Once a Week (magazine)/Series 1/Volume 3/Is the yellow jack at Shorncliffe?
IS THE YELLOW JACK AT SHORNCLIFFE?
The newspapers have lately contained some statements regarding the appearance of a species of fever at Shorncliffe, which, if they were thoroughly reliable, would afford us a novel cause for alarm. Thus it has been stated that a disease had broken out there, and that this disease, although not strictly speaking genuine yellow fever, was so near akin to that tropical malady, that the doctors were sorely puzzled to make a distinction. “The symptoms,” it was said, “are so similar to those of the terrible yellow jack of Jamaica, that the doctors are sorely puzzled to call it anything else.” This statement has been subsequently controverted in the “Times” by the Incumbent of Sandgate as having been based on reports in various particulars exaggerated. Now we are inclined to accept the Incumbent’s view, and questioning the appearance of any disease which is new to these islands, we think it may be useful to state the symptoms of those fevers which alone are acclimatised here.
The three forms of fever which always prevail to a greater or less extent in this country, and which at times produce great domestic desolation, are severally named typhus, typhoid, and relapsing. The terms, we admit, are unsuitable and unfortunate; but as they are in common use, we shall here accept them, and seek to state their respective significations. Putting aside mild and imperfectly marked cases, so as to give sharpness and brevity to our descriptions, we offer the following as a simple and yet rigidly accurate account of the characters of these three fevers.
1. Typhus Fever, or, as it is also called, “filth fever,” and “low nervous fever,” has certain very distinctive characters. An ordinary uncomplicated case has generally the following symptoms and course: The attack is ushered in by shivering fits, prostration of strength, and pain in the back; the tongue becomes dry and hard; and there is headache, accompanied by more or less wandering of the mind, or a low muttering form of delirium. When there is no mismanagement, convalescence usually begins about the fourteenth, and is seldom delayed beyond the twenty-first day. The diagnostic symptom of this fever is a mulberry rash, which appears most commonly between the fifth and eighth day, and fades away after a few days in favourable cases. The spots do not disappear when pressed by the finger. In this, and in other respects, it essentially differs from the fever which so nearly resembles it in name, typhoid fever. It very rarely twice affects the same individual. By protracted contact, and in crowded dwellings, it is contagious. In such places it likewise spontaneously rises among the inhabitants, probably, as Mr. Simon suggests, from “the putrefaction of their undispersed exhalations.”
2. Typhoid or Gastric Fever.—This is the fever which created so much anxiety in 1858, at Windsor. Then and there, as in other well-observed outbreaks of it, the engendering morbific influence was proved to arise from emanations consequent upon defective ventilation in the drains, and from the gases which belong to such nuisances as pigsties, dungheaps, and foul gulleys. There is no class which suffers so much from typhoid fever as domestic servants, a circumstance which may be explained by the fact of their living and sleeping apartments being so often in the basement of houses, proximity to the sink holes and crevices, whence emanate the sewer gases. They must, therefore, oftener breathe the poisonous gases in a less diluted form than other members of the same household. Cowkeepers and others exposed to concentrated exhalations from excrementitious matter are peculiarly liable to typhoid fever.
The haunts of cholera and typhoid fever are identical. In other respects, which we cannot now enlarge upon, the two pestilences are closely related to each other. In the meantime, the point to be remembered is, that when we dislodge one we dislodge both.
Passing over minor characteristics, we may at once mention that the diagnostic symptom of typhoid fever is an elevated rose-coloured rash, occurring about the seventh day in patches of papules, which lose their colour when pressed. In fatal cases, certain glands of the intestinal surface are found, on examination after death, to be in an ulcerated state. Neither the elevated rosy rash disappearing on pressure nor the ulcerated intestine are ever met with in cases of typhus. The importance of these medical facts as guides to the employment of the proper measures of preventive sanitary police must have already suggested themselves to the reader. A single case of typhoid fever ought always to be at once attended to, as a call to test with care the state of sewers and stink-traps, and to remove all reeking cesspools and such like nuisances from the vicinity of dwellings.
3. Relapsing Fever has sometimes manifested great severity as an epidemic. During a portion of the duration of the celebrated epidemic of 1843 (as appears from Dr. Cormack’s description) it was a very severe fever in Edinburgh, Glasgow, Dundee, and other towns. Speaking generally, however, relapsing fever is much less serious than either typhus or typhoid, provided the patients are adequately clothed and fed during the whole period of convalescence. When there is neglect in these particulars, many perish from dropsy and other secondary affections, after passing well through the fever.
Relapsing fever possesses great social importance, from its relation to, or we may say its actual dependence upon destitution. It is the “famine fever,” just as typhus is the “filth fever” and typhoid the “sewage fever.” At the commencement of an epidemic all, and during its continuance nearly all, its victims, are among the destitute and imperfectly nourished. Like typhus, and unlike typhoid fever, it is contagious under certain conditions. It does not spread readily by slight and casual contact with the infected, but is freely communicated when the contact with or contiguity to the sick is prolonged and takes place in confined rooms. Relapsing fever sets in abruptly and violently. The pyrexial condition continues for a few days; it then ceases for a day or several days; and afterwards returns once or oftener. Hence the name of “relapsing fever,” by which it is now generally designated.
The practical conclusions to be drawn from the above statements are apparent. Use all possible means to prevent people crowding together in filthy ill-aired houses, and so prevent typhus; give protection from sewage gases, and so prevent typhoid fever; and lastly, in times of scarcity and destitution, give timely succour, and so prevent the poor from falling under the relapsing fever. The thorough application of these preventives requires a better system of sanitary police than we possess, and a higher grade of officers to carry out the administrative details. The supervision of dwellings must be made stringent and general, in respect of number of occupants, ventilation, cleanliness, and sewage gases. In respect of all of these conditions, authoritative and intelligent supervision is required, but particularly in respect of house and town drainage. Sewers may be good; but if they are ventilated into the houses, in place of external to them, they become the most pestiferous agencies which can be imagined. Moreover, all drains are liable to go wrong, and all of them, therefore, require frequent inspection by experienced persons. Unfortunately, the inspectors of nuisances appointed by the rate-payers are very often not competent. They are generally tradesmen who have failed or are failing in business, who by favour of some parochial coterie manage to be placed in office. The Privy Council, by the Public Health Act of 1858, have power to issue regulations for securing the due qualification of public vaccinators. Why should they not have a similar control over the appointment of officers of health and inspectors of nuisances?