AN epidemic of relapsing fever in EDINBURGH IN 1843 By E. D. w. GREIG, C.I.E., Lt.-Col. I.M.S. (Ret.)
^Actly o ^Undred was in the throes an ext ?^e years ago Edinburgh ^ediCai ^S*Ve fever epidemic which presented a problem for the samePr?^ess^on- The problem was, whether this fever was ^ch the?r ^^erent from the fevers, particularly typhus, with ^en was familiar-. Fortunately, Edinburgh had atld seve^r?^ess^0n who the sucr j CornPetent observers, investigated epidemic ^ ^ 1 h^]> M so^v*n? ^e problem. David Craigie [1793- has the credit of being the first to give aPsino---g ^'"^"C.P.E., ProVi Fever its name,2 and, by clinical ? 0th, fthat ?as a separate clinical entity and different from thet William Henderson* al*? '^fevers.and [.8.0-873] S described it as and sh C and Relapsing Fever, ?thal P relapsing fever were two distinct lseases. , was a ajf'gie physician to the Edinbu , on Royal Infirmary, g s?ho i'rer systematic and clinical medicine in t e ex the ' retiral of Christison, he became d thls Coll. Journal from 1827 to to ** of 1853; Secretary Physicians from 1836 to 1848 ; President from 8 Chi 3C: InsPector of Anatomy.1 He was a candi J beir, Pathology in 1842 and lost it by only one votedatsfOTth^ H > elected.* In a fairly long obituary notice in indica?ntl0n made of his observations on re ap j, ln? that their importance was not appreciate a time> was Professor of m u vers^ersonto Pathology the f Pathol?gist? Professor of Clinical Me icine Reid 7 fVer wards in the Royal Infirmary. a^ ^ r4iPU"ished (i839) various ?bse-a?ons JLCh led to the establi*u enteric fever as a > ^ a 6 ? separate wfcch^ c0nv by the w?rk of Sir William ^ became to Jenner' c him his Chair. 5^Ul Homoeopathy, which near y eff?rts ??st him however and he d 4n ? failed, <11 ? i869. three years before his In c??ege of Physicians, Edinburgh, intimatedeath^ ^ ^ 68l E. D. W. Greig
to exp he was expected to resign his fellowship or submit ^ Dece but the intimation was not followed by any action. In Q{ Socie 1851 he was expelled from the Medico-Chirurgical
. Edinburgh.8 _ _ / Both the above published their observations in this Jo ^ These investigations were not merely of local inter ra importance, but the light which they threw on the subject ^ far beyond, because it is now authoritatively rec?gnise by them the main characters of relapsing fever were first to the notice of the medical world. . ^43 Sir John Rose Cormack (1815-1882) also published ^ ^e an interesting and valuable monograph on the epidemic- ^ his in with a medal for ^ in < O EdinburghO 1837? Ogold graduated? ? ? 1 j 1 j_ r> t-> 1 , e j_l T? /-lira 1 JV-^ and in that was Senior President of the Royal year ctise Society. After a time in Paris he returned to pracl ^ Edinburgh, becoming physician to the Royal Infirm tufe5 Fever Hospital. He sought permission to give clinica to in the Infirmary, but on this being refused he migrated in health drove him to France and he Failing practised ^ ^ a (1866) and in Paris (1869), where he became P^y5*0'13*1 cSLtfie British Embassy. He took the M.D. of Paris (1870), .^gd i*1 chevalier of the Legion of Honour (1871) and was the e 1872. Amongst other activities he founded and g^y), ^ Edinburgh Monthly Journal of Medical Science 0 the London Journal of Medicine (1849-1852), and from His c0jjecte<^ 1858 was editor of the British Medical Journal. were writings published in 1876.11 . o0rta(li This, being the centennial anniversary of these j^e^P them to investigations, offers a suitable occasion to recall ^ alive the memory of these workers. It is early o future a stirnl^or look back on the early efforts of to blaze trail ggjit pioneers o workers and to interpret their observations in the light knowledge. Craigie's conclusions regarding the nature of the " is jfi be given in his own words : This febrile disorder from and the usual form of continu j0e5 typhus synochus, ^ ^ Edinburgh and neighbourhood, in several respects. same kindo not proceed in the same manner, or with the a being shorter in duration, but always almost showing resefl* ^ to recur, in other words, the patients re-lapsing. .ce ta not the usual febrile eruption of red spots which vio en ^s0{d^ typhus. 3d, It shows not the same tendency to 682 v An v pidemic of Relapsing Fever in Edinburgh
ofthe ? brain an a typhus ' lts membranes, which, in several cases of genuine ?^Servec^ to take While it affects ^"eat i place. And, 4th, ers ^hic^ . of people, it shows not nearly the mortality with ?US ^ever *s attended." In his paper is given an accUrate h escr*Ption of what is now known as or lice- k?rne reja European Rpide ^Sln? fever, as will be seen from the following summary : appeared first in March 1843 ; ^usa^r^?epidemicSynochus which the ^inter th (continued fever), prevailed during no't 0ugh not to a great extent, became less frequent, but ISaPPear at this time. Thus there were two lice-borne ^ections in the summer of In ^'a the ?CCUrr*n?> Edinburgh 1843. at the eP^em^cs ?f relapsing fever tend to occur also end^reatt^le co^ lice at that PartiCui 1 weather, period becoming k?t seaso^y lively- Indian epidemics cease at the height of the Produces a natural delousing of the population. f ^?nthl rQl^ ?The admissions for fever cases, which Oct k ^4, to the end of varied from to r0Se j ?rl842 February 1843 53 I842), T,,n ^arch 1843 to 85, April 96, May 134 (against 76 in (againSt July 2Si (against 55). a *?' was small. Of 315 cases treated 17 died, ^?fth 12 Were ^ue to t the R typhus. infirmary, in the wards of which fever cases were jn eSG ^Gre^eated ^ays> could admit no more cases, and, as 30 to 40 ^ still ^ever public funds were applied to open h0sUnaccornmodated,^lta* *n Surgeon's Square on 3rd August. The disease C?ntinuecj an<^ an?ther house to the was jspared f belonging Infirmary N L25tt?30 cases. On 1st September, although the two fever had ^? cases under t-_" +U hospitals1?? 380 eatrHent"-Utj ' ere casCaSes Was still a demand for accommodation for
Q i ^?CaUties m which Cases came from the q asSfriarket came.?They *n the High Street, Canongate and Cowgate. rern' ?^?SesS otia ^sease T *^a* these were very favourable for the origin er ?n conditions ; but, on the j) hand h ePenchng atmospherical ^?tes that cases came from Musselburgh, Tranent, i^icuik, he the not dense gt?n and Dunbar, where, says, population I and the ventilation excellent. Similar epidemics ere?ccUrrie ^ ^undee an(^ c Glasgow. sr?Wding ^ Refects, slums and dirty environment with over- ((>ingor bad Vgiene have an undoubted share in the fever. Engel calls it the morbus pauperum, Unta edrelaPsing Pay their tax in disease." Overcrowding plays a 683 E. D. W. Greig
because 01 part in spreading the infection once started, ^ also to contact and passage of lice. Privation was thought " and tyP a causative factor, and the name famine fever,"
" . famelicus or starvation typhus," evidence this idea. g that Occupation of Cases.?It is very interesting to note ^ the remark was made on the number of laundry-^ ^ epidemic is attacked after the clothes of the This washing patients. oc readily explained as they were engaged in the dangerous lice, v tion of handling clothes heavily infested with infected of relapsing fever. . ^ give > Symptomatology.?Both Craigie and Henderson accurate record of the symptoms of relapsing fever. ( The fever in the original attack lasted four to five days- ^ and dry- rate varied from 90 to 120. Skin was hot ^ pulse a s critical with the fall of temperature was ^ sweating 1:0 feature. One or, less frequently, two relapses g? five r Henderson records, however, three, four and even ^ 8 from the noted in Apart fever, Craigie jaundice ^ butcaS^'g 4 of them died. The jaundice was not obstructive, ortj0n to a No was but in a certain hepatitis. eruption noted, o in thePr?^gjrial of cases purpuric-like spots were observed only to attack, not in the relapses : they were ascribed reSefl- perhaps they may have been louse-bites. Joint pains ^^^gple#1-1 in several cases after the febrile symptoms subsided. ^ was much enlarged in some cases, in others it was by been*ar^ej detec not markedly, and the enlargement could only
and not . percussion by palpation. in restifl? 10 in his records certain ^^ Sequela.?Cormack study o he noticed a form sequelae. Amongst others, peculiar c The 0Pj-tj0n I mitis, usually preceded by amaurotic symptoms. ^at of the eye, bore a striking resemblance to syphilitic lesions ^ ^ other. -1 it was difficult to distinguish one from the
W TTtlnent'?Cormack gave quinine gr. 3, 6 pills in twenty- ?Urs' iiripre 23 pills in all being taken. He was much Qlent ^ the imPr?vement in the cases following this treat- mad* f rcurials were not found effective, and no mention is Pon -senic* in ?Wlng the pioneer work in on relapsing fever a Edinburgh ^Scov quarter of a century elapsed before Obermeier, 1868, t^e tion causal agent, Spirochceta recurrentis. His descrip- 0^redlt Was necess not published till 1873. For the next advance it was in Ind^t0 Wait for more than half a century (l9?7) when Mackie itnp0rtla showed that the body louse, Pediculous corporis, was the Polly^ vector of relapsing fever in India. In 1912 Sergent, Nicolle demonstrated that infection was acquired, not VtheT^ ?f intent the louse' but by the inoculation of the crushed body lhat infected lice. Incidentally, it is worthy of mention anS er to famous Scotsman, David Livingstone, was the first fepor^ ?r transm>' suggest, in 1857, that relapsing fever in Africa is I^ejate^ the bite of a tick.9 J'ke fever has been employed as a therapeutic measure, maiPS!ngar*a> in ^ the treatment of General Paralysis of the Insane. s*-rain of the parasite has been used as a rule. It spiro^11 ?Und, however, that it is difficult to destroy the inoculated w^th the so ^ich js usual specific drugs, and stop the infection, ?Wed) to die out At 6 therefore, spontaneously. ^>resen^ and time relapsing fever has a special interest, as S^re3d conditions are particularly favourable for the 0f^?S^"War*Ce~borne Ver infections. Both typhus and relapsing fever ^ ^revalent in the Balkans and Eastern Europe in the ^e*ect th ^ese circumstances it is essential, therefore, to Cases at +k the earliest and suitable means to ^revent the moment, by spread.
i P REFERENCES
lGlE, Day " Notice ?f a Febrile Disorder which has prevailed ^ g^^inbur?' the Summer of Edin. Med. and q, 4lo. during 1843," Surg. Journ., ' 3n t. Notice ' GAwary ? Med. 12, Part I, 188. a. S?N, pj Journ. (1866) 3 ELding H., and Morton, Leslie T. (1943). A Medical 2<^1' (Grafton & Co., London.) ' "V'' " On some of the Characters which distinguish i16 fever * * ^x?44)? Urg. , Present Epidemic from Typhus Fever," Edin. Med. and J0Ur?, 6i, 20I 685
1 E. D. W. Greig
j a * 498'H 5?9' 4 ed., 2> Comrie, J. D. (1932), History of Scottish Medicine, 2nd 613 and 623. (Bailliere, Tindall & Cox, London.) x 119* his sons, 6 Life of Sir Robert Christison, Bart. (1885), edited by (William Blackwood and Sons, Edinburgh and London.) 6 188. Obituary Notice, Edin. Med. fourn. (1866), 12, Part I, 7 Henderson, W., and Reid, J. (1839), Edin. Med. andSurg.J?urn"'^o^ & Co., 8 Dictionary of National Biography (1891). (Smith, Elder 9 Scott, H. H. (1939), A History of Tropical Medicine, 2, 1%1- Arnold & Co., London.) j 10 CORMACK, Sir John ROSE (1843), Natural History, Pathology oW Edit ment of the Epidemic Fever at present prevailing in other Towns. (J. Churchill, London.) , c^seS 11 Cormack, Sir John Rose (1876), Clifiical Studies, illustrate observed in hospital and private practice. 2 vols. London.