The Relapsing Fever of 1827-28.
The epidemic of relapsing fever which was at a height in Dublin in 1826, did not culminate in Edinburgh, Glasgow, and other towns of Scotland until 1828. It was a somewhat close repetition of the epidemic of 1817-19, except that it was chiefly an affair of the towns, owing to depression of trade and want of work following the great crash of commercial credit in 1825-26. In Glasgow, the admissions for fever to the Royal Infirmary began to rise in 1825[339]:
Glasgow: Admissions for Fever.
At Edinburgh the cases of fever treated in hospital were fewer in ordinary years than at Glasgow, but they rose to a higher point in the epidemic years[341]:
Edinburgh: Admissions for Fever.
| Year | ||
| 1824 | 177 | |
| 1825 | 341 | |
| 1826 (nine months) | 456 | |
| 1827 | 1875 | |
| 1828 | 2013 | |
| 1829 | 771 | |
| 1830 | 346 |
Christison gives the following account of the epidemic in Edinburgh in 1827-28:
“Like that of 1817-19, it arose in Edinburgh during a protracted period of want of work and low wages among the labouring classes and tradespeople; it prevailed only among the working classes and unemployed poor—in the Fountainbridge and West Port districts, the Grassmarket ‘closes,’ the Cowgate and the narrow ‘wynds’ descending on either side of the long sloping back of the High Street and Canongate.” The fever had the same three types as in 1817-19—many cases of inflammatory, or relapsing, or synocha, a few of low fever (typhus), and some between the two—militant or inflammatory for a week, then becoming low, and running the continuous course of typhus.... “The inflammatory fever presented the same extreme violence of reaction as in the former epidemic—the same tendency to abrupt cessation, with profuse sweating—the same liability to return abruptly a few days afterwards—and the same disposition to depart finally in a few days more, and again abruptly with free perspiration. The cases of typhus were more frequently severe than in 1818-19. Icteric synocha occurred also oftener, although far from frequently[342].”
The epidemic of relapsing fever in 1826-28, which made a great impression in the towns of Ireland and Scotland, has left few traces in specially English records. But it is clear that there was some increase of fever about the same time in London; and it becomes a matter of interest, as well as of no little difficulty, to ascertain the type or types of the same. It was just after this quasi-epidemic in London that Dr Burne published his essay on fevers, the preface bearing the date of 28th February, 1828[343]. The materials of this essay came from Guy’s Hospital, and they were both clinical and anatomical. The author seeks to find a common name for all varieties of continued fever, the name that he chooses being “Adynamic Fever.” “By far the greater number of cases,” he says, “are of the first or second degree only of severity, and not dangerous.” These were cases of “simple continued fever,” or fever of short duration, with flushed face, suffused eyes and other signs of the “inflammatory” type, or of synocha. Although Burne does not give the exact proportion of cases with relapse, as Bateman had done for the London epidemic of 1817-18, yet he makes it clear that relapses did occur, and he discusses the phenomenon in a manner which makes his testimony interesting: “Convalescents are more liable to a relapse after the adynamic fever than after any other disease; and this may be accounted for by the very enfeebled and exhausted state in which the powers of the system are left.” His relapses were obviously a return of the original fever, beginning again suddenly in the midst of convalescence with flushing of the face, headache, dry tongue, and scanty urine, and with a great access of febrile heat in the night, a disturbance of the system which generally continued for several days, while in some it went off sooner with a diarrhoea. He assigned three principal causes for the relapse—overloading the enfeebled but craving stomach, walking out in the open air too soon, and giving way to emotion[344].
The references to relapse apply almost certainly to fevers of the shorter periods (synocha or “inflammatory” fever), and not to those cases of enteric fever which did undoubtedly occur in the practice of Guy’s Hospital in the same seasons.