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Part II. the State of Epidemic, Epizootic, and Epiphytic Disease In REPOKT ON EPIDEMICS, 18G1-2. 393 Part II. The State of Epidemic, Epizootic, and Epiphytic Disease in Great Britain, in 1861-62. By J. N. RADCLIFFE, M.R.C.S. The following Report refers to the twelve months ending November the 31st, 1862. In respect of epidemics, this Report is necessarily based on the different returns of the Registrars-General of England and Scotland, published during the period to which it relates. The information contained in these returns on outbreaks of epidemic disease, at the time of, or soon after, their occurrence, is very imperfect. No other source of information, however, exists, or if existing, is accessible. I propose to bring the different facts on epi- demics together in one connected view. The history thus formed will fall far short of what a scientific annual record of epidemic diseases should be; but the first step towards a more perfect history must be the systematic collation of exist- ing materials. It is necessary to remark that, in the subsequent report, I have, as a rule, substituted the term continued fever for the word typhus, so commonly made use of in the reports of local registrars, unless there is other evidence that the dis- ease referred to was typhus properly so-called. In the old nosological arrangement of the Registrar-General of England (still in use in Scotland, although rejected in this country), " typhus" is used as a synonym of continued fever. In the new arrangement adopted here, consistently with nosological " " more recent researches, the terms typhus", typhoid", and " relapsing" are made use of in place of the common designa- tion of continued fever; but in the official instructions to medical men for the registration of deaths, typhus is still directed to be used as the generic term of continued fever. If " " typhus", typhoid", and "relapsing" fever are to be regarded etiologically and nosologically as distinct forms of disease, as Dr. Murchison and others cogently argue, and as would seem " most probable, it is manifest that the use of the term typhus" in the returns of the Registrars-General of England and Scot- land, diminishes very greatly the scientific and practical value of the returns, and tends to no little confusion. The need for the discrimination of " typhus" from other forms of fever, and consequently the disuse of the term as a synonym of "con- D D 394 REPORT ON EPIDEMICS, 1861-2. tinued fever" in the published returns of causes of death, is clearly shewn by the remarkable epidemic of the disease which has for several months prevailed, almost unnoticed, in London, and by the partial outbreaks in Lancashire. It may be a question for future discussion, whether the Society should not submit to the consideration of the Registrars-General of Eng- " land and Scotland the need of substituting the term continued " fever" for typhus" in the published returns of the Causes of Death. But it is not to be forgotten that the etiological and noso- logical distinctions of the different forms of fever had not, until very recently, assumed that position in the scientific and practical teaching of medicine, which would induce so strict an attention to the diagnosis of the maladies as it is important to secure. Moreover, there has been a much felt want of a text-book which accurately represented recent researches into the nature and forms of continued fever. This want has now been happily supplied by the publication of Dr. Murchison's treatise on the Continued Fevers of Great Britain.* The publication of this work will constitute an epoch in the study of fever. What Louis' book effected for typhoid fever, Dr. Murchison's treatise will effect for our knowledge of the whole subject. The latter sums up pre- vious information, adds largely to it, throws a flood of light upon debated points, and places these in the best position for subsequent examination. The work, indeed, at once becomes the great classic on continued fever in this country. The chief immediate interest of the Report I now enter upon consists in the fact, that it presents an account (how- ever imperfect) of the state of epidemic disease at a time when the health of the population, as measured by the rate of mortality, was above the average. LAST QUARTER OF 1861. England.?There was no unusual amount of fatal sickness throughout the kingdom in 1861; for th,e mortality was below the average in each quarter. In the last quarter of the year, the price of wheat was higher than in the same quarter of the two previous years, and meat dearer than in the correspond- ing quarter of 1860. The temperature of October was greater than had been observed in the same month since 1831, and before that year, since 181]. November was cold from the 1st to the 24th; then a warm period set in, which continued * A Treatise on the Continued Fevers of Great Britain. By Charles Murchison, M.D. London : Parker, Son, and Bourn. 1863. REPORT ON EPIDEMICS, 1861-2. 395 until the 24tli December. The fall of rain in November (5-2 inches) was greater than had occurred in that month for forty- five years, with one exception. The year closed with cold weather. Pauperism had largely increased during the three months. The mortality of the quarter exceeded that of the same quarter of 1860, but was less than the like period of 1859. The diminution of mortality, as compared with 1859, was noted in all the registration divisions, with the exception of the North-Western and the Northern. The excess in the latter division was unimportant ; but that in the north- western counties was considerable, and arose from the higher mortality of Lancashire. The deaths in Lancashire were about two thousand more than in either of the two previous December quarters. Fever, under various designations?typhus (?), typhoid, con- tinued, and low?scarlatina, and measles, prevailed exten- sively in many parts of the country. Several towns and villages in the South-Eastern Counties suffered from typhus (so-called) and typhoid fever. An outbreak of the latter form of fever doubled the mortality of Steyning in Sussex. An account of this outbreak by Dr. Whitley, is given in the recently published (the fourth) Report of the Medical Officer of the Privy Council. Although the village is well situated, it would appear that its sanitary condition has been much neglected, and that, within the last few years, it has been the scene of epidemic outbreaks of cholera, small-pox, scar- latina, and diphtheria, as well as of typhoid fever. Scarlatina was prevalent at Woking, in Surrey; and an enormous, but little fatal, outbreak of measles occurred at Brenchley, in Kent. There were but ten deaths in about five hundred cases of the disease. Measles was also prevalent at Arundel, in Sussex. Diphtheria prevailed at Perry Hill, in Surrey; broke out at Ashurst, in Kent; and the malady was very fatal amongst the soldiers' children at Parkhurst barracks, in the Isle of Wight. Thirty-two deaths from measles and whooping- cough, and pneumonia and bronchitis following measles, were registered at Reading, in Berkshire ; and nine deaths from small-pox at Windsor. In the South-Midland Counties, puerperal peritonitis oc- casioned a sad fatality at Isleworth, in the extra-metropolitan division of Middlesex. There were no less than four women lying dead from this formidable affection at one time. Con- tinued fever was also prevalent in several districts of Hert- fordshire, Northamptonshire, Huntingdonshire, Bedfordshire, D D 2 396 REPORT ON EPIDEMICS, 1861-2. and Cambridgeshire. Scarlatina was fatal at Aylesbury, in Buckinghamshire; and diphtheria at Peterborough. Measles prevailed at Newport Pagnell, Turvey (in Bedfordshire), and Wisbech. In the Eastern Counties, continued fever, scarlatina, diph- theria, and measles, were prevalent in many parts. Numerous deaths were also registered from small-pox. One-fourth of the deaths recorded (twenty-five) at Litcham, in Norfolk, were from diphtheria. At Snettisham, in the same county, malig- nant sore throat and diphtheria were very fatal. Measles prevailed at West Flegg, and measles and whooping-cough at Hillington, both localities also in Norfolk. In the South-Western Counties, continued fever prevailed in the Warminster and Mere districts, in Wiltshire; at Bere Regis, in Dorsetshire; at Gunnislake, in Devonshire; St. Clement and St. Just, in Cornwall; and Ban well and Keyns- ham, in Somersetshire. Dr. Bristowe has described the con- ditions of the outbreak at Gunnislake, in a report to the Medical Officer of the Privy Council, published in the Report already referred to. Typhoid fever, it would appear, is an annual visitant in that locality, and the disease has more than once assumed epidemic proportions. An outbreak of unusual " severity occurred three years ago. One of the most remark- able features in the place" (Gunnislake) writes Dr. Bristowe, " is the want of privy accommodation. In some few cases, in- deed, two or three privies, with cesspools, are supplied for the use of eight or a dozen houses; but in the majority of in- stances, even in the centre of the town, no accommodation of any kind is provided, and hence the adult male population de- fgecate habitually in the gardens or in the road, and the women and children make use of the pot de chambre, which they empty over the garden, on the dust-heap, or in any other convenient spot. Occasionally a wooden erection may be seen, having the external aspect of a privy, and used as such, but with, only a crossbar or plank for a seat, and no cesspool whatever; the excrement being allowed to accumulate there, and diffuse itself thence for an unlimited time, or until it is required for manure." Drainage and cleanliness, as will readily be imagined, are regarded as superfluities in Gun- nislake.
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