Cholera Nostras.
Thus far I have considered diarrhoea as the “disease of the season” for the age of infancy or early childhood; and undoubtedly the large totals of deaths from it in the London bills, whether under the name of “griping in the guts” or afterwards under the generic name of “convulsions” were nearly all infantile deaths, both in earlier and later times. If we had regard only to the statistics of mortality and the effects upon population, we might now pass from the subject of epidemic diarrhoea, having said all that has to be said of it in those respects. But the deaths from epidemic diarrhoea, mostly of the summer and autumn, are far from being a correct measure of its prevalence, whether in our own time or in earlier times. Adults suffered from it in a fair proportion of the numbers living at the higher ages, although few of them died of it, except among the elderly and aged. It is only for modern times that we have any figures of the number of persons attacked at the respective periods of life; and these I shall take first in order, as illustrating the probabilities or generalities that may be collected from earlier writers such as Willis and Sydenham.
The following Table of the ages attacked at Leicester during a recent series of years shows a smaller proportion of attacks in infancy than some other modern tables do; but it is not misleading for general experience, and it will serve emphatically to correct the illusion that infants, because they contribute the bulk of the deaths, are most obnoxious to the attacks[1408]:
44,678 cases of Summer Diarrhoea at Leicester in seven epidemic seasons, 1881-87.
| Age | Cases | Per cent. | ||
| Under one year | 2,284 | 5·2 | ||
| One year and under five | 8,956 | 20·0 | ||
| Five years and upwards | 33,438 | 74·8 | ||
| 44,678 | 100·0 | |||
On the other hand, the fatalities from diarrhoea in all England during the same seven years had the following very different incidence upon the periods of life:
| Under one year | One year and under five | Five years and upwards | |||||||
| 1881 | 9408 | 2476 | 2852 | = | 19·3 | per cent. | |||
| 1882 | 10680 | 3555 | 3050 | = | 17·6 | " | |||
| 1883 | 9962 | 2843 | 3128 | = | 19·6 | " | |||
| 1884 | 17854 | 4794 | 3764 | = | 14·2 | " | |||
| 1885 | 8821 | 2023 | 2524 | = | 17·9 | " | |||
| 1886 | 16514 | 4936 | 3298 | = | 13·3 | " | |||
| 1887 | 14101 | 2936 | 3205 | = | 15·8 | " | |||
| Annual average per cent. above five | 16·8 | ||||||||
Thus, while (at Leicester) the attacks above the age of five years were 74·8 per cent. the fatalities above that age (in all England) were only 16·8 per cent. and the greater part of the deaths in that small fraction were of elderly or aged persons. This means that persons attacked by diarrhoea between the ages of five and (say) fifty nearly all recover; on the other hand a large proportion of infants in their first year succumb to the attack, and a considerable proportion of elderly or aged persons succumb to it.
If we were to judge from the direct testimony of Sydenham and Willis, we should say that the cholera nostras of London in the 17th century was chiefly a malady of the higher ages; there is little in their writings to suggest the enormous mortality of infants from that cause, which can be deduced from a close study of the bills. One reason for this, as already said, was that the ailments of infants and young children in former times came little under the notice of physicians, being left to the “mulierculae” or nurses, and that among the working class, from which most of the deaths in the bills came, there was in those times an almost total lack of the medical experiences now gained through dispensaries, hospitals and other charities or public institutions. With this proviso we may take the accounts of the older writers as giving a correct picture of the epidemic cholera nostras of a hot and close summer or autumn in former times.
The great seasons of choleraic disease in the 16th century were the years 1539-40, (which were remarkable all over Europe for dysentery as well), 1557-58, 1580-82, and probably 1596[1409]. The term commonly used in that period was a choleric lask, which meant profluvium. In some, if not in all, of those seasons there was unusual heat and drought. It is clear that these were only the years when cholera nostras of the summer season was exceptionally common and severe. According to a medical work of the year 1610, dealing with the indications for the use of tobacco by individuals, including the seasons of the year when it was most admissible, midsummer is characterized in general terms, and perhaps in the stock language of foreign medical treatises, as the season for “continuall and burning fevers, bleareyedness, tertian agues, vomiting of yellow choler, cholericke fluxes of the belly, paines of the eares and ulcerations of the mouth, putrefactions of the lower parts: especially when the summer, besides his heat, is enclined to overmuch moisture, and that no windes blow, and the weather bee darke, foule, close and rainie.... So that in this season, and for these remembered griefes, no man, I trust, will grant tobacco to be verie holesome[1410].” Consistently with this Sydenham says that, while the cholera morbus of August, 1669, was more general than he had ever known it, yet in every year, at the end of summer and beginning of autumn, there was some of it; and he compares its regularity to the coming of the swallow in spring or of the cuckoo in early summer. It was marked by enormous vomiting, purging, vehement pain in the bowels, inflation and distension, cardialgia, thirst, a quick pulse, sometimes small and unequal, heat and anxiety, nausea, sweats, spasms of the arms and legs, faintings, coldness of the extremities, and other symptoms, alarming to the attendants and sometimes causing death within twenty-four hours[1411]. Next year, 1670, in the corresponding season, he describes under the name of a bilious colic, a prevalent malady which, he says, should count rather among chronic diseases[1412]. It was marked by intolerable pain, the abdomen being now bound as if in a tight bandage, now bored through as if by a gimlet. These pains would remit for a time, and the paroxysm come back, the patient shrinking from the mere idea of it with misery expressed in his face and voice. This was evidently somewhat different from the cholera morbus of the summer of 1669; it was apt to end in inverted peristaltic action, with vomiting of the matters of enemata, or in iliac passion[1413]. There was also dysentery in both years, as we shall see.
Morton gives the first choleraic and dysenteric season under the year 1666, and says of its recurrence in the following autumn, that hardly any other disease was to be seen, that the whole town was seized, and that 300, 400 or 500 died of it in a week. This is obviously antedated by two years, just as Morton is two years earlier than Sydenham with the great fatality of measles (1672 instead of 1674). Willis, again, who wrote some twenty years nearer to the events than Morton did, places the great choleraic seasons in 1670 and 1671, instead of 1669 and 1670. Sydenham’s dates are undoubtedly correct, both as borne out by the bills of mortality, and as occurring in consecutive order in the annals which he kept for a period of twenty-five years. The correctness of his dates apart, Willis may be cited for the symptoms of the London cholera[1414].
The onset was sudden, with vomiting and watery purging, accompanied by prostration: “I knew a great many that, though the day before they were well enough and very hearty, yet within twelve hours were so miserably cast down by the tyranny of this disease that they seemed ready to expire, in that their pulse was weak and slender, a cold sweat came upon them and their breath was short and gasping; and indeed many of them, that wanted either fit remedies or the help of physicians, died quickly of it. This distemper raged for a whole month, but began to decrease about the middle of October, and before the first of November was almost quite gone.” The vomitings and purgings were copious, watery, almost limpid, not bilious. The sickness was peculiar to London or the country within three miles of it. It did not seem to be infectious, but to attack only those predisposed to it; for it would seize those who kept out of the way of the sick and spare those who attended them. Morton, however, declares that he was infected in two successive seasons, “dum, mense Augusto, sedes dysentericorum minus cauté inspicerem.”
These illustrations from the highly choleraic summers of 1669 and 1670 will serve to show the prevalence of cholera nostras among adults in London in former times. Its great seasons were the same as those of cholera infantum, of which numerous instances have been given from the London weekly bills of mortality. The years 1727-29 were specially noted for cholera by the annalists, such as Wintringham, of York. Hillary, of Ripon, having entered in his annals a “cholera morbus” in 1731, adds: “which disease I have observed to appear almost every year towards the latter end of summer[1415].” A letter from Darlington, 29 July, 1751, having mentioned the death of the earl of Derby by “the cholera morbus,” adds that the disease usually rages at the close of summer and towards the beginning of autumn[1416]. Newcastle was much subject to it, as well as to dysentery, Wilson, of that town, devoting an essay to dysentery in 1761 and to cholera in 1765. Lind, who went to Haslar Hospital in the very unwholesome period about 1756-58, found much aguish and choleraic sickness: “Obstinate agues, and what is called the bilious cholic, from being accompanied with vomitings and a purging of supposed bile, but especially the flux, are often at Portsmouth and Gosport in the autumnal season highly epidemical. Since I resided here, I have observed those distempers to rage among the inhabitants, strangers and troops with an uncommon degree of mortality; while, during this period of universal distress at land, ten thousand men in the ships at Spithead remained unaffected with them[1417].” At Manchester, in the burning summer of 1794, a bilious colic, says Ferriar, “raged among all ranks of people[1418].” Clarke, of Nottingham, writing in 1807 of the great prevalence of cholera nostras, calls it “the usual attendant on autumn[1419].”
The appearance of Asiatic cholera in England in the end of 1831 gave rise to much controversial writing for a few months, as to whether the epidemic were really the foreign pestilence. Every effort was made by a certain school to find native precedents for a disease equally malignant; which, if they did not prove the point in question, gave more exact particulars of cholera nostras than we might otherwise have received. The only one of these accounts that need concern us here is Thackrah’s for Leeds and its vicinity in 1825[1420].
The weather had been exceptional. In May, three-eighths more rain fell than usual, the wind being in the east the whole month. June was showery and sultry, the thermometer on the 12th marking 87°. July was sultry, with drought for several weeks to the 3rd of August, when showers fell. There had been a few cases of cholera in May, June and July, but it was not until August that the disease became rife in Leeds and still more in certain villages near it. The symptoms were purging, vomiting, cramps, prostration, coldness of the extremities, shrinking of the features, &c. At Moor Allerton, a parish three or four miles north of Leeds, with a poor scattered population occupied on the farms, there were found in 60 houses, containing 299 persons, no fewer than 114 cases of sickness in July, August and September, 81 of these from cholera, with 3 deaths. Dysentery was common, both as a sequel of the cholera and as a primary malady. At Halton, three or four miles east of Leeds, with a population better off than in the former, there were found in 60 houses, with 298 persons, 74 cases of sickness, of which 63 were choleraic. At Grawthorpe, four miles west of Wakefield, with a weaving population not poor but of filthy habits, there had been for two months before the visit of inspection more sickness than any one remembered. Twenty of all ages had died of the epidemic, there having been 7 corpses in the village on one morning. Of 70 houses inspected, only 7 had been exempt from cholera and dysentery. In one house of 9 persons 7 were ill, 2 with cholera, others with dysentery and typhus. This was one of the most unhealthy villages, supplied with water from ponds only. In Leeds the choleraic epidemic was less than in the adjoining country, and the few deaths that occurred from it were all among the poor and debilitated. The hot summer of 1825 was unusual for the amount of cholera nostras. It prevailed at South Shields that season with unusual severity, the cramps and spasms being peculiarly manifest[1421].