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Counting and Classifying Diseases: Contagion, Enumeration and Cullen’s Nosology

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Abstract

Interest in vital and medical statistics also revived at mid-century. John Fothergill, members of his circle, and other allies campaigned for better data collection. A group of reformers in the north of England who were closely associated with Fothergill’s circle put this idea into practice. Many of the reformers were Dissenters; most were graduates of the Edinburgh medical school, where their friend William Cullen was simultaneously reordering the map of acute diseases. Contagion and taxonomy interacted in Cullen’s work when he concluded that acute diseases were “species” whose nature was determined by the nature of the pathogens that had caused them. This transformed medical language and reoriented medical research.

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Notes

  1. 1.

    Andrea A. Rusnock, Vital Accounts: Quantifying Health and Population in Eighteenth-Century England and France (Cambridge: 2002), 22–3.

  2. 2.

    Rusnock, Vital Accounts, 16–17. Graunt assumed that about 36 percent of the population died before the age of five and that only one in 100 lived past 76; he interpolated for the number surviving each intervening decade of life. In 1693, astronomer Edmond Halley made a more accurate life table using mortality data from Breslau, which did include age at death.

  3. 3.

    Rusnock, Vital Accounts, gives an example of sixteenth- and seventeenth-century bills on 20–3. A compilation published anonymously as A Collection of Yearly Bills of Mortality, from 1657 to 1758 Inclusive (London: 1759) is available online from Google. This is often attributed to Thomas Birch, then secretary of the Royal Society; Ernest Heberden, William Heberden: Physician of the Age of Reason (London: 1989), 74 attributes it to William Heberden Sr. See also William Black, An Arithmetical and Medical Analysis of the Diseases and Mortality of the Human Species, 2nd edn (London: 1789); Andrew Wear, Knowledge and Practice in English Medicine, 1550–1660 (Cambridge: 2000), 104–17; Margaret DeLacy,“Nosology, Mortality, and Disease Theory in the Eighteenth Century,” Journal of the History of Medicine (1999) 54:261–84. Portions of this article are used with permission from Oxford University Press.

  4. 4.

    The Oxford English Dictionary (Oxford: 1961).

  5. 5.

    Online from http://www.stat.ucla.edu/history/bill_of_m.gif. The 1632 bill that Rusnock reproduces from Graunt adds “Affrighted,” “Bit with a mad dog” and “Brused, Issues, sores, and ulcers” but omits “Bedrid, Blasted and Calenture.” Clearly the bills were modified to fit perceived needs. The Oxford English Dictionary poetically describes “calenture” as “a disease incident to sailors within the tropics, characterized by delirium in which the patient…fancies the sea to be green fields,” but it was most likely a burning fever.

  6. 6.

    Graunt, “Observations upon the Bills of Mortality,” in The Economic Writings of Sir William Petty: Together with the Observations upon the Bills of Mortality More Probably by Captain John Graunt, ed. Charles Henry Hull, vol. 2 (Cambridge: 1899), 356, online from the HathiTrust.

  7. 7.

    Petty…Graunt, 2:348–9.

  8. 8.

    Petty…Graunt, 2:350 and see Rusnock, Vital Accounts, 29.

  9. 9.

    Petty…Graunt, 2:352. Graunt here separates “purples” from “spotted fever,” but the 1632 bill he reproduces on 344 lists them together.

  10. 10.

    Petty…Graunt, 2:342–4.

  11. 11.

    William Black, An Arithmetical and Medical Analysis of the Diseases and Mortality of the Human Species, 2nd edn (London: 1789), 44. Febrile illnesses accounted for about a quarter of the nearly 1.8 million London deaths tabulated by Black between 1701 and 1777.

  12. 12.

    William Petty, “Observations upon the Dublin Bills of Mortality, 1681,” in Petty…Graunt, 2:481–492 on 488–91. See also Margaret DeLacy, The Germ of an Idea: Contagionism, Religion, and Society in Britain, 1660–1730 (New York: 2016), 63.

  13. 13.

    Quinsy is an abscess around the tonsils, usually caused by infection with group A streptococci.

  14. 14.

    Rusnock, Vital Accounts, 51–70.

  15. 15.

    Francis Clifton, The State of Physick, Ancient and Modern…(London: 1732), 171, online from ECCO.

  16. 16.

    Matthew Eddy offers a detailed description of this form of paper technology in mid-eighteenth-century Scotland in “The Shape of Knowledge: Children and the Visual Culture of Literacy and Numeracy,” Science in Context (2013) 26:215–45.

  17. 17.

    Clifton, Tabular Observations, 19–20. London lecturer George Fordyce appended an even more formidable form for recording clinical observations to his article, “An Attempt to Improve the Evidence of Medicine,” Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge (1793) 1:243–92. Fordyce added that the publisher Joseph Johnson had blank copies of this form for sale.

  18. 18.

    Clifton, State, 171.

  19. 19.

    In Edinburgh the number of burials tripled during this period. See Margaret DeLacy, “The Conceptualization of Influenza in Eighteenth-Century Britain: Specificity and Contagion,” Bulletin of the History of Medicine (1993) 67:74–118. Portions of this article are reused with permission by Johns Hopkins University Press.

  20. 20.

    John Chandler, “Histories of the Epidemick Colds which happened in the Years 1729 and 1732/3; Drawn from Observations Made at those Times, in London, and now Digested into Order,” Old Jury, 18 October 1734, British Library, Add. Mss. 4433 (Birch Collection, Royal Society Papers, vol. ii, ff. 28–44b). This seems to be the second work published in England specifically about an epidemic of this illness; the first was John Turner’s De Febre Britannica Anni 1712 (London: 1713). The term “influenza” was not yet in general use. The Edinburgh author(s) referred to this disease as “fevers of cold.” The fact that influenza often kills by lowering resistance to other diseases such as pneumonia remains a problem for demographers and epidemiologists to this day. Even in non-epidemic years, it is a factor in a significant proportion of all deaths.

  21. 21.

    A Collection of Yearly Bills of Mortality, from 1657 to 1758 Inclusive (London, 1759), 12.

  22. 22.

    Ernest Heberden, William Heberden, 74.

  23. 23.

    Ernest Heberden, William Heberden, 74–5.

  24. 24.

    Short was a graduate of Glasgow and the author of works on the chemical analysis of mineral water. Norman Moore, “Short, Thomas (c.1690–1772),” rev. Patrick Wallis, ODNB (Oxford: 2004), http://www.oxforddnb.com/view/article/25461.

  25. 25.

    Thomas Short, New Observations, Natural, Moral, Civil, Political, and Medical, on City, Town and Country Bills of Mortality (London: 1750), 109–10.

  26. 26.

    Short, Observations, 110.

  27. 27.

    See Rusnock, Vital Accounts, 135; James C. Riley, The Eighteenth Century Campaign to Avoid Disease (New York: 1987).

  28. 28.

    These were reprinted as “On Weather and Diseases,” in The Works of John Fothergill, ed. John Coakley Lettsom (London: 1783) 1:145–240. I thank the National Library of Medicine for providing a microfilm. I have also used an online copy from the Internet Archive. It first appeared in three volumes: vols 1 and 2 in 1783 and vol. 3 in 1784. ECCO has three volumes in one (1784).

  29. 29.

    Fothergill, “Weather and Diseases,” 147.

  30. 30.

    On the bills of mortality, see Fothergill, “Weather and Diseases,” 157, 159–60, 165–6.

  31. 31.

    John Fothergill, “Some Remarks on the Bills of Mortality in London with an Account of a Late Attempt to Establish an Annual Bill for this Nation,” in Works of Fothergill 2:107–14.

  32. 32.

    Fothergill, “Remarks,” 108–9.

  33. 33.

    Fothergill, “Remarks,” 110.

  34. 34.

    Fothergill, “Remarks,” 109.

  35. 35.

    “Abstract of the Marriages, Births, and Deaths, and also the Age, Sex and Disease, of those Who have Died…,” in The Development of Population Statistics, ed. D.V. Glass (Farnborough UK: 1973), 28. I have not seen this form in any online editions of the original journal or in Lettsom’s edition of Fothergill’s Works. The list of diseases from Glass’s anthology is in the Appendix to this book.

  36. 36.

    Arthur Cash, John Wilkes: The Scandalous Father of Civil Liberty (New Haven: 2006), 29–38; R. D. E. Eagles, “Potter, Thomas (1718–1759),” ODNB (Oxford: 2004; online edition, January 2008), http://www.oxforddnb.com/view/article/22619.

  37. 37.

    Franklin wrote Observations concerning the Increase of Mankind in 1751. He had not yet made his second visit to England but had been corresponding with Collinson. Fothergill arranged for the publication of Franklin’s letter about electricity in the same year, and the two men began corresponding directly. Franklin would also become a friend and frequent house-guest of Dashwood’s. Alexander Webster carried out a parochial census in Scotland and produced an unpublished “Account of the Number of People in Scotland in the Year 1755.”

  38. 38.

    Fothergill, “Some Remarks,” 295; Fox, Fothergill, 228–9. See also Peter Buck, “People Who Counted: Political Arithmetic in the Eighteenth Century,” Isis (1982) 73:28–45. Buck attributes the failure of the bill to “country” opposition to any expansion of central government power and its ability to assess taxes.

  39. 39.

    Booth, Haygarth, 44.

  40. 40.

    Hanway had been a merchant, trading in Persia and Russia. Fuller was the son of John Fuller and Elizabeth Rose, Hans Sloane’s step-daughter.

  41. 41.

    James Stephen Taylor, Jonas Hanway, Founder of the Marine Society: Charity and Policy in Eighteenth-Century Britain (London: 1985), 106–15; Ruth McClure, Coram’s Children: The London Foundling Hospital in the Eighteenth Century (New Haven: 1981), 145–7 questioned this claim because parishes tried to avoid payment.

  42. 42.

    Between c. 1744 and 1757, Price was the chaplain in a house that had been Daniel Defoe’s in Newington Green in the Borough of Hackney. John Howard lived in Newington Green from 1752 until 1756. Price and John Aikin assisted Howard with the State of the Prisons. Aikin moved to London in 1792 and to Stoke Newington in 1798. Anna Letitia Le Breton, Memoir of Mrs. Barbauld (London: 1874).

  43. 43.

    Bayesian probability is used in medicine to estimate the likelihood that a patient has a particular disease, and in other fields to make statistical inferences. Ann E. Nicholson, Bayesian Artificial Intelligence, 2nd edn (Boca Raton: 2010); Colin Howson and Peter Urbach, Scientific Reasoning: the Bayesian Approach, 3rd edn (Chicago: 2006); Tom Siegfried, “Odds Are, It’s Wrong,” Science News (March 27, 2010), 177 no. 7, http://www.sciencenews.org/view/feature/id/57091/title/Odds_Are,_Its_Wrong; D. R. Bellhouse, “The Reverend Thomas Bayes, F.R.S.: A Biography to Celebrate the Tercentenary of His Birth,” Statistical Science (2004) 19, no. 1:3–43. I thank Tom Shillock for the Siegfried article. Bellhouse speculates that Price’s Arian views commended him to Bayes, and Bayes’s work appealed to Price because he believed it provided evidence for the existence of God.

  44. 44.

    Price and Howard both studied with the Newtonian John Eames at the Moorfields Academy. Following Eames’s death in 1744, many of his students went to David Jennings, a Moorfields graduate and Dr John Aikin’s maternal great-uncle. His school was succeeded by the Hoxton Academy led by Samuel Morton Savage, where Andrew Kippis FRS was a tutor. Kippis, a Northampton graduate, later taught in the Dissenting New College at Hackney with Price and Priestley, and (briefly) the radical author Gilbert Wakefield, whose daughter would marry Dr Aikin’s son. Hackney College, with Price’s chapel nearby, became the epicenter of Rational Dissent. See “The Dissenting Academies Online, Database and Encyclopedia,” http://dissacad.english.qmul.ac.uk/index.php/.

  45. 45.

    Buck, “People Who Counted,” 36.

  46. 46.

    Ulrich Tröhler’s PhD dissertation, “Quantification in British Medicine and Surgery, 1750–1830, with Special Reference to Its Introduction into Therapeutics” (University College, London; 1978) is the best secondary source on the statistical work of this circle. It is now online at www.jameslindlibrary.org/pdf/theses/troehler-1978.pdf. For Percival, see 133–5.

  47. 47.

    A graduate of the Taunton Academy, Willoughby was one of the original trustees of the British Museum and also became president of the Society of Antiquaries.

  48. 48.

    Lisbeth Haakonssen, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush (Clio Medica 44) (Amsterdam: 1997), 108. Willoughby proposed Percival on November 30, 1764 but died suddenly on January 22. 1765. Percival was elected on March 7, 1765. Royal Society, Past Fellows, Archives, https://royalsociety.org/fellows/ search on “find past fellows.”

  49. 49.

    Brian Keith-Lucas, “Some Influences Affecting the Development of Sanitary Legislation in England,” Economic History Review, 2nd series (1953–1954) 6:290–6; Edward M. Brockbank, “Thomas Percival, A Medical Statistician of a Century and a Half Ago,” Centenary Session of the Manchester Statistical Society (Manchester: 1934). Keith Lucas says that a letter from Franklin to Percival about the problem of mortality in 1773 initiated his interest; Brockbank says that it was a reading of Price’s Observations on Reversionary Payments in 1773. That is too late for Percival to have begun his interest in collecting health data (see n. 55 below), but Percival himself states in the introduction to volume 2 of his Essays Medical and Experimental (1773) that his “Proposals for…Accurate and Comprehensive Bills of Mortality” were “suggested by the perusal of a Treatise on Reversionary Payments.” The inspiration may have been Price’s earlier essay in the Philosophical Transactions or the first edition of his Observations (1771). The members of this group were so interconnected that it is difficult to isolate a single influence.

  50. 50.

    Joseph Priestley, the radical chemist, was a tutor at the Warrington Academy from 1761 to 1767. Percival helped obtain an honorary doctorate from Edinburgh for him during this time; Pringle nominated him for FRS and Fothergill later established a subscription to support his research. Robert E. Schofield, The Enlightenment of Joseph Priestley: A Study of His Life and Work from 1733 to 1773 (University Park, PA: 1997), 119. See also Simon Schaffer, “Measuring Virtue: Eudiometry, Enlightenment and Pneumatic Medicine,” in The Medical Enlightenment of the Eighteenth Century, ed. Andrew Cunningham and Roger French (Cambridge: 1990), 281–318. Schaffer notes the “alliances” between Priestley, physicians and reformers on 282.

  51. 51.

    See Marilyn L. Brooks, “Aikin, John (1747–1822),” ODNB (Oxford: 2004), http://www.oxforddnb.com/view/article/230; Lucy Aikin, Memoir of John Aikin M.D.… (Philadelphia: 1824). I thank Dickinson College for providing a copy of this rare work. Both this and the two-volume London edition of 1823 are now available on the HathiTrust website. The Philadelphia edition includes the entire contents of both London volumes but in a different order. Aikin’s biography is the first item in both. See also Tröhler, “Quantification,” 143.

  52. 52.

    See Thornton, James Currie: The Entire Stranger and Robert Burns (Edinburgh: 1963), 156–7. Until the Warrington Academy closed in 1786, a literary meeting distinct from the medical group met on Saturdays in the tutors’ homes. Participants included John Aikin Sr and his son, Gilbert Wakefield, Joseph Priestley, William Enfield, Pendlebury Houghton, George Walker, William Roscoe, Arthur Heywood, George Bell and James Currie. Not all of these were in Warrington at the same time. Priestley left Warrington in 1767; Walker tutored mathematics there from 1772 until 1774; and Wakefield arrived in 1779.

  53. 53.

    Scholarly Societies Project, http://www.scholarly-societies.org/history/1781lpsm.html; R. Angus Smith, A Centenary of Science in Manchester (London: 1883).

  54. 54.

    A short list of works can be found in Catalogue of an Exhibition Illustrating the History of Actuarial Science in the United Kingdom (n. pl: 1973). See also Rusnock, Vital Accounts.

  55. 55.

    This appears only in some copies of volume 2 of his Essays, Medical and Experimental. The first edition of volume 2 was published in London by Joseph Johnson in 1772. It was reprinted in 1773 as Essays Medical and Experimental…To Which are Added, Select Histories of Diseases…and Proposals for Establishing More Accurate and Comprehensive Bills of Mortality. Percival writes in his “Further Observations” (1774), “note a,” that Haygarth and Aikin had subsequently acted on his proposal, so he must have drafted it before Haygarth’s first enumeration in 1772.

  56. 56.

    Edward Mansfield Brockbank, Sketches of the Lives and Work of the Honorary Medical Staff of the Manchester Infirmary (Manchester: 1904), 92.

  57. 57.

    In London, John Coakley Lettsom commented that it had been Percival who prompted him to compile a list of the patients admitted to the General Dispensary by disease with the outcomes of their cases. Although he acknowledged its inadequacy, his list of diseases was the familiar alphabetical listing from the bills of mortality. Medical Memoirs of the General Dispensary in London, for Part of the Years 1773 and 1774 (London: 1774), 345. See also Ulrich Tröhler, “The Doctor as Naturalist: The Idea and Practice of Clinical Teaching and Research in British Policlinics 1770–1850,” Clio Medica (1987–8) 21:21–34.

  58. 58.

    Thomas Percival, “Further Observations on the State of Population in Manchester, and Other Adjacent Places” (1774). Percival sent this to the Royal Society and also had copies printed for colleagues in Manchester. One of these copies is online from ECCO. See also “Observations on the State of Population in Manchester, and Other Adjacent Places, Concluded,” communicated by the Rev. Dr Price, Phil. Trans. (1775) 65:322–35.

  59. 59.

    “Observations on the Difference between the Duration of Human Life in Towns and in Country Parishes and Villages,” Phil. Trans. (1775) 65:424–5.

  60. 60.

    Price, “Farther Proofs of the Insalubrity of Marshy Situations,” Phil. Trans. (1774) 64:96–8. Priestley’s short-lived theory of noxious “airs” sometimes supported theories of airborne contagion and sometimes competed with them. Franklin heard stories of the inflammatory nature of marsh air in New Jersey in 1764 and later mentioned them to Priestley. The theory led Thomas Paine and George Washington to experiment by igniting the air released from a pond in 1783. In 1806, Paine attributed outbreaks of yellow fever to this effluvium. See Kevin Olsen, “Early Investigations of Methane,” The Indicator (January, 2005) 86 no. 1:20–2; C. A. Browne, “Thomas Paine’s Theory of Atmospheric Contagion and His Account of an Experiment Performed by George Washington…,” Journal of Chemical Education (1925) 2, no. 2:99–101; Benjamin Franklin’s letter to Joseph Priestley in the appendix to Priestley’s Experiments and Observations on Different Kinds of Air, 2nd edn (London: 1775), 1:321–3, online at the Internet Archive. See also Schaffer, “Eudiometry,” 293.

  61. 61.

    See also C. M. Law, “Local Censuses in the 18th Century,” Population Studies (1969) 23, no. 1:87–99. Law found 126 local censuses.

  62. 62.

    William Enfield, An Essay towards the History of Leverpool, Drawn Up from Papers by the Late Mr. George Perry, and from Other Materials Since Collected, 2nd edn (London: 1774).

  63. 63.

    John Bostock Sr (1740–1774), physician to Liverpool Infirmary, was a “rapturous admirer of Sidney and an ardent republican” who converted Benjamin Rush to his political views. Caroline Robbins, The Eighteenth-Century Commonwealthman, 358. His distinguished son, John Bostock Jr, an equally ardent reformer, was Priestley’s student and laboratory assistant in Hackney.

  64. 64.

    Dobson in Enfield, Essay, 24. They found 34,407 inhabitants in Liverpool, about 5.7 per house and 4.3 per family. The enumeration of Manchester was still taking place at the time of writing.

  65. 65.

    Aikin, “Warrington,” Phil. Trans. (1774) 64, part 2:438–44, on 441.

  66. 66.

    Aikin, “Warrington,” 439.

  67. 67.

    Aikin, “Warrington,” 440.

  68. 68.

    Essay II. “On the Proportional Mortality of the Small Pox and Measles…” (London: 1784), 87–108. This work was also published by Joseph Johnson.

  69. 69.

    Dobson’s father, the Rev. Joshua Dobson, had helped John Seddon found the academy.

  70. 70.

    In 1783, Aikin obtained an MD from Leyden. In 1792, after failing to establish a medical practice in Great Yarmouth, he joined his sister, Anna Letitia Barbauld, in London and became part of the Hackney circle. See notes 42 and 44 above.

  71. 71.

    Fothergill’s friend and ally, the prison reformer John Howard, who had once lived in Hackney but moved to Bedfordshire in 1756, stayed in Warrington in 1777 to work on his State of the Prisons with Dr John Aikin. This was printed by John Eyres, the printer for the Warrington Academy.

  72. 72.

    Fothergill’s brother Samuel, a Quaker preacher, lived in Warrington. He was Lettsom’s guardian.

  73. 73.

    Mary E. Fissell, Patients, Power and the Poor in Eighteenth-Century Bristol (Cambridge: 1991), 158–62 sees this transition as evidence of the displacement of personal, patient-centered medicine by impersonal, clinician-controlled medicine.

  74. 74.

    See, for example, Rosalie Stott, “Health and Virtue: Or, How to Keep Out of Harm’s Way, Lectures on Pathology and Therapeutics by William Cullen c. 1770,” Medical History (1987) 31:123–42. Even Lester King, who devotes an entire chapter of The Medical World of the Eighteenth Century (Scranton PA: 1958) to nosology, ends his brief discussion of Cullen with the lukewarm conclusion that “Defects Cullen certainly had, but, to present-day critics, his faults were far fewer than his predecessors’,” 219.

  75. 75.

    For Cullen’s impact on Edinburgh, see Christopher John Lawrence, “Medicine as Culture: Edinburgh and the Scottish Enlightenment,” PhD dissertation (London University: 1984). See also Lawrence, “Early Edinburgh Medicine: Theory and Practice,” in The Early Years of the Edinburgh Medical School, ed. R. G. W. Anderson and A. D. C. Simpson (Edinburgh, 1976), 81–94. Jeffrey Charles Wolf, “ ‘Our Master and Father at the Head of Physick’: the Learned Medicine of William Cullen,” PhD dissertation (Edinburgh University: 2015), online at https://www.createspace.com/6292898, also focuses on Cullen’s physiology and natural philosophy.

  76. 76.

    As Bruno Latour noted about maps, nosology becomes such a fundamental part of medical knowledge (a “black box”) that its presence is taken for granted. The table of contents for most medical textbooks is an abbreviated nosology: Science in Action (Cambridge UK: 2003), 223.

  77. 77.

    This section follows the argument in Margaret DeLacy’s “Nosology, Mortality and Disease Theory in the Eighteenth Century,” Journal of the History of Medicine (1999) 54:261–84. Portions of that article are used with permission of Oxford University Press. See the Appendix in this volume for an excerpt from Cullen’s nosology and the implicit taxonomies of Boerhaave and Huxham.

  78. 78.

    François Boissier de Sauvages, Nosologie Méthodique, dans laquelle les Maladies Sont Rangées par Classes, Suivant le Système de Sydenham, & l’Ordre des Botanistes, trans. from Latin, 3 vols. (Paris: 1771), 341, online from Google. The term “nosology” appears to have been coined by Sauvages. He had been a student of the Montpellier physician Antoine Deidier, who wrote about the Great Plague of Marseilles. See also Elizabeth A. Williams, A Cultural History of Medical Vitalism in Enlightenment Montpellier (Aldershot, Hampshire: 2003); Julian Martin, “Sauvages’ Nosology,” in The Medical Enlightenment of the Eighteenth Century, ed. A. Cunningham and R. French (Cambridge: 1990), 111–37; Lester King, Transformations in American Medicine: From Benjamin Rush to William Osler (Baltimore, MD: 1991); Knud Faber, Nosography in Modern Internal Medicine (New York: 1923). For Deidier, see DeLacy, Germ of an Idea, 68–9, 93 and 149–51.

  79. 79.

    Sauvages, Nosologie Méthodique, 1: 341.

  80. 80.

    Sauvages de Lacroix [François Boissier de Sauvages], preface to Nouvelles Classes de Maladies (Avignon: 1731) x, online from Google.

  81. 81.

    Volker Hess and J. Andrew Mendelsohn, “Sauvages’ Paperwork: How Disease Classification Arose from Scholarly Note-Taking,” Early Science and Medicine (2014) 19:471–503 analyze Sauvages’ working methods. On 473–4 they list the editions of this work as it evolved into Nosologie Méthodique.

  82. 82.

    There has been a resurgence of interest in early modern technologies of classification and its relationship to print culture and humanist methodologies. Historians have investigated the connection between taxonomic work and the development of Enlightenment botany, geology, materia medica and chemistry, although disease classifications have often been overlooked. For a brief overview, see Matthew D. Eddy, “Essay Review: The Dark Side of Collecting—Early Modern Chemistry, Humanism and Classification,” Ambix (2008) 55:283–92. Brian Ogilvie, The Science of Describing: Natural History in Renaissance Europe (Chicago: 2008), in a discussion of early modern botanists such as Caspar Bauhin (1560–1624), points out that “Linnaeus’s descriptions, though similar…in form and concision, rely on concepts of genus and species that Bauhin did not possess.” 218. He concludes that “classification was not a significant problem for Renaissance naturalists. Most organized their works according to folktaxonomic intuitions…without giving the matter much thought,” 228.

  83. 83.

    Sauvages, Nosologie, “Table des classes, des orders et de genres.” This precedes p. 1 in vol. 3. See also David Hosack, A System of Practical Nosology: To Which Is Prefixed, a Synopsis of the Systems of Sauvages, Linnaeus, Vogel, Sagar, Macbride, Cullen, Darwin, Crichton, Pinel, Parr, Swediaur, Young, and Good (New York: 1821) for a side-by-side comparison of the nosologies created during this period.

  84. 84.

    Hess and Mendelsohn, “Sauvages,” 481.

  85. 85.

    Hess and Mendelsohn, “Sauvages,” 492.

  86. 86.

    Sauvages, Nosologie, 1:120.

  87. 87.

    DeLacy, “Nosology,” 279.

  88. 88.

    Sauvages, Nosologie, 1:391. They were in Class II (Fevers), Order 1 (Continued fevers), 2. Synocha (fevers lasting a week).

  89. 89.

    Hess and Mendelsohn, “Sauvages,” 497.

  90. 90.

    Hess and Mendelsohn, “Sauvages,” 502.

  91. 91.

    Hess and Mendelsohn, “Sauvages,” 480.

  92. 92.

    Guilielmus Cullen, Synopsis Nosologiae Methodicae (Edinburgh: 1769). The second revised edition appeared in 1772 (Edinburgh and London), a third in 1780 and a fourth in 1785. The 1785 edition was reprinted (in the original Latin) in The Works of William Cullen M.D., ed. John Thomson, vol. 1 (of 2) (Edinburgh: 1827). It is now online, as is the first edition. The first English translation seems to be by William Creech (Edinburgh: 1800). Except where editions are compared, references are to Thomson’s edition.

  93. 93.

    DeLacy, “Nosology,” 279–80. Chapter 4 noted that Linnaeus had also suggested that the “agent” of fermentation and putrefaction was a “living molecule.”

  94. 94.

    When blood sits in a glass or bowl, a relatively clear portion rises to the top and a red clot forms below. In the eighteenth-century the top portion was known as the “serum” and the portion below was the “crassamentum.” In the mid-eighteenth century a skin or “buffy coat” that formed on the surface of the crassamentum was seen as a sign that a fever was “inflammatory.”

  95. 95.

    That is, the botanist’s “artificial” classification. Linnaeus hoped to uncover the “natural” classification that reflected the true relationship between plants at the time of Creation. His “sexual system” introduced a causative mechanism into the system as most plants depended on sexual reproduction to maintain their species. Richard Pulteney, A General View of the Writings of Linnaeus, 171–200, esp. 199 (London: 1781) offers a clear explanation of Linnaeus’s disease classifications and a point-by-point comparison with those of Sauvages and Cullen. See also Hosack, Practical Nosology.

  96. 96.

    Commenting on Joseph Rogers’s Essay on Epidemic Diseases…of the City of Cork (1734), Christopher Hamlin notes: “Rogers knew that similar diseases were arising elsewhere but he maintained Cork’s was unique.…Since disease specificity was a function of geographic specificity, Cork’s slow fever would differ from Derry’s, and even more from those in England”: More than Hot: A Short History of Fever (Baltimore: 2014), 110.

  97. 97.

    Linnaeus listed “petechia” under “exanthemata” but “continued fever” under “critici.”

  98. 98.

    A. L. Donovan, Philosophical Chemistry in the Scottish Enlightenment (Edinburgh: 1975), 113. On Cullen’s dogmatism, see Wolf, “Cullen,” 114–24 and 143–4.

  99. 99.

    William Cullen, “Introductory Lectures on Nosology,” in Works, 1:451–2.

  100. 100.

    DeLacy, “Nosology,” 282. See also King, Transformations, 70–1.

  101. 101.

    Peter Anstey, John Locke and Natural Philosophy (Oxford: 2011), 191–4. Locke may have written the famous passage containing this comparison. G. G. Meynell, “John Locke and the Preface to Thomas Sydenham’s Observationes Medicae,” Medical History (January 1, 2006), 50: 93–110. See also Peter Anstey, “Boyle on Seminal Principles,” Studies in the History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences (2002) 33:597–630. For Lind’s use of this metaphor, see Chapter 3.

  102. 102.

    Cullen was a vitalist or monist who posited a reactive power in the nervous system of the bodies of living beings that he called “the Vital Principle of Animals” or the “Nervous Power.” This disappeared at death. He denied that disease resulted either from the consistency of the fluids or their acidity or alkalinity. See John Thomson, An Account of the Life, Lectures, and Writings of William Cullen, vol. 1 (Edinburgh: 1832). For the complex publication history of the two-volume Life, see Wolf, “Cullen,” 22–41; David E. Shuttleton, “An Account of…William Cullen: John Thomson and the Making of a Medical Biography,” in Scottish Medicine and Literary Culture, 1726–1832, ed. Megan J. Coyer and David E. Shuttleton (Amsterdam: 2014), 240–66. Works on Scottish vitalism include Tamas Demeter’s “The Anatomy and Physiology of Mind: David Hume’s Vitalistic Account,” in Blood, Sweat and Tears—The Changing Concepts of Physiology from Antiquity into Early Modern Europe, ed. Manfred Horstmanshoff, Helen King and Claus Zittel (Leiden: 2012), 217–240.

  103. 103.

    Cullen, “On Nosology,” in Works of William Cullen, 1:452–3. “Modern” refers to the germ theory era of medicine from the mid-nineteenth to the mid-twentieth century. The development of genetic analysis has transformed that perspective in both botany and medicine.

  104. 104.

    Cullen, “On Nosology,” in Works, 1:453.

  105. 105.

    Cullen, Synopsis Nosologiae Methodicae (Edinburgh, 1785), in Works of William Cullen, 1:243.

  106. 106.

    Remittent fever was an especially confused category. Cullen was essentially assigning all diseases called “remittent fevers” to the category of malaria. The term “remittent fever” was in fact used then for outbreaks of malaria, but non-malarial illnesses were also called “remittent fever.” Although our term “malaria” implies a single disease, different Plasmodium parasites are responsible, each causing a distinctive level of severity and pattern of chills and fever, a phenomenon recognized by older terminology.

  107. 107.

    DeLacy, “Nosology,” 283.

  108. 108.

    William Cullen, Synopsis, in Works of William Cullen, 1:254–9. Sauvages, Nosologie, 409–16 listed five genera of continued fevers: ephemeral, synochus, continued, continued/malignant and slow (lente). It is difficult to obtain a clear clinical picture of Cullen’s “synochus” from contemporary works. See also Edward Percival, “Observations on the Epidemic Fevers of Dublin,” Transactions of the Association of Fellows and Licentiates of the Kings and Queens College of Physicians in Ireland (1817) 1:243–366, on 293–4 and n. For modern discussions, see Gunter Risse, “Epidemics and Medicine,” Bulletin of the History of Medicine (1979) 53: 505–19, esp. 511–12; King, Medical World, 139–43; King, Transformations, 43–8.

  109. 109.

    For example, Cullen, Synopsis, in Works of William Cullen, 1:257. Cullen’s 1769 entry on typhus in “Pars Quarta: Genera Morborum Praecipua Definita a Guielmo Cullen,” in Synopsis Nosologiae Methodicae (Edinburgh: 1769), 256–7 had referenced Sauvages and included just one citation of Huxham (nervous fever) and one of Pringle (jail fever). The 1769 description of the disease had stated in its entirety: “heat not much augmented, pulse weak, small and frequent, sensory functions much disturbed” (my translation). In 1772, in addition to a greatly expanded list of references, Cullen added “very contagious disease” (morbus contagiosus) to the beginning of the description and “strength greatly diminished” (vires multum [d]imminutae) to the end.

  110. 110.

    Thus, following his earlier rule, Cullen viewed these two ailments as unrelated to each other.

  111. 111.

    Cullen, Synopsis, in Works of William Cullen 1:256. He omitted Sauvages’ more fanciful maladies, such as the typhus resulting from too much venery (Typhus des gens épuisés).

  112. 112.

    Cullen, Synopsis, in Works of William Cullen 1:256. Irvine Loudon notes in Medical Care and the General Practitioner, 1750–1850 (Oxford: 1986), 59 that Charles Murchison, Treatise on the Continued Fevers of Great Britain (1873) listed 88 synonyms for typhus in different languages.

  113. 113.

    J. P. Schotte, A Treatise on the Synochus Atrabiliosa, a Contagious Fever Which Raged at Senegal in 1778... (London: 1782).

  114. 114.

    Presumably it would also have helped reduce cross-infection by such pathogens as Staphylococcus aureus.

  115. 115.

    John Haygarth, A Letter to Dr. Percival on the Prevention of Infectious Fevers (Bath, 1801), 5–6.

  116. 116.

    Fissell, Bristol, 159.

  117. 117.

    Reflections on the General Treatment and Cure of Fevers (London: 1772), 8–15. This was published anonymously but known to be by Lettsom, who was accused of plagiarizing Cullen’s lectures. Abraham, Lettsom, 115.

  118. 118.

    John Heysham, An Account of the Jail Fever or Typhus carcerum as it appeared at Carlisle in the Year 1781 (London: 1782). Heysham graduated from Edinburgh in 1777 and in 1778 began a series of Observations on the Bills of Mortality in Carlisle, using Cullen’s nosology to assign causes of death. He was a founder of both the Carlisle Dispensary and the Carlisle Fever Hospital. Henry Lonsdale, ed., The Life of John Heysham M.D.: and His Correspondence with Mr. Joshua Milne…(London: 1870).

  119. 119.

    William Black, A Comparative View of the Mortality of the Human Species… (London: 1788), 90 and 126 “published at the unanimous Request of the Medical Society of London, ” online from Google.

  120. 120.

    Francis Geach, Some Observations on the Present Epidemic Dysentery (London: 1781), 7–9. Geach was trained as a surgeon but had an MD from Aberdeen. Peter J. Wallis, Ruth Wallis and T. D. Whittet, Eighteenth-Century Medics: Subscriptions, Licenses, Apprenticeships, 2nd edn (Newcastle: 1988). He became FRS in 1767. Royal Society archives, https://royalsociety.org/collections/#archive.

  121. 121.

    Gunter B. Risse, New Medical Challenges during the Scottish Enlightenment (Clio Medica 78) (Amsterdam: 2005), chapter 3: “The Royal Medical Society versus Campbell Denovan…”, 105–34.

  122. 122.

    William Heberden Jr, Observations on the Increase and Decrease of Different Diseases (London: 1801), rpt in Population and Disease in Early Industrial England (Farnborough UK: 1973), 54. The pamphlets in this compilation are separately paginated. See also Rusnock, Vital Accounts, 167–70; William Woollcombe, Remarks on the Frequency and Fatality of Different Diseases…with Observations on the Influence of the Seasons on Mortality (London: 1808).

  123. 123.

    Heberden, Observations, 46, quoted in Rusnock, Vital Accounts, 170.

  124. 124.

    Heberden, Observations, 55.

  125. 125.

    Heberden, Observations, 56–7.

  126. 126.

    Heberden, Observations, 57.

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DeLacy, M. (2017). Counting and Classifying Diseases: Contagion, Enumeration and Cullen’s Nosology. In: Contagionism Catches On . Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-50959-4_5

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