46

to the different configurations; in theone, the head is more developed be-fore the ear; in the others, the greatest.portion of brain is situated behind it.On the next evening, I shall proceedto speak of the head more particu-larly.

I

REVIEW.

An Account of the Disease lately preva-lent at the General Penitentiary.By P.MERE LATHAM, M. D. Fellow

, of the College of,"Physicians, and

Physician to Saint Bartholomew’s

Hospital.

[Concluded from p. 407. vol. vi.]In a former number we investigated

-briefly the nature, symptoms, causes,’and post-obit appearances of the bowelcomplaint of the Penitentiary—We-now come to speak more particularlyof the disease and its treatment, underthe varied forms it occasionally as-sumed—

11 At the beginning of the month ofApril," says Dr. Latham, " the flux,"which had affected between four and,:five hundred individuals, had almost°.disappeared, no other remedy havingbeen used but the chalk mixture and’tincture of opium ; and, under the in-fluence of an improved diet, the ge-neral health of the prisoners had visi-b!y improved.

But, when the flux of the bowelsreturned, at the end of the month of

’April, it was no longer amenable tothe same remedies. Not even in thosecases which bore the character of

simple diarrhoea, did chalk mixtureand tincture of opium procure thesmallest relief. No effectual good was’ derived from practice directed to the

simple purpose of restraining the flux,even where this was the only indica-’tion to follow.

Still we endeavoured to reach the’disease, by addressing our remedies

to the more conspicuous symptoms.Where there was pain, aggravated bypressure, and attended with fever,bleeding, or blistering, or fomenta-tions were used, according to the ur-gency of particular cases. But littleabatement, even of the pain, ensued,and none whatever of other symp.toms, or of the flux. Where therewas simple colic pain, all the methodsof soothing were employed, by opium,fomentations, &c. &c. But the con-sequence was only a brief respite fromsuffering, while the flux continued.When common remedies, directed

to the fulfilment of plain and intelli-gible purposes, did not succeed, wewere, in a manner, compelled to pur-sue other less certain indications, andto employ other expedients of less

acknowledged efncacy; such as astrin-gent bitters, aromatics, mucilaginousdrinks, antimonials, and ipecacuan.-Ipecacuan. was given in small doses ofa grain or two grains, three or fourtimes a day ; or it was given once ortwice only in large doses, of fifteen ortwenty grains, combined with a coupleof grains of opium. Moreover, theroot was infused in water, and thus itwas employed as a lavement. But,inall modes of its administration, and inevery quantity, the result was equallyunfavourable to the efficacy of theremedy.

Glysters, composed of starch andopium, and of liq. plumbi acetatisdilut. and opium, were administered,with temporary benefit, in a few in-stances, but they did no permanentgood.Warm baths were used; the belly

was swathed in flannel rollers ; andstimulant liniments were rubbed uponthe abdomen ; but they did no appa-rent good."An efficacious palliative was found

in a sort of opiate cataplasm, which,-when spread upon folds of linen, andlaid on the abdomen, procured a re-

mission of the pain. The denounce-ment of the use of mercury in scurvy

by, many writers of reputation, andthe information they had received

fi OH the medical officers of the Peni-

47

tentiary, of its previous uselessness,had determined the physicians to be

cautious in employing it.

"We abstained, therefore, from theuse of mercury, because we suspectedat least that we had still to deal with Ithe same disease in which it had beenalready found prejudicial, and that itmight possibly stili partake of the na-ture of scurvy.

But, after the failure of every othermedicine in the treatment of this dis-ease, were we justified in abstainingeven from the cautious use of a re-

medy, which its present circumstancesespecially called for, merely fromthe recollection of certain symptomswhich had been its concomitants amonth ago?With regard to mercury, as a re-

medy in scurvy, writers of authorityhad denounced it as injurious, and wecould not help placing a certain reli-ance on what seemed to be the resultof their observation. But still theirtheory about putridity and the crasisof the blood had evidently determinedtheir notion of the essential nature ofscurvy ; and their theory about septicand antiseptic remedies, had evidentlyled them to assign to mercury a placeamong the former. Hence there wasroom to suspect, that these specula-tions might possibly have had a sharein producing their unqualified con-

demnation of mercury in scorbuticcomplaints. So that, even if the scur-vy had still been present, in the veryslight degree (the slightest possible)in which it formerly existed, 1 cannotthink, when every other remedy failed,that it ought to have been an absoluteprohibition of the trial of mercury,after the cautious manner in whichwe proceeded to employ it. But, infact, the scurvy had almost entirelydisappeared.While two hundred individuals were Isuffering a flux of the bowels at the

same time, and many seemed gi-adti-ally approaching to their dissolution ;and while the numbers of the sickwere every day increasing, and theforms of the disease were becomingmore and more various and complex,and all the methods of treatment hi-therto employed had served to palliate

only, and not to cure, Dr. Roget andmyself determined, after mature deli-beration, to get rid of all restrictionupon our practice, which had arisenfrom the consideration that the flaxwas originally combined with scurvy;and we agreed to employ mercury, insuch forms and combinations as theexigencies of particular cases mightseem to require.. We first made trial of this remedyin those cases which our experiencehad brought ns to regard with thegreatest apprehension, cases (if I mayso say) of mere passive diarrhœa,where there was no excitement of thecirculation, where there was little pain,and little of morbid quality in the eva-cuations, but where the evacuationswere enormously frequent, and hi-therto absolutely incontrollable. Inthese cases all medical expedients hadfailed, and we were now compelledto content ourselves with such tempo-rary relief, and such short intervalsof ease, as opium, administered indraughts, or clysters, or in cataplasmswas able to procure. In our trial ofmercury for these cases, we proceeded -.thus :-Equal quantities of hydrager.c. creta and pulv. ipec. comp. weremade into pills ; each pill consisted ..

of five grains, two grains and a half.of each ingredient, and one of themwas administered three times a day,to about twenty patients. Still there =was no abatement of the diarrhoea.They were administered four times aday, and still the diarrhcea continued.They were given five times a day-;when, upon our next visit to the Pe-nitentiary, we found, among thosewho had taken mercury, one femalein a profuse salivation, and the diar- rhoea completely arrested in her, andin her alone. This poor creature hadformerly had scorbutic spots upon theskin, at the same time that she suffer-ed a flux of the bowels. The scor-

butic spots had disappeared alto-

gether; the flux had subsided, butreturned ; and that form of it, which ,has been described, had now brought.her life into imminent hazard."

The beneficial result of the employ-ment of mercury being so obviouslyapparent, more patients were subject-ed to the same plan of treatment, and.

48

with a like happy effect; and as sali-

vation was to be arrived at, it was

given in increased doses, " still iii,

combination with Dover’s powder,More and more of the patients were

subjected to the same treatment, andwere carefully watched,* for the sakeof still more confidently ascertainingthe precise condition which should

prove essential to the success of the

remedy." This was uniformly foundto consist in salivation. When its suc-

cess had been fully demonstrated,other preparations were employed,and large doses of calomel and opiumwere occasionally given, and fre-

quently operated as a charm. In-

unction was in some cases resorted to

with a similar effect. The crisis often

appeared under different aspects, butmost frequently its approach was ma-nifested " by a severe griping pain ofthe bowels, and afterwards an incon-trollable urgency to stool. With the

evacuation came the relief of all the

preceding misery. The stools were

entirely changed. A few hours beforethey consisted perhaps of slime or

blood, or some colourless turbid fluid- now they were a colluvies of thefoulest, blackest matter, and of everykind ; heavy, ropy mncas, and bile,formed a considerable part of them."

The importance of watchfulnessover the progress of disease, and theoperation of remedies have alwaysbeen inculcated by Dr. P. Latham,and the most happy results have beeneffected by the practice, which, onone occasion, produced from ourfriendJemmy Copland some ill-natured re-marks—like exhalations from a muddypuddle, abominated by all but the un-clean.

- Page 75. The patients were thusrelieved, but sometimes relapsed, andwere again restored by the same re-

medy ; its first employment was cau-

tiously instituted, and was induced

by the faiiure of all other methods ofprocedure.Chap. 4. The disorders of the brain

and nervous system.This form of the disease was more

gradually developed, and its compli-cation with the reigning epidemic less

perfectly understood, till experiencehad demonstrated its identity. Two

cases occurred at an early period ofthe physicians’ attendance at the Pe.nitentiary, but at first they 11 saw noreason to conclude that these cases

had any essential connexion with the

predominant disease."

" In process of time, however, dis-orders of the brain and nervous system

became more and more frequent, andof various kinds, head-ach, vertigo,cramps, and twitching of the limbs,delirium, convulsions, and apoplexy.But since these disorders did not iiii-

mediately discover themselves in alltheir variety and magnitude, it wasnot until after much observation, thatwe were enabled to tell their geniusand character, and to know that theyconstituted one form of the predomi-nant disease ; that they were not con-tingent upon the flux, nor the fluxcontingent upon them ; that eithermight exist separately, although theywere generally found in combination;and that both arose from a morbidcondition, essentially the same, but

falling upon different parts.

! I shall best convey a notion of whatthese nervous affections were, by fol-lowing the order of my own experi-ence concerning them, and describingthem as they tell under my own ob-servation.

Upon our first visiting the Peniten-tiary, out of seventy men, whom wefound in the iufirmary, there were

; five who had no other complaint but

49

severe head-ach, three who had no i

other complaint but cramp in thelimbs, and one who had cramp in Icombination with diarrœa; and outof ninety-three women, whom wefound in the infirmary, thirteen hadsimple head-ach, three had no othercomplaint but cramp, and five hadhead-ach combined with diarrhoea.We did not, however, from thesecases, at all suspect that the predo-minant disease involved the brain andnervous system.We had not, however, been in at-

tendance more than a week, when aman (Robert Dyer), thirty-one yearsof age, in the infirmary, and sufferingcramp and diarrhoea, died suddenly,apoplectic. Upon dissection, we foundthe vessels of the brain slightly turgidwith blood, and a few spots of ecchy-mosis in the intestines, although therehad been no scorbutic appearanceupon the skin.Soon afterwards, as we were one

day going round the infirmaries, ourattention was called to a young woman

(Louisa Cornforth) who was sufferingthe most agenizing spasms. Her legsand arms were as rigidly tense as intetanus. Suddenly she gave a loud Ishriek, and her eyes were fixed, and Ishe became as pale as death. No 10pulse could be felt, and her breathingwas only just perceptible. By atlierand ammonia, and all the means of

stimulating within our reach, we suc-ceeded in rescuing her. In two or

three minutes perhaps (but it is not

easy to reckon time on such occasions),we could feel the pulse beginning tonndnlate, and see the countenance

beginning to redden, so that it wasevident that the blood v< as in motion

again. Then her eyes began to passfrom object to object, and it was plainher consciousness had returned. Shecould not yet speak ; but, by inarticu-late sounds, and by the motion of herhands around the heart and stomach,she made us understand, that it wasthere the sudden agony had seized11pon her. This young woman sur-

vived six weeks; and, in the meantime, all her dreadful symptoms fre-

qnently recurred, and her existencewas upheld, from hour to hour, by themost potent stimulants. If she wasleft more than a certain period, with-out a small quantity of brandy, her

I pnlse became imperceptible ; but itwas felt again, as soon as the stimuluswas again applied. And, in this man-ner, even for as long a time as sixweeks, existence was still maintained,while it was continually tottering uponthe verge of dissolution. Before herdeath, diarrh&oelig;a. was added to herother complaints. Upon dissection,nothing was found at the origin of thenerves, to account for the dreadfulsymptoms referable to them. At in.tervals, throughout the intestines,therewere smail circumscribed patches.of red, occasioned by blood accumu-lated in the small blood vessels ; butthere was no ecchymosis.

This form of the disease occurred

also in another female prisoner (Har-riet Chnrch) with apparently less se-verity, but with the same fatal result.

" These three cases occurred in themonth of March ; and, occurring (asthey did) among various other nervousaffections, they may be thought tohave excited in us a suspicion, at least,.that the disease of the Penitentiarydid not belong exclusively to the bow-els. Still we wanted further expe-rience to assure us of the fact.

Early in the month of April, thebowel complaints and the scurvy, inwhich the peculiar disease of the Pe-nitentiary (as we then thought) ex-clusively consisted, almost entirelydisappeared. The scurvy, indeed,never returned; but the bowel com-plaints returned before the end ofApril, and spread throughout the pri-son more extensively than before.With them there appeared nervous

affections of every kind, and of thatkind especially which betrayed itselfin cramps of the muscles. The cha-racter and the frequency of thesecases were very remarkable. Theyoccurred both to those who had, andthose who had not, bowel complaints ;to men as well as women ; but it wasin the women that, from their severityand the frightful circumstances ac-

companying them, they occasioned usthe greatest alarm.Many women were affected nearly

in the same manner as Cornforth hadbeen, and our apprehension was that

they would all come to the same mi-

50

serable end. They had cramps in thelimbs and in the trunk. A few hadthat indescribable agony at the heart,and the pit of the stomach, bringingwith it those frightful circumstanceswhich seemed to threaten instant dis-solution. Their life was again and

again brought into jeopardy; but oneonly (Sarah Farley) eventually died."

These cases occurred early in the

month of March, 1823, and in ano-

ther month the bowel complaints andthe scurvy had nearly disappeared;before the end of April, however, theformer variety of the disease againappeared, and became much more ge-neral than previously. The scurvydid not return with its late asso-

ciate, but a far more dreadful concomi-tant was substituted. Some of the

female prisoners suffered nearly in thesame manner as Cornforth, but one

only so affected died. 11 Upon dis-

section, small vascular patches werefound in the mucous membrane of the

intestines, and nothing more." p. 85.

A few cases ofphrenitis occurred; butthe usual methods of treatment were

sometimes unavailing, and sometimes

apparently injurious. ’

11 In process of time, disorders re-ferable to the brain and nervous sys-tem prevailed, almost as extensivelythroughout the prison, as bowel com-plaints. In the majority of cases, in-deed, they did not reach the formid-able character which has been de-scribed. They consisted, for the mostpart, of pain, and strange sensationsin the head, and cramps of the limbs.But to this mere head-ach was super-added, so often and so suddenly, ver-tigo, or delirium ; and to these merecramps of the limbs, was superadded,so often and so suddenly, a more ter-rible spasm of some internal organ,that we could not help seeing, in theminor affections, a tendency to somefatal result.Sometimes, in going round a divi-

sion of the prison, where the patientshad all been in a state of improvementthe day before, we found a dozen inbed, and were told, that they had se-vere pain in their heads, and thatsome were so giddy as to be unable tostand. The next day, perhaps, threeor four of them had become delirious,and had twitching of the muscles, andwere rapidly passing into that formi.dable state which has been described.There were instances of individuals

falling down suddenly, as if they wereshot (thus the seizure was describedby the by-standers), who, beingbrought into the infirmary, graduallyrallied, and referred to the head asthe seat of severe uneasiness. Inthese cases, no symptoms of a moreformidable kind ensued, in respect ofthe brain or nervous system. A per-manent head-ach, or vertigo, was thecommon consequence."

The frightful sufferings of some ofthe patients dismayed the remainder,and terror and alarm reigned supremein the infirmary. -

It is impossible by abridgement todo justice to the reasoning which theauthor employs to illustrate the natureof this strange disease, and we have

already been extremely free with ourextracts. Suffice it to say, that all

precedents were useless ; remedies

successful, in diseases apparentlyresembling the present, entirely,failed; mercury again became the

sheet anchor of the physicians, andthe same happy security was the

result. We do not know, however,that because both forms of the diseasewere cured by mercury, it necessarilyfollows that they " were essentiallythe same," although we confess, inthe present instance, a multitude offacts appear to support the assertion -in the limited sense in which it has

been employed.Chap. 5.-The Fever.

51

From Dr. LATHAM’s account, it ap- Bpears that two varieties of fever oc-curred in the Penitentiary.

1st, Accompanying the flux and

nervous disorders.

2d. Fever szsi generis and idiopathic.In the first instance of its alliance

with cases of flux, and of disordersof the brain or nervous system, it wasso peculiar as to raise a doubt " whe-

ther the fever was derived from the

local disease; or the local disease fromthe fever.

Of the second, Dr. L. says," When this fever occurred alone,

(as it sometimes did, even at the time’when the bowel complaint and thedisorders of the brain and nervous

system were most prevalent,) its typewas manifestly peculiar. It was a

’fever of very moderate excitement,and generally went off in three orfour days by perspiration. Or, if itfailed of such relief, either sponta-neously or by the help of medicine, itwas apt to be protracted in the formof hectic during several weeks. Whenthis fever occurred (as it generally did)in combination of some form of bowelcomplaint, or some affection of thebrain or nervous system, its own pe-culiar type was still visible, notwith-standing certain differences which itexhibited correspondent with the dis-order of a particular organ.

-

Further, since the fever and thelocal affection did not bear the samerelation to each other in the differentcases where they were found com-bined, it might hence be suspectedthat they had no necessary alliance.Thus, in some the fever would firstarise, and the flux would follow, per-haps immediately, perhaps not forseveral days, or perhaps not until the-fever had been protracted in the formof hectic for several weeks. In somethe flux would arise first, and then thefever would follow, perhaps immedi-ately, or perhaps not until- the fluxhad become a chronic disease."

In some cases the fever appears to

have been cured without difficulty;

and in a very short period, -by theexhibition of an emetic or a brisk pur-

gative, followed by salines ; in others,which proved fatal, the brain, sto-mach, or bowels presented traces ofrecent disease. The fever of the

Penitentiary generally disappearedwithin a week, but when it was car-ried into the second, it assumed the

type of hectic, in which a free use ofbark and acid proved most beneficial.The many substantial observations inthis chapter should procure for it anattentive perusal.

Chap. 6.-Intercurrent Diseases.-These were principally erysipelas,and several very anomalous cases are

rendered interesting by the extrememinuteness of observation and detail

they exhibit.The remainder of the volume is oc-

cupied by a review of the progress ofthe disease, and an inquiry into its

origin. From the ascertained fact,that large quantities of chalk mixtureand tincture of opium had been servedout to the prisoners of the Peiliten-tiary from its first establishment, the

physicians were led to infer that diar-rh&oelig;a had always been the prevailingdisease of the place ; it appears alsothat head-ach and vertigo had been

equally present at an early period.The visitor of the prison, however,(Mr. Holford) has put forth a docu-ment, in which he denies that anyinference can be drawn from the fact,of large quantities of chalk mixture

and tincture of opium having been ad-ministered.

" I deny that the liability of theprisoners to diarrhoea of any kind can

, be estimated by the quantity of medi-

52

cine administered for that disorder inthe prison.The first thing which it occurs to a

prisoner in any prison to say, when hewishes to feign illness, is, that he hasa pain in his bowels ; and wheneversuch a complaint has been mentionedin the Penitentiary, the party has hadthe chalk mixture, or powder, ofcourse, without any previous investi-gation into the reality of the disease,as the suyeon will testify."

The Surgeon, it would appear, is

Mr. Pratt, the 4pothecary, who " is to

testify that he has given chalk mix-ture and tincture of opium to all pri-soners complaining of pain in the

bowels, as a matter of course," with-

out ascertaining the nature, or indeedthe existence, of any complaint ; andit does appear to us, that if this were

the case, no other " noxious influence

peculiar to the place" need be lookedfor.-As, if he had done that which

has been alleged, he is as likely to

have given the chalk and opium forenteritis as diarrheea. Gallons of

chalk mixture, with laudanum, wereserved out, and considerable quanti-tities of 11 ptilv cret&aelig;," which is saidto be the pulv. cret&aelig; co. cu. opio ofthe pharmacopceia, and if this do not

prove the existence of diarrh&oelig;a, it

certainly proves Mr. Pratt to have

acted in a very negligent and unwar-rantable manner. But we have onlyMr. Holford’s assertion that Mr. Pratt

will testify any such thing; an

against it we have an extract from

Mr. Pratt’s examination before a

Committee of the House of Commons,which we must suppose correct :-

" Question.-Do you give the chalkmixture for any disorder but diar-rh&oelig;a?

Answer.&mdash;No"!!!

When the author and Dr. Rogetfirst visited the Penitentiary, the totalnumber of prisoners was 858, of whom531 were males and 327 were females.

Of the former, 50 had been set at

liberty and 13 had died; of the latter,143 had been set at liberty and 17 haddied. Of the 30 who died, 22 fell

victims to the disease, under some ofits forms, and the remaining eight toother complaints.The whole of the prisoners at the

Penitentiary (635) were subseqiientivremoved to some hulks at Woolwich,which had been fitted for their re-

ception, and for a considerable perioda rapid improvement was manifest.

In process of time, however, the diar-rhoea again returned, but in a milderform, which did not prove fatal. All

the female prisoners were now recom-mended to the mercy of the Crown

and the males were transferred to the

hulk establishment, and thus endedthe attendance of the physicians.There were many reasons for con-

sidering the disease contagious, and

some also for referring its rapid spreadto a noxious influence peculiar to the

place, rendered more active by an

impoverished diet and a cold winter.But it must be observed, in regard tothe latter, that of 132 patients admittedinto the Penitentiary, when the diethad been improved and mild weatherhad returned, one hundred and threehad the disease, and in process of timethe Chaplain also, and several of theresident officers and their servants,who had hitherto escaped.What degree of health the present

inmates of the Penitentiary enjoy wehave no correct means of knowing.