Nothing more is heard of dysentery at Newcastle until the date of the opening of the dispensary there, 1 October, 1777. From that date to 1 September, 1779, when the disease was not epidemic there, 72 cases were treated from the dispensary.
Some importance, as regards priority, attaches to one of Dr Andrew Wilson’s observations of the Newcastle dysentery of 1759: “It was not uncommon to find it complicated with agues, rheumatisms, &c., into the latter of which it frequently degenerated.” The pains, he says, were not confined to the lower belly, but were felt also in the back; or, after the dysentery was gone, the muscular pains remained as a lumbago or sciatica, striking down the thighs. This curious relationship of dysentery to rheumatism, shadowed forth in the Newcastle essay of 1761 [1760], was formally stated by Akenside in his essay of 1764, being perhaps the best of his various attempted originalities. It was afterwards taken up in Germany by Stoll, Richter, Zimmermann and others in the 18th century, and was illustrated from the Dublin epidemics of the 19th century by O’Brien[1442] and Harty[1443]. The doctrine of a relationship between dysentery and acute rheumatism has been discovered in the 7th century writer, Alexander of Tralles, but erroneously. The Byzantine writer does indeed introduce into two paragraphs on bowel-complaint the word ῥευματισμός—one of them relating to the alvine profluvium attending fevers or following fevers, the other relating to “dysenteria rheumatica[1444].” But it is clear that he is merely ascribing to the diarrhoea in the one case and to the dysentery in the other a rheumy nature, on certain theoretical grounds of humoral pathology; there is no reference to joint pains or muscular pains, or to anything else connoted in the later use of the word rheumatism. The idea is originally an English one, from the middle of the 18th century, and belongs most properly to Akenside, although Wilson, a not less trained and capable observer, had recorded the empirical fact three or four years earlier. Akenside was led to regard dysentery “as a rheumatism of the intestines,” and to maintain that “the cause and the materies of each disease were similar[1445].” Stoll adopted these phrases, adding that dysentery differed from rheumatism of the joints “merely in form and situation.” But for a few empirical facts, the relationship would be thought fanciful. These, however, may be finger-post instances, pointing to the true pathology of a somewhat mysterious malady. They are simple enough: e.g. cases of dysentery have “degenerated,” as Wilson said, into rheumatism; or cases of acute rheumatism, treated by purging, have developed the gripings, tenesmus and stools of dysentery; or, in a time of dysentery, cases have occurred in which the symptoms of the latter were joined to those of acute rheumatism, or cases in which the symptoms of the one disease obtained, say for twenty-four hours, to give place to the symptoms of the other. Again there are countries such as Lower Egypt where the frequency of dysentery is not more remarkable than the frequency of rheumatic fever. Harty points out that the rheumatic complications of dysentery seem to have arisen only when the latter malady was improperly treated by opium and astringents; but, howsoever the signs of affinity were called forth, they may prove to be true indications for the pathology. The circumstances of taking dysentery are those of taking rheumatic fever—exposure to chill after being heated with labour[1446]. In rheumatism the effect of the chill falls upon the great groups of voluntary muscles, pain being manifested at the surfaces where the muscular work is applied, namely the joints; while the redness, heat and swelling are as if restricted to the tissues by which the muscles become effective, namely the tendons, aponeuroses, ligaments and synovial membranes[1447]. In dysentery, it may be said, the effect of the chill falls upon the great involuntary muscle, that of the intestine, or upon a section of it, a muscle which serves, so to speak, as its own tendons and insertions, and is the seat of its own pains, while the tissues next to the muscular, the submucosa and mucosa with the lymph-follicles, become the seats of congestion, inflammation and suppuration. In acute rheumatism, the muscles generate heat without doing any work; in dysentery there is often febrile heat (although not invariably), and the work of the involuntary muscle is paroxysmal and ineffective. In some such way the parallel suggested by Akenside might be followed out.
After 1762, the next period of epidemic dysentery in England was from about 1779 to 1785, a period when agues also were epidemic, as well as workhouse fevers and typhus under its various names. In London it was prevalent in the autumns of 1779, 1780 and 1781, a strictly autumnal disease like the diarrhoea of children or the cholera nostras of adults. From the list of symptoms, the latter disease must have formed part of the dysenteric epidemic:—“profuse watery evacuations, mucous evacuations mixed with blood, gripings, tenesmus, pain in the back and loins, fever.” Some had tormina without flux. Some few old and infirm died; but usually the malady yielded to treatment[1448]. It is heard of also at Liverpool about 1784[1449], and its prevalence at Plymouth called forth an essay[1450]. It must have been a considerable disease in the dockyard towns; for a body of troops, originally numbering 2800, which arrived at Kingston, Jamaica, in the beginning of August, had been put on board the transports in March with much dysentery and putrid fever among them, so that the diseases with which they put to sea became more violent during the five months’ voyage, and caused many deaths. Arriving at Jamaica, four hundred were sent on shore sick, exhausted with flux and fever, of whom scarce the half recovered in the military hospitals[1451]. Here we have the singular fact of transports from England bringing dysentery to Jamaica. On the other hand, Clark, of Newcastle, who had seen much of tropical maladies, says that the dysentery which became epidemic there in 1781 was introduced first into a dockyard by some sailors returned from abroad ill of the complaint, and that it soon spread among the workmen, of whom several died. But it was epidemic in London the same year; and in Newcastle itself there were extensive epidemics in 1783 and 1785, for which no foreign source was sought or found. In those years it “attacked great numbers of the poor,” as well as some of the richer class, to which Clark’s eleven cases from the epidemic of 1785 mostly belong. In the Tables of diseases treated at the Dispensary, the epidemic dysentery of 1783 and 1785 is credited with 329 cases, of which 17 were fatal; but these, of course, were but a fraction of all that occurred in Newcastle and neighbourhood. Every year until 1805 there are a few cases of dysentery in the Dispensary books; but they become fewer to that year (except in 1801 when there were 23 cases), and at length disappear from the list altogether. A remarkable outbreak of dysentery, within narrow limits, occurred in a fishing village or “town” in the neighbourhood of Aberdeen during some months of the spring and summer of 1789: “It has proved fatal to numbers. As such a disease could not be admitted into our hospital, a temporary one has been fitted up for those that are worst, and the faculty here have given their attendance by rotation[1452].”
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.