summer of 1707 were the coldest, and the harvest the worst, that had occurred for forty-seven years (that of 1698 excepted), while the winter of 1708-9 was characterized by 'the greatest frost all over Europe within the memory of man.' r

In 1718, a fever, in all respects the same' as that of 1708, became again epidemic in Ireland and continued until 1721, when 'it abated of its severity, dwindling insensibly away, till at length it was rarely to be met with.'s It was always most prevalent during the cold months of the year. From O'Connell's description there can be no doubt that this fever was typhus. The symptoms were headache and anxiety; in some stupor, and in others wakefulness; taciturn, or occasionally vociferous delirium; tremors and subsultus; a dry black tongue, with sordes on the teeth, and an eruption of ' petechia rubræ, purpureæ aut lividæ ': the duration of the fever was from fourteen to twenty-one days. O'Connell practised venesection under certain conditions; but the contra-indications, respecting which he says, 'a venesectione manum tempero,' were so numerous as to have precluded the practice from most cases. The rest of his treatment consisted in blisters, salines, and cordials (sal-volatile). A similar fever commenced in York and other parts of England in 1718, reached its acme in July 1719, and terminated about the close of the latter year." Little is known as to the circumstances under which this epidemic appeared, except that the preceding summer and harvest-time of 1717 had been remarkably cold and wet."

After 1721, there was an interval of good health in Ireland, and there was scarcely any fever until 1728, when it returned after a succession of three bad harvests. Oatmeal, it is stated, rose to an extravagant price, and food of all sorts was so scarce that riots occurred all over the country, to suppress which the military were called out. This epidemic lasted four years, and reached its climax in 1731. Rogers attributed the origin of the fever to the same causes as the 'jail-fever,' which had appeared at the Oxford and Taunton Assizes. The symptoms, as recorded by Rogers, O'Connell, and Rutty, show clearly that the fever was typhus. The tongue became dry and black; the pulse was weak, and there was headache, delirium, and stupor passing into coma. The eruption is well, though quaintly, described by Rogers, as follows: 'An universal Petechial Efflorescence, not unlike the measles, paints the whole surface of the body, limbs, and sometimes the very face. This appearance is very general. In some few, and but few, have appeared Purple and Livid Spots, exactly circular, not unlike those observed in the most mortal kind of Small-Pock, some as large as a vetch, others not bigger than a middling pin's head' (p. 7, 8.) All the observers mentioned found that the fever 'did not bear bleeding,' and that a tonic and stimulant treatment was necessary. Rogers recommended

SHORT, 1749, i, 441 and 453. ROGERS, 1734, P. 4.

O'CONNELL, 1746, p. 65.

For notices of this epidemic, see ROGERS, 1734; O'CONNELL, 1746; SHORT, 1749;

BARKER and CHEYNE, 1821.

▾ SHORT, 1749, ii, 21; ROGERS, 1734, p. 5.

sack-whey, wine, salines and blisters. This epidemic was not only general over Ireland, but extended to England. In London, where i was described by Dr. Edward Strother, F.R.C.P., as a 'very remarkabl spotted fever,' it proved fatal to many, and in one week raised the bil of mortality to nearly one thousand. The patients had both petechis and a rash.' In 1728 also, we find from Winteringham, that a feve was prevalent at York characterized by 'red spots, not unlike flea bites, on the breast, sometimes interspersed, so that the skin had marbled appearance.' Huxham states that petechial fevers were pre valent everywhere. Although Strother practised bleeding in ordinary fevers, he recommended in this spotted fever a stimulant treatment consisting of warm, moderately strong sack-whey, with tea, mutton or chicken-broths, water-gruel and wine.'w

6

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In 1735 Dr. Browne Langrish, F.R.S., published an excellent accoun of the fevers prevalent in London in his time. Typhus was described under the term Malignant Ferer,' and it was believed to originate from 'the effluvia of human live bodies.' Its principal cause was thought to be overcrowding with deficient ventilation, as a result of which people were made to inhale their own steams.' At page 364, the cutaneou eruption is described as follows:-'Petechial spots or red efflorescenc in large areas sometimes appear upon the skin, and never rise abov the surface. They seem to be constituted of broken particles of re blood oozing from the capillary sanguine arteries through the lymphati arteries and cutaneous glandules, which, being not minute nor subtl enough to perspire through the pores of the epidermis, do remai between the epidermis and the cutis in the form of flat spots. The do not seem to be critical discharges from the blood, because the sic does not grow a whit the better for their appearance. The brighte red they are of, so much the better sign; but when they appear purple brown, or dusky or black colour, they manifest a greater degre of putrefaction.' Under the head of treatment, Langrish recommende wine, sulphuric and other acids, and made the following remark which are worthy of attention at the present day:- All medicine which strengthen the action of the heart and arteries and raise th pulse, . . . . without colliquating and dissolving the globules of th blood and increasing the alkaline acrimony of the juices, are of exceller use.' 'But all the volatile salts and spirits, such as Sal. Volat. Succin Sal. Corn. Cervi, Sp. Sal. Ammon., are destructive medicines, becaus they are known to break down and colliquate the blood-globules, an to render the animal juices more acrid and alkaline.'*

of

The first edition of Huxham's celebrated Essay on Fevers' ap peared in 1739. Chapter viii. is entitled:-'Of Putrid, Malignan Petechial Fevers' and contained one of the best descriptions of Typh

The account of this epidemic has been extracted from SHORT, 1749, ii, 4 ROGERS, 1734, p. 5: O'CONNELL, 1746, p. 268; HUXHAM, 1752; RUTTY, 1770, p. 2 STROTHER, 1729; WINTERINGHAM, quoted by LAYCOCK, 1847, p. 790; BARKER a CHEYNE, 1821, i, p. 5.

LANGRISH, 1735, pp. 364 and 369. HUXHAM, 1739; see also HUXHAM, 175

that had yet appeared. He regarded the disease as contagious, and described both petechial spots and a measly efflorescence. The eruption of the petechiae is uncertain; sometimes they appear the fourth or fifth day, sometimes not till the eleventh, or even later.' 'The more florid the spots are, the less is to be feared.' 'We frequently meet with an efflorescence also, like the Measles, in malignant Fevers, but of a more dull and lurid hue, in which the skin, especially on the breast, appears as it were marbled or variegated.' Huxham recommended bleeding, provided the patient was very plethoric and seen at the commencement of the attack; but in most cases he placed the greatest reliance on bark, mineral and vegetable acids, and generous

red wine.

'Petechial Fever' was unusually prevalent in Ireland in the spring of 1735, and in 1736; in connection with this, it may be observed that the years 1734 and 1735 were very rainy and the summers were like winters. After 1731, however, there was no great epidemic of fever until 1740. The winter of 1739-40 was one of intense severity both in Great Britain and in Ireland. Numbers of cattle and poultry perished of the cold, which also destroyed all vegetable products and especially the potatoes. The surplus produce of the preceding season having been all exported, a great scarcity followed, so that wheat was sold for 448. the kilderkin, although the same quantity, two years later, fetched only 6s. 6d. There was great distress among the poor, and many died of starvation. O'Connell's words were :- -'Et, quod adhuc funestorum malorum cumulum multo gravius adauxit, radices istæ tuberosa (battata vulgo dicta), nutrimentum fere constans et integrum plebecula et inferiorum hujus regni incolarum, a dirissimo hoc et diuturno gelu penitus putrescebant. Hinc funesta annonæ charitas, et inter pauperes populumque inferiorem immaniter sæviens dira fames; hinc putrida plebeculæ alimenta, ex pravis et corruptis istis radicibus, aliis pravi succi vegetabilibus, et morbidorum animalium cadaveribus conflata' (page 325). In August, 1740, an epidemic of fever arose and raged over the whole of Ireland, but particularly in the province of Munster. The epidemic continued throughout the summer of 1741, but towards the close of the year began to abate; in the winter of 1742, after an abundant harvest, it almost completely disappeared. The fever attacked the poor first, but from them it spread to the rich. O'Connell computed that in 1740-41, Ireland lost at least 80,000 inhabitants by famine and spotted fever, and that one-fifth of the population of Munster, where the poor were worse provided for, perished. The fever was characterized by a 'measly rash,' and by the ordinary symptoms of typhus. It is important to notice, however, that there is evidence in Ratty's description of the co-existence of Relapsing Fever with Typhus. This circumstance must be borne in mind, when we read that in some of the cases the pulse was full and hard, and that bleeding was of service a statement which must be viewed in connection with the fact, 'that many of the poor, abandoned through necessity to a low aces

• RUTTY, 1770. Pref. p. 33.

D

cent diet, and some of them drinking nothing but water, recovered.' In the worst (Typhus) cases, it is stated that bleeding was of no service, and that the pulse was so depressed, as not even to be raised by 'generous cordials and great plenty of sack.' Short says that in Galway 'blisters and bleeding had made doubly fine work of it.' O'Connell strongly condemned much bleeding; and although he bled to ten ounces at the commencement of the complaint, he honestly acknowledged that the treatment was of no use. About the same period, although a little later, a very fatal epidemic fever made its appearance in England and Scotland, and there are records of its prevalence in London, Bristol, Worcester, Plymouth, etc. In Bristol and Worcester it was observed in 1740, but in London not until July 1741. In London it is said to have broken out among the poor who had been half starved for two years, and obliged to eat uncommon and unwholesome things. In all the accounts, mention is made of the eruption; in some cases, it is described as like that of measles, in others as like so many small flea-bites, while in a few instances it is said to have been mixed up with petechia and vibices. Parotid abscesses and buboes are mentioned by Huxham as frequent complications. In an anonymous pamphlet, published at the time, the treatment recommended consisted in bleeding and purging; but the experience of most observers was opposed to bleeding. Dr. Wall treated his cases with bark and acids; and, in reference to bleeding, he wrote, 'As to myself, I lay so little stress upon bleeding, that I have always omitted it, unless some very urgent symptom seemed to require it.' Short tells us that the cases in London 'could not bear bleeding.'a

In 1750, and again in 1752, Sir John Pringle, Physician-General to His Majesty's Forces, and afterwards President of the Royal Society, described Typhus as 'the Hospital- or Jayl-Fever.' As to the eruption he wrote as follows:- There are certain spots, which are the frequent, but not inseparable, attendants upon fever.' They are the true petechiae, being sometimes of a brighter or paler red, at other times of a lurid colour, and are never raised above the skin. They are small, and commonly distinct, but sometimes so confluent, that at a little distance the skin looks only somewhat 'redder than ordinary, but upon a nearer inspection the interstices are seen.' 'They sometimes appear as early as the fourth or fifth day.' 'The nearer they approach to a purple, the more ominous they are.' From the account of the post-mortem appearances, however, it is obvious that Pringle included under Hospital-Fever, cases which were not Typhus, and which, in fact, were probably not fever at all. As to treatment, he ordered that the patient should first be removed out of the foul air. Speaking of depletion, he observed: Large bleedings have generally proved fatal, by sinking the pulse and bringing on a delirium;' and again: Many have recovered without bleeding, but few who have lost much blood.' He commended bark and serpentaria and thought there was nothing comparable to wine, whereof the common men had an allowance to half a pint a day.'

For an account of this Epidemic, see O'CONNELL, 1746; SHORT, 1749; Anonym. 1741; RUTTY, 1770; HUXHAM, 1752; BARKER and CHEYNE, 1821, i.; STARK, 1865.

Concerning the cause of the fever, Pringle observed: The hospitals of an army, when crowded with sick . . . . or at any time when the air is confined, produce a fever of a malignant kind and very mortal. I have observed the same sort arise in foul and crowded barracks; and in transport ships, when filled beyond a due number and detained long by contrary winds, or when the men were kept at sea under close hatches in stormy weather.' b

Al

Towards the end of 1757 Typhus appeared in Vienna, and lasted till 1759. An account of this epidemic was written by Storck and Hasenöhrl. The disease principally prevailed in overcrowded localities. The pulse was always soft, and the blood drawn in many cases, even at the commencement of the illness, did not congulate, though Hasenöhrl recommended venesection in certain cases, he allowed that it was but an anceps auxilium.' He spoke, however, in the highest praise of nitric and sulphuric acids, and of the stupendous virtues of Peruvian bark. Storck noted a fatal case, complicated with gangrene of the nose and abscesses of both parotids. About the same time (1757-8) the first epidemic of Typhus in Berlin, of which there are authentic records, was noted. It was very contagious, but its origin was traced to overcrowding and deficient ventilation with insufficient food. It was characterized by red or petechial spots and severe cerebral symptoms. In some cases there were buboes in the axillæ and groins, and occasionally death occurred as early as the third day.

In 1763 Dr. James Lind, physician to Haslar Hospital, published 'Two Papers on Fevers and Infections,' in which he showed that Typhus fever was then a very common disease on board ship, especially during the long voyages from North America. He considered bleeding injudicious, and very often dangerous, treatment.

In 1764 a dreadful epidemic of Typhus and dysentery raged at Naples, which was attributed to a great scarcity of provisions, and the consequent starvation and misery of the poorer classes, to whom the disease was for the most part confined. The people from the surrounding country flocked into the city, where they had so few opportunities for attending to the cleanliness of their persons, and were so overcrowded, that their garments are described as saturated with a most offensive effluvium.8

After the epidemic of 1740-41, there was but little Typhus in Ireland. until 1770. In that year we learn from Dr. James Sims, of Tyrone, a fever appeared in the east of Ireland which, in the summer of 1771 reached Tyrone, and, as autumn advanced, raged there with great violence, and lasted for about a year. It was contagious, and was characterized by constipation, soreness of the eyeballs, headache and oppression; about the fourth day, delirium and watchfulness; and in the later stages, picking of the bed-clothes, pupils insensible to light, black tongue, sordes on the teeth, and involuntary stools. There were