[376] The Third Report of the Registrar-General gives the mortality in all parts of England from typhus in 1839 (as well as from scarlatina) in an elaborate table of the registration districts and sub-districts.
[377] W. Budd, M.D., Lancet, 27 Dec. 1856, and 2 July, 1859. Dr Budd, who had been studying in Paris and seeing much typhoid fever, but little or no typhus, in the service of Louis at La Pitié hospital, took the whole of these cases for enteric or typhoid, and insisted, in his later life, on the ground of his North Tawton experiences in 1839, that typhoid fever spread by contagion. He published numerous papers on this theme (Lancet, 27 Dec. 1856, another series in the same journal from 2 July to Nov. 1859, Brit. Med. Journ. Nov.-Dec. 1861, and, finally, a volume of reprints with additions, Typhoid Fever, its Nature, Mode of Spreading and Prevention, London, 1873). But he published no clinical cases nor post-mortem notes, to make good his 1839 diagnosis, on which the whole matter turned, contenting himself with an assurance that he knew typhoid well from studying it under Louis (who, at that time, believed that the typhus of armies, gaols, &c. and of the British writers, was the same as the fever which he, and others after him, named typhoid). He also made the following six statements, as if he were making affidavit: (1) that the great majority of the cases had early diarrhoea, (2) that three had profuse intestinal haemorrhage, (3) that more or less of tympanitis was almost universal in the epidemic, (4) that in nearly every case he found the rose-coloured lenticular spots, (5) that one case, which was the only one examined post-mortem, had the characteristic ulceration of the intestine, and (6) that one fatal case had the symptoms of perforation of the gut. This summary manner, asking in effect to be taken on trust, is not usually accepted from innovators, none of the great discoverers having resorted to it. Hitherto, however, no one has thought proper to question Budd’s diagnosis of the epidemic fever in his North Tawton practice, nor even to remark upon his strange error of treating the epidemic of 1838-39 all over Britain as purely one of typhoid (Lancet, 27 Dec. 1856). But everyone knew that typhoid fever did not spread in the way that he described (doubtless correctly for the above cases). After the publication of his book in 1873 an attempt was made by an influential layman in the Times (9 Nov. 1874) to popularize Budd’s fallacies or paradoxes on the contagiousness of typhoid. “How,” it was asked, after a summary of the North Tawton epidemic in 1839, “could a disease whose characters are so severely demonstrable, have ever been imagined to be non-contagious? How could such a doctrine be followed, as it has been, to the destruction of human life?”
[378] “For three years past trade had been getting worse and worse, and the price of provisions higher and higher. This disparity between the amount of the earnings of the working classes and the price of their food occasioned, in more cases than could well be imagined, disease and death. Whole families went through a gradual starvation. They only wanted a Dante to record their sufferings. And yet even his words would fall short of the awful truth; they could only present an outline of the tremendous facts of the destitution that surrounded thousands upon thousands in the terrible years 1839, 1840, and 1841. Even philanthropists who had studied the subject were forced to own themselves perplexed in their endeavour to ascertain the real causes of the misery; the whole matter was of so complicated a nature that it became next to impossible to understand it thoroughly.... The most deplorable and enduring evil that arose out of the period of commercial depression to which I refer, was this feeling of alienation between the different classes of society. It is so impossible to describe, or even faintly to picture, the state of distress which prevailed in the town [Manchester] at that time, that I will not attempt it; and yet I think again that surely, in a Christian land, it was not known even so feebly as words could tell it, or the more happy and fortunate would have thronged with their sympathy and their aid. In many instances the sufferers wept first, and then they cursed. Their vindictive feelings exhibited themselves in rabid politics. And when I hear, as I have heard, of the sufferings and privations of the poor, of provision shops, where ha’porths of tea, sugar, butter, and even flour, were sold to accommodate the indigent—of parents sitting in their clothes by the fireside during the whole night for seven weeks together, in order that their only bed and bedding might be reserved for the use of their large family—of others sleeping upon the cold hearthstone for weeks in succession, without adequate means of providing themselves with food or fuel—and this in the depth of winter—of others being compelled to fast for days together, uncheered by any hope of better fortune, living, moreover, or rather starving, in a crowded garret, or damp cellar, and gradually sinking under the pressure of want and despair into a premature grave; and when this has been confirmed by the evidence of their careworn looks, their excited feelings, and their desolate homes—can I wonder that many of them, in such times of misery and destitution, spoke and acted with ferocious precipitation?” Mrs Gaskell, Mary Barton.
[379] John Goodsir, “On a Diseased Condition of the Intestinal Glands,” Lond. and Edin. Monthly Journ. of Med. Science, April, 1842. He does not enter on the question “as to whether the subject of the present paper constitutes a distinct species of disease, or be merely a form of the ordinary continued fever”; but he appears to recognize that a certain district may have a form of fever special to it, as Reid had probably told him.
[380] John Reid, M.D., “Analysis and Details of Forty-seven Inspections after Death,” Edin. Med. and Surg. Journ., Oct. 1839, p. 456.
[381] Reid, u. s., from Home’s records.
[382] Murchison, Continued Fevers, 2nd ed. 1873, p. 444.
[383] Lombard, in Dublin Journal of Med. Sc. X. (1836), p. 17. He bore witness, also, to the rarity of the bowel-lesion in the Glasgow fevers. This was confirmed by Dr Perry, of that city, Ibid. X. 381. See also Julius Staberoh, M.D., “Researches on the Occurrence of Typhus in the Manufacturing Cities of Great Britain,” Ibid. XIII. 426.
[384] Trans. Prov. Med. Assoc. II. (1834), p. 176.
[385] Continued Fevers, 2nd ed. 1873, p. 443.