Dr Christopher H Collins MBE, Former Senior Visiting Research Fellow at the Imperial College of Medicine at the National Heart and Lung Institute, and Dr David A Kennedy, Former Visiting Fellow at Cranfield Medical Centre, Cranfield University, discuss the history of typhus In the late 18th and through the 19th century there was a marked increase in the number of people who suffered from what they called fevers. Among those recognized by physicians, two were of particular interest to the government and the merchant classes: gaol (or jail, sometimes spelled jayle) fever and ship fever. The first of these had been mentioned in a book published as early as 1547 by Boorde, ' who called it the sycknesse of In 1 750 it was described by Sir John Pringle,2 physician to the armed forces. Ship fever, described by Lind, a naval surgeon, in 1774.a was important because it affected the efficiency of the navy when the country was at war and because sickness among the crews of merchant ships affected trade and profit. As long as gaol fever affected only the inmates of prisons it was of little concern to the government and the public. At times of gaol delivery, however, when prisoners were brought into court for trial, court officers, officials and spectators were liable to be affected. The first of what became known as was at Cambridge in 1522. The cause was said to be foul air and the pestilential savour, whether arising from the smell of the prisoners or from the damp of the ground and the filth of the house. The next was that at Oxford in 1 577 when note was made of the nauseating stench that came from the cells beneath the courtroom, which housed some 300 prisoners in close confinement. This incident was followed by an epidemic in the city that killed 300 people. After the Assizes in Exeter in 1586, there seems to be an absence of further reports until 1730 when, at the Lent Assize at Taunton, several high officials succumbed - allegedly as a result of the infected stench of the prisoners brought from !!ehester Gaol. Probably the last was the Black Assize at the Old Bailey in 1750. In 1729 the government appointed a Parliamentary Select Committee to inquire into the very low levels of cleanliness and sanitation in prisons. Only two prisons were investigated: the Fleet and the Marshalsea. The committee reported overcrowding, with as many as three inmates sleeping in a single bed; up to 40 prisoners in a room 16x14 feet and only 8 feet high, with no sanitation and a noisome stench beyond expression. Further evidence of conditions can be found in the reports of Mayhew and Binny,-' as well as in reports and contemporary novels,5 Probably the most detailed account concerns Newgate Gaol, which stood on the site of the present Central Criminal Court (the Old Bailey). The stench and nastiness of gaol fever and the lack of or absence of sanitation are described in The Newgate Calender6 and include accounts of rotting corpses that stayed in the gaol until claimed by relatives or Poor Law officials. Conditions in ships were no better, except for the officers. Other ranks, whether naval or mercantile, lived on the lower decks where ventilation was poor, cleanliness almost unheard of and sanitation primitive. It is difficult to assess morbidity and mortality levels because, apart from the paucity of official records, the physicians of the time were liable to include other gaol or ship fevers if they occurred in those areas. In his Survey of London, Stow7 tells that in 1414, 64 prisoners as well as some gaolers died of fever in Newgate. When the prison reformer Howard investigated the conditions in 33 prisons in 1773-74 he commented on the high incidence of jail fever in 22 of them and noted that more people died of gaol fever than were executed. According to Creighton, the losses from ship fever were very high (as many as 150 in a single ship). …