The Mad Hatters:18thC Living Conditions, Part 5

Continuing on from Part 4: Scurvy, Smallpox, Syphilis: 18thC Living Conditions, Part 4

Enteric fever (Typhoid and Paratyphoid)            


This is caused by the typhoid bacillus, Salmonella typhi. The symptoms include, high fever from 39°C to 40°C, lassitude, headache, muscle & abdominal pains, constipation, diarrhoea, loss of appetite, sweating, and chills. Usually, contamination is through the ingestion of food or water which has become contaminated by the faeces of an infected person. Flies which feed on faeces can also transfer the bacteria to food. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria which can be transmitted to others as mentioned above. Both ill persons and carriers shed Salmonella typhi in their faeces and urine. Without treatment, the death rate may be as high as 25%.


Paratyphoid is a bacterial infection which is caused by any of three strains of Salmonella paratyphi: S. paratyphi A; S. schottmuelleri (also called S. paratyphi C); or S. hirschfeldii (also called S. paratyphi B). Like typhoid, infection is invariably from a human source, although it can be transmitted by animals or by animal products, the bacteria gaining access to the body through contaminated food or drink. Although not as deadly as typhoid, the death rate being between 10% and 15%, it is still a very dangerous disease.


In the restricted sense, this refers to the classical epidemic, or louse-borne disease caused by the bacteria, Rickettsia prowazekii. It is transmitted to man by the human body louse, Pediculus humanus which becomes infected by feeding on the blood of someone who is suffering from the disease.

Human body louse
By Janice Harney Carr, Center for Disease Control [Public domain], via Wikimedia Commons

Infected lice excrete rickettsia onto the skin while feeding on a second host, who becomes infected by rubbing louse faecal matter or crushed lice into the bite wound. Typhus can also be spread by infected dried faeces dust inhaled into the mucous membranes of the upper respiratory tract, a common cause in closed buildings during cold weather. The onset is often sudden, with a high fever rising to 41.1°C. (106°F.) or so within 48 hours and continuing for up to two weeks. Various other symptoms include, cough, chills, delirium, joint pain, confusion, low blood pressure, severe headache, muscle pain, stupor, rash beginning on chest and spreading to rest of body, but not to face, palms of hands or soles of feet, eyes may be hurt by light. The disease runs a severe and often fatal course, with a death rate of between 40%-60% if left untreated.

Whooping cough or pertussis

Whooping cough is a highly contagious disease caused by the bacteria, Bordetella pertussis. Before the introduction of a whooping cough vaccine, in 1950, it was a common cause of death among young children. The disease comes in two stages, the first, known as the catarrhal stage, lasts from a few days to a fortnight, and resembles a common cold, with sneezing, runny nose, watery eyes, and mild fever. In the second or paroxysmal stage, the cold symptoms disappear, but the cough gets worse, leading to intense bouts of coughing, followed by a characteristic whooping sound on the intake of breath, vomiting and sometimes fainting may follow. Coughing can also cause subconjunctival haemorrhages, hernias, fractured ribs, and pneumothorax or collapsed lung. Babies or young children can suffer from dehydration, low blood pressure, kidney failure, fits, brain damage and pneumonia, the latter two proving fatal without treatment.


According to the “New and Complete Dictionary of Art and Sciences” at least three types of intestinal worm were recognised during the 18th century:

There are three species of worms, most frequent in the human body; the lumbrici, the ascarides, and the taenia. The lumbricid […] are generally broad and long, and roll themselves up in a strange manner. The ascarides have their feet chiefly in the gross intestines, and are more plentiful in the rectum; they are round and small, and are thrown out in large quantities. The broad worm, called taenia, is like a swathe, commonly two ells (2.3m) long, but sometimes much longer, and divided with cross joints or knots.

These worms which are now called roundworms , thread or pinworms , and tapeworms were clearly recognised as unpleasant nuisances. Infection from roundworms occurs through the ingestion of their eggs in food, for example in vegetables not properly cooked or prepared, or through contact with soil or water contaminated with faeces. Threadworm infections are spread from person to person by swallowing the worm eggs. They are transferred through direct human contact, or by touching a contaminated object. Tapeworm infections are usually spread by eating raw or undercooked beef, pork, or freshwater fish. They can also be caught by drinking water or food that has been in contact with faeces of an infected person, or by close contact with clothing, articles or food handled by such a person.

Intestinal worms, described as were a common occurrence amongst children, and although extremely unpleasant, would probably not have caused any deaths directly. However, it seems quite possible that they could lower the resistance of a child who repeatedly ingested the eggs through unwashed hands, thus prolonging the infection and increasing the likelihood that it would succumb to other more life-threatening diseases.

John Pechey, writing at the end of the 17th century, had the following to say:

Oftentimes Children are extreamly troubled with Worms; they are generated of a viscous and flegmy humor; are sometimes round, and then Children are commonly troubled with a Feaver, and grow lean, their appetite fails them, they start in their sleep, they have a dry cough joyned with it, with a stinking breath, and an ill colour in their faces; the eyes hollow and dark with a kind of irregular Feaver, which comes three or four times a night, and they often rub their noses; if they be little worms, they have always a desire to go to stool, and their excrements are very purous.

Occupational Diseases

An occupational disease is any chronic disability that occurs as a result of work or occupational activity. Although these afflictions were unlikely to kill in the short term, they might so weaken the constitution of the victim that he died from one or other of the diseases which were prevalent at the time, especially when an epidemic such as smallpox was raging. Many of the diseases mentioned below affected the lungs and would, therefore, have been exacerbated by a sulphurous fog such as Laki’s.

A Mr. J. Howlett, writing in the “Gentleman’s Magazine” of 1782, was under no misapprehension as to the severity of these diseases and their devastating effects:

The collier, the clothier, the painter, the gilder, the miner, the makers of glass, the workers in iron, tin, lead, copper, while they minister to our necessities, or please our tastes and fancies, are impairing their health and shortening their days…Arts and Manufactures can present as long a catalogue of our fellow creatures suffocated in mines and pits, or gradually poisoned by the noxious effluvia of metals, oils, powders, spirits, &c. used in their work and can exhibit as mournful a scene of blind and lame, of enfeebled, decrepit, asthmatic, consumptive wretches, panting for breath, and crawling half alive upon the surface of the earth.

Although Howlett was writing some 20 years after the start of the Industrial Revolution, he failed to mention the rise of the factory system with all its attendant ills. Workers in cotton mills had to endure working in a hot, damp atmosphere for some twelve or more hours per day, six days a week. In a report to the House of Lords Committee regarding the health of workers in cotton factories, Dr Michael Ward, had this to say about the horrendous conditions in which they worked:

I have had frequent opportunities of seeing people coming out from the factories and occasionally attending as patients. Last summer I visited three cotton factories with Dr Clough of Preston and Mr. Barker of Manchester and we could not remain ten minutes in the factory without gasping for breath. How it is possible for those who are doomed to remain there twelve or fifteen hours to endure it?  If we take into account the heated temperature of the air, and the contamination of the air, it is a matter of astonishment to my mind, how the work people can bear the confinement for so great a length of time.

Working conditions such as these led to an appalling rise in tuberculosis, bronchitis, asthma, and byssinosis (brown lung disease), whilst forcing children to crawl into unguarded machinery to pick up threads made injuries commonplace. Grinders’ lung or Sheffield grinders’ disease caused by dry-grinding cutlery, lead poisoning from paint manufacture and lead glazes used in the potteries were often lethal.

Breathing in fumes from poisonous chemicals was highly dangerous; for example, inhaling vapour from mercury used in the manufacture of felt hats, caused Mad hatter disease. Close contact with soot, a carcinogenic substance, caused Chimney sweeps’ carcinoma, a form of skin cancer affecting the scrotum of young men or boys who had worked as sweeps for most of their lives, and which, if left untreated, proved fatal.

The Mad Hatter in Alice’s Adventures in Wonderland as illustrated by John Tenniel

People living in rural environments were not immune from the effects of work-related diseases. For example, “farmers lung”, a potentially fatal disease, was liable to be caught by those working with damp mouldy hay or other cereal crops and inhaling the dust and spores so produced, which, in turn, could cause an allergic reaction in the lungs of susceptible individuals.

In Part 6: How did volcanic ash affect people in the 18th century?

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