Bulletin of the History of Medicine

Plague and Contagionism in Eighteenth-Century England:

The Role of Richard Mead

Arnold Zuckerman

The plague was an unwelcome visitor in England from the time of the Black Death in the fourteenth century until the Great Plague of London in 1665, the last major outbreak in the country. The intervening years were seldom entirely free of it: this most devastating of diseases hung like a sword of Damocles over the heads of the English people until its [End Page 273] disappearance from England after the 1670s.¹ London alone experienced major plague outbreaks in 1603, 1625, 1636, and 1665, and these spread to neighboring communities.² It is hardly surprising that news of a plague epidemic in France in 1720 would be met with an immediate response by the English government.

Proclamations required that ships coming from the Mediterranean, Bordeaux, and French ports in the Bay of Biscay submit to quarantine.³ A new quarantine act replacing that of 1710 was deemed necessary, but first the government sought advice.⁴ The lords justices (the king being in Hanover) directed James Craggs, a principal secretary of state, to "apply to Dr Mead, as the man best qualified by his skill in ancient and modern physic, to find out the most effectual methods to prevent, or, in case of necessity, to stop, the plague."⁵ The result was Richard Mead's Short Discourse Concerning Pestilential Contagion, and the Methods to Be Used to Prevent It, the "first book of epidemiological advice produced by a medical practitioner at request of the state."⁶ His recommendations were followed in a new quarantine act.

By 1720 Mead, who began his practice in the village of Stepney where he was born, was a leader of London's medical circle.⁷ His publication A Mechanical Account of Poisons, in Several Essays (1702) received a favorable review in the Philosophical Transactions of the Royal Society, and perhaps because of this he was elected a fellow in 1703.⁸ In the same year, he was elected physician to St. Thomas's, one of London's largest hospitals.⁹ In [End Page 274] 1717 at the behest of his friend and patient Sir Isaac Newton, then president of the Royal Society, he became the Society's vice-president.¹⁰ The College of Physicians admitted him as a candidate (member) in 1708; he was elected a fellow in 1716.¹¹ Mead's treatment of the wife of the future George II added to his prestige: he "hath recovered the Princess of Wales (as she is called), when the other physitians had certainly killed her, had their Prescriptions been followed. This hath gained Dr. Mead a great Reputation at Pr. George's Court," records the Reliquiae Hearnianae.¹² Fortune also fell Mead's way politically. By the 1720s, the Whigs were in control of the government; the College of Physicians had become something of a Whig stronghold,¹³ and Mead, himself a Whig, had as his patient Sir Robert Walpole, England's "first prime minister." That Mead would be turned to for advice at this critical time was quite natural.

Mead believed that the plague was a contagious disease, and he explained it that way in his Short Discourse. There were other medical writers who did not. It was only toward the middle of the century, with John Fothergill and his circle, that contagionism entered the medical mainstream as a possible explanation for some epidemic diseases¹⁴ —but Mead, notes Wesley W. Spink, had "advanced the concept of contagion [End Page 275] substantially."¹⁵ A controversy followed the appearance of the Short Discourse: critics denied that the plague could be conveyed from person to person, or that it came only from abroad, as well as denying other supposed misconceptions of Mead, and this did not end with his death in 1754. There were, however, medical writers and laypersons who saw his proposals to protect the nation based on the contagion theory, and his practical suggestions, as a significant contribution well into the nineteenth century, as I will show.

The plague epidemic in Marseilles, France's largest port, was the last major outbreak in western Europe. It occurred following the arrival of the ship Grand Saint-Antoine from the Levant, where plague had been raging. Some sailors died en route to Marseilles, which the captain reported to the city authorities, but it was decided that their deaths were not due to the disease. Plague was no stranger to Marseilles: it had last struck in 1649, and there were safeguards in place regarding passengers, crew, and cargo to prevent recurrence. It seems, however, that some of the ship's cotton merchandise was made available for purchase by the public despite regulations to the contrary. The porters who carried the merchandise died, as did most of the people who bought it. Fleas infected with the organism that causes the plague, it should be noted, can exist for almost a month in certain materials without losing the ability to convey the disease.¹⁶ With regard to the merchandise, "there is clear evidence," notes Thomas F. Sheppard, "that several local officials had a financial interest in the cargo of the Grand St. Antoine," and they made it available for purchase without following the usual procedures.¹⁷ The disease began to spread throughout the city in June. Some people fled to neighboring communities, causing further outbreaks. One measure used by the city authorities involved a tradition going back to Hippocrates: the belief in the purifying power of fire.¹⁸ Fires were lit at strategic places about the city (squares, ramparts)—"a gigantic and useless medical auto-da-fe," comments Alain Corbin.¹⁹ [End Page 276]

Some Marseilles physicians who examined the first victims identified the disease as the plague and as being contagious.²⁰ The city authorities, however, not wanting to arouse the public or hurt commerce, and perhaps doubting themselves that it was contagious,²¹ turned to Pierre Chirac, physician to the regent, who in turn sent a mission from the Montpellier Medical School headed by François Chicoyneau. The disease, the investigators concluded, was not contagious and was due to various other factors, including poor diet. Mead responds to this conclusion in the eighth edition of his Short Discourse.

The epidemic for a time seemed to be running its course, but then showed renewed activity in 1721. There were fears that it might reach London: "The plague is at present the topic of most conversations," wrote Lady Lechmere to Lord Carlisle in October, the same month that the Privy Council consulted with Mead, John Arbuthnot, and Sir Hans Sloane about the possibility.²² Their recommendations included creating health districts, with searchers for deaths in the city and suburban parishes, and the placing of victims in barracks with separate accommodations for the uninfected from the same household.²³ Their advice did not get beyond the drawing board. The plague in France did spread beyond Provence but was confined to the southeast corner of the country—an achievement, explain Laurence Brockliss and Colin Jones, that was more administrative than medical.²⁴

The concept of "contagion," which Mead ascribes to the plague,²⁵ was known in ancient times to medical professionals and laypersons, if not by that name, but "learned physicians" had found it difficult to reconcile [End Page 277] contagion with humoral and miasmatic theories of epidemic diseases.²⁶ "The man in the Roman street," however, comments Vivian Nutton, "was well aware of the phenomenon of contagion."²⁷ The two centuries following the Black Death of 1348-49 saw the appearance of the plague tractates, documents written to advise physicians and others on the treatment of plague victims, and some of these included comment on the origin and nature of the epidemics.²⁸ C.-E. A. Winslow concludes from his study of them that the plague was believed to be contagious, for documents that did not specifically state this did not deny it either.²⁹

"The best early summary of the case for the contagiousness of the plague," comments Margaret DeLacy, is to be found in Fracastoro's On Contagion and Contagious Diseases and Their Cure (1546).³⁰ Girolamo Fracastoro, a Veronese physician, turned to the atomism of Lucretius's De rerum natura and other earlier sources to explain by means of "seeds" (seminaria) how contagious diseases including plague are transmitted; he attributed to them a self-multiplying or generating property, though he probably did not consider them "living" entities in the modern sense of the word.³¹ Contagious diseases, Fracastoro speculated, were spread by direct contact; by "fomes," by which he meant "clothes, wooden objects, and things of that sort, which though not themselves corrupted can, nevertheless, preserve the original germs of the contagion and infect by means of these"; and at a distance, carried by the air.³² Mead, in the Short Discourse, though not mentioning Fracastoro by name, makes a similar statement about how contagion is spread.³³ Fracastoro's views, notes DeLacy, were "echoed and ultimately adopted in the eighteenth century."³⁴ [End Page 278]

Thomas Sydenham, the neo-Hippocratist, associated epidemic diseases with seasonal and atmospheric factors and with emanations from the earth that interacted with them to bring about an epidemic constitution or disposition of the atmosphere. His revival of the Hippocratic concept, though modified, comments Robert P. Hudson, "led medical thinking away from contagionism."³⁵ Regarding Sydenham's belief that the plague "seldom rages violently in England" more than once in thirty or forty years,³⁶ Mead responds that this is an error "countenanced by authors of great name . . . which is a mere fancy, without foundation either in reason or experience."³⁷ Nor could Mead accept his belief that one disease could be changed into another.³⁸

When Mead wrote his Short Discourse, there were, as noted, medical writers who doubted that the plague was contagious; works were appearing in England and France, however, in part as a consequence of the Marseilles plague, arguing that certain diseases were in fact contagious. The successful smallpox inoculation experiment in which Mead played an important part further contributed to the revived interest in contagionism.

There was also interest in the animalcular theory of disease in England at this time. Richard Bradley, F.R.S. and professor of botany at the University of Cambridge, had studied plant diseases and concluded that not only plant diseases but also diseases of animals and humans were caused by animalcules: minute, living entities that he referred to as "insects" or "worms," as did other writers of his day.³⁹ Mead could not accept this:

Some authors have imagined infection to be performed by the means of insects, the eggs of which may be conveyed from place to place, and make the disease when they come to be hatched. As this is a supposition grounded upon no manner of observation, so I think there is no need to have recourse to it.⁴⁰

Bradley, with Mead in mind, remarks:

we had the happiness to see a treatise concerning contagion, publish'd by a learned member of the college of physicians, wherein the author espouses the [End Page 279] other opinion, Viz. that infection is communicated from one person to another, by means of vitiated air; and that there are no insects in the case.⁴¹

There are "echoes" of the Mead-Bradley dispute in Daniel Defoe's Journal of the Plague Year.⁴²

"S. M.," the author of a treatise on the plague, commenting on the theory of insects and the idea of "eggs lying concealed in goods," asserts: "it will certainly be the more difficultly admitted, after its having been rejected by so great an authority as that of Dr. Mead."⁴³ Mead, in "Medical Precepts and Cautions," discussing the "itch" (scabies), attributes it to "small animals"; this is as close as he came to animalcular contagionism.⁴⁴

At the time when Mead wrote his Short Discourse, a number of related works became available to the English public, but none furthered an understanding of the plague beyond what had been known in 1665.⁴⁵ Many of the tracts published at this time, notes Charles F. Mullett, could have been written a century earlier.⁴⁶ Some were reprints of works of 1665 or English translations of earlier works, with the purpose of helping people cope with the plague scare. The emphasis in 1720 was on prevention, not cure.

One such work was A Collection of Very Valuable and Scarce Pieces Relating to the Last Plague in 1665 (1721), a compilation ascribed to William Beckett, which includes "Orders drawn up and published by the Lord Mayor and Aldermen of the City of London, to prevent the spreading of the Infection," "Necessary Directions for the Prevention and Cure of the Plague . . . by the College of Physicians," and "An Account of the first Rise, Progress, Symptoms and Cure of the Plague, being the Substance of a Letter from Doctor Hodges to a Person of Quality."⁴⁷ Nathaniel Hodges, [End Page 280] M.D. and fellow of the College of Physicians, published an expansion of this letter in Latin in 1672, which during the Marseilles plague scare was made available in English by John Quincy.⁴⁸ Hodges is described by Mullett as "one of the best informed theorists in 1665."⁴⁹ His explanation of the origins of the plague involves the concept of nitro-aerial particles that had become corrupted. Their source was a nitrous spirit emanating from the earth, which ordinarily had a beneficial effect in nature, but not when it was altered or corrupted by atmospheric or terrestrial factors.⁵⁰ The editor of the Collection claims that Mead misrepresented Hodges "and that almost in every particular," and he follows up this claim with examples of Mead's errors.⁵¹ Mullett comments that a reader of today would find this no more than "moderate and legitimate differences of opinion."⁵² Mead and Hodges, in fact, shared many ideas: that the plague was contagious (for both, the atmospheric factor had an important role), that it could be transmitted by infected merchandise, that the sick and the well in an infected household should be sent to separate places. Neither accepted the theory of contagium animatum.

Another work available to the English public at this time was Isbrand de Diemerbroeck's Tractatus de Peste, translated from the Latin by Thomas Stanton. Diemerbroeck, a professor of medicine at Utrecht, saw the plague primarily as God's punishment for the nation's sins—but secondarily (for he was a contagionist) as perhaps due to "some secret, malignant, and virulent seeds . . . consisting of very subtile and volatile particles, whensoever they are put into a commotion, are effectually dilated, and disperse their pernicious contagion throughout the spacious atmosphere."⁵³ During the London plague of 1665, his work became [End Page 281] "something of a standard authority" in England.⁵⁴ In Mead's discussion of the disease and contagion in his plague tract, he notes an observation of Diemerbroeck's: Some members of a family had moved to a town that was not infected, while others remained in a town that did become infected and fell victim to the disease. The family members in the plague-free town also became infected, "which certainly would scarce have happened, unless a communication between the healthy and the sick, by letters or otherwise, was capable of causing it."⁵⁵

When Mead wrote his earliest works in the first decade of the eighteenth century, corpuscular iatromechanism, a theory of medical explanation, had undergone a "transformation" into a hydraulic "Newtonian" iatromechanism.⁵⁶ The body, according to the mechanistic natural philosophy, is a machine conforming to the laws of physics and consisting of particles in motion. The philosophy's "estimable parent" was the French philosopher and mathematician René Descartes. In England the physician and Oxford professor Thomas Willis, in his Diatribae duae (1659), a work that can be included in the iatrochemical school, put forth a mechanical and corpuscular theory of fevers.⁵⁷ Willis was influenced by the atomistic philosophy of Epicurus as revived by Pierre Gassendi, a French priest and philosopher. There were also Italian contributors to the mechanical philosophy, who came to be greatly admired in England.

The new hydraulic natural philosophy is associated with Sir Isaac Newton and his disciple Archibald Pitcairne. Pitcairne, an original member of the College of Physicians of Edinburgh, was introduced to Newton's Principia and encouraged to study mathematics by David Gregory, a mathematician with medical interests. The Principia led Pitcairne to believe that mathematical certitude was possible for medicine; he envisioned a "mathematical physic." It could not be known in 1700, notes G. S. Rousseau, that "the exactness of mathematics could not ultimately apply to medicine—especially at a moment when relatively little was [End Page 282] known about physiology."⁵⁸ Newton's methodology became the foundation for Pitcairne's hydraulic iatromechanism, which also drew upon the ideas of Italian mechanists Giovanni Borelli and Lorenzo Bellini. The body, for Pitcairne, was a complex of vessels or canals conveying fluids: the central factor was the flow of the blood, and illness was a consequence of impaired circulation.

Mead, when a medical student at Leiden, heard Pitcairne's lectures, as did Herman Boerhaave (noted below). G. A. Lindeboom refers to a letter of 1722 in which Mead addresses Boerhaave as "dearest friend," suggesting they may have met at Leiden.⁵⁹ Mead, in "A Mechanical Account of Poisons, in Several Essays," describes Pitcairne as "the honour of his profession in Scotland," and says that "mathematical learning will be the distinguishing mark of a physician from the quack."⁶⁰ Mead's first publications were iatromechanical works with Newtonian and Pitcairnean elements.

By 1720, however, Mead had become skeptical of "mathematical physic." Changes can be seen in his Short Discourse: more attention is given to practical matters than in his earlier works, and iatromechanical theory is now corpuscular, not hydraulic. A shift in thinking can also be seen in the works of George Cheyne and Edward Strother.⁶¹ Theodore M. Brown offers an explanation of why this took place: It had to do with the great influence of Boerhaave, a professor at the University of Leiden whose views were well known in English medical circles through his publications, which were available in translation and through physicians who had studied at Leiden. It also had to do with the increasing emphasis on experimentation, which followed upon (though not immediately) the publication of Newton's Optics in 1704. Boerhaave admired Pitcairne but [End Page 283] placed less emphasis on mathematical explanation for some medical problems, turning rather to the experimental method. He stressed solids and their fibers, along with fluids, as part of his eclectic system.⁶² "What Pitcairne had been for the first two decades of the century Boerhaave quickly became for the next two."⁶³ His influence can be seen in Mead's "Medical Precepts and Cautions," where he says that "health consists in the regular motions of fluids, together with a proper state of the solids."⁶⁴

How qualified was Mead to write about the plague? His critics made much of the fact that he had no firsthand knowledge of the disease—yet he undertook this work with confidence. He saw a similarity between the plague and smallpox, which he describes as "a plague of its own kind":⁶⁵ both diseases originated in Africa, were contagious, and were characterized by eruptions.⁶⁶ Thus he says: "I hope the great resemblance, I have observed between the plague and the smallpox, will justify my writing upon the cure of a disease, which I have never seen."⁶⁷ Mead had access to and was aided by advice given to the Privy Council. He cites a report presented to the council by Theodore Turquet de Mayerne, physician to Charles I, following an outbreak of plague in 1630: among Mayerne's recommendations was the creation of a board of health for London and suburbs; Mead, in the eighth edition of his Short Discourse, recommends a council of health.⁶⁸

Mead spoke to the son of William Mompesson, the rector of Eyam, another source of information for him: when plague struck this Derbyshire village in 1665-66, some residents were about to flee, but Mompesson, "the hero of Eyam," persuaded them not to,⁶⁹ and thereby, notes Mead, "protected his neighbours from infection with complete success."⁷⁰ Mead's extensive reading of medical works also prepared him to undertake the [End Page 284] Short Discourse. His appreciation of the classical past is attested to by the many references to ancient writers in his publications.⁷¹ He had a specially designed library added to his Great Ormond Street residence, which he occupied in 1720, to house his growing collection of books and manuscripts. Joan Campbell, in a study of Mead's library using the 1754-55 sale catalogue, states that it consisted of more than ten thousand volumes, with the medical part numbering 1,240 titles, 70 of which had to do with epidemics and contagious diseases.⁷² "The remarkable breadth of his reading, in both classical and modern authors," comments William Coleman, "put[s] him . . . among the most erudite men of the generation."⁷³

The Short Discourse

In the early decades of the eighteenth century, medical works appeared that argued that some diseases were contagious, but most were not generally accepted in the mainstream of medical literature.⁷⁴ An exception was Mead's Short Discourse: it went through nine editions, the first seven unchanged. That his "principles were generally approved," declares Gentleman's Magazine, "appears by the prodigious sale of his short discourse on the plague . . . of which seven editions were sold in one year."⁷⁵ [End Page 285] It was translated into Latin, French, German, Dutch, Italian, and, when the plague struck Russia in the early 1770s, Russian. Mead dedicated it to James Craggs. It is in two parts, dealing first with the origin and nature of the plague and second with methods of prevention. It is "an excellent description of prevailing views and procedures," comments Richard Shryock.⁷⁶ Although Mead regarded the plague as a contagious disease, it is not contagious: it is a disease of the black rat (and other rodents) transmitted to humans by fleas. There is also a contagious type that is spread directly from person to person: pneumonic or pulmonary plague, which can follow upon a case of the original disease and is spread by coughing or sneezing.⁷⁷ The presence of the two types (the pneumonic probably playing a lesser role in the sixteenth and seventeenth centuries) and differences in symptoms inevitably led to conflicting views as to the plague's origin. "The role of rats and fleas," observes Paul Slack, "was as little understood in 1720 as in 1520."⁷⁸

Contagion, Mead explains in part 1, is propagated by diseased persons, by merchandise from infected places, and by the air. His plague tract is something of a compromise between the contagionist and miasmatic theories. Air plays an important part, but it cannot of itself generate the disease; something more is needed, and that is the contagious matter emitted by a victim. The healthy person is infected by inhalation of this matter, which results from a process of putrefaction or fermentation ("putrefaction is a form of fermentation") caused by the disease; fermentation for Mead was inorganic, a chemical process, and the contagious matter something like a salt: "Bodies in a ferment," he explains, "emit a volatile active spirit, of power to agitate, and put into intestine motions, that is, to change the nature of other fluids into which it insinuates it self."⁷⁹ When the air is in a normal ("right") state, a well [End Page 286] person, if near a victim, can become infected. When, however, the air is in an "evil" state (putrid or corrupted) due to various environmental conditions, the particles "meet with the subtle parts, its corruption has generated, by uniting with them they become much more active and powerful . . . so as to form an infectious matter capable of conveying the mischief to a great distance from the diseased body, out of which it was produced."⁸⁰

Mead believed that the plague was not native to England but, rather, originated in eastern and southern parts of the world, and entered the country through commerce. There were, to be sure, medical writers who attributed the plague mainly to atmospheric factors. One such writer was Sir Richard Manningham, M.D., F.R.S., and member of the College of Physicians. In his Discourse Concerning the Plague, he relates that when Dr. John Radcliffe was asked how one became infected with the plague, he replied: "suppose it should rain, and we two should go together into the rain; we should certainly both be wet, tho' we did not wet one another."⁸¹

In part 2 Mead recommends measures both for keeping the disease out of the country and for coping with it should it enter. He recommends quarantine, though by this time its use was being questioned. The plague, in fact, as we now know, could enter the country by ship in several ways: by passengers and crew with infected fleas on their persons, by merchandise harboring such fleas, and by infected ship rats and their fleas that descend mooring lines. If a ship came from an infected place, or a place suspected of being so, quarantine would have to be imposed. Mead favored the building of lazarettos near ports for this purpose. Well persons from an infected ship would have to undergo quarantine for thirty or forty days; even if they had been infected and had recovered, they might still retain infectious matter. The sick would be sent elsewhere and when (and if) they recovered would have to go through the same procedure. Quarantine would not be necessary if there were no illness on the ship. Certain kinds of merchandise (cotton, wool) would have to [End Page 287] be aired for forty days in warehouses located in lazarettos. This recommendation of Mead's, as well as the burning of the clothes of infected persons, could have been of value in reducing the risk of infected fleas in circulation.⁸² In later editions of his plague tract, he recommends burying rather than burning, since infectious particles could be spread through the air by smoke.

Mead opposed a practice common in England since the early sixteenth century, as did other medical writers, of confining the sick and the well in the same household. This did, to be sure, keep "infected" people off the streets, but it forced them to live together in a situation where the disease might spread; infected rats with their fleas could be nesting in the house. The confinement would continue for at least a month after all had recovered, if they did. Mead argues that upon opening the windows of these "seminaries of contagion," tainted air would spread from house to house and from street to street.⁸³ He also comments on psychological factors that physicians believed disposed the body to receive the disease: fear, despair, and dejection of spirits.⁸⁴ It does not tax the imagination to see how people so confined would experience this—another reason, he felt, to end such confinement.

The accuracy of bills of mortality was a concern of Mead's.⁸⁵ He also favored "understanding and diligent men," rather than "ignorant old women,"⁸⁶ serving as searchers in parishes who would determine the causes of death (typhus could be mistaken for the plague); if they found that someone had died in an "uncommon manner," as with the signs of the plague such as buboes—swellings in the lymph nodes that would show up in the groin or armpit—and carbuncles, this would be reported to a magistrate who would send physicians to investigate. Whole families could be ordered removed from their homes, the well and sick sent to separate places several miles from town. "Removing the infected from their houses, by force," remarks Patrick Russell, "is the most material thing that is new in the Doctor's rules, with respect to England."⁸⁷ [End Page 288]

It is more than a coincidence that Mead, in the eighth edition of the Short Discourse (published when certain clauses of the new quarantine act were encountering public condemnation), decided that the sick need be removed from their homes only in the early stages of the disease, which he said would mainly affect the "poorer sort," where it usually begins.⁸⁸ Andrew Wear, noting that by the seventeenth century the plague was usually seen as a disease of the poor, considers this an instance of how "medical attitudes to the social and moral implications of plague were shaped by the wider beliefs and prejudices that surrounded the disease."⁸⁹ Mead approved of the use of lines with guards around infected towns to contain the disease, as was done in France. He would, however, permit people to leave after a quarantine period of about twenty days, which was not permitted in France.⁹⁰ He was skeptical about the traditional use of fire to purify the air once the disease had struck, stating that heat only exacerbated it, although he did see some value to it before the onset of the disease. He stressed cleanliness for streets and houses of confinement: "as nastiness is a great source of infection, so cleanliness is the greatest preservative."⁹¹

Plague, as an individual rather than group affliction, was explained in terms not only of contagion but also of humoral factors.⁹² Mead, discussing how one might protect oneself from the disease, mentions putting the "humours of the body into such a state, as not to be alterable by the matter of infection."⁹³ He admits that this is difficult to do. He does, however, recommend a regimen that includes temperate living and a good diet—though nothing, he stresses, will guarantee protection from the plague except leaving an infected place. Paul Slack, commenting on the medical knowledge of the day, observes: "Mead's recommendations were remarkably enlightened, and it is difficult to find fault with the government's acceptance of them."⁹⁴

Mead was a participant in a series of smallpox inoculation experiments in 1721 that further contributed to the acceptance of the idea of contagion. Some prisoners from Newgate Prison were involved, the purpose being to artificially bring about a mild case of the disease, thus rendering the person immune to a "natural," more severe case. The [End Page 289] method used was recommended by Lady Mary Wortley Montagu, wife of the ambassador to Constantinople, who learned of it when in Turkey; it was, however, already known to the Royal Society.⁹⁵ Matter taken from a smallpox pustule was placed under the skin of a participant by incision. Mead used a different (Chinese) method, placing such matter in the nostrils of the participant.⁹⁶ The experiment was a success: with the exception of one person, who had previously had smallpox, all developed a mild case, and all recovered. With this success and with the inoculation of the royal family, the procedure came into wide use in England in the next decades. There were, however, opponents of inoculation: political and religious conservatives, and some physicians who considered it unsafe (it did result in some deaths).⁹⁷ Support came from the Whigs and religious dissenters, such as Mead, and from members of the Royal Society. This writer recalls that, at a visit to the memorial to Dr. Mead in Westminster Abbey, the guide emphasized his pioneering efforts on behalf of smallpox inoculation.

The publication of the Short Discourse was almost immediately followed by critical works, with most authors choosing anonymity. Writers were now addressing problems long observed (such as why some people near plague victims did not get the disease) but not openly questioned because of, according to Paul Slack, the "contagionist assumptions on which the government's activity was . . . based"; Slack explains that "in part [this] was a consequence of the absence of censorship and the new intellectual tolerance of the early eighteenth century."⁹⁸ Mead believed that plague did not originate in England but entered the country through trade. Critics argued that it was of local origin, not a new idea. William Boghurst, an apothecary and the author of Loimographia, looked to exhalations from the earth for its source (an "old poison" in the soil).⁹⁹ The localist view seemed confirmed for some by articles in the Free Thinker, edited by Ambrose Phillips, that accounted for the absence of [End Page 290] plague in England after 1666 (the year of the Great Fire of London) by urban improvements.¹⁰⁰

The litany of anticontagionist arguments pouring forth from works attacking the Short Discourse described the plague as more a matter of the disposition of the air than of human effluvia: persons were first infected from the air, and the disease seldom, if ever, was transmitted from person to person or by merchandise. If isolating infected households in the past had proved of little value in protecting the public, why would lines with guards around infected towns be any more effective? Quarantine was of little value; it interfered with trade and hurt the nation. Dr. George Pye, one critic who did not use the cloak of anonymity, argued that the "plague may possibly destroy a hundred thousand lives; but the loss of trade may starve and destroy ten times a hundred thousand."¹⁰¹

One critic believed that the plague is a fever and not a contagious disease, arising from a number of causes and found in every country.¹⁰² This writer relates that the concept of the plague as a pestilential contagion ("passing by contagion from the body of one man into that of another"¹⁰³ ) described by Fracastoro was used by Pope Paul III as a pretext for having the Council of Trent (1545-63) moved from the city of Trent to Bologna, in papal territory: "Had not this new doctrine fallen in with a very particular conjuncture of politicks," claims the writer, "it had neither been so favourably received; nor had it subsisted, in all probability, till our times."¹⁰⁴ Another writer, however, commenting on the works critical of Mead and noting that the "opinion maintained against Doctor Mead's notions, appears to be the most agreeable to [readers'] wishes," observes that "the generality of readers . . . are apt, in some measure, to incline to the sentiments of the last author they have perused."¹⁰⁵ Yet, he says, "if any one will read [the Short Discourse] over with due caution, and compare it with any thing that has been written in opposition to what is [End Page 291] there advanced, he will readily discover the truth to be on Dr. Mead's side."¹⁰⁶

A new quarantine act, based on Mead's recommendations,¹⁰⁷ went into effect on 10 February 1721, replacing that of 1710 (9 Anne, c. 2), which was enacted when the plague was in the Baltic region. The act mentions the plague in France, and states that the previous act is "defective and insufficient" for the present situation.¹⁰⁸ The new act (7 Geo. I, c. 3) required ships, persons, and goods coming from infected places to undergo quarantine, and included provisions in case the plague should reach England, such as the use of guarded lines around stricken towns to prevent the disease from spreading. Penalties for infractions could be severe; thus, an infected person refusing to "repair" to a designated place could suffer death as a felon.¹⁰⁹ "Draconian measures" were necessary, remarks Adrian Wilson, because the plague not only threatened human life but could destabilize society, interrupting trade and "public order" (as people fled their communities).¹¹⁰

Newspaper articles made the public more aware of events in France and more receptive to the idea that the English government envisioned establishing a despotism similar to that in France: the domestic clauses of the new quarantine act (permitting the establishment of lines with guards around infected towns should the plague reach London, forcing victims to move to designated places) were like practices across the channel.¹¹¹ In [End Page 292] this connection Daniel Defoe may be noted. Defoe, an "administration man" writing for Applebee's Original Weekly Journal, an opposition paper, provides graphic descriptions of the events in France. He comments on the "cruel barbarous things . . . done, when despair or famine has driven the distress'd people to break out beyond the limits prescrib'd," and yet, he explains, "this is certainly the most certain and effectual method to stop the spreading of the infection."¹¹² He further says, "we have these things call'd priviledges [sic] and liberties, which will not allow the Government to proceed with the people as they do in France."¹¹³ Defoe's purpose was to reduce criticism of the Whig ministry in opposition newspapers, and to have readers look more favorably on the government's measures to protect the nation.¹¹⁴

The quarantine act, though generally accepted at first, encountered public opposition because of the domestic clauses.¹¹⁵ This was fueled in part by anticontagionist views, such as those in the works critical of the Short Discourse and in medical works published in France (and available in translation) during the Marseilles plague. There was also a patriotic element, the sentiment that the use of lines with guards and other provisions of the domestic clauses endangered "the liberties of a free people."¹¹⁶ With pressure mounting, a new act was passed (8 Geo. I, c. 10) that did away with the offensive clauses but retained quarantine.¹¹⁷ This was done with Walpole's acquiescence. He was in the process of securing his political base as chief minister at the time and had to contend with opposition both from within the Parliament and from other sources, such as the pro-Jacobite bishop of Rochester, Francis Atterbury. "This I very well remember, that a learned prelate, now dead," recalls Mead, "who had more of political than of christian [sic] zeal, and was one who made the loudest noise about the quarantine bill, frankly owned to me in conversation, that though the directions were good, yet he and his friends had resolved to take that opportunity of shewing their disaffection to the ministry."¹¹⁸ Walpole also was interested in getting through Parliament bills that would prohibit trade with infected places and would curb smuggling (Mead warned about the danger for the nation in the "clandestine importing of goods"),¹¹⁹ and this was another reason he [End Page 293] compromised on the domestic clauses. Walpole's political sail-trimming paid off: the bills he sought were enacted as 8 Geo. I, cs. 8, 18.¹²⁰ Mead, however, regretted that a "great officer in the state thought fit to oblige his enemies by giving way to them."¹²¹

Mead himself did not escape disfavor in the wake of the public condemnation of the domestic clauses of the new quarantine act; "great clamours were raised against the doctor," states the author of the article on Mead in the Biographia Britannica.¹²² Had the plague reached London, however, the reader is informed, "it is to be presumed" that his recommendations would have been followed.¹²³

The Eighth Edition

An eighth, expanded edition of the Short Discourse appeared in 1722.¹²⁴ Mead's purpose now was to provide a fuller description of the disease and its causes, in which he would elaborate on his earlier directions with further references to authorities. He also wished to reaffirm his belief in the plague's infectiousness and to question the opinions of some French physicians as to its cause; to confirm by examples the effectiveness of his recommendations; and to include a chapter on the disease's cure using the analogy of smallpox and the plague. It is in this edition that Mead for the first time in his plague tract mentions the Newtonian natural philosophy, in the form of the Optics. With the publication of Newton's Optics, notes Roger French, physicians were turning to "the notion of ether to explain how the body worked."¹²⁵ Mead thought it would be helpful in understanding how the plague affected the body.

In the eighth edition, Mead reaffirms his commitment to the contagion theory. Thus he says, by way of confirmation: if a member of a household gets the disease, "it immediately after attacks the greatest part of the family."¹²⁶ Persons near victims are sometimes not "infected"; this he explains by their having a "particular advantage of constitution."¹²⁷ Mead takes issue with physicians in France who deny that the disease is [End Page 294] contagious even though "they have the most undeniable arguments . . . before their eyes."¹²⁸ He is referring to members of the Montpellier medical mission (François Chicoyneau, François Verny), anticontagionists who found a justification for their views in the experiments of Anton Deidier, a Montpellier professor of medicine, F.R.S., and admirer of Newton. Deidier injected the bile of deceased victims into the veins of dogs, producing plague symptoms in them.¹²⁹ We know today that the bile contained the plague bacillus,¹³⁰ but the Montpellier physicians believed the bile had become corrupted "by the long use of bad aliment" (there was, it might be noted, "undernourishment" among the poor in the southern part of France at this time).¹³¹ Mead questions the conclusions drawn from Deidier's experiments, saying that more experiments are needed and that it has not been proved that "the bile can be so corrupted, as to breed the disease without any infection received."¹³²

Mead includes in his preface a "paper" he requested from one of the king's ministers in the German lands, from which he learned of the measures used when the plague struck Hanover in 1712-13. Those measures included forming lines around infected communities, sending the sick and the well occupants of a house to separate places, and imposing quarantine. They had the desired effect, that of confining the disease to a small number of towns and villages. "I have the satisfaction," he comments, "to find them very conformable to my precepts."¹³³

In this edition Mead responds to the disapproval of the aforementioned "domestic clauses." He says that their application is "not my proper business, as a physician, to determine,"¹³⁴ that they ought never to "endanger the rights and liberties of a people,"¹³⁵ and that it is sometimes "necessary to give way to popular prejudices and clamours, and reject even the best laws that can be made."¹³⁶ He clearly was distancing himself from these provisions. [End Page 295]

Mead more exactly locates the origin of the disease in Egypt (traditionally regarded as the "cradle of the plague") in this edition, specifically in Grand Cairo and Ethiopia.¹³⁷ Merchants relate that Turkey's frequent plague epidemics came from the African coast, and that it had spread west "in these latter ages" through trade with Turkey.¹³⁸ He also elaborates further on putrefaction and the plague, specifically with reference to animal substances in the aforementioned geographic regions and countries. He uses the analogy of the humors in plague victims being altered into a substance that can infect well persons. Thus, he says, "it is not improbable, that the volatile parts with which animals abound, may in some ill states of air in the sultry heats of Africa be converted by putrefaction into a substance of the same kind."¹³⁹

Mead refers to Newton's ether theory in this edition. He has explained the cause of the plague in terms of putrefaction and atmospheric factors and has acknowledged that there may be "disorders in the air . . . more latent than the intemperate heat and moisture" that contribute to it.¹⁴⁰ Yet what is it, he asks, that upon entering the body brings about changes in the blood and other fluids, affecting the humors and producing the disease? He concludes that we do not know: "We are acquainted too little with the laws, by which the small parts of matter act upon each other" to determine this.¹⁴¹ He says, citing Newton's Optics (queries 18-24), that it probably involves a "subtile and elastic spirit diffused throughout the universe"; we have yet, however, to learn from our "great philosopher" how this "spirit" functions.¹⁴² Mead returns to the ether theory in connection with the so-called nervous fluid in his last (ninth) edition.

The use of "contagion" in spreading the disease is changed in the eighth edition. In the earlier editions, Mead said that contagion is propagated by diseased persons, goods imported from infected places, and the air.¹⁴³ In so doing, he opened the door to one of his critics: thus, the "explainer" asks what he meant by this. Is he saying that contagion and plague are the same thing, or that these "causes" spread contagion but not the plague? "In order to avoid future cavil," observes Patrick Russell, Mead restates this: he now says that the causes that spread the [End Page 296] plague are diseased persons, goods from infected places, and a corrupt state of air.¹⁴⁴

In part 2 of the eighth edition Mead recommends some relatively new measures, since none of those formerly in use "answers the purpose of discovering the beginning of the infection, nor of putting a stop to it when discovered."¹⁴⁵ Among these is the creation of a council of health consisting of officers of the state, city magistrates, and physicians; searchers in parishes would report to the council, and the aforementioned procedures would be followed.¹⁴⁶ Mayerne had recommended a board of health, as noted;¹⁴⁷ nothing came of either suggestion. For a brief time a central board of health (1805-6), "as earlier advocated by Mead," was formed to advise the government when the Gibraltar sickness (yellow fever) struck southern Spain.¹⁴⁸ The General Board of Health came into existence with the British Public Act of 1848.

Mead's "new" suggestions included reducing a town's population by encouraging people to leave ("the thinner it is, will be the more healthy")¹⁴⁹ and burying rather than burning goods in infected houses to avoid spreading infectious particles.¹⁵⁰ As to forcing people from their homes, he says, in the preface: "As soon as ever the sick are grown numerous, I advise, that they be left in their houses."¹⁵¹ He explains this: the poor are the first victims of the disease, so this mainly applies to them; they would be sent to more healthful accommodations. He did not see the need to state this before, but now does "to prevent cavils."¹⁵² This turnabout in his advice seems clearly a response to the provision in the quarantine act compelling persons in infected households to remove to specified places. His recommendations on how to preserve one's health, toward the end of the section, are similar to those in earlier editions. [End Page 297]

The Ninth Edition

An outbreak of plague in 1743 in Messina, Sicily, proceeded "in a most dreadful manner," reports Gentleman's Magazine.¹⁵³ Fortunately, it did not extend west. It was, however, responsible for the appearance of a number of works on the plague, including in 1744 a ninth and last edition of Mead's plague tract, now titled A Discourse on the Plague.¹⁵⁴ Theophilus Lobb, F.R.S., and member of the College of Physicians, wrote one such work. He relates that when attending a meeting of the Royal Society on 19 April 1744, he heard a "paper" (an extract of a letter from Messina) provided by Mead and giving the dismal details of the epidemic.¹⁵⁵

Mead, in his last edition, has "here and there added some new strokes of reasoning."¹⁵⁶ The preface follows along the same lines as in the previous edition: There is criticism of the Montpellier physicians who denied that the plague is contagious, attributing it to a corruption of the bile due to unwholesome food (as noted above), with the "terrors of the mind" (fear, despair) and the season as contributing factors.¹⁵⁷ All of the humors (not just the bile) are corrupted by the disease, comments Mead, and any mixed with a dog's blood would produce the plague symptoms.¹⁵⁸

Jean Astruc, a Montpellier professor of medicine, is cited by Mead as one who "both by strong reasoning and undeniable instances" established the "reality" of contagion:¹⁵⁹ Astruc was one Montpellier physician who believed that the disease in Provence was the plague, and that it was contagious. Mead alludes to the overcrowding of hospitals in France and to the guarded lines around infected towns with no departure permitted, all hardships on the French public. He defends his own advice, mentioning the "offensive" clauses of the quarantine act and some "great men" of the Parliament who insisted that the ministry could not be trusted, that it would use an infected household as a pretext for confining or removing persons not in favor. This happens, says Mead, in a government where there is "too much of faction, and too little of a public spirit."¹⁶⁰ He includes the Hanover "paper" in the preface.

By the time this edition was published, the mechanical and mathematical philosophies were less influential in medical theory. In the last [End Page 298] edition of his work on poisons, Mead disavows his earlier commitment to mechanical explanation, saying: "neither have I been ashamed, on some occasions . . . to retrench or alter whatever I have judged to be wrong. . . . I think truth never comes so well recommended, as from one who owns his error."¹⁶¹ Yet he does not wholly separate himself from the earlier theory: in his last publication he describes the body as a hydraulic machine with "numberless tubes, properly adjusted and disposed for the conveyance of fluids of different kinds."¹⁶² His thinking was now influenced by Newton's ether theory and by recent electrical experimentation (he cites the work of Stephen Gray and of Charles Du Fay),¹⁶³ both of which furthered his understanding of the nervous fluid that supposedly was responsible for muscular motion and sensation. Given the context of the time, comments Roderick W. Home, it was not unreasonable to identify the nervous fluid with the electricity (electrical fluid) that had been shown to stimulate muscular contractions.¹⁶⁴

Newton had been impressed by electrical experiments; in the General Scholium added to the second edition of the Principia (1713), he designates as "electric" a quality of a "most subtle spirit," the ether.¹⁶⁵ Mead, in his last edition, cites queries 18-24 of the Optics, commenting that Newton has shown that "there is diffused through the universe a subtile and elastic fluid of great force and activity" and that it, "readily pervading all bodies, produces many of their effects upon one another."¹⁶⁶ This "fluid," the ether, Mead identifies with the nervous fluid or animal spirits (the older term), saying "it is not improbable that the animal spirits are a thin liquor, separated in the brain [from the blood], and from thence derived into the nerves," and "that it admits, and has incorporated with it, a great quantity of this elastic fluid; which makes it a vital substance of great energy."¹⁶⁷ The concept of animal spirits is part of Galenic doctrine, which in turn is derived from Plato's three-part division of the soul. Vital [End Page 299] functions are determined by the rational, vegetative, and animal spirits (or souls).¹⁶⁸

Mead was not alone in identifying the nervous fluid with the ether; Bryan Robinson and Henry Pemberton were other physicians who did the same.¹⁶⁹ Newton, in his early reference to the ether, regards it as the same as or similar to the animal spirits or the nervous fluid in the nerves. He later says it can be perceived as a vibration along solid nerves, resulting in "animal motion."¹⁷⁰ Newton's concept of the ether, explains I. Bernard Cohen, went through "different successive stages."¹⁷¹ Mead's reference to the Optics suggests that he too considered the nerves to be solid, not hollow or tubular—though he describes the animal spirits as the "liquid of the nerves," and in his earlier work on poisons he speculated that the poison of venomous creatures infects the nervous fluid.¹⁷²

In discussing the porters at Marseilles ("patients of the first class") who upon opening the "infected merchandise" soon died, Mead says this must be due to particles or corpuscles "of great force" affecting the nervous fluid, for death would not come so quickly if only the blood were involved; we cannot explain this, he says: we do not know enough about "the laws of attractions, repulsions, and cohesions, among the minutest parcels of matter, to be able to determine all the ways by which they affect one another, especially within animal bodies."¹⁷³ The nervous fluid, he speculates, can be altered by "other active bodies of a different nature from it" if they are mixed with it (he gives as an example the result of combining certain "chymical spirits").¹⁷⁴ In the plague, the humors of a victim are in a corrupted state: the effluvia (or exhalations) have the [End Page 300] "qualities of those fermenting juices" from which they proceed, and when entering the body of a well person they can affect the nervous fluid, rendering it "unfit for the purposes of the animal oeconomy."¹⁷⁵ Mead's reference to patients of the "first class" is from a designation in A Succinct Account of the Plague at Marseilles, a work of the Montpellier physicians translated from the French by a physician (the names of Chicoyneau, Verney, and Soullier are on the title page), in which the plague is described in terms of classes or categories with corresponding symptoms and possible lengths of victims' survival: those in the first class died "in the space of some hours, of a night, of a day, or of two or three at farthest."¹⁷⁶ The origin of A Succinct Account, suggests Mullett, may have been Chicoyneau's Relation de la peste de Marseille (1721).¹⁷⁷ The author of the article on Mead in Biographia Britannica ("P") describes his turning to the Optics with the comment: "as he had done before, so now he ran with the same implicit conviction into the new succeeding fashion," attributing motion, sensation, and other phenomena to the nervous fluid.¹⁷⁸

Mead was one of a group of physicians associated with Pitcairne, described above, who looked upon Newton as their patron and "popularized" a Newtonian medicine. This in time meant for Mead a lucrative practice and prestigious appointments. He correctly perceived that he had to appear abreast of the new "Newtonian" medicine to further his career. This also should be seen as a part of the intense competition among physicians for patients, particularly among the aristocracy in his day. Mead, of middle-class background, had to contend with the medical marketplace.¹⁷⁹

Mead's advice in part 2 of the ninth edition for keeping the plague out of the country, and what to do should it enter, is not dissimilar from that in the eighth edition. Here, however, when discussing the most "dismal scene of misery,"¹⁸⁰ the household isolation of the well and the sick, he cites A Journal of the Plague in 1665, by a Citizen: London, 1722.¹⁸¹ This is a fictional, if realistic, work by Daniel Defoe, who was about five years old at [End Page 301] the time of London's "Great Plague."¹⁸² Ironically, Defoe's views on the origin and nature of the disease came from Mead's Short Discourse and from Hodges's Loimologia.¹⁸³ Mead's use of the Journal did not go unnoticed: later commentators observed that the "eminent Dr. Richard Mead" had used it as a historical source for the London plague of 1665.¹⁸⁴ Defoe's work seemed so authentic, however, comments Charles Mullett, that some later physicians based their "theoretical position" on it.¹⁸⁵ Mead concludes this edition with a chapter on the cure of the plague.

Mead's Plague Tract in Later Years

A medical historian writing on the "lost half-century" in English medicine, and responding to C.-E. A. Winslow's statement that Mead "clearly understood contagion and that his best contribution to medicine was in the publication of this knowledge," considered Mead's acceptance of it not influential.¹⁸⁶ This could not be said of it or of his practical suggestions in the years following his death, while the contagionist/anticontagionist controversy remained unresolved and sanitarians were questioning contagion and epidemic disease and the utilitarian value of quarantine.

There are references to Mead in a publication of William Brownrigg, M.D., F.R.S., that followed outbreaks of plague on the Continent in the 1770s. Brownrigg observes that the works of our "latest medical writers" (Sir John Pringle, James Lind) have aided in an understanding of the nature of contagion in general, but he credits the "justly celebrated" Dr. Mead with "useful observations" concerning the plague and "many excellent rules" regarding quarantine.¹⁸⁷ He finds useful Mead's reference to the measures taken when the plague was in the king's German lands, described in a "paper" he included in the eighth edition of his Short Discourse.¹⁸⁸ [End Page 302]

Patrick Russell, M.D., F.R.S., a contagionist, had experienced outbreaks of plague when physician to the British factory at Aleppo, Syria. He mentions the Short Discourse in his Treatise of the Plague. Russell admits differing with Mead in some matters, as is to be expected "in subjects of this kind,"¹⁸⁹ but says, "I have the pleasure to concur with him in the most material points."¹⁹⁰ Mullett considers Russell's treatise "the finest volume on the plague" up to that time.¹⁹¹

William Macmichael, M.D., F.R.S., F.R.C.P., published "A Brief Sketch of the Progress of Opinion on the Subject of Contagion" in 1825, a time when contagion and quarantine were coming under critical examination by miasmatists. Macmichael, a contagionist, quotes passages from the "learned and judicious" Mead's plague tract and describes him as "one of the best medical writers on the plague."¹⁹² Macmichael, it may be added, was the author of the classic work The Gold-Headed Cane, in which the "cane" relates its experiences with each of its owners. Mead was one of those owners, having received it from his patron John Radcliffe.¹⁹³ Mead occupied Radcliffe's Bloomsbury Square residence following his death in 1714 and acquired much of his practice. Radcliffe once told Mead that when he was "a young physician he possessed twenty remedies for every disease, and at the close of his career he found twenty diseases for which he had not one remedy."¹⁹⁴

Between the contagionist and anticontagionist positions, there was for some medical men a middle ground: limited, or contingent, contagion. For anticontagionists, this was unacceptable: a disease simply was or was not contagious. Thomas Hancock, M.D., member of the College of Physicians, recognized that there were many unresolved questions regarding the plague. He accepted the reality of contagion and believed that the plague could be conveyed from person to person, but also that contingent factors (season, poor diet) had to be considered.¹⁹⁵ In his Researches into the Laws and the Phenomena of Pestilence, he comments on Mead's plague tract, noting that it was written at the request of the [End Page 303] government and that it is not without "contradictions" and "unwarrantable assumptions."¹⁹⁶ Hancock's judgment, however, is that

in proportion to his ability and learning, and the high station he occupied in society, has been the influence of his opinions on the subject ever since. That he had numerous recorded facts to authorize many of his conclusions, and to justify the strong ground he had taken . . . cannot, I think, be reasonably denied.¹⁹⁷

Some anticontagionists recognized the influence of Mead's plague tract. Dale Ingram, surgeon and man-midwife, in the introduction to his publication of 1755 called his readers' attention to a "conceit" that has for some time persisted that the plague is contagious and can be transported from foreign places.¹⁹⁸ The disease, for Ingram, is an infection bred in the air: the constitution of the air (heat, moisture), he says, is the "mother and nurse of the plague."¹⁹⁹ He alludes to Pope Paul III and the Council of Trent as the source of the concept of plague as a pestilential contagion. Ingram may have had Mead in mind when he wrote: "the principal modern writers on the plague have been only those, who, in a warm room, have travelled over the works of a few who wrote in the last century. They never saw the disease itself in its mother country."²⁰⁰ Ingram denied that the plague could be conveyed from one place to another in merchandise, but yet believed that it could pass from person to person. "It is far from an improbability," he says, "that this opinion of contagion had not died gradually away before this time, had not the late eminent Dr Mead reviv'd and endeavour'd to support it" in his plague tract; he finds Mead's arguments unconvincing, but concedes that "they are of no small weight with many people, on account of his great credit and high character."²⁰¹ Patrick Russell saw Ingram as merely another critic of Mead, who utilized the remarks of his detractors.²⁰²

Noah Webster, of dictionary fame, published a two-volume history of epidemic and pestilential diseases in 1799; it was reprinted in England in [End Page 304] 1800. Epidemics of yellow fever in Philadelphia and elsewhere in the 1790s awakened his interest in epidemiology; he was not medically trained. The theory of the epidemic constitution of the atmosphere influenced Webster's thinking. He was "particularly bitter" with regard to Mead.²⁰³ It will probably be shown, he says in contrast to Mead, that the plague "generally, if not always, originates in the country where it exists as an epidemic,"²⁰⁴ and that it is not spread by infected merchandise, except in rare instance, such as clothes worn by a victim, not cleansed, and packed away.²⁰⁵ Mead's essay, he says, "is intended to demonstrate that the plague is propagated by specific contagion only."²⁰⁶ Webster takes issue with this. He defines smallpox and measles as specific contagions: they are communicated to a well person by a victim's effluvia or breath under any and all circumstances and conditions. Not so with plague, he explains: it is not communicated from a victim to a well person without the aid of foul air, warm weather, or other factors. He considers the plague to be a nonspecific contagion or an infection.²⁰⁷ Webster acknowledges, however, that Mead's "attempts to prove the specific contagion of plague, aided by his popularity, had a most surprising success; his treatise was received as a standard of truth."²⁰⁸

Mainly owing to the provocations of Charles Maclean, "the chief apostle of anticontagionism,"²⁰⁹ questions relating to the plague, contagion, and quarantine came under review by Parliament in the early nineteenth century. Maclean, educated as a physician, had himself fallen victim to the disease but denied that it was contagious (he did consider some diseases contagious, such as smallpox and measles). The source of the plague for Maclean was atmospheric, the epidemic constitution. He believed, notes Thomas Hancock, that the concept of contagion was unknown in ancient times, attributing it to a papal plot of the sixteenth century, which he claimed to have first discovered.²¹⁰ (Augustus B. Granville, M.D., F.R.S., in a letter to W. Huskisson, president of the Board of Trade, says this story appeared in an anonymous pamphlet of 1720 and has been "renewed by a contemporary physician," one recognized as a [End Page 305] leader of the anticontagionists.)²¹¹ Maclean's vitriol was directed at Mead and others who gave the papal story its "intellectual respectability."²¹² Thus, he says,

the absurd fables, respecting contagion, [were] invented by Fracastorius, in 1546, at the instigation of the Pope and his Legates, and since quoted, as knowledge, by every successive writer upon the plague. . . . Such . . . have been the tales, first fraudulently imposed upon the world, in Italy, afterwards implicitly adopted by Mead, and servilely copied by his successors, in England²¹³

and that this has become the basis of the quarantine laws that are harmful for trade and navigation. Maclean's publications and influence (he had supporters in Parliament) resulted in the formation of committees to determine whether the plague is contagious and to consider foreign trade and the quarantine laws.

In 1819 a select committee was appointed by the House of Commons "to consider of the validity of the doctrine of contagion in the plague" and to report its findings to the House.²¹⁴ Charles Maclean testified before the committee, as did Dr. John Mitchell, also an anticontagionist. Mitchell mentions Mead. He "whittled down" Mead's status, remarks Mullett, with the comment that Mead had not seen the disease.²¹⁵ Mitchell does, however, note Mead's role in determining the quarantine regulations for the country (orthodoxy for contagionists).²¹⁶ Sir Arthur Brooke Faulkner, M.D., F.R.S., physician to the forces, who had seen plague in Malta, testified before the committee for the contagionist position. Faulkner's Treatise on the Plague includes a number of quotations from ancient physicians, poets, and historians to show that they were familiar with contagion; should the readers want further references, one of the sources Faulkner directs them to is Mead's publication.²¹⁷ Of the medical [End Page 306] witnesses before the committee, all but two opted for the "received doctrine," that the plague is communicated by contact only, although some of the evidence indicated that it can also be affected by atmospheric factors.²¹⁸ The contagionist position was that of the College of Physicians. No changes were recommended with regard to quarantine. A second select committee met in 1824 to review matters of foreign trade and quarantine regulations; it retained quarantine with some modifications.²¹⁹

In 1849 the General Board of Health submitted a Report on Quarantine to the Parliament. It was mainly the work of Dr. Thomas Southwood Smith, medical advisor to the General Board and a Benthamite utilitarian.²²⁰ The report included a reference to Mead: Dr. James Ranken, the author of a report on the Pali plague, which broke out in India in 1836, commenting on the epidemic atmosphere and contagion, mentions Mead as one who had studied the plague "profoundly."²²¹

Southwood Smith in his Treatise on Fever comments on the "true solution of the origin of the plague" and refers to Mead.²²² He explains that the putrefaction of organic material (particularly animal matter) produces a febrile poison, and that the plague prevails in areas where this is present in abundance. Noting Mead's plague tract, he mentions the stench from filth arising from the canal in Grand Cairo when it periodically dries up, and the effluvia from the putrefaction of dead swarms of locusts in Ethiopia; these places also had unwholesome weather conditions (heat, moisture, lack of winds), and outbreaks of plague were frequent.

The sanitarian movement of the nineteenth century turned to the anticontagionists of the 1820s and 1830s and the environment to explain the cause of epidemic diseases now thought to be mainly of local origin. Contagionism was being narrowly interpreted; most medical men, [End Page 307] however, favored a compromise position.²²³ The sanitarians, Southwood Smith among them, advocated urban reforms to protect the public from disease-causing matter in the environment, particularly the atmosphere. They considered quarantine useless, if for practical reasons (utility) rather than disease theory, and in this they had the support of the merchant and industrial classes, advocates of free trade.

Fraser's Magazine for Town and Country, which for more than fifty years stood for "progressive thought" in a number of areas,²²⁴ questioned the General Board of Health's abandonment of quarantine and the emphasis on the reform measures of the sanitarians to prevent the spread of disease. Fraser's, while acknowledging the "wisdom" of some of the sanitary measures, would not do away with quarantine: "We have always understood," remarks the author of the article, that the plague is contagious and is not dependent on certain conditions for its transmission.²²⁵ The writer offers historical evidence for the plague's contagiousness, although noting that this was questioned by some French physicians during the Marseilles plague. The "celebrated" Dr. Mead is mentioned, and his plague tract is described as a "concise but consistent and well supported exposition of the doctrine of contagion and infection, and of the efficacy of quarantine for their prevention and extirpation."²²⁶ The writer sees a similarity between Dr. George Pye's criticisms of Mead in his Discourse of the Plague and views expressed in the report. The favorable reference in Fraser's to Mead's Short Discourse concerning Pestilential Contagion appeared almost one hundred years after his death.

William H. Welch, addressing the achievements of preventive medicine in the eighteenth century, names Mead's Short Discourse as a work that "sets forth far more advanced and enlightened views concerning isolation, quarantine, and continued observation of contacts than had hitherto prevailed."²²⁷ Until the identification of the organism that caused the plague (Yersinia pestis) in the late nineteenth century, and an understanding of the mode of transmission of the disease from the black rat and its fleas to humans, Mead had made an enduring contribution.

Footnotes

I would like to thank Nga T. Nguyen, library specialist, senior, and Hannah M. Fisher, associate librarian, University of Arizona Health Sciences Library; Steven Sowards, head, Main Library Reference, and Agnes Widder, humanities bibliographer, Michigan State University Libraries; and Elaine M. Challacombe, curator, Bio-Medical Library, University of Minnesota, for their suggestions and for providing materials for this article. I also wish to thank the reviewers of the Bulletin of the History of Medicine for their recommendations.

1. Paul Slack, introduction to The Plague Reconsidered: A New Look at Its Origins and Effects in Sixteenth- and Seventeenth-Century England (Matlock: Local Population Studies, 1977), p. 7.

2. Archibald W. Sloan, English Medicine in the Seventeenth Century (Durham: Durham Academic Press, 1996), p. 153.

3. Robert Steele, ed., Handlist of Proclamations Issued by Royal and Other Constitutional Authorities: 1714-1910, George I to Edward VII, 4 vols. (New York: Franklin, 1967), 4: 17-18.

4. Paul Slack, The Impact of Plague in Tudor and Stuart England (London: Routledge & Kegan Paul, 1985), p. 327.

5. Biographia Britannica, vol. 5 (London: Meadows, 1760), p. 3082.

6. Emerson Crosby Kelly, Encyclopedia of Medical Sources (Baltimore: Williams & Wilkins, 1948), p. 282.

7. Mead's father, Matthew, was a Nonconformist minister. Mead went to Leiden for his medical studies, since as a Nonconformist student he did not have the option of obtaining a medical degree from Oxford or Cambridge. He received his M.D. from the University of Padua in 1695; it was confirmed by diploma by Oxford in 1707.

8. "An Abstract of Dr Mead's Mechanical Account of Poysons sent to the publisher, by Sam. Morland," Philos. Trans. Roy. Soc. London, 1702-3, 23 : 1320-28.

9. With Mead's resignation from St. Thomas's, he became a governor of the hospital: "the first instance of a retired member of the staff receiving that honour" (Frederick Gymer Parsons, The History of St. Thomas's Hospital, 3 vols. [London: Methuen, 1932-36], 2: 160). I wish to thank Dr. Moira Rudolf, art historian, St. Thomas's Hospital, for providing me with materials on Mead at St. Thomas's.

10. William Coleman, "Mechanical Philosophy and Hypothetical Physiology," in The Annus Mirabilis of Sir Isaac Newton 1666-1966, ed. Robert Palter (Cambridge: MIT Press, 1970), pp. 322-32, at p. 331 n. 27.

11. Mead was elected president in 1744 but did not accept the office: Sir George Clark, A History of the Royal College of Physicians of London, 3 vols. (Oxford: Clarendon Press, 1964-72), 2: 536.

12. Dr. John Bliss, comp., The Remains of Thomas Hearne Reliquiae Hearnianae Being Extracts from His M S Diaries, new rev. by John Buchanan-Brown (Carbondale: Southern Illinois University Press, 1967), p. 192. Mead attended Queen Anne in her final illness. He predicted her early demise and advised that the physicians of the Elector of Hanover be notified of this: "It has always been considered that the prompt boldness of this political physician occasioned the peaceable proclamation of George I," and this may have contributed to his being appointed physician to George II in 1727 (Agnes Strickland, Lives of the Queens of England from the Norman Conquest, 16 vols. [Philadelphia: Barrie, 1903], 16: 219-20).

13. Marina Benjamin, "Medicine, Morality and the Politics of Berkeley's Tar-Water," in The Medical Enlightenment of the Eighteenth Century, ed. Andrew Cunningham and Roger French (Cambridge: Cambridge University Press, 1990), pp. 165-93, on p. 173.

14. Margaret DeLacy, "Influenza Research and the Medical Profession in Eighteenth-Century Britain," Albion, 1993, 25 : 37-66, on p. 50.

15. Wesley W. Spink, Infectious Diseases: Prevention and Treatment in the Nineteenth and Twentieth Centuries (Minneapolis: University of Minnesota Press, 1978), p. 6.

16. Slack, Impact of Plague (n. 4), p. 421 n. 34.

17. Thomas F. Sheppard, Lourmarin in the Eighteenth Century: A Study of a French Village (Baltimore: Johns Hopkins Press, 1971), p. 117.

18. Andrew Wear, Knowledge and Practice in English Medicine, 1550-1680 (New York: Cambridge University Press, 2000), p. 320.

19. Alain Corbin, The Foul and the Fragrant: Odor and the French Social Imagination, trans. Miriam L. Kochan (Cambridge: Harvard University Press, 1986), p. 103. Corbin is quoting Jean-Noël Biraben, Les hommes et la peste en France et dans les pays européens et méditerranéens, 3 vols. (Paris: Mouton, 1975), 1: 235.

20. Jean-Baptiste Bertrand, a Marseilles physician, theorized that invisible living entities ("insects") caused the plague: J.-B. Bertrand, introduction to A Historical Relation of the Plague at Marseilles in the Year 1720, trans. Anne Plumptre (Westmead, England: Gregg International, 1973).

21. The story was circulating in Marseilles in 1720 that the idea that the plague is contagious had its origins in the sixteenth century, when Pope Paul III used a "plague scare" as a way to have the Council of Trent moved to Bologna. See Charles F. Mullett, "Politics, Economics and Medicine: Charles Maclean and Anticontagion in England," Osiris, 1952, 10 : 224-51, at p. 229 n. 5. The publications of Professor Mullett have been very helpful in preparing this paper.

22. Historical Mss. Commission, 15th Report, appendix, part 6, Carlisle Mss (London, 1897), p. 36.

23. Slack, Impact of Plague (n. 4), p. 333; Clark, History (n. 11), 2: 524.

24. Laurence Brockliss and Colin Jones, The Medical World of Early Modern France (Oxford: Clarendon Press, 1997), p. 354.

25. Richard Mead, "A Discourse on the Plague," in The Medical Works of Richard Mead, M.D. (Edinburgh, 1775; reprint, New York: AMS Press, 1978), pp. 157-221, on pp. 175-76. This is the 1744 edition of the plague tract.

26. DeLacy, "Influenza Research" (n. 14), p. 50.

27. Vivian Nutton, "The Reception of Fracastoro's Theory of Contagion: The Seed That Fell among Thorns?" Osiris, 2d ser., 1990, 6 : 196-234, quotation on p. 229.

28. Dorothea W. Singer, "Some Plague Tractates (Fourteenth and Fifteenth Centuries)," Proc. Roy. Soc. Med. (Sect. Hist. Med.), 1916, 9 : 159-212, on p. 160.

29. Charles-Edward Amory Winslow, The Conquest of Epidemic Disease: A Chapter in the History of Ideas (Madison: University of Wisconsin Press, 1980), pp. 98-100.

30. Margaret DeLacy, "Nosology, Mortality, and Disease Theory in the Eighteenth Century," J. Hist. Med. & Allied Sci., 1999, 54 : 261-84, quotation on p. 268.

31. Vivian Nutton, "The Seeds of Disease: An Explanation of Contagion and Infection from the Greeks to the Renaissance," Med. Hist., 1983, 27 : 1-34, on pp. 28-29; Margaret Pelling, "Contagion/Germ Theory/Specificity," in Companion Encyclopedia of the History of Medicine, 2 vols., ed. W. F. Bynum and Roy Porter (London: Routledge, 1993), 1: 309-34, on p. 319.

32. Hieronymi Fracastorii, De contagione et contagiosis morbis et eorum curatione, libri III, trans. and notes by Wilmer Cave Wright, History of Medicine Series, no. 2 (New York: Putnam, 1930), p. 7.

33. Richard Mead, A Short Discourse concerning Pestilential Contagion, and the Methods to be used to Prevent it, 3rd ed. (London: Buckley and Smith, 1720), p. 2.

34. DeLacy, "Nosology" (n. 30), p. 268.

35. Robert P. Hudson, Disease and Its Control: The Shaping of Modern Thought (Westport, Conn.: Greenwood Press, 1983), p. 144.

36. John Swan, M.D., The Entire Works of Dr Thomas Sydenham, newly made English from the originals: wherein the History of Acute and Chronic Diseases, and the safest and most effectual methods of treating them, are faithfully, clearly, and accurately delivered, 3rd ed. (London: Cave, 1753), p. 75.

37. Mead, "Discourse on the Plague" (n. 25), p. 193.

38. C.-E. A. Winslow, "A Physician of Two Centuries Ago: Richard Mead and His Contributions to Epidemiology," Bull. Inst. Hist. Med., 1935, 3 : 509-44, on p. 537.

39. Lise Wilkinson, Animals and Disease: An Introduction to the History of Comparative Medicine (Cambridge: Cambridge University Press, 1992), p. 47.

40. Mead, Short Discourse (n. 33), p. 16.

41. Richard Bradley, Precautions Against Infection; Containing many observations necessary to be consider'd, at this time, on account of the dreadful plague in France (London: Corbett, ?1722), p. 2.

42. Daniel Defoe, A Journal of the Plague Year, ed. Louis Landa (Oxford: Oxford University Press, 1990), pp. 270-71; Catherine Wilson, The Invisible World: Early Modern Philosophy and the Invention of the Microscope (Princeton: Princeton University Press, 1995), p. 168.

43. "S. M.," A Treatise of the Plague. By a Physician in York (London: Osborn, 1721), pp. 9-10.

44. Richard Mead, "Medical Precepts and Cautions," in Medical Works (n. 25), p. 416.

45. Charles F. Mullett, "The English Plague Scare of 1720-23," Osiris, 1936, 11 : 224-51, on p. 485; Slack, Impact of Plague (n. 4), p. 329.

46. Charles F. Mullett, The Bubonic Plague and England: An Essay in the History of Preventive Medicine (Lexington: University of Kentucky Press, 1956), p. 334.

47. John B. Blake, comp., A Short Title Catalogue of Eighteenth-Century Printed Books in the National Library of Medicine (Bethesda, Md.: National Library of Medicine, 1979), p. 37; Sir Leslie Stephen and Sir Sidney Lee, eds., Dictionary of National Biography (Oxford: Oxford University Press, 1917-) , 2: 78. See also Samuel Austin Allibone, A Critical Dictionary of English Literature and British and American Authors Living and Deceased, from the Earliest Accounts to the Latter Half of the Nineteenth Century, 3 vols. (Philadelphia: Lippincott, 1897-98), 1: 152.

48. Nathaniel Hodges, Loimologia: or, an Historical Account of the Plague in London in 1665: With precautionary Directions against the like Contagion. To which is added, An Essay on the different Causes of Pestilential Diseases, and how they become Contagious by John Quincy (London: Bell and Osborn, 1720).

49. Mullett, "English Plague Scare" (n. 45), p. 504.

50. Wear, Knowledge and Practice (n. 18), pp. 309-11.

51. Preface to A Collection of very Valuable and Scarce Pieces relating to the last Plague in the Year 1665 (London: Roberts, 1721), n.p.

52. Mullett, "English Plague Scare" (n. 45), p. 506.

53. Isbrand de Diemerbroeck, A Treatise concerning the Pestilence: Describing its Particular causes, various Symptoms, and Method of Cure, trans. Thomas Stanton (London: Downing and Warner, 1722), p. 3.

54. Ole Peter Grell, "Plague, Prayer and Physic: Helmontian Medicine in Restoration England," in Religio Medici: Medicine and Religion in Seventeenth-Century England, ed. Ole Peter Grell and Andrew Cunningham (Aldershot: Scolar Press, 1996), pp. 204-27, on pp. 210-11.

55. Mead, "Discourse on the Plague" (n. 25), p. 177.

56. Theodore M. Brown, "From Mechanism to Vitalism in Eighteenth-Century English Physiology," J. Hist. Biol., 1974, 7 : 179-216, on p. 194. Iatromechanism is sometimes referred to as iatrophysics or iatromathematics. See idem, "The College of Physicians and the Acceptance of Iatromechanism in England, 1665-1695," Bull. Hist. Med., 1970, 44 : 12-30, on p. 12.

57. Brown, "College of Physicians" (n. 56), pp. 20-22.; idem, "From Mechanism to Vitalism" (n. 56), p. 216.

58. G. S. Rousseau, "'Sowing the Wind, and Reaping the Whirlwind': Aspects of Change in Eighteenth-Century Medicine," in Studies in Change and Revolution: Aspects of English Intellectual History, 1640-1800, ed. Paul J. Korshin (Menston: Scolar Press, 1972), pp. 129-59, on p. 137.

59. Pitcairne taught at Leiden in 1692-93. See G. A. Lindeboom, Boerhaave and Great Britain: Three Lectures on Boerhaave with Particular Reference to His Relations with Great Britain (Leiden: Brill, 1974), p. 11; Richard H. Meade, In the Sunshine of Life: A Biography of Dr. Richard Mead, 1673-1754 (Philadelphia: Dorrance, 1974), pp. 32-35.

60. Richard Mead, preface to "A Mechanical Account of Poisons, in Several Essays," 1st ed., in Medical Works (n. 25), p. 7. In his later years, Mead had an opportunity to perform a service for his professor: Pitcairne's son was sent to the Tower and he faced the death penalty for his part in the "Fifteen," a Jacobite uprising to restore the Stuarts. Mead brought about his release through the intercession of Robert Walpole.

61. Brown, "Mechanism to Vitalism" (n. 56), pp. 195-99. Mead had been "deeply immersed" in Robert Boyle's corpuscular philosophy (Theodore Brown, The Mechanical Philosophy and the "Animal Oeconomy" [New York: Arno Press, 1981], p. 255).

62. Brown, "Mechanism to Vitalism" (n. 56), pp. 200-204.

63. Brown, Mechanical Philosophy (n. 61), p. 303.

64. Mead, "Medical Precepts and Cautions" (n. 44), p. 345.

65. Richard Mead, "A Discourse on the Small-Pox and Measles," in Medical Works (n. 25), p. 231.

66. Richard Mead, A Short Discourse concerning Pestilential Contagion, and the Methods to be used to Prevent it, 8th ed. (London: Buckley, 1722), pp. 137-38.

67. Ibid., p. ii.

68. Paul Slack, "Metropolitan Government in Crisis: The Response to Plague," in London 1500-1700: The Making of a Metropolis, ed. A. L. Beier and Roger Finlay (London: Longman, 1986), pp. 60-81, on p. 71; idem, Impact of Plague (n. 4), pp. 219, 327; Mead, Short Discourse (n. 66), p. 97.

69. William Macmichael, "A Brief Sketch of the Progress of Opinion on the Subject of Contagion; with Some Remarks on Quarantine," Pamphleteer, 1825, 25 : 519-31, at pp. 527-28.

70. Mead, "Discourse on the Plague" (n. 25), pp. 216-17.

71. William Macmichael, in The Gold-Headed Cane, tells the story of how Dr. John Radcliffe observes Mead in his library reading Hippocrates and says, "What! My young friend, do you read Hippocrates in the original language? Well, take my word for it, when I am dead you will occupy the throne of physic in this great town" (William MacMichael, The Gold-Headed Cane [Springfield, Ill.: Thomas, 1953], p. 23).

72. Joan Campbell, "The Library of Dr. Richard Mead, 1673-1754, with Emphasis on the Titles Related to Medicine" (thesis, University of Chicago Graduate Library School, 1962), pp. 3, 23.

73. Coleman, "Mechanical Philosophy" (n. 10), p. 325.

74. DeLacy, "Influenza Research" (n. 14), p. 50. In the early years of the eighteenth century, there were medical writers who did not distinguish between a corruption of the atmosphere by matter harmful to health, and contagion: the air or the exhalations of an infected person could be the source of a disease. See Margaret DeLacy, "The Conceptualization of Influenza in Eighteenth-Century Britain: Specificity and Contagion," Bull. Hist. Med., 1993, 67 : 74-118, at p. 82.

75. Gentleman's Mag. & Hist. Chron., 1754, 24 : 510-15, quotation on p. 513. The article, written the year of Mead's death, concludes with an acknowledgment "to the learned Dr Mattley, author of the Journal Britannique, from whose French it is translated"; this is a reference to Matthew Maty's life of Mead in the Journal Britannique, 1754, 14 : 215-48 ("Éloge du Docteur Richard Mead"), for which Maty used materials provided by Mead's friend Thomas Birch, secretary of the Royal Society, 1752-65. See John Lawrence Abbott, "Samuel Johnson and 'The Life of Dr. Richard Mead,'" John Rylands Lib. Bull., 1971, 54 : 12-27; A. E. Gunther, "Matthew Maty MD, FRS (1718-76) and Science at the Foundation of the British Museum, 1753-80," Bull. Brit. Mus. (Nat. Hist.), 1987, 15 : 1-58, at p. 14. "Mattley" may have been a misprint; see Valerie Anne Ferguson, "A Bibliography of the Works of Richard Mead, M.D., F.R.S. (1673-1754)" (submitted as a partial requirement for the University of London diploma in Librarianship, 1959), p. 42.

76. Richard H. Shryock, The Development of Modern Medicine: An Interpretation of the Social and Scientific Factors Involved (Madison: University of Wisconsin Press, 1979), p. 83 n. 14.

77. There is also a septicemic type of bubonic plague in which the bacilli enter the bloodstream and death can ensue without the usual symptoms (such as buboes) of the disease. Some medical historians have considered the possibility that plague epidemics of the past may have involved a combination of diseases, including typhus and smallpox. See Mary Lindemann, Medicine and Society in Early Modern Europe (Cambridge: Cambridge University Press, 1999), pp. 40-43.

78. Slack, Impact of Plague (n. 4), quotation on p. 340; see also p. 9.

79. Mead, Short Discourse (n. 33), pp. 11, 17, quotation on p. 11. It was long accepted that the plague "poison," whether viewed as an occult but penetrating quality or as particles or corpuscles, caused putrefaction in a body: Wear, Knowledge and Practice (n. 18), p. 303.

80. Mead, Short Discourse (n. 33), pp. 12-13.

81. Sir Richard Manningham, A Discourse concerning the Plague and Pestilential Fevers (London: Robinson, 1758), p. 14. For Richard Boulton, a physician, the air impregnated with emanations from within the earth harmful to health and a predisposition of the humors were the primary cause of the disease; its conveyance by persons and goods from infected places was a secondary cause (Richard Boulton, An Essay on the Plague Containing a Discourse of the Reasons of It, and What May Be Proper to Prevent It (Dublin: Harding, 1721), pp. 6-8. Philip Rose, M.D., was among a number of writers who attributed the plague to both local and foreign causes (Philip Rose, A Theorico-Practical, Miscellaneous, and Succinct Treatise of the Plague (London: Jauncy, 1721), pp. 9, 12, 13, 18, 19). Only Rose, observes Paul Slack, "was as lucid on the subject as Mead" (Slack, Impact of Plague [n. 4], quotation on p. 423 n. 62).

82. Slack, Impact of Plague (n. 4), p. 35.

83. Mead, Short Discourse (n. 33), pp. 32-35, quotation on p. 35.

84. Defoe, Journal (n. 42), p. 267; Slack, Impact of Plague (n. 4), pp. 250-51; Mead, Short Discourse (n. 33), pp. 32-35.

85. James H. Cassedy, "Medicine and the Rise of Statistics," in Medicine in Seventeenth-Century England: A Symposium Held at UCLA in Honor of C. D. O'Malley, ed. Allen G. Debus (Berkeley: University of California Press, 1974), pp. 283-312, on p. 310.

86. Mead, Short Discourse (n. 33), p. 38.

87. Patrick Russell, A Treatise of the Plague: containing an Historical Journal, and Medical Account, of the Plague, at Aleppo, in the Years 1760, 1761, and 1762 (London: Robinson, 1791), p. 486.

88. Mead, Short Discourse (n. 66), p. 98.

89. Wear, Knowledge and Practice (n. 18), p. 281.

90. Mead, Short Discourse (n. 33), pp. 53-54.

91. Ibid., p. 48.

92. Wear, Knowledge and Practice (n. 18), p. 280.

93. Mead, Short Discourse (n. 33), p. 48.

94. Slack, Impact of Plague (n. 4), p. 328.

95. Arnold Zuckerman, "Dr. Richard Mead (1673-1754), a Biographical Study" (Ph.D. diss., University of Illinois at Champaign-Urbana, 1965), pp. 98-99; Adrian Wilson, "The Politics of Medical Improvement in Early Hanoverian London," in Cunningham and French, Medical Enlightenment (n. 13), pp. 4-39, on pp. 26-27.

96. Mead, "Discourse on the Small-Pox and Measles" (n. 66), p. 257; Isobel Grundy, Lady Mary Wortley Montagu (Oxford: Oxford University Press, 1999), p. 213.

97. Lindemann, Medicine and Society (n. 77), p. 53.

98. Slack, Impact of Plague (n. 4), p. 330.

99. William Boghurst, Loimographia: An Account of the Great Plague of London in the Year 1665, ed. Joseph Frank Payne (London: Shaw, 1894; first printed from the British Museum, Sloane MS. 349, for the Epidemiological Society of London), p. xiv. See also Wilson, Invisible World (n. 42), p. 152.

100. Considerations on the Nature, Causes, Cure, and Prevention of Pestilences; being a Collection of Papers, Published on that Subject by "The Free-Thinker" (London: Wilkins, 1721), pp. 106-8.

101. George Pye, A Discourse of the Plague; Wherein Dr. Mead's Notions are Consider'd and Refuted (London: Darby, 1721), p. 51. See also ibid., pp. 3, 18, 19, 23, 26, 38, 43, 51; Doctor Mead's Short Discourse Explain'd. Or, His Account of Pestilential Contagion, and Preventing, Exploded, 2nd ed. (London: Peele, 1722), pp. 24, 25, 27, 34.

102. Distinct Notions of the Plague, with the Rise and Fall of Pestilential Contagion. By the Explainer (London: Peele, 1722), preface, n.p.

103. Ibid., p. 121; see also pp. 122-25. The "explainer" is the author of Doctor Mead's Short Discourse Explain'd (n. 101).

104. Distinct Notions of the Plague (n. 102), p. 122.

105. Some Remarks on Three Treatises of the Plague: viz. I. Dr. Mead's Short Discourse concerning Pestilential Contagion. II. Dr. Mead's Short Discourse Explain'd, Ec. III. Dr. Pye's Discourse of the Plague, &c. (London: Roberts, 1721), p. 5.

106. Ibid., p. 81. Apart from the immediate controversy, there were other writers who took issue with Mead. One, Joseph Browne, expresses disappointment upon reading Mead's "late piece" (Joseph Browne, A Practical Treatise of the Plague, and all Pestilential Infections that have happen'd in this Island for the last Century. With a Prefatory Epistle address'd to Dr. Mead, on Account of his short Discourse concerning Pestilential Contagion [London: Wilcox, 1720], p. 5). For Browne the air was the source of the plague (the "first cause in propagating contagion" [p. 6]). To Mead's causes for the propagation of contagion, he would add diet and diseases causing other diseases; he questioned the need to require the quarantine and airing of imported goods, which, he felt, hurt trade (pp. 6, 24-25). Browne is described in Rogal as an "accused charlatan" who "claimed" the title of doctor, though he never received the M.D. degree (Samuel J. Rogal, comp., Medicine in Great Britain from the Restoration to the Nineteenth Century, 1660-1800; An Annotated Bibliography [New York: Greenwood Press, 1992], pp. 40 n. 394, 91-92 n. 842).

107. Mead, "Discourse on the Plague" (n. 25), p. 159.

108. Danby Pickering, The Statutes at Large from the Magna Charta, to the end of the eleventh Parliament of Great Britain, anno 1761, continued to 1806, vol. 14, The Statutes at Large, from the Fifth to the Ninth Year of King George I (Cambridge: Bentham, 1762-1807), p. 301.

109. Ibid., pp. 301-2.

110. Wilson, "Politics of Medical Improvement" (n. 95), p. 32.

111. Alfred J. Henderson, London and the National Government, 1721-1742: A Study of City Politics and the Walpole Administration (Durham, N.C.: Duke Universiy Press, 1945), p. 45; Slack, Impact of Plague (n. 4), p. 327.

112. Applebee's Orig. Weekly J., 16 September 1721, p. 2061.

113. Ibid., 4 November 1721, p. 2203.

114. Henderson, London and the National Government (n. 111), pp. 43-44 n. 90.

115. Slack, Impact of Plague (n. 4), pp. 331-32.

116. Henderson, London and the National Government (n. 111), p. 35.

117. Pickering, Statutes at Large (n. 108), pp. 381-83.

118. Mead, "Discourse on the Plague" (n. 25), p. 170.

119. Mead, Short Discourse (n. 66), p. 88.

120. Pickering, Statutes at Large (n. 108), pp. 380-81, 408-21.

121. Mead, "Discourse on the Plague" (n. 25), p. 170.

122. Biographia Britannica (n. 5), p. 3082I.

123. Ibid., p. 3082.

124. This edition consists of 150 pages with a preface of 36 pages and a dedication; the earlier edition cited (n. 33) consists of 59 pages and a dedication.

125. Roger French, "The Anatomical Tradition," in Bynum and Porter, Companion Encyclopedia (n. 31), 1: 81-101, quotation on p. 94.

126. Mead, Short Discourse (n. 66), pp. 13-14.

127. Ibid., pp. 15-16.

128. Ibid., pp. ii-iii.

129. "An Account of some Experiments made with the Bile of Persons dead of the Plague at Marseilles . . . ," Philos. Trans. Roy. Soc. London, 1722-23, 32 : 20-32.

130. Raymond Williamson, "The Plague of Marseilles and the Experiments of Professor Anton Deidier on Its Transmission," Med. Hist., 1958, 2 : 237-52, on p. 237.

131. John Carswell, The South Sea Bubble (Stanford, Calif.: Stanford University Press, 1960), p. 173.

132. Mead, Short Discourse (n. 66), pp. vi-ix, quotation on p. ix.

133. Ibid., pp. xxx-xxxi.

134. Ibid., p. xiv.

135. Ibid.

136. Ibid., p. xxix.

137. Dorothy Porter, "Public Health," in Bynum and Porter, Companion Encyclopedia (n. 31), 2: 1231-61, on p. 1233.

138. Mead, Short Discourse (n. 66), pp. 23, 29.

139. Ibid., pp. 31-33, quotation on p. 32-33.

140. Ibid., p. 36.

141. Ibid., p. 38.

142. Ibid., pp. 38-39.

143. Mead, Short Discourse (n. 33), p. 2.

144. Russell, Treatise of the Plague (n. 87), pp. 202-3; Mead, Short Discourse (n. 66), p. 41.

145. Mead, Short Discourse (n. 66), pp. 96-97. See C. Fraser Brockington, A Short History of Public Health (London: Churchill, 1956), p. 4; Winslow, "Physician of Two Centuries Ago" (n. 38), pp. 541-43.

146. Mead, Short Discourse (n. 66), pp. 97-99; Mead, Short Discourse (n. 33), pp. 38-39.

147. Slack, "Metropolitan Government" (n. 68), p. 71.

148. C. Fraser Brockington, A Short History of Public Health, 2nd ed. (London: Churchill, 1966), p. 26.

149. Mead, Short Discourse (n. 66), pp. 99-100.

150. Ibid., p. 108.

151. Ibid., pp. xx-xxv, quotation on p. xx.

152. Ibid., p. xxiv.

153. Gent. Mag., 1743, 13 : 391.

154. Mead, "Discourse on the Plague" (n. 25).

155. Theophilus Lobb, Letters relating to the Plague, and other Contagious Diseases (London: Buckland, 1745), p. 128.

156. Mead, "Discourse on the Plague" (n. 25), p. 159.

157. Ibid., p. 161.

158. Ibid., p. 162.

159. Ibid., p. 163.

160. Ibid., p. 170.

161. Mead, "Mechanical Account of Poisons" (n. 60), p. 3. See also Robert E. Schofield, Mechanism and Materialism: British Natural Philosophy in an Age of Reason (Princeton: Princeton University Press, 1970), p. 51.

162. Mead, "Medical Precepts and Cautions" (n. 44), p. 342.

163. Roderick W. Home, "Electricity and the Nervous Fluid," J. Hist. Biol., 1970, 3 : 235-51, on p. 242 n. 23; Mead, "Mechanical Account of Poisons" (n. 60), pp. 3-4.

164. Home, "Electricity" (n. 163), p. 236 n. 1.

165. Anita Guerrini, "Ether Madness: Newtonianism, Religion, and Insanity in Eighteenth-Century England," in Action and Reaction: Proceedings of a Symposium to Commemorate the Tercentenary of Newton's Principia, ed. Paul Theerman and Adele F. Seeff (Newark: University of Delaware Press, 1993), p. 238.

166. Mead, "Discourse on the Plague" (n. 25), p. 187.

167. Ibid. See Stanley W. Jackson, "Melancholia and Mechanical Explanation in Eighteenth-Century Medicine," J. Hist. Med. & Allied Sci., 1983, 38 : 298-319, on pp. 308-9.

168. Andrew Wear, "Medicine in Early Modern Europe, 1500-1700," in The Western Medical Tradition, 800 BC to AD 1800, ed. Lawrence I. Conrad et al. (Cambridge: Cambridge University Press, 1995), pp. 215-361, on pp. 262-63; Lois N. Magner, A History of Medicine (New York: Dekker, 1992), p. 90.

169. Guerrini, "Ether Madness" (n. 165), p. 243; Anita Guerrini, "Newtonianism, Medicine and Religion," in Grell and Cunningham, Religio Medici (n. 54), pp. 293-312, on p. 305.

170. Sir Isaac Newton, Opticks, or a Treatise of the Reflections, Refractions, Inflections & Colours of Light (reprt. of 4th ed.; London: Bell, 1931), pp. 353-54.

171. I. Bernard Cohen, ed., assisted by Robert E. Schofield, Isaac Newton's Papers and Letters on Natural Philosophy and Related Documents, 2nd ed. (Cambridge: Harvard University Press, 1978), p. 11.

172. Mead, "Discourse on the Plague" (n. 25), p. 186; Mead, "Mechanical Account of Poisons" (n. 60), p. 13. And see Edwin Clarke, "The Doctrine of the Hollow Nerve in the Seventeenth and Eighteenth Centuries," in Medicine, Science, and Culture: Historical Essays in Honor of Owsei Temkin, ed. Lloyd G. Stevenson and Robert P. Multhauf (Baltimore: Johns Hopkins Press, 1968), pp. 123-41, at p. 134.

173. Mead, "Discourse on the Plague" (n. 25), pp. 186-87.

174. Ibid., p. 187.

175. Ibid.

176. MM. Chicoyneau, Verney, and Soullier, A Succinct Account of the Plague at Marseilles, its Symptoms, and the Methods and Medicines used for Curing it (Dublin: Grierson, 1721), pp. 6-7.

177. Mullett, Bubonic Plague (n. 46), p. 299 n. 40.

178. "P," Biographia Britannica (n. 5), p. 3080G.

179. Wear, "Medicine in Early Modern Europe" (n. 168), p. 357; Roy Porter, "The Eighteenth Century," in Conrad et al., Western Medical Tradition (n. 168), pp. 371-475, on p. 450.

180. Mead, "Discourse on the Plague" (n. 25), p. 203; and see "Orders drawn up and Published by the Lord Mayor and Aldermen of the city of London, to prevent the spreading of the infection," in Collection (n. 51), p. 6.

181. Mead, "Discourse on the Plague" (n. 25), p. 204.

182. Ann Steinecke, "Medicine and the Arts," Academic Med., 1998, 73 : 770-71, on pp. 770-71.

183. David Roberts, introduction to Defoe, Journal (n. 42), p. ix.

184. Spiro Peterson, Daniel Defoe: A Reference Guide, 1731-1924 (Boston: Hall, 1987), p. 8.

185. Mullett, Bubonic Plague (n. 46), p. 293.

186. William R. Le Fanu, "The Lost Half-Century in English Medicine, 1700-1750," Bull. Hist. Med., 1972, 46 : 319-48, quotation on pp. 327-28.

187. William Brownrigg, Considerations on the Means of Preventing the Communication of Pestilential Contagion, and of eradicating it in infected places (London: Lockyer Davis, 1771), p. 3 n. 2.

188. Ibid., p. 18 n. 12. In the Compleat Family Physician, Hugh Smythson, M.D., assures his readers that this work includes "the best and most approved preservatives against epidemick and contagious diseases" (Hugh Smythson, The Compleat Family Physician; or, Universal Medical Repository [London: Harrison, 1781], title page); chapter 19, on the plague, is taken largely from the last edition of Mead's plague tract, though his name is not mentioned.

189. Russell, Treatise of the Plague (n. 87), p. 483.

190. Ibid., preface, n.p.

191. Mullett, Bubonic Plague (n. 46), p. 322.

192. Macmichael, "Brief Sketch" (n. 69), pp. 520-21.

193. Macmichael, Gold-Headed Cane (n. 71), pp. 35, 37.

194. Campbell R. Hone, The Life of Dr. John Radcliffe, 1652-1714: Benefactor of the University of Oxford (London: Faber and Faber, 1950), p. 101.

195. Mullett, Bubonic Plague (n. 46), pp. 347-49.

196. Thomas Hancock, Researches into the Laws and Phenomena of Pestilence; including a Medical Sketch and Review of the Plague of London, In 1665; and Remarks on Quarantine (London: Phillips, George Yard, 1821), p. 7.

197. Ibid., pp. 6-7.

198. Dale Ingram, An Historical Account of the Several Plagues that have appeared in the World since the Year 1346 (London: Baldwin and Clark, 1755), p. ii.

199. Ibid., p. 59.

200. Ibid., p. ii.

201. Ibid., pp. 39-40.

202. Russell, Treatise of the Plague (n. 87), p. 211. There is a critical review of Ingram's Historical Account in the Monthly Review or, Literary Journal, 1755, 12 : 129-40.

203. Winslow, Conquest of Epidemic Disease (n. 29), p. 216.

204. Noah Webster, A Brief History of Epidemic and Pestilential Diseases, with the Principal Phenomena of the Physical World, which precede and accompany them, and Observations deduced from the facts stated. in two volumes (Hartford: Hudson & Goodwin, 1799), 1: 17.

205. Ibid., 2: 148-49.

206. Ibid., 1: 16.

207. Ibid., 2: 140-41.

208. Ibid., 2: 208.

209. Mullett, Bubonic Plague (n. 46), p. 336.

210. Hancock, Researches (n. 196), p. 18.

211. Augustus B. Granville, "A Letter to the Right Hon. W. Huskisson, M.P. President of the Board of Trade, on the Quarantine Bill," Pamphleteer, 1825, 25 : 393-403, quotation on p. 399.

212. Mullett, "Politics" (n. 21), p. 230.

213. Charles Maclean, "Suggestions for the Prevention and Mitigation of Epidemic and Pestilential Diseases, comprehending the Abolition of Quarantines and Lazarettos," Pamphleteer, 1817, 10 : 443-82, quotation on p. 461.

214. Parliamentary Debates, 1st ser., vol. 39 (1819), cols. 424-26.

215. Mullett, Bubonic Plague (n. 46), p. 341.

216. "Report from the Select Committee Appointed to consider the validity of the doctrine of Contagion in the Plague," Philos. Mag. & J., 1820, 55 : 22 (concluded from 1819, 54 : 417-39).

217. Sir Arthur Brooke Faulkner, A Treatise on the Plague, designed to prove it contagious, From Facts, collected during the Author's residence in Malta, when visited by the malady in 1813 (London: Longman, Hurst, Rees, Orme, and Brown, 1820), advertisement, pp. 193-94.

218. House of Commons, "Report from the Select Committee Appointed to Consider the Validity of the Doctrine of Contagion in the Plague," Sessional Papers, 1819, vol. 2 (doc. 449), pp. 537-638. See Norman Howard-Jones, "Fracastoro and Henle: A Re-Appraisal of Their Contribution to the Concept of Communicable Diseases," Med. Hist., 1977, 21 : 61-68, esp. p. 66; Mullett, Bubonic Plague (n. 46), p. 340.

219. House of Commons, "Second Report from the Select Committee Appointed to Consider of the Means of Improving and Maintaining the Foreign Trade of the Country," Sessional Papers,Quarantine, 14 June 1824, vol. 6 (doc. 417), pp. 165-369.

220. Porter, "Public Health" (n. 137), p. 1244.

221. "Quarantine," Fraser's Mag., 1853, 47 : 74-83, quotation on p. 79. See also Great Britain, General Board of Health, "Report on Quarantine," Sessional Papers, 1849, [Cmd. 1070], vol. 24, pp. 137-308. I wish to thank Stephen J. Greenberg, reference/collection access librarian, History of Medicine Division, National Library of Medicine, for providing me with information on Dr. James Ranken.

222. Southwood Smith, A Treatise on Fever (Philadelphia: Carey and Lea, 1831), pp. 211-13, quotation on p. 212.

223. Pelling, "Contagionism / Germ Theory / Specificity" (n. 31), p. 322; John M. Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr (Baltimore: Johns Hopkins University Press, 1979), pp. 97-98.

224. Ruth Hodgkinson, Public Health in the Victorian Age: Debates on the Issue from Nineteenth-Century Critical Journals, 2 vols. (Westmead, England: Gregg International, 1973), vol. 1, introduction, n.p.

225. "Quarantine" (n. 221), p. 75.

226. Ibid., p. 79.

227. William H. Welch, Public Health in Theory and Practice: An Historical Review (New Haven: Yale University Press, 1925), pp. 17-18.