The three observers agree that it attacked the poorer classes, children more than adults, convalescents, lying-in women and the like. Akenside says that it was mostly a slow non-febrile disease (in the autumnal outburst of 1762, the subjects of it were more fevered), and that some patients came to him who had been labouring under it for two or three months. His account agrees on the whole with Sydenham’s for the years 1669-72: some had vomiting, some had a painless flux following the dysentery, some had dropsy as a sequel. In cases about to end fatally there was a remission of the griping before the end; in some there were aphthae of the mouth, stupor, and somnolence, with cold sweats. Watson saw three children (of four or five years) die from debility a week or more after the gripings and discharges had ceased; they could keep down no food, and were greatly emaciated. In another case, a young child, the motions were pure blood, and death followed on the third day. Baker gives Hewson’s notes of the anatomy in a case that was clearly one of follicular dysentery, as well as Charlton Wollaston’s account of two other anatomies (mixed catarrhal and follicular), with plates of the dysenteric bowel.
Watson, physician to the Foundling Hospital, says that the dysentery, or dysenteric fever, was very prevalent among the children in 1762, the year of its most general prevalence[1439]. It may have been part of that dysenteric “constitution” which caused the following outbreak among the foundlings at the hospital at Westerham, Kent, a branch of the Guilford Street charity: “26 January, 1765. The apothecary visited the children at the hospital at Westerham, January 12th, 1765, and found twenty ill with dysenteries, many of whom had the whooping-cough complicated with it. Two of them are since dead, which, with six that died before he went down, make eight dead of that disease.” Two cases of dysentery were in the infirmary of the Foundling Hospital in London on the 2nd of March, 1765[1440]. These accounts of dysentery in London in the middle third of the 18th century show it to have been then a very occasional malady and a very small contributor to the bills of mortality.
Next to the capital, the town that seems to have had most dysentery in the 18th century was Newcastle, which had been also the seat of frequent and severe plagues. There was much dysentery in it and in the neighbouring places on Tyneside during the autumns of 1758 and 1759, but the disease was not epidemic in 1762, the season of the malady in London[1441]. It was prevalent among the same classes in Newcastle as in London—the poorer households, children, weakly persons. It recurred in the harvest quarter, in fine clear weather, when the days were almost as hot as at midsummer, but the evenings and mornings remarkably cold and the nights frequently foggy. The reason why the lower class of people were most liable to it seemed to be their “negligence in the article of cooling after heats by labour, exercise, &c.” But there may have been something also in the soil and situation of Newcastle which made these common risks to be followed by so special an effect.
The Newcastle dysentery of 1758-59, two or three years earlier than the London epidemic, was the occasion of the essay by Dr Andrew Wilson, a work which compares favourably with the writings of the metropolitan physicians. Among the symptoms of true autumnal dysentery he gives the following:
“Constant fever, drought, parchedness of the mouth and throat, dejection of the spirits, prostration of the strength, frequent viscid, acid or bilious vomiting, flatulency in the belly, wringing pain in the lower part of it, and often in the same region of the back; these pains sometimes constant, but always preceding stools; an almost constant pressing to stool, with great pain and irresistible tendency to it at the same time, called a tenesmus; the stools generally bloody, always slimy, and full of glary stuff, sometimes mixed with a whitish matter of less tenacity, which appears in separate little curdled-like parcels, often with blackish corrupted-like bile; the stools always odiously fetid; they are seldom natural without the assistance of purgatives, and then they are often discharged in hard, dry little lumps; dryness of the skin, except when clammy unbenign sweats are raised by the intenseness of the gripings and tenesmus; great watchfulness, their sleep, when accidentally they drop into any, being short and broken, with recurring pains which awake them unrefreshed. These are the principal symptoms which attend a true febrile dysentery. When such a disease is epidemic there are many slight appearances of it which happily do not extend to all these complaints, and which easily yield to proper applications.
The signs of danger in this disease are the violence with which all the above symptoms appear. But the signs of immediate danger are, decrease of pain, great sinking of the spirits, lowness of the pulse, beginning coldness of the extremities, parchedness and blackness of the tongue, aphthae; white scurf or ulceration of the throat and fauces, and constant hiccup. When there is a cessation of pain, intolerably fetid and involuntary stools, shiverings, with sometimes a sense of coldness in the belly, a slight delirium, and often unaccountable fits of agony, or rather anxiety; then the case is beyond remedy, and the patient hastens to dissolution. This stage of the disease is generally attended with a small obscure pulse and cold extremities, but I have seen it in some particular cases otherwise.
... When dysentery is epidemic, it is not uncommon for people who escape the dysentery itself to have their stools altered from their natural colour to sometimes a greenish hue, as if they had eaten much herbs, sometimes of a clay colour, and sometimes quite blackish, as if they had eaten a quantity of blood.... In 1759 particularly, it was very common for numbers of people who escaped the dysentery to be troubled with flatulencies, slight gripings and twitchings in the belly, which was generally attended with blackish stools. Stranguaries were likewise pretty frequent, and icteric complaints, or the jaundice. The stranguary was a very common symptom in many fevers which occurred during the prevalency of the dysentery. Another complaint which frequently occurred during the last dysenteric season was dry gripes.
The dysentery this last season [1759] differed in many respects from its appearance in the former season. In the latter season greater numbers had it in that slight degree which was attended with little fever and no danger. In many who were seized with seemingly great violence, it was unexpectedly checked when there appeared all reason to apprehend it would have run to a much greater length. It was not uncommon to find it complicated with agues, rheumatisms, &c., into the latter of which it frequently degenerated. In the former season the griping pains attending it were confined to the lower belly. In the latter they were very ordinarily felt also in the back, along, as might be supposed, the windings of the rectum and colon; yet, after the dysenteric stools were in a great measure gone, and the disease over, these pains often remained, or assumed the appearance of a lumbago or sciatic, with pains striking down the thighs.... The more the season advances, and the later in the year it is when persons are seized with this epidemic, the more chronical do the symptoms of it grow.”
The last sentence is probably the explanation of Akenside’s original point, that dysentery was as much a winter as an autumnal malady, not really abating until the spring. Wilson himself claims originality in the following point relating to the sluggishness of the bowels in dysentery, his treatment having been largely determined by that view of the pathology:
“During the increase and height of this distemper, it is very improperly called a flux. A proper flux, or diarrhoea, is a constant flow of immoderately liquid but otherwise natural stools, dissolved by too great an irritation upon, or too great a relaxation of, the vessels destined for mollifying the faeces and lubricating the passages by their humours; by which means they are disposed to dismiss a superfluous quantity of them. But in the dysentery the passage of the natural discharges is resisted, and their consistence is often increased to such a degree that, when they are urged along by the assistance of purgatives, they are excluded in unnaturally hard and dry little lumps or balls” (p. 3). The question whether scybala were an essential character of dysentery was often referred to in later writings.