The Victorianist:

No photo, going slightly off-topic here with something else regarding the streets of Victorian London, and that thing is disease.

Walking through any city or town it is worth thinking of things that occurred in the past and imagining the ghosts of those events still clinging to the fabric of the streets and the buildings that witnessed them.

I recently wrote an article for Luke at http://victorianjournal.co.uk/ about the 1837 influenza outbreak which affected London, and particularly its poor populations. As an addendum to that article, here is a full excerpt of a piece from medical newspaper ‘The Lancet’ explaining the effects and possible treatments of the ailment:

THE INFLUENZA 

  The prevailing epidemic has become of so serious a character and has been productive in several of the localities of the metropolis of fatal results in so many instances that we have deemed it to be our duty to place on record a description of the malady as it has appeared in the district in which the office of The Lancet is situated. We cannot avoid hoping that as in some of the parochial institutions of this metropolis the deaths have been numerous, descriptions of the complaint will be forwarded to the medical journals by the medical officers of those establishments, though as yet none have appeared from them.

Mr. Cosgreave, surgeon of our parochial infirmary, has cheerfully opened his books for the purpose of enabling us to present to the public the following details; and the observations of his able coadjutor Mr. Carpenter, have been communicated to us with equal readiness. The nature of the affection and the treatment has been the same among the wealthier and the humbler classes of patients, though, in the latter the epidemic has seemed, on the whole, to be somewhat milder in its attacks. In order that some estimate may be formed of the increase of disease which it has occasioned among the poor, we extract from the parochial documents the following statements of the weekly numbers of patients under treatment before and since the epidemic commenced.

 The total number of “orders” for out-of-door medical relief received by the surgeon of the eastern division of St. Clement’s Danes, in the –

1st Week in December, 1836, was          10

New cases in the house………………………1

2d Week in December, out patients       15

In-door cases……………………………………7

1st Week in January, 1837 out patients  30

In-door cases……………………………………..5

2d Week in January, out door patients    48

In-door cases…………………………………….16

  In the first week, about 25 of the cases were affected with influenza. In the second, about 40, raising the number of out-door poor who received medical aid, to 98; the in-door to 35.

 The present epidemic, then, as it has appeared in the eastern division of the Strand Union, presents many points of peculiar interest. At no period, we understand, have so many persons been invalided in this locality, and never has disorder of the animal functions been so general among the inhabitants. The typhus fever which raged in the same district during a portion of the last spring, was confined in its attacks to a single point, and although much more formidable per se, was less dangerous in its complications.

 The prevailing influenza made its appearance, about three weeks since, in a few scattered cases, some of which seemed at the time to be rather anomalous, but even in those, for the most part, features were noticed which furnished proof of a connection, more or less intimate, with the symptoms which followed. In a few days the indications of disorder became more decidedly and continuously catarrhal, being at first of that species which has been denominated “nervous,” and chiefly confined to persons of a “nervous” temperament. In about a week the characters of the epidemic became still more strongly marked, and the attacks were more numerous, severely affecting persons of all habits, most frequently adults, rarely infants, still more rarely children.

 Finally, from the date of about a week or ten days since (we are writing on the 19^th) up to last Monday it attained its height, both as regards the numbers assailed and the severity of the attack, extending in a most distinct manner to individuals of from 10 to 14 years of age, - a class which had previously suffered the least from the epidemic.

 The milder forms of the complaint, which chiefly occurred at the commencement, consisted of sneezing, discharges from the nose, with a sense of pressure and fulness at the frontal sinuses, headach (attended by slight cough, seldom with pain, or soreness, on inspiration), and some degree of lassitude.

 The severe attacks were in general preceded, for a day or two, by more or less of headach, by lassitude, and especially by pain in the back, followed by discharge from the nose, sneezing, &c These symptoms induced but very few to seek medical advice; professional assistance, indeed, was in almost all instances, neglected, until the full establishment of the disease, which was almost invariably indicated by the occurrence of cold shivers. Towards the evening of the same day, or on that which succeeded the one in which the cough was first noticed, the headach, which was most commonly referred to the situation of the frontal sinus, but was often seated in the vertex and occiput, now rapidly increased, and pain extended to the shoulders, the loins, and the thighs. In some cases there was deafness, commonly of one ea,r perhaps of both, accompanied by dimness of sight, in one or both eyes; there was, also, occasionally, sore throat, never severe, and seldom occurring at the onset of the disorder. Hoarseness often came on as the attack subsided. The prostration of strength was extreme in many instances, and the countenance was expressive of great depression. A spasmodic and peculiar cough, soon followed by soreness felt at about, or rather above, the scrobiculus cordis, was now always met with.

 In few or no uncomplicated cases did the stethoscope give any sign of inflammatory action at first, though the difficulty of breathing was excessively severe. The pulse was at this period generally depressed, but subsequently it became quick, and more or less full; never hard. After some days, however, distinct bronchitis was observed in several patients; still the lesion, did not correspond with the indications supplied by the dyspnoea.

 The urine varied extremely, being often copious, and of the usual colour. It was even sometimes stated to be increased in quantity generally however it was reduced in quantity; rather high coloured, and sometimes attended with scalding. A few patients remarked that they found an unusual dryness and harshness of the skin, but the greater number did not notice any thing particular respecting that division of the structure.

 The bowels were, with the exception of one case observed, more or less constipated. In two cases there was colic; in a few, nausea. The tongne was generally moist and clean, sometimes white and furred, or even loaded.

 The attack was in many cases distinctly referred to untimely exposure to the prevailing cold and raw atmosphere, which frequently excited a premonitory cough, and made a distinct impression on the parts affected. In several cases, where it seemed to originate thus, the disorder extended to persons in the same family, or hous,e who had not been exposed; more commonly, however, no cause could be traced but the variable state of the weather.

 In twelve cases the disorder supervened on bronchitis, which was greatly aggravated by it. In three cases it accelerated the fatal termination of asthenic congestion of the lungs. Its appearance in the form of the suffocation and catarrh of infants, always denoted the greatest danger. In two cases regular podagra took its place. In five well marked cases, after some premonitary symptoms, such as sneezing, stuffing, running from the nostrils &c, these suddenly ceased, and pain in the wrists, elbows, and shoulders, appeared, followed by swelling, (but in no instance was there redness of the wrists.) The pain on motion was very great; there was commonly tenderness, which, however, was sometimes absent. In one case there was a distinct metastasis to erysipelas, and in another to obstinate vomiting, accompanied by extreme depression.

 The uncomplicated cases, however severe, were never dangerous.

 The treatment in the milder forms, and at the commencement of the more severe, was very simple, in fact, warm drinks, with a full dose of some diaphoretic, combined, occasionally, with an anodyne, were found to be sufficient. Of these, perhaps the best were the liquor ammon. acetatis, especially with the nervous patients, and the muriate or acetate of morphine, and sp. nit. aeth., was useful when there was much depression.

 In the severe cases, the most effectual treatment was found to consist in the administration of an aperient, containing two or three grains of protochloride of mercury, generally combined with aloes. This in all cases was found essential, and here we may notice the signal relief which all such cases as small pox, scarlet fever, under treatment at this period derived at their commencement, especially from purgatives of which protochloride of mercury, and rhubarb, or jalap, followed by castor oil &c, were the most useful.

 A saline mixture, composed of tartar emetic, and sulphate of magnesia, generally produced, in a night or two, a diaphoresis, which was always attended with relief in the arthritic varieties, small doses of vin. sem. colch., in the above mixture gave great and immediate relief.

-         The Lancet, January 1837