171 1 to 1740 (when there was no inoculation), 1741 to 
 1770 (when inoculation was coming into general use), 
 and 177 1 to 1800 (when inoculation was almost univer- 
 sal), obtained for the three periods the following deaths : — 
 ^^^2>^?) j ^2>i?>'^^ '■) 57>2'58, or an ultimate saving of 81 15 
 lives ! Reasonable objection may, I think, be taken to 
 this division, on the ground that inoculation was certainly 
 practised to some extent long prior to the year 1741 j and 
 also to the omission of a very necessary element in any 
 such comparison — the number of the population. I shall 
 steer clear of both these objections if I take the deaths by 
 small-pox in three periods of ten years and compare them 
 with the estimated population within the Bills of Mor- 
 tality at or about the periods in question. I take, as 
 fairly representing the mortality caused by small-pox, un- 
 modified by inoculation, the decade ending 17 19; as 
 corresponding to the introduction of inoculation into 
 partial use, that ending 1749; and, as corresponding to 
 the large and general practice of it, the ten years ending 
 17995 and these are the ratios reduced to the common 
 standard of a million inhabitants : — First decade, 31,416 
 deaths 3 second, 28,282 5 third, 22,863. There is, therefore, 
 a reduction in the last decade as compared with the first 
 of 8553 deaths ; and sc far a confirmation of the thesis
 
 2c6 Small-pox at the close of the i^th Century. 
 
 maintained by Dr. Gregory against Sir Gilbert Blane. \i 
 we take into account the salutary effect likely to have 
 resulted from improved treatment and management of 
 the sick, there will still probably remain some saving of 
 life to place to the credit of inoculation. 
 
 Before I pass from Inoculation the palliative, to Vac- 
 cination the preventive, I must dwell for a short time on 
 the small-pox as it showed itself in the last few years of 
 the century when Jenner was busy with his great discovery. 
 The disease then existed in two forms — natural small-pox, 
 and small-pox modified by inoculation. What proportion 
 the one bore to the other we do not know. But we learn 
 from the London Bills that it was still a most destructive 
 disease. Within their narrow limits it destroyed, in the 
 last five years of the century, no less than 9827 lives 5 
 3548 in the first year of the series, 2409 in the last. We 
 must go back 15 years to find so fatal a year as the first 3 
 and, with that exception, nearly as many to find a match 
 for the last. That the disease still retained its epidemic 
 character, the fall from 3548 deaths in 1796 to 522 the 
 following year sufficiently attests 3 and that, when not 
 modified by inoculation, it was as fatal as ever we have 
 abundant evidence. So that medical men and the public 
 at large must have had, at the time to which I refer, 
 stringent reasons for desiring and welcoming some better 
 means of dealing with small-pox than inoculation had pro- 
 vided for them. They had had three quarters of a cen- 
 tury of palliation with the evils always inherent in that 
 mode of procedure ; they were now to have conferred on 
 them the far greater boon of prevention with all its con- 
 tingent advantages. 
 
 The early history of vaccination belongs to the latter 
 end of the i8th century, as that of inoculation did to the 
 beginning of it. As the progress and development of 
 Jenner's discovery belongs to the J 9th century, it does not
 
 Vaccination and Edward Joiner, 207 
 
 come within the scope of these lectures j and I shall refer 
 to it, therefore, only as far as may be necessary to prove 
 its value. 
 
 The history of Vaccination is, to a degree quite unusual 
 with great discoveries, that of the discoverer himself. I 
 shall, therefore, treat Jenner in this lecture as I did 
 Howard in my last. I shall blend the history of the dis- 
 covery with the hfe of the man. 
 
 These are the leading facts of Jenner's history. He 
 was born May 17, 17493 the son of a clergyman. He 
 was apprenticed, at the usual age, to a surgeon at Sodbury, 
 near Bristol. On the expiration of his articles, he came to 
 London to finish his studies, and lived in the house of the 
 celebrated John Hunter two years, with my grandfather 
 as fellow-pupil. He then established himself in practice 
 in his native town — Berkeley, in Gloucestershire ; took the 
 degree of M.D. at St. Andrews in 17925 made his first 
 experiment in 17955 published the results of his experi- 
 ments in 17985 received, in two Parliamentary grants, the 
 sum of 30,000/., in 1802 and 18075 lived to see the 
 triumph of vaccination, and died in 1823, 74 years of age. 
 
 And now as to the discovery itself Jenner was born, 
 apprenticed, and settled in practice in a county in which 
 the cow-pox prevailed. It does not occur in all the coun- 
 ties of England. Fortunately, during his apprenticeship, 
 a young woman came into his master's surgery, and hap- 
 pening to speak about small-pox and its dangers, said, ** I 
 cannot take the disease, for I have had the cow-pox." This 
 remark, coinciding as it did with the popular belief, made a 
 strong impression on his mind. Other medical pupils and 
 other medical men must have heard the same remark, and 
 known of this popular belief 5 but Jenner alone stored it 
 up as matter for thought and further inquiry. He spoke 
 about it to John Hunter, and, on settling at Berkeley, 
 often talked of it at his medical club, till his brethren
 
 2o8 Character of Jenner^s Discovery. 
 
 jocosely threatened to expel him as a bore. But Jenner 
 was not to be deterred. He held to his opinions, and at 
 length contrived to put them to the decisive test of experi- 
 ment. 
 
 If any one is inclined to think lightly of this tenacity 
 and perseverance, or to suppose that any medical man 
 with the same opportunities would have done the same, 
 I would quote to him a case in point. Inoculation was 
 introduced into England by Lady Montague, after her son 
 had been inoculated by ]Mr. Maitland, surgeon to the 
 embassy, in March, 17 17. Now that gentleman, by his 
 own account, was fully convinced of the efficacy and 
 safety of inoculation at that early date, and yet it is not 
 till the summer of 1721 that we find him operating on 
 the criminals in Newgate. Seeing that the experiments 
 which Jenner had to make were already made for Mait- 
 land in Constantinople, and that he was quite satisfied 
 by them, he certainly showed a want of lively interest 
 and alacrity which contrasts strongly with Jenner's earnest 
 perseverance, though the censure which Dr. Robert 
 Williams passes upon him is certainly exaggerated, and 
 not wholly deser\^ed. Another consideration which en- 
 hances the merit of Jenner arises out of the fact just 
 stated, that inoculation had been practised in parts of Wales 
 for a long term of years, and yet no medical man had 
 o-iven serious attention to the immunity from small-pox 
 which that local custom had notoriously conferred, 
 jenner's merit, then, consisted mainly in the intelligence 
 with which he received, and the perseverance with 
 which he followed up, the information he had obtained 
 from the milkers in Gloucestershire. His was not a great 
 discover)', in the sense of requiring great original powers 
 of mind, or great advantages of education ; it was great 
 on account of the moral courage and undaunted perse- 
 verance which carried it to a successful issue : and great
 
 What Vaccination is. 209 
 
 beyond all other discoveries of its class, or indeed of any- 
 class, in the benefits conferred upon mankind. In a 
 word, the discovery of vaccination is stamped by moral 
 rather than by intellectual greatness, and this its moral 
 character shines forth in every part of its history. For 
 I need not tell you that in clinging to his first strong and 
 just impressions, in bringing his convictions to the test of 
 experiment, in promulgating and defending his discovery, 
 he had to encounter grievous opposition, the compassionate 
 incredulity of friends, the envious carping of rivals, the 
 misrepresentations of enemies — nay, even the mistaken 
 •objections of good and pious men — in a word, to undergo 
 the martyrdom which seems to have been decreed as the 
 lot of those who confer on the world the boon of 
 great discoveries. It redounds to the credit of Jenner 
 that he bore these severe trials well ; and that these an- 
 noyances had as little power to irritate him as had his 
 ultimate success to impair the native modesty and un- 
 assuming worth of his character. Unspoiled by flattery, 
 •unchanged by success, he continued to the last the same 
 kind, affectionate, simple, truthful character he had ever 
 been 5 constant in his attachment to natural history, active in 
 the discharge of all his duties as a citizen, and unremitting 
 in his atteniion to the pooi. 
 
 Let us now examine this great discovery, and look for- 
 ward as far into this, our nineteenth century, as may be 
 necessary to test and determine its value. 
 
 I assume that you know what vaccination is, that you 
 understand it to be the introduction into the human body, 
 by a puncture or punctures in the skin, of that same matter 
 which forms on the udder and teats of the milch 
 cow, and is transferred to the hands of the milkers j that 
 its insertion gives rise only to local effects, with very 
 slight constitutional disturbance 5 that it is not com- 
 municable otherwise than by direct contact ; that 
 
 F
 
 I o Success of Vaccination. 
 
 it is a preventive of the natural small-pox, in the great 
 majority of cases 5 and that when it does not prevent 
 an attack, it mitigates its severity more certainly than a 
 previous attack of small-pox itself does. It is interesting, 
 though comparatively unimportant, to state that the local 
 disease thus imparted to the human subject is but the 
 small-pox itself, modified by passing through the body 
 of the cow, and further that the same human malady 
 becomes in the horse the horse-pox, or variolous grease. All 
 this has been ascertained by experiments suggested by 
 observation. 
 
 Now vaccination, as we practise it, and as Jenner himself 
 performed it, owes its origin to a series of simple infe- 
 rences from the confident statement made to Jenner and 
 others by the milkers — that having contracted cow-pox 
 from the cow, they were thereby rendered proof against 
 the natural small-pox — the first inference being that the 
 infections matter would take effect as well when inserted 
 by the point of a lancet as when rubbed into the skin of 
 the hand 5 and the second that, if this insertion were 
 followed by distinct local effects involving the production 
 of lymph, that lymph would itself give rise to the same 
 local consequences, and so on through an indefinite series 
 of insertions. In a word, it was assumed, and happily 
 demonstrated, that just as small-pox had been made to 
 pass from person to person by the inoculation of the 
 matter of a small-pox vesicle or pustule, so cow-pox 
 might be communicated from person to person by the 
 same mode of procedure. 
 
 I will now apply to this preventive of small-pox that 
 test of figures which I brought to bear on the palliative of 
 inoculation. 
 
 Vaccination, \\'hich may be said to have been introduced 
 in 1796, could have had little eflect in limiting the deaths 
 from small-pox in the remaining years of the century j for in
 
 Numerical Statements. 211 
 
 1 80 1 the total number of the vaccinated is beHeved not 
 to have exceeded 6000. We must, therefore, allow a few 
 years of the nineteenth century to elapse before we select 
 a decade of years for comparison with the three which I 
 chose as tests of inoculation in the eighteenth century. 
 Let us take the ten years ending 1819, when vaccination 
 had been brought into general use, and also the ten years, 
 ending 1849, when ii^oculation may be said to have been 
 superseded by vaccination. Well, the deaths by small- 
 pox in London, which, in the ten years ending 1799 were 
 22,863 to the million of inhabitants, were reduced to 
 8045 ^"^ ^^^ million in the decade ending 18J9, 
 and to 4798 in that ending i S49. So that, while 
 inoculation could claim, at the outside, to have 
 reduced the mortality from small-pox in eighty years by 
 about 8500 deaths in somewhat less than 3 1,500, vaccina- 
 tion might boast of having lowered the death-rate from 
 nearly 23,000 to little more than 8000 in twenty years, 
 and to considerably less than 5000 in 30 years more 5 or 
 (to bring these figures together) from 22,863 in the decade 
 that closed the eighteenth century, to 4798 in the short 
 space of fifty years. But this is not all ^ for if I reduce 
 my figures to the scale of one year instead of ten, still 
 retaining the standard of one million of inhabitants, I am 
 able to show a further decline of mortality coincident with 
 a further extension of vaccination. 
 
 Let me premise that, in the history of vaccination in the 
 present century, there are three periods to be noted — one 
 ending 1 840, prior to the enactment of any vaccination laws ; 
 one ending 1853, during which vaccination was gratuitously 
 provided J and one in which we are now living, that may 
 be called the era of compulsory vaccination. Now, I will 
 retain my own decades, with the understanding that the one 
 ending 1849 fairly represents the gratuitous period, and add 
 the decade ending with i860 as embracing seven years of
 
 2 1 2 Extirpating Pouter of Vaccination. 
 
 the period of compulsion. I take my last figures from Dr. 
 Seaton's excellent Handbook of Vaccination. The figures 
 for the eighteenth century which show the possible in- 
 fluence of inoculation are .3141, 2828, and 22865 and for 
 the nineteenth century, which display the effect of vaccina- 
 tion, 805, 480, 272. A fall from 3141 per million per 
 annum to 2286, represents, therefore, the reduction of 
 mortality from the reign of small-pox uncontrolled, to the 
 rule of small-pox modified by inoculation j and from 
 2286 to 272 the superiority of vaccination with State 
 patronage and aid to inoculation without it. Or, if we 
 employ a method of comparison I have so often resorted 
 to in these Lectures, — I mean the ratio of deaths by small- 
 pox to deaths from all causes — I find a progressive fall, 
 with a single trifling interruption, from a maximum mor- 
 tality by the natural small-pox of \ 08 in the thousand in 
 the ten years ending 1770, to j 1 in the thousand in the 
 ten years ending i860. I will place the figures before 
 you for each decade. They are 108, 98, 87, 88, for the 
 ioxxx decades of the eighteenth century ; 64, 42, 32, 23, 16,. 
 1 1, for the six decades of the nineteenth. These are 
 remarkable figures ; but they are not such as would have 
 satisfied the aspirations of Jenner, nor should they content 
 us. We ought not to count our work done while any- 
 thing remains to be accomplished. 
 
 It was the cherished opinion of Jenner himself that 
 vaccination is competent to the entire extinction, or, as we 
 should now term it, stamping out, of tiie small-pox ; 
 and this opinion of his was shown to be no idle dream by 
 facts which came to his own knowledge. A manuscript 
 of his, published by Baron in his " Life of Jenner," con- 
 tains this striking history : " From the year 1762 to 1792, 
 the number that died of small-pox in the Danish dominions 
 amounted to 9728. About the year 1802, vaccination 
 was first introduced, and the practice became general, but
 
 Past Sanitary Progress. 213 
 
 not universal \ however, 58 persons only died of the small- 
 pox to the year 18 10. Vaccination, by command of the 
 King, was now universally adopted, and small-pox inocu- 
 lation prohibited, and from the year 18 10 to the year 
 1819, not a single case of small-pox has occurred.' 
 Again, " From Bombay, I learn the small-pox is there 
 completely subdued, not a single case having occurred for 
 the last two years." These facts, amply confirmed as 
 they are by others of the same order industriously 
 brought together by Sir Gilbert Blane, are exactly such as 
 we could wish to see gilding the sunset of Jenner's well- 
 spent life, food for his joyful and pious reveries, warrants of 
 the gratitude he felt towards God for the good he had made 
 him the instrument of conveying to his fellow-creatures. 
 If, when he was on the point of proclaiming the pre- 
 ventive efficacy of vaccination, '' the situation in which he 
 stood (to use the words of his biographer) has seldom had 
 a parallel in the history of our race," what must have been 
 his feelings, as, armed with such facts as these, he looked 
 forward with confidence to the time when " this most 
 loathsome and af^icting of all the scourges of humanity" 
 would be banished, not from his own England only, but 
 from the whole habitable world ? 
 
 What else remains of this Romance of Science belongs 
 to the nineteenth century, with which we are not at 
 present concerned. And now I approach the end of 
 these Lectures, and will take my stand for a few minutes 
 at the point of time that separates the eighteenth from the 
 nineteenth century, casting a glance back to the past, and 
 forward to the future. 
 
 The history of the remote past teaches us, I think, that 
 whatever may be the case in warmer climates, it is true 
 in these colder and temperate ones, that the nearer men 
 are to nature the farther they are from health. In those 
 days when the chief occupation of men was the care of
 
 ^14 Health and Civilization. 
 
 cattle and the culture of a few fruits, and when manufac- 
 turing industry was limited to the production of coarse 
 clothing, frail and combustible habitations, and imple- 
 ments for warfare and the chase, they were the prey of 
 frequent famines and pestilences, and subject to a rate of 
 mortality of which, in these days, we have happily no ex- 
 perience. How much the contests of rival chiefs, the in- 
 security of life and property, the condition of serfdom, 
 the absence of roads, the huge unreclaimed tracts of 
 forest and marsh, must hav^e weakened production and 
 strengthened disease, it is not difficult to imagine. 
 
 Passing on to the time when men began to collect in 
 cities, and to fortify themselves by walls and moats 
 against lawless violence, when the culture of grain took 
 the place, to some extent, of the care of cattle, we still 
 rind both town and country, the dwellings and the habits 
 of the people^ hostile to health, favourable to the produc- 
 tion of disease at home and the reception of pestilence 
 from abroad. 
 
 And even when we arrive at times that may claim to be 
 •called civilized 3 when we had attained to a central and 
 stable government, had long thrown otF the incubus of 
 serfdom, had established flourishing manufactures and 
 were carrying on an extensive commerce, had largely im- 
 proved our agriculture, and taken our rirst lessons in horti- 
 culture, our cities and houses were so squalid and rilthy that 
 the plague found itself quite at home in them. 
 
 Then, little by little, as civilization advanced, the twin 
 virtues of cleanliness and temperance asserted their rights. 
 Men bathed and washed oftener, submitted to frequent 
 changes of linen, and admitted tea, cofl^ee, and chocolate 
 into competition with beer, wine, and spirits. They came 
 by degrees to live in better houses and cleaner towns. We 
 saw the last of the plague, and were in the right way to rid 
 ourselves of some, at least, of our home-bred pestilences.
 
 Sanitary Discoveries of the i^th Centzcry. 315 
 
 But I need not remind you how much remained to be 
 accomplished, even as late as the last quarter of the 
 eighteenth century. I have entered so fully into this sub- 
 ject, and done, as I venture to think, such ample justice 
 to it, that I must content myself now with reiterating 
 what I said in my first lecture of the immense importance, 
 in a hygienic point of view, of that remarkable epoch. 
 
 One question, indeed, the sanitary triumphs of that 
 epoch do suggest, for the answer to which we must 
 look forward into the times of which men now living have 
 had experience. Does the history of the last 70 years 
 warrant us in looking forward to fresh sanitary discoveries 
 and triumphs ; to a healthier, and therefore, happier 
 future ? I answer this question, without hesitation, in the 
 affirmative. These are the grounds of my confidence. 
 
 In the first place, I am encouraged by the fact that 
 Jenner's singular discovery has proved no idle dream of 
 philosophy, but a great truth, fruitful in results, and in a fiiir 
 way to realize the most sanguine expectations of its author. 
 
 In the second place, I attach great importance to the 
 fact that already this century can boast one capital hygienic 
 discovery, — with which the name of Dr. Snow is so honour- 
 ably connected — the discovery that cholera, to which we 
 may confidently add typhoid fever, may pass from person 
 to person, from house to house, from district to district, in 
 drinking water. I recognise, too, as very important that 
 other hygienic discovery due to the independent researches 
 of Drs. Bowditch and Buchanan — that there is a decided 
 relation of cause and effect between dampness of soil and 
 consumption. These two truths must have a grand effect 
 on the future of water-supply and drainage, on the cleansing 
 of our towns, and the application of their refuse, solid and 
 liquid, to our least fertile soils. 
 
 In the third place, it is impossible not to feel the great 
 importance which attaches to the happy results that have
 
 2.i6 Gro2Lnds of Hope for the Future. 
 
 followed in so many towns, on well devised measures of 
 drainage and water supply. 
 
 In the fourth place, I draw many inferences highly favour- 
 able to our future progress in hygiene from the modern his- 
 tory of medicine. We have made immense progress in the 
 knowledge of minute structures, healthy and diseased, in 
 the instruments by which we assist our senses, in our 
 diagnosis and recognition of diseases, and in their treat- 
 ment also. We have attained to a wonderful command over 
 the function of sensation, as shown by our painless opera- 
 tions and local anaesthetics. We have made, and are still 
 making, immense progress towards what I may call the 
 natural treatment of disease, as distinguished from those 
 artificial procedures of w4iich I have given you some in- 
 stances in these Lectures. We are far beyond the point at 
 which 400 scorbutic patients could be sacrificed to a wild 
 mercurial theory, or the lancet be ruthlessly employed to 
 slay, not the fever, but the patient. 
 
 In the fifth place, it is difficult to exaggerate the value 
 of the mortuary returns now obtained from every part 
 of the United Kingdom, or of the special inquiries set on 
 foot by the medical officer of the Privy Council. 
 
 And lastly, I augur well for the, future from the change 
 slowly, but surely, coming over the public mind. It is being 
 taught, in many ways, that the Policy of Palliation, in which 
 we have so long indulged, is eminently unfruitful, and posi- 
 tively mischievous. The time is evidently approaching when 
 the Preventive Philanthropy (as I have ventured to call it) 
 that guided the footsteps of Howard, will fill the hearts of 
 the people, and the Policy of Prevention become the one 
 rule of action of the Legislature. 
 
 Should these Lectures be found to have helped forward, 
 in some slight degree, the advent of this better time, I shall 
 feel amply repaid for the labour I have bestowed upon them. 
 
 THE END.
 
 ^^m^-m 
 
 UNIVERSITY OF CALIFORNIA LIBRARY 
 
 Los Angeles 
 
 This book is DUE on the last date stamped below. 
 
 NOV 2 9 1361 
 
 MAY 4 1362 
 
 MAY 1? ion 
 
 NOV 2 5 1963 
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 MAY 1 3 1966 
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