Dysentery in the 19th century.
Willan, who was practising in London as early as 1785-6, says that dysentery had not been epidemic there from the autumn of 1780, until the autumn of 1800, his position at the Public Dispensary in Carey Street enabling him to know the prevalent diseases. In the autumn of 1800 the epidemic was extensive. There were, he says, some sporadic cases every autumn, but he never saw a fatal case of it[1453]. In Bateman’s continuation of the same records from 1804, dysentery first appears in 1805 and remains sporadic every autumn. It was “very prevalent” in the autumn and winter of 1808, but not fatal; and it was not unusual among the dispensary patients every year until these records end in 1816[1454]. The years 1800-02 form one of the more distinct dysenteric periods also for Ireland and Scotland. Old Glasgow practitioners in the severe epidemic of 1827-28 recalled the fact that they had last seen the disease about 1802, and the books of the Glasgow Infirmary bore witness to its prevalence from 1800 to 1803 or 1804. In 1801-2 there was a good deal of it also at Hamilton, among a regiment of dragoons as well as among the people at large[1455]. The troops in various parts of Ireland suffered from it in the same years[1456]. In 1808, during a somewhat unwholesome season in which agues also were met with, some cases of dysentery were admitted to the General Infirmary of Nottingham[1457]. An altogether exceptional outbreak of a dysenteric nature occurred in 1823 among the prisoners in Milbank Penitentiary[1458].
The great dysenteric period of the 19th century coincided with, or followed, the two hot summers of 1825 and 1826, the latter of which was probably the hottest and driest summer of the century. Of its prevalence in and near Leeds in 1825, Thackrah says it was “before almost unknown as an epidemic to the present practitioners of this district.” In the same summer it was unusually common in Dublin, and was epidemic the next year in other parts of Ireland as well (supra, p. 271). In Glasgow it began about the end of July, 1827, in the flat district to the south of the Clyde, and in the course of the autumn became prevalent in all parts of the city. An outbreak of plague itself could hardly have caused more surprise, so strange was dysentery to that generation. A few deaths by it in one crowded street of the Gorbals were mentioned in a newspaper before the disease had become general, and “gave rise to that groundless fear which pervaded and distracted the public mind during the whole course of the epidemic[1459].”
The symptoms were severe and alarming, but the fatalities were few, perhaps not more than one in fifty attacks. The proper dysenteric symptoms usually lasted from ten to fourteen days, and were followed by diarrhoea, it might be, for many weeks. The morbid anatomy showed in the mucous membrane of the great intestine the three degrees of congestion, follicular ulceration and sloughing of the whole mucous coat (in the sigmoid flexure and rectum). The cases were nearly all above the age of puberty, and among the poorer classes. September and October were the worst months. The weather was remarkably close, damp and relaxing. One practitioner saw two cases of genuine ague in natives of Glasgow, having never seen a case of ague before. The ordinary cholera nostras of summer and autumn was much less frequent than for several years before, and it was the general remark that it had given place to the dysentery.
Having declined in the winter of 1827-28, it revived in May, and again reached a great height in the autumn of 1828, while cases of it (probably chronic, or renewals of old attacks) continued to the summer of 1830. The following table shows the number of cases treated by the poor’s surgeons in the several seasons, 1827-30; the 435 cases in the autumn of 1827 were nearly a third part of all the cases so treated (1462):
Cases of Dysentery in Glasgow treated by the Surgeons to the Poor.
| Quarter | 1827 | 1828 | 1829 | 1830 | ||||
| Feb.-April | — | 28 | 29 | 26 | ||||
| May-July | — | 62 | 35 | 26 | ||||
| Aug.-Oct. | 435 | 261 | 50 | — | ||||
| Nov.-Jan. | 143 | 68 | 22 | — |
It extended to the villages and country districts all round Glasgow. It was believed to be somewhat general in Scotland in 1827-28, but the only answers to a circular of queries sent out by the editors of the ‘Glasgow Medical Journal’ came from Hamilton (and Bothwell), Ayr and Callander (including the flooded valley of the Teith and the Braes of Balquhiddar)[1460].
In Edinburgh the outbreak of dysentery began about the end of July, 1828, a year later than in Glasgow, just as the epidemic in that city was a year or more later than in Dublin. Attacks of it were numerous among the patients admitted to the Edinburgh Infirmary for other diseases; but it occurred at the same time throughout the city generally and in the country around; “nor has it been confined entirely to the lower orders.” In the imperfectly kept register of the Infirmary there were 42 admissions, with 11 deaths, from August to October. Christison, who treated some of these, had never seen dysentery before[1461]. The morbid anatomy was the same as at Glasgow—congestions, numerous small ulcerations especially of the transverse colon, or sloughing of considerable portions of the mucous membrane.
In the same years 1827-28 there was much dysentery in the Lunatic Asylum at Wakefield. It is well known that aged paupers in workhouses or asylums are peculiarly subject to the epidemic influences that produce diarrhoeal or choleraic sickness; and there had been much of that disease in the West Riding Asylum from its opening in 1819. Some cases of dysentery had also occurred, but it was not until after the exceptional summer of 1826 that they became common. In 1828 there were 55 cases among 375 inmates, mostly in old and incurable lunatics, the fatalities being at the very high rate of one in four. The morbid anatomy was that of true dysentery—follicular ulceration in the transverse colon, with occasional sloughing of large pieces of the mucous membrane. The whole sewage of the asylum collected in cesspools or “tanks of ordure” within a few feet of the wards[1462].
The causes of the rare and surprising outbreak of dysentery in 1827-28 were much debated. In Glasgow it was remarked that the choleraic complaints of the summer and autumn were much less frequent than usual; also that the first season of it, the year 1827, was remarkable for rain every day for some months, and for a close, oppressive, relaxing atmosphere. Brown, of Glasgow, thought the weather might account for it, the labouring class being thereby made peculiarly subject to heats and chills, which, grafted upon the usual bowel-complaints of the season, easily turned them to dysentery. Dr Andrew Buchanan was of opinion that exhalations from the soil were the chief, if not the sole, exciting cause of dysentery, reserving the question of contagiousness. Other forms of miasmatic febrile disease, formerly rare, had, he said, made their appearance of late years and become epidemic. Christison had already spoken in the same sense for the Edinburgh outbreak. For five or six weeks, he said, before the dysentery appeared there in the end of July, 1828, the tendency to bowel affections during the epidemic fever (which was chiefly of the relapsing type) was increased in a very marked degree. The same tendency continued throughout the whole progress of the dysentery; “nay in some instances true acute dysentery was formed during the height or towards the termination of continued fever; and now that the dysentery has in great measure disappeared, or assumed a mild form, the tendency of low gastro-enteric inflammation to accompany continued fever is very strongly marked, perhaps is more frequent than ever.” This may relate to a remarkable outbreak of fever among the richer classes in the New Town of Edinburgh, more talked about than written on, which seems to have been enteric or typhoid, according to the clinical history of a case of it that came from Edinburgh to Hamilton and was recorded by a physician of the latter place[1463]. It was more especially that strange epidemic in Edinburgh that Dr Andrew Buchanan had in mind when he wrote that the dysentery of 1827-28 was not the only disease due to exhalations from the soil with which Scotland had of late been visited[1464]. This is an instructive line to take in seeking an explanation of the dysentery of 1827-28, even if we keep something of the old doctrine of heats and chills as affecting those who labour in a damp atmosphere. The ground-water theory of miasmatic infective diseases was not then formulated; but there has rarely been in our latitudes so signal an instance of extreme drought and heat followed by excessive dampness as in the two years 1825 and 1826, and the year 1827. The second dry year, 1826, was certainly the season when enteric fever was described and figured for the first time in London. It was said, also, that enteric cases occurred among the relapsing fever and dysentery of Dublin in the same year; and enteric cases are known to have occurred in Edinburgh towards the end of the epidemic of relapsing fever and dysentery, which was one or two years later in that city than in Dublin. In Glasgow, where the dysentery was probably a more extensive outbreak than elsewhere, there appears to have been at that time no enteric fever; in London, on the other hand, where there was a good deal of the latter, there does not appear to have been any notable prevalence of dysentery.
Along with the cholera nostras which was unusually common in the autumn of 1831, just before the outbreak of Asiatic cholera, there was some dysentery, notably an epidemic at Bolton[1465]. At the end of the Asiatic cholera of 1832 a succession of cases of dysentery occurred in the Edinburgh Charity Workhouse[1466].
The next occasion of dysentery was the autumn of 1836, which was, like that of 1827, a wet season. The outbreak at Glasgow on this occasion is recorded only in a few figures (the medical journal of the city having ceased to appear for a time), according to which there were 144 cases throughout the year treated by the surgeons to the poor, of which 8 were fatal, and 15 cases sent to the Infirmary, of which 4 were fatal[1467]. At Dundee also, from October to December, 1836, bowel-complaints were not unusual among the cases of typhus, which occurred in hundreds. “Many of the cases of diarrhoea and dysentery,” said Arrott, “occurred in December, and were accompanied by catarrhal and rheumatic symptoms, implying an origin distinct from the bilious diarrhoea and bilious vomiting of summer.” Of 22 cases of dysentery at the Infirmary, 2 were fatal[1468].
Next year, 1837, there occurred in Somersetshire a remarkable epidemic which was for the most part dysenteric. It was seen first at Bridgewater, and in July it caused two deaths at Taunton, where it afterwards prevailed with high malignancy. Of 223 deaths, 206 were set down to dysentery, 16 to diarrhoea and 1 to cholera; the high ratio of children’s deaths in the following table of ages is in accordance with other recent experiences to be given in the sequel:
| Ages | 0-5 | -10 | -15 | -20 | -30 | -40 | -50 | -60 | -70 | -80 | -90 | Over 90 | ||||||||||||
| Deaths | 93 | 17 | 11 | 7 | 6 | 3 | 7 | 16 | 26 | 24 | 11 | 2 |
The monthly mortalities were, 75 in August, 105 in September, 29 in October, 10 in November, 2 in December. The epidemic spread partially amongst the unions around Taunton[1469].
In London from the beginning of registration (1837) until 1846, the deaths set down to dysentery averaged fully a hundred in the year—a statistical fact to which there is nothing corresponding in contemporary writings: Watson said it was hardly ever seen in practice except in the chronic form among sailors and soldiers who had contracted it abroad. During the prevalence of the “Irish fever” of 1846-48, the disease was truly epidemic and a cause of many deaths along with typhus itself, especially in Liverpool and mostly among destitute Irish. In 1846 it was in Milbank Penitentiary[1470]. A most instructive instance of its connexion with the Irish emigration occurred at Penzance in the summer and autumn of 1848.
The brig ‘Sandwich’ sailed from Cork for Boston, U. S., in the end of May, carrying a number of Irish farmers and their families. Having met with rough weather and head winds she put in leaky to Penzance on 7 June, sixteen days out from Cork. The provisions had been bad and there was sickness in the ship, with a very filthy state of things. Three of the women passengers died on shore of dysentery. The ship sailed again on 10 July, two more of the emigrants dying of dysentery before she reached Boston, while two of the crew survived the attack. On 16 July, two cases of the same disease occurred among the lower class in Penzance, and thereafter the epidemic spread widely through most parts of the town and the three adjoining parishes of Madron, Galval and Paul, causing a great mortality, as in the following table:
Deaths from Dysentery in Penzance and three adjoining parishes.
1848.
| Deaths from Dysentery in Penzance town | Deaths from Dysentery in 3 other parishes | Total deaths from Dysentery | Deaths from all causes in Penzance and 3 other parishes | |||||
| July | 5 | 0 | 5 | 31 | ||||
| August | 37 | 1 | 38 | 71 | ||||
| Sept. | 26 | 12 | 38 | 67 | ||||
| Oct. | 13 | 9 | 22 | 48 | ||||
| Nov. | 1 | 1 | 2 | 31 | ||||
| 82 | 23 | 105 | 248 | |||||
As many as five hundred cases were under medical treatment in the town. No death occurred there or in the three parishes within the registration district after 10 November, “but very many in the country beyond its limits.” Of the 105 deaths in the table, 46 were of young children, 35 of aged persons, and 24 between the ages of five and sixty years[1471]. There was no resisting the evidence that an infection had been introduced by the weather-bound Irish emigrants; instances were also known of new foci in the country districts having been created by domestics or others suffering from dysentery who had been sent from Penzance to their homes. At the same time the summer had been exceptionally wet, the rainfall having been as follows:
| Inches of rain | ||
| May | 0·777 | |
| June | 3·287 | |
| July | 3·277 | |
| Aug. | 4·972 | |
| Sept. | 3·042 | |
| Oct. | 4·425 | |
| Nov. | 3·981 |
A singular epidemic of dysentery occurred between the 14th and 26th September, 1853, among the thirty-six inmates of a row of nine cottages near the village of Hermiston, five miles west of Edinburgh. Seven children were attacked, of whom six died, and six adults, who all recovered. Besides these there were three cases among the four inmates of a cottage about a hundred yards away, and one case in each of two houses in the adjacent village of Hermiston. Christison found that a drain which received the sewage or slops of the hamlet was in a most offensive state, having been choked probably for years, and that the water of a well near it was foetid. These are the conditions that have often caused village epidemics of enteric fever in recent times; but there was no doubt that the disease in this case was dysentery[1472]. Another asylum outbreak of dysentery occurred in 1865 in the Cumberland and Westmoreland Asylum[1473].
Perhaps the last general prevalence of dysentery was during the Asiatic cholera of 1849, when the house-to-house visitations in Leeds and some other towns brought to light a somewhat surprising number of cases mixed with the more ordinary bowel-complaints of the season.
It is impossible to trace the subsequent history of dysentery in England by the usual statistical means of the Registrar-General’s tables of the causes of death, for the reason that dysentery, a rare and curious disease of all ages in this country, is merged with diarrhoea, one of the commonest causes of infantile mortality. However, it is not likely that any such epidemic outbursts, local or general, as those described for certain years of the 18th and 19th centuries could have occurred without their being otherwise known. It may be safely said that there has been little of it in this country for the last thirty or forty years, except among a few soldiers, sailors or others returned from abroad; in Ireland itself, the immemorial “country disease” has now only a small annual total of deaths.
One of the last experiences of dysentery in an English port was instructive for the relation of the disease to typhus fever.
On 16 February, 1861, an Egyptian frigate, the ‘Scheah Gehaed,’ sent from Alexandria to be fitted with new engines, arrived in the Mersey. The only European on the ship was her commander, an Austrian. She carried 476 men, mostly Arabs, with a small proportion of Nubians and Abyssinians. Some two hundred were convicts, who had been brought on board in chained gangs. The passage had been long and stormy, and attended with much sickness, dysenteric and diarrhoeal; one man died and was thrown overboard two or three days before the ship reached Liverpool. The pilot who boarded her was at once struck by the horrible state of filth of the ’tween decks; he remained two days on board, and on returning home said to his wife, “This frigate will be heard of yet.” He sickened in about a week of malignant typhus and died. Two others who boarded the ship took typhus, of whom one recovered. There had been no fever on board during the voyage. Thirty-two of the Arabs or Nubians were admitted to the Southern Hospital suffering, most of them, from dysentery or diarrhoea. Typhus fever attacked 17 of the ordinary patients, 2 nurses, 2 porters, 2 house-surgeons and 2 others in the hospital, of whom several died. The Arabs &c. to the number of 340 were taken in batches of 80 a day to a public bath, in which they remained three hours. Typhus broke out among the bath attendants. The whole number of cases of typhus traced to the ship was 31, of which 8 were fatal. The ship was sunk in the graving dock in order to clean her[1474].
This is a classical instance of the breeding of typhus from the effluvia of dysentery, of which other instances, on a greater scale, have been given in connexion with the Jamaica expedition of 1655 (in the former volume), the siege of Londonderry and the camp of Dundalk in 1689, the hospitals after the battle of Dettingen in 1743, and the Irish famine of 1846-48.
CHAPTER IX.
ASIATIC CHOLERA.
The Indian or Asiatic cholera, which first showed itself on British soil in one or more houses on the Quay of Sunderland in the month of October, 1831, was a “new disease” in a more real sense than anything in this country since the sweating sickness of 1485. The English profession had been hearing a good deal about it for some years before it reached our shores. The outbreak in Lower Bengal in 1817, from which the modern history of cholera dates, had been the subject of reports and essays by Anglo-Indian physicians and surgeons; an extensive prevalence of it in the Madras Presidency shortly after, as well as in Mauritius in 1819 and 1829, had been observed by other medical men in the service of the East India Company or of the British army or navy. Many who had seen cholera in India, and some who had written upon it, returned to England in due course, so that the formidable new pestilence of the East began to be heard of in medical circles at home. Various essays upon it issued from the English press between 1821 and 1830[1475]; and in 1825 it appeared for the first time, and at considerable length, in the pages of an English systematic treatise, the new edition of Dr Mason Good’s ‘Study of Medicine.’
Previous to 1829, Asiatic cholera had obtained no footing in Europe. The first great movement westwards from India through Central Asia, which was continuous with the memorable eruption in Bengal after the rains of 1817, had reached to Astrakhan, at the mouths of the Volga, and had there caused the deaths of some 144 persons in September, 1823. Another progress westwards from India, after an interval of six years, reached the soil of European Russia in the Government of Orenburg in August 1829, the mortality in the whole province during the autumn and winter (to February, 1830) amounting to about one thousand. A much more severe epidemic of it arose in the summer of 1830 in the town and province of Astrakhan (supposed to have been introduced by an infected brig from Baku), which spread with enormous rapidity, destroying in the course of a month some four thousand in Astrakhan itself and upwards of twenty thousand in other parts of the province[1476]. Thus established in the basin of the Volga, Asiatic cholera overran the whole of Russia. Before the spring of 1831 it had entered Hungary and Poland, and in the end of May had reached Danzig and other German ports on the Baltic and North Seas. Lord Heytesbury, the British Ambassador at St Petersburg, had sent home a despatch upon it early in 1831; in April, the Admiralty issued orders for a strict quarantine of all arrivals from Russia at British ports, which were afterwards extended to arrivals from all ports abroad invaded or threatened by cholera. On 20 June a royal proclamation ordering various precautions was issued, and next day a Board of Health was gazetted, composed of leading physicians in London and of the medical heads of departments, with Sir Henry Halford as president. Local Boards of Health were formed voluntarily in many parts of the country during the summer of 1831. Two medical men were at the same time commissioned by the Government to proceed to Russia to study the disease there, their letters to the Board of Health commencing from the 1st of July. The growing interest in the disease as it came nearer called forth another crop of writings, some of them based on old Indian experience, others speculative[1477]. The most important of these was the treatise by Orton, which had been published in its original form at Madras in 1820. Writing from Yorkshire in August, 1831, he surmised (with a proviso that no one could say confidently what might happen) that Asiatic cholera might be expected to be a mild visitation upon Britain at large, falling most upon the large manufacturing towns in which typhus was common, but that it would be “far otherwise” with Ireland owing to its chronic poverty, distress and over-population. By a singular chance the only town which he specially mentioned in England was Sunderland, where, he had been told by Dr Clanny, there had been an unusual number of cases of malignant cholera nostras in the early part of the autumn: “it is greatly to be feared,” he said, “that those are but the skirts of the approaching shower[1478].”
In other places besides Sunderland there had been perhaps more than the usual amount of summer diarrhoea in 1831. Dr Burne, in his London dispensary reports, entered on the 2nd and 16th July an unusual prevalence of “dysenteric diarrhoea and cholera,” and cases of scarlet fever of an “adynamic” type or with a tendency to fatal collapse[1479]. (Clanny observed the same type of scarlatina at Sunderland along with some typhus.) Choleraic disorders were uncommonly rife on board the ships of war in the Medway[1480]. A succession of twenty-four cases at Port Glasgow, from 2 July to 2 August, chiefly among workers in Riga flax, gave rise to an alarm of the real Asiatic cholera, the more readily that the first case was fatal (the only death)[1481]. Similar alarms arose at Leith and Hull.