Dysentery in the 17th and 18th centuries.
The younger Heberden remarks, “There is scarcely any fact to be collected from the bills of mortality more worthy the attention of physicians than the gradual decline of dysentery.” I have shown the fallacy of Heberden’s proof in the first part of this chapter on Infantile Diarrhoea. It is true that dysentery did decline in London, but not on the evidence adduced by Heberden, nor within the noteworthy limits that he supposed. It was at no time one of the greater causes of death in London, and it had already by the middle of the 18th century reached as low a point as it stood at when Heberden wrote. As it is one of the diseases that have become rare in this country, there is a scientific interest in establishing the fact of its decrease, even although its prevalence had been at no time more than occasional.
Hirsch groups the outbreaks of dysentery as of four degrees of extent: (1) localized in a single town or village, or even a single house, or barrack, or prison, or ship; (2) dispersed over a few neighbouring localities; (3) dispersed over a large tract of country in the same season; (4) simultaneous in many countries, or extending over a great part of the globe, and continuing as a pandemic for several years[1422]. The last are the most curious; and of these there are at least two in which Britain had a share, the dysenteries of 1539-40 and of 1780-85. Of the next degree, there have been several in Ireland and Scotland, including those of the great Irish famines of the 18th and 19th centuries, and the “wame-ill” of Scotland in 1439. Of the two minor degrees of extent, there have been, of course, many instances in the towns, counties or provinces of Britain.
A considerable decline of dysentery in London before the end of the 17th century is made probable by various facts that can be gathered from the bills of mortality. When these began to be printed in 1629, dysentery appeared in them under the unambiguous name of bloody flux; there were 449 deaths from that cause in 1629, they had decreased to 165 in 1669 (a year remarkable for dysentery and other forms of bowel-complaint), and to 20 in the year 1690, soon after which the article of bloody flux ceased in the bills. But we are not to judge of the amount of dysentery from the entries under the name of bloody flux alone. In 1650 there began the article of “griping in the guts”; as I have shown, it was mostly infantile diarrhoea of the summer and autumn, but, so long as it lasted, it had probably included some dysentery. Besides the articles of bloody flux and griping in the guts, there was a third article for a time in the bills, namely “surfeit,” a term which came at length to mean dysentery[1423]. Thus the great plague of 1625 is said to have been preceded by a surfeit in Whitechapel; and it is clear from other uses of that word, for example as applied to slaves shipped on the West Coast of Africa for transport to the West Indies, that it meant dysentery more than any other form of bowel-complaint[1424]. Accordingly when we find in the weekly bills of mortality for London that a series of weeks in the dysenteric summer and autumn of 1669 had deaths from “surfeit” to the numbers of 9, 11, 10, 12, 9, 15, &c., we may take it that these were dysenteric rather than choleraic, the more so as the other name “bloody flux” has fewer deaths to it than we might have expected from Sydenham’s general language. These various items in the London bills cannot be used for an exact statistical purpose, but only as indications. Perhaps the most trustworthy indication is the total of 449 deaths from bloody flux in the year 1629, being a twentieth part of the mortality from all causes (8771 deaths). That was a prevalence of fatal dysentery in London far in excess of anything that is known in the 18th century, for example in the dysenteric seasons of 1762 and 1781. So long as plague lasted, dysentery seems to have been somewhat common, and probably most so in the plague years; for, besides the surfeit in Whitechapel with which the plague of 1625 is said to have begun, we find many deaths from bloody flux in the year of the Great Plague itself, 1665. As Sydenham and Willis have left good accounts of the London dysentery of 1669-72, it will be convenient to take from these sources our impressions of the disease in the 17th century.
Referring to the dysentery of 1669, Sydenham says that there had been comparatively little of it for ten years before, not including, doubtless, the plague-year of 1665, when Sydenham was out of town[1425]. Both he and Willis are clear that there was a certain amount of it every year, although it was seldom fatal in ordinary seasons. The ordinary London dysentery, says Willis, though it be horrid or dreadful by reason of its bloody stools, and is most commonly of a long continuance, yet it is not very contagious nor often mortal[1426]. Sydenham says that it was fatal more particularly to aged persons, but highly benign in children, who might be subject to it for months sine quovis incommodo. However, in certain seasons it became malignant and caused a good many deaths.
It began usually with chills and shiverings, to which succeeded heat of the whole body, and shortly after tormina with dejections; but sometimes the griping and stools were the first symptoms. Always there was intense suffering and “depression of the intestines,” with frequent straining at stool. The stools were mucous, not stercoraceous, and with traces of blood. The tongue might be whitish, or dry and black; the strength was prostrated and the spirits faint. After a time the streaks of blood in the motions would be replaced by pure blood, without even mucus, a change which threatened a fatal end. Sometimes the bowel became gangrenous, while aphthae would appear in the mouth and fauces. If the patient were about to recover, the symptoms would gradually be restricted to the rectum, in the form of tenesmus. Willis says that the dysentery of the autumn of 1671 was really a bloody one, and extraordinarily sharp and severe, hurrying many to their graves. At the outset blood was voided plentifully, with griping pains; there might be twenty stools in a day. Some were able to rise after a week; but the malady would go on for several weeks or even months. It was protracted also in fatal cases, the end being marked by watchfulness, roughness of the tongue, thirst and thrush in the mouth. He gives a case of a strong young man who recovered after having had not only terrible bloody stools, but also bloody vomit, which, Willis thought, might have come from ulceration of the stomach. But with good diet and treatment most of those attacked escaped death. Sometimes it became virulent and, as it were, pestilential, destroying many and diffusing its infection very largely by contagion.
It was most common, says Willis, in camps and in prisons, by reason of the stench of the places and the evil diet. From what Sydenham was told by Dr Butler, who accompanied Lord Henry Howard in his embassy to Morocco, the dysentery of North Africa was the same as that which prevailed in London, as an occasional epidemic, in 1669-70.
The dysentery of the siege of Londonderry and of the camp at Dundalk, both in the year 1689, have been described elsewhere. During the same reign, Dr William Cockburn got fame and wealth by a secret remedy for dysentery, which was tried first on board the king’s ships at Portsmouth[1427]. In 1693-99, there was dysentery in Scotland and in Wales. Of Scotland in 1698, the climax of the “seven ill years,” Fletcher of Saltoun says: “From unwholesome food diseases are so multiplied among poor people that, if some course be not taken, this famine may very probably be followed by a plague[1428].” A Welsh practitioner, who graduated at Dublin in 1697 said, in his thesis, that dysentery had raged for the space of three years in several maritime regions of South Wales so severely and had made such havock that in not a few houses there were hardly one or two left to bury the dead[1429]. Writing before the seven ill years, Sir Robert Sibbald mentions dysentery as one of the dira morborum cohors that everywhere affected the Scots peasantry in the end of the 17th century, the causes of which were coarse food and excesses in spirit-drinking. In the century following we hear of dysentery in Scotland in particular years, which correspond on the whole to the unwholesome seasons in England. Thus in 1717, special mention is made of a fatal bloody flux in Lorn, Argyllshire. In 1731 there were dysenteries in Edinburgh in autumn, often tedious, rarely mortal. In 1733, during the harvest months, dysenteries were frequent and mortal in Fife, especially along the shores of the Firth of Forth. In the following autumn (1734) many in Edinburgh were seized with a dysentery, which continued more or less epidemic all the winter: “It had the ordinary symptoms of slight fever, frequent stools, for the most part bloody and mucous, violent gripes and an almost constant tenesmus”—being fatal to some and very tedious to others[1430]. This was a well-marked dysenteric period in Scotland, but just as much a rare or occasional experience as the corresponding epidemic a century after in 1827-30. It appears to have lasted in various parts of Scotland until the end of 1737. A regimental surgeon, who was stationed at Glasgow in the end of 1735 and afterwards at Edinburgh, had 190 dysenteric patients (civil and military) from December, 1735, to February, 1738[1431]. The summer and autumn of 1736 appear to have been its more severe seasons; it is heard of at St Andrews and in the country near it, at Kingsbarns and Crail (where “many of the boys” were seized), at Dalkeith, and in Glasgow and the neighbourhood, where one practitioner claims to have treated “some hundreds” with cerate of antimony[1432]. In the great period of epidemic fever shortly after, the years 1740 and 1741, flux in the Edinburgh bills of mortality has respectively 3 and 36 deaths, which would probably have meant thirty to fifty times as many cases[1433].
The English epidemiographists, Wintringham, Hillary and Huxham, mention dysentery in certain years, which were the seasons of high general mortality. Wintringham’s first entry for York is under the year 1717, his second in 1723 (autumnal), a third in 1724 (some fluxus alvi with blood), in 1726 diarrhoeas and dysenteries “called morbus cholera,” and the same for two or three weeks of September, 1727. Wintringham was one of the first in England to emphasize the seasonal connexion between dysenteries and agues. There was undoubtedly dysentery among the many forms of sickness in the disastrous years 1727-29. Huxham includes it among the fluxes which were common at Plymouth in 1734-36. A still greater dysenteric period followed the influenza epidemic of 1743, Huxham being again the chief chronicler of it[1434].
In the second half of the 18th century, two periods were specially noted for dysentery, the years about 1758-62 and 1780-82. The first of these called forth perhaps the only medical piece written by Dr Mark Akenside, physician to St Thomas’s Hospital and author of the ‘Pleasures of the Imagination[1435],’ as well as accounts by Sir G. Baker[1436] and Sir W. Watson[1437]. All three writers agree that the true epidemic prevalence occurred in London in the autumn of 1762. It is clear, however, that Akenside had been treating in St Thomas’s Hospital since 1759 many cases of true dysentery (which he defines as a bowel complaint with gripes, tenesmus and bloody or mucous evacuations). He had more than one hundred and thirty cases of it described in his ward-books in the five or six years previous to his writing (1764); he had proved the good effects of ipecacuanha on many in 1759; and he had remarked that the autumnal dysenteries of 1760, 1761 and 1762 in each case lasted the whole winter, not abating until the spring. Perhaps this may have been a special experience of the Surrey side of the Thames; for both Watson and Baker are clear that dysentery was something of a novelty to them in the early autumn of 1762. Says the former, writing to Huxham on 9 Dec. 1762: “We have had here this autumn a disease which has not been in my remembrance epidemic at London. Very few of our physicians have seen this disorder as it has appeared of late. You mention it as frequent at Plymouth in the year 1743....” And Baker begins his essay by saying that there became epidemic in London in the end of July, 1762, the disease of dysentery—“morbi genus hac in civitate novum feré, aut nuperis saltem annis inauditum[1438].”