A Scarlet Fever outbreak in St Albans, 1748

The advice of Dr Nathaniel Cotton

By David Kelsall


Nathaniel Cotton (1705-1788), poet and physician, was born in London. He came to St Albans in about 1740, and remained here until his death. Besides his general practice, he kept a private madhouse in the town which he dignified with the title of 'Collegium Insanorum.'

It was in this madhouse that the poet William Cowper was confined during his first period of acute depression, from December 1763 to June 1765. Cowper spoke very highly of Dr Cotton afterwards, and wrote that he was "treated with kindness by him when I was ill, and attended with the utmost diligence.... "

Observations on Scarlet Fever is the only publication credited to him on a professional subject. He describes an epidemic of scarlet fever in and around St Albans in the winter of 1748. This illness was a very virulent one in those days, caused we know now by a bacterium called haemolytic streptococcus. This same bacterium was recently in the news, as it is the cause of necrosing fasciitis. This aggressively infective condition is particularly severe in those whose health was otherwise compromised, and may lead to the amputation of limbs.

Scarlet fever is now of little consequence, due mainly to the fact that the causative organism is always sensitive to penicillin. Indeed, it is nowadays known by the less frightening name of scarletina. There is also evidence that over the past fifty years the bacterium has lost much of its former virulence.

Nathaniel Cotton relates the symptoms well. He describes the rash, inflamed and ulcerated tonsils, enlarged and infected neck glands and very high fever with delirium lasting several days. He goes on to describe changes in the urine which we know now to result from the kidney damage that may accompany the infection.

The treatment that he advises would not prove acceptable these days. It included medicine containing bitters, draughts of whale oil and saltpetre in barley gruel, white wine or whey, gargles and asses milk. In more severe cases he prescribed bleeding (but only if the pulse was strong), emollient enemas, and blistering of the back, upper arms and head. He found opiates of no help, and reports that they neither helped the delirium nor did they procure sleep.


This page was added by Jonathan Mein on 05/01/2013.

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