Relapsing Fever in Scotland, 1842-44.
The epidemic of 1836-39 had been typhus of a specially maculated kind. The period or “constitution” of synocha, rising twice to epidemics of relapsing fever, had lasted from near the beginning of the century until 1828 or 1829. Then came the new constitution of low, depressed, spotted fever, which would not stand blood-letting. But in 1842-44 relapsing fever reappeared in Scotland. This reappearance was a blow to two doctrines of the time—first that Ireland was the original breeding-place of all such fevers, and secondly, that a return of the “constitution” of relapsing fever would warrant a return to the practice of blood-letting, which had fallen into disuse during the epidemic of typhus. The epidemic of 1842-44 was at first purely a Scots affair, with some extension to England, but none to Ireland. As to blood-letting, once it had been given over in fevers it was not readily taken up again, notwithstanding the theory that relapsing fever belonged to those sthenic or inflammatory types of sickness in which the lancet was still thought admissible. Moreover, Christison, who remembered the relapsing synocha of 1817-19 and of 1827-28, said of the third epidemic: “The synocha of 1843-44, though so prevalent, by no means presented the same strong phlogistic or sthenic character as in the earlier epidemics of 1817-20 and 1826-29. The pulse was neither so frequent nor so strong; the heat was not so pungent; the glow of the integuments was less lively and less general[386].”
I take conveniently from Murchison the following succinct account of the Scots relapsing fever of 1842-44[387]:
“The next epidemic of fever in 1843 differed from those that preceded it, inasmuch as it did not originate in or implicate Ireland, but was mainly confined to Scotland. There was no increase of fever in the Irish hospitals during this year, whereas the number of admissions into the Glasgow Infirmary rose from 1,194 to 3,467; in the Edinburgh Infirmary from 842 to 2,080; and in the Aberdeen Infirmary from 282 to 1,280. These numbers, too, are far from representing the true extent of the epidemic, for thousands of sick were sent from the hospital doors. The fever was almost exclusively relapsing fever; typhus was comparatively rare. The first cases were observed on the east coast of Fife, in 1841-2 (by H. Goodsir), and not in the crowded localities of large towns. In Dundee, where the proportion of typhus cases was comparatively great, the fever appeared early in the summer of 1842, and raged to a considerable extent during the whole of the autumn, before it showed itself elsewhere. In Glasgow the first cases occurred in September, 1842; but the fever was not generally prevalent until December, from which month the cases rapidly increased until October, 1843, when the epidemic began to decline. The number of cases in Glasgow was estimated at 33,000, or 11½ per cent. of the entire population. In Edinburgh relapsing fever was first observed in February, 1843. It rapidly spread until October, after which it gradually abated, until, by the following April, it had well nigh disappeared. In the month of October, 1843, the number of fever cases admitted into the Edinburgh Infirmary amounted to 638, and during several months, from thirty to fifty cases were daily refused admission. The total number of cases in Edinburgh was calculated by Alison at 9,000. In Aberdeen the epidemic commenced about the same time, and followed the same course as in Edinburgh. At Leith, curiously enough, it did not appear until September, 1843; it then spread rapidly for two months, after which it declined, and by the end of February, 1844, it had almost ceased; but during this brief period it attacked 1,800 persons, or one in every fourteen of the population. The disease was general over Scotland, and was not restricted to the large towns; it prevailed in Greenock, Paisley, Musselburgh, Tranent, Penicuick, Haddington, Dunbar, the Isle of Skye, etc. Although the epidemic was mostly confined to Scotland, the same fever was observed in some of the large towns of England. The number of admissions into the London Fever Hospital rose from 252 in the preceding year to 1,385 in 1843: and the annual report for 1843 makes it evident that a large proportion of these cases were relapsing fever. The rate of mortality of the epidemic was small, not exceeding from two-and-a-half to four per cent. Although this was the same fever as prevailed in 1817-19, even local bleeding was rarely resorted to, and many of the cases were thought to demand stimulants. All accounts agree in stating that the epidemic supervened upon a period of great distress among the Scottish poor, and that it was restricted throughout to the poorest and most wretched of the population.”
This epidemic, which was the subject of an altogether unusual amount of writing in Edinburgh[388], partly on the supposition that relapsing fever was a “new disease,” proved once for all that one had not to go to Ireland for the engendering or making of a famine-fever. The demonstration came just in time; for the epidemic was hardly over in Scotland, when the series of great potato-famines in Ireland began in 1845, soon to be followed by the disastrous epidemics of dysentery, relapsing fever and typhus from 1846 to 1848. Indeed, so near was the Scots epidemic to the Irish, that in the North of Ireland the first of the relapsing fever, in 1846, was called “the Scotch Fever,” on the supposition that it had reached them from its recent focus in the West of Scotland[389]. The Irish and original part of the great epidemic of 1846-48 has been fully described in another chapter; much of the mortality was due to dysentery, and the most prevalent fever was relapsing fever, with a very low rate of fatality among the poorer classes. But in Ireland itself there was also much typhus, very mortal to the richer classes who came in contact with the starving multitudes.