Notes on epidemics : for the use of the public (1866)

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On account of the remarkable stupor which almost always attended it, Sydenham called the fever of this constitution a comatose fever. It began with sharp pains in the head and back, pains in the limbs, heats and chills, etc. When they began to mend, they would crave for absurd things to eat or drink. During convalescence the head, through weakness, could not be kept straight but would incline first to one side and then to the other [28].

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A fever which began in the milder form would often degenerate into the more malignant, the cause assigned, in the usual recriminatory manner of the time between rival schools, being mistaken treatment. But sometimes the fever was malignant from the outset, with purple spots, petechiae, morbillous efflorescence, watery vesicles on the neck and breast, buboes, and anthraceous boils.

It is the more remarkable, therefore, that Sydenham should have discovered, in the beginning of , the outbreak of a new fever, different from any that had prevailed for seven years before. Mason died this morning in his lodging at Whitehall. A fever rages that proves very mortal, and gives great apprehensions of a plague [32]. In his first account of the epidemic of fever in [33] , which began with a thaw in February, he points out that the thaw in March, , had been followed by pestilential fever and thereafter by the plague proper. There are some phenomena which so far incline me to that belief [34].

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The reign of plague, as the event showed, was over; the fever which had been on former occasions its portent and satellite, came into the place of reigning disease. Its antecedents and circumstances were very much those of plague itself.

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Its mortality was greatest in the old plague-seasons of summer and autumn, it had slight relation to famine or scarcity, or to other obvious cause of domestic typhus. The winter of was one of intense frost; an ice-carnival was held on the Thames during the whole of January.

There is no clue to the forms of sickness that caused the excessive mortality in country parishes and provincial towns. But in London it appears from the Bills that the one great cause of the unusual excess of deaths in was an enormous mortality from infantile diarrhoea, from the end of July to the middle of September, during the weather which Evelyn describes as excessively hot and dry with occasional storms of rain. It was in the second year of the long drought, February, , that Sydenham dated the beginning of his new febrile constitutions.

The mortality of was just twenty deaths more than in 23, ; but fever with spotted fever and smallpox had each a thousand more out of the total than in the year before.

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Sydenham says that the fever did not spare children, which might be alleged of typhus at all times; but a fever of the kind, even if it ran through the children of a household, seldom cut off the very young, the mortality being in greatest part of adults and adolescents. Hence, although the weekly fever-deaths in the following Table may not appear sufficient for the professional and other interest that they excited, it is to be kept in mind that they had been mostly of adult lives. The fever was a continued one, with exacerbation towards evening; it was apt to change into a phrensy, with tranquil or muttering delirium; petechiae and livid blotches were brought out in some cases Sydenham thought they were caused by cordials and a heating regimen , and there were occasional eruptions of miliary vesicles.

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The tongue might be moist and white at the edges for a time, latterly brown and dry. Clammy sweats were apt to break out, especially from the head. If the brain became the organ most touched, the fever-heat declined, the pulse became irregular, and jerking of the limbs came on before death. Later writers, for example those who described the great epidemic fever of , have identified the fever of with the contagious malignant fever afterwards called typhus, and Murchison, in his brief retrospect of typhus in Britain, has included it under that name.

Physicians, he says, had learned to drive off by bark the fevers of the former constitution, from to the beginning of , even when the fever intermitted little and sometimes when it intermitted not at all; and they saw an indication for bark in the nocturnal exacerbations of the new fever.

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We have a good instance of how the bark-craze was at this time influencing the very highest circles of practice in the case of Lord Keeper Guildford, in July, , as related in another chapter. It will be seen from the table of weekly deaths that the second of the two hard winters was over before the fever began to attract notice.

Sydenham compares its beginning after the thaw in February, , to the beginning of the plague when the frost broke in March, If it had been merely the typhus of a hard winter, of overcrowding indoors, of work and wages stopped by the frost, and of want of fuel which things Evelyn mentions as matters of fact , it would have come sooner than the spring of The fever began definitely for him in February, , and was at its worst in the old plague-seasons of summer and autumn.

If the seasons had any relation at all to it, the epidemic was a late effect of the long drought, an effect which was manifested most when the rain came, in the summer of and throughout the mild winter and normal summer of At these times, as often as by inspiration we draw into the naked blood miasmata of this kind, noxious and inimical to nature, and we fall into those epidemical diseases which they are apt to produce, Nature raises a fever,—her accustomed means of vindicating the blood from some hostile matter.

And such diseases are commonly called epidemical ; and they are short and sharp because they have thus a quick and violent movement [39]. An account of his theory will be found in the chapter on Influenzas and Epidemic Agues. It may be said here that it needs only a few changes, especially the substitution of organic for inorganic matters in the soil, to bring it into line with the modern doctrine of miasmatic infective disease as expounded by the Munich school.

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The most instructive instance of pestis mitior in Britain is not the pestilential fever which led up to the last plague , but the great epidemic of fever all over England and Scotland which reigned for two or three years before the great outburst of plague in I go back to this because it was not wholly or even mainly a famine fever although it was as general as one of the medieval famine-fevers , and because in that respect it furnishes a close parallel to the fever of , which I regard as the successor of the plague.

After this interlude in the history, we shall proceed to consider the question of the final extinction of plague. In Scotland the fever of was directly connected with famine, but in England it was not obviously so according to the records that remain. It was the year following, , that really brought famine and famine-sickness to Scotland, as the second of two bad harvests had always done.

But speciallie in this burgh, that no familie in all the citie was frie of this visitation. Thair was also great mortalitie amonge the poore. The same spotted fever was all over England in , but it did not, as in Scotland, come in the wake of famine. These were not famine-prices in England, and there is no evidence of general sickness directly after the harvest of , when corn was dearest.

But it was not until the summer and autumn of that the spotted fever became epidemic in England. Although there is no word of the epidemic continuing in Scotland in , it was undoubtedly as prevalent in England in that year as the year before, and prevalent in country houses as [Pg 32] well as in towns and cities. It was clearly an inexplicable visitation. Thus far there had been no plague; and if the spotted fever were cousin-german to the plague, as Chamberlain said, it was remarkable in this that it prevailed in the mansions of the rich in town and country and took off more victims among the upper classes than the plague itself even in its most terrific outbursts.

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However, a plague of the first rank followed in London and elsewhere in the summer and autumn of Besides the famine-fever of Scotland in , there was another associated thing which should not be left out of account. Before the famine and fever had begun in that country, the notorious Hungarian fever was raging in the Palatinate, and continued to rage for four years.

It had been so often engendered since the 16th century in campaigns upon Hungarian soil as to have become known everywhere under the name of that country. Its infection spread, also, everywhere through Europe; thus it is said to have even reached England [Pg 33] in , and again in , although it is not easy to find English evidence of it for either year. In the last years of James I.

That doctrine made little of contagion from person to person; yet the idea of contagion was familiar, and had been so since medieval times. If we might assume contagion to explain such cases as those that occurred in the houses of squires and nobles, we might find a source of it either in the famine-fever of Scotland or in the war-fever of the Palatinate. But the teaching of the time was that it was in the air; and if the infective principle had been generated either in Scotland or on the upper Rhine it had diffused itself in some inscrutable way.

The doctrine of epidemic constitutions seems strange to us; but some of the facts that it was meant to embrace are also strange to us. On the other hand, we have now a scientific doctrine of the effects of great fluctuations of the ground-water upon the production of telluric miasmata, which may be used to rationalize the theory of emanations adopted by Sydenham and Boyle. From this modern point of view the remarkable droughts preceding the pestilential fevers and plagues of and , and preceding the fever of , which is the one that immediately concerns us, may be not without significance.

The London fever of having been suspected at the time to be the forerunner of a plague, as other such fevers in [Pg 34] the earlier part of the century had been, and no plague having ensued, the question arises most naturally at this stage, why the plague should have never come back in London or elsewhere in Britain after the great outbreak of Plague had been the grand infective disease of Britain from the year of the Black Death, , for more than three centuries, down to The last of plague in Scotland was in , in the west and north-west of England about in Wales probably in , in Ireland in , and in all other parts of the kingdom including London in , the absolute last of its provincial prevalence having been at Peterborough in the first months of [53] , while two or three occasional deaths continued to occur annually in London down to False reports of plague, contradicted by public advertisement, were circulated for Bath in [54] , and for Newcastle in [55] ; while in London as late as , during a bad time of typhus fever, the occurrence of plague was alleged [56].

It is not easy to say why the plague should have died out. It had been continuous in England from , at first in general epidemics, all over the country in certain years, thereafter mostly in the towns, either in great explosions at long intervals or at a moderate level for years together. The final outburst in , which was one of the most severe in its whole history, had followed an unusually long period of freedom from plague in London, and was followed, as it were, by a still longer period of freedom until at last it could be said that the plague was extinct.

In some large towns it had been extinct, as the event showed, at a much earlier date; thus at York the last known epidemic was in , and it can hardly be doubted that many [Pg 35] other towns in England, Scotland and Ireland would have closed their records of plague earlier than they did had not the sieges and military occupations of the Civil Wars given especial occasion for the seeds of the infection to spring into life.

Plague seemed to be dying out all over England and Scotland in Ireland it is little heard of except in connexion with the Elizabethan and Cromwellian conquests for some time before its final grand explosion in London in In seeking for the causes of its decline and extinction we must keep prominently in view the fact that the virus was brought into the country from abroad as the Black Death of But for that importation it is conceivable that there would have been no signal history of plague in Britain.

Its original prevalence was on a great scale, and there were several other widespread epidemics throughout the rest of the 14th century. In the first volume of this history I have collected evidence that plague was endemic or steady for long periods of the 15th and 16th centuries in London, with greater outbursts at intervals, and that in the 17th century it came chiefly in great explosions.

Something must have served to keep the virus in the country, and more especially in the towns, until at length it was exhausted. An exotic infection, or one that had not arisen from indigenous conditions, and would probably never have so arisen, does not remain indefinitely in the country to which it is imported. Thus Asiatic cholera, imported into Europe on six, or perhaps five, occasions in the 19th century, has never become domesticated; and yellow fever had a career in the southern provinces of Spain during some twenty years only.

Plague did become domesticated for about three centuries in England, and for longer in some other countries of Europe; but it died out at length, and it would almost certainly have died out sooner had it not found in all European countries some conditions not altogether unsuited to it.

What were the favouring conditions? If, as I believe, the virus of plague had its habitat in the soil, from which it rose in emanations, and if it depended therein, both remotely for its origin in some distant country, as well as immediately for its continuance in all countries, upon the decomposition of human bodies, then it is easy to understand that the immense mortalities caused by each epidemic would preserve the seeds of the disease, or the crude matters of the disease, in the soil.

Buried plague-bodies would be the most obvious [Pg 36] sources of future plagues. But if the theory given of the Black Death be correct, bodies dead of famine or famine-fever would also favour in an especial way the continuance of the plague-virus in certain spots of ground, although they would probably never have originated it in this country.

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Moreover, the products of ordinary cadaveric decomposition would be so much pabulum or nutriment for the continuance of the virus. But all those things being constant, the continuance of plague would largely depend upon the manner in which the dead, after plague, or after famine and fever, or in general, were disposed of. The soil of all England in was filled with multitudes of the dead laid in trenches, and there were several general revivals of plague in the fifty or sixty years following.