The Cholera Epidemic in the Kingdom of Denmark in 1853
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I860.] The last Cholera Epidemic in Denmark.. I/V 145 Review XYI. Cholera-Epidemim i Kongeriget Danmark i Aaret 1853. Ved Dr. Th. Bricka. The Cholera Epidemic in the Kingdom, of Denmark in 1853. By Dk. Theodore Bricka 8vo, pp. 288, with Five Plans. Copen- hagen, 1855. We have in former numbers of this periodical called the attention of our readers to the details of the cholera epidemics in Sweden and in Norway, and we are now able to complete these reports by the statistics and history of the epidemic of cholera in Copenhagen and in Denmark in 1853. It was in that year that the last severe visitation of cholera occurred in England, when Newcastle-on-Tyne and many other towns suffered so much from the ravages of the disease. The admirable organization of the profession in Denmark has provided ample reports on the progress of the disorder, both in the city of Copenhagen and in the various localities of that kingdom where it manifested itself, and these reports have been very ably condensed by Dr. Bricka in the present volume. Copenhagen had up to 1853 entirely escaped the ravages of cholera during the great epidemics that had spread over Northern Europe, devastating the countries on either side of the little kingdom of Denmark. In 1848, when cholera prevailed extensively in Sweden, as well as in other parts of the Continent, a few isolated cases did indeed show themselves in Denmark, but the malady did not spread beyond the immediate vicinity of the spot where the cases first appeared. A well marked case of cholera certainly occurred on the 6th of November, 1848, at Dragoer, on the island of Amager, close to Copenhagen. The ? patient, a man of sixty, and an assistant pilot, recovered but his wife, who attended upon him, took cholera on the 11th of November, and died on the 16th. A cousin of this woman's, a female, aged thirty- eight, nursed her in her illness, and then took the disease on the 13th, and died on the 15th of November. It was ascertained that the old man in whom the malady commenced, had been on board of a ship coming from St. Petersburg, where cholera then prevailed ; but it could not be made out that any of the crew of that ship were then affected with the malady. A slight epidemic of cholera likewise showed itself at Bandholm, on the island of Lolland, in 1850, in the month of August, and this epidemic was peculiarly fatal among children; nor could it be traced to any positive importation. A schooner from Lubeck had indeed come into the harbour on the 28th of July, but none of the crew were sick, and Lubeck. was not declared to be infected till the 31st of July. The disease, however, would probably be was in the town for a few days before the fact of its presence there declared. In Corsoer, in Zealand, two or three cases of cholera were observed 49-xxv. 10 146 Reviews. [Jan. in October of the same year. The first was in the person of a sailor, who had been working on board of two vessels from suspected ports; arid the second victim was a shoemaker, who inhabited the same chamber as the first. A number of minor cases afterwards occurred in the same house, and in others in the same street, but the malady did not spread further. Copenhagen.?When cholera broke out in the capital of Denmark, in June, 1853, there was no cause for anticipating its appearance. At the time when the malady had prevailed in former years in all the neighbouring kingdoms, its vicinity to Denmark was indicated by an extraordinary prevalence of diarrhoea, both in country districts and in Copenhagen itself. In 1852, when no cholera existed in Sweden, Norway, or Germany, diarrhoea was extremely prevalent in Copen- hagen ; but in the spring of 1853, that capital was remarkably free from bowel complaints; so much so, indeed, that in April and May only four fatal cases are recorded (inclusive of infants); and in the first half of June not a single death occurred from the same cause. Cholera at that time prevailed at St. Petersburg and at Cronstadt, but this was its nearest approach to Copenhagen. On the 11th of June, 1858, a carpenter, who worked on a dredging- lighter at Nyholm, was attacked with vomiting and diarrhoea, and on the following day he was placed in the Nyboder Hospital. He recovered, and went out on the 25th of June. On the 12th of June, a man of fifty-nine years of age was brought into this hospital from the same locality ; he was placed alongside of the first-named patient, and died on the 15th of June of well marked cholera. The disease then spread through this hospital, and showed itself next in various parts of the city. It is certain that the epidemic first appeared in the Nyboder quarter, and then spread itself over the north-eastern portion of Copenhagen. The inmates of the prisons in Nyhavn entirely escaped. The small, narrow streets in the centre of the town were less severely visited than some of the larger thoroughfares; nor was the malady most intense in the dirtiest localities. In the district of the Yesterbro, where the drinking water is notoriously bad, where butchers'-shops and pigsties abound, and where drainage is scarcely possible from the want of fall, only a very few cases of cholera occurred. The epidemic lasted from the 11th of June to the 13 th of October. It was a pretty general rule that the disease died out soonest in those parts of the town where it showed itself at first with most marked severity. Two streets (the Tester gaden and the Fridriks- borg gaden) in both of which an epidemic of typhus had prevailed during the previous summer, remained singularly free from cholera. The mortality was greatest in the back rooms of sunken dwellings, and next in the rooms immediately above those, and was least in those rooms that looked into the street. The relative condition of life of the these persons inhabiting respective dwellings must not be overlooked, as the dwellers in the back rooms were mostly individuals of the lowest class and in the most impoverished circumstances. Cholerine and I860.] The last Cholera Epidemic in Denmark. 147 diarrhoea were of course extremely prevalent during the whole course of the epidemic. The total number of cases was 7219, and the deaths 4737. The aged were the readiest victims, not one individual above eighty years of age recovered when attacked, and children under a year old rarely survived. The mortality from other diseases remained during the epidemic at its usual average. In the garrison of Copenhagen, amounting to 6500 men, there occurred 116 cases, 68 of which proved fatal?a very small per-centage indeed of cases, but which has been observed to occur also among garrison soldiers in England. Cholera at this time (June, 1853)prevailed only atSt. Petersburg and Cronstadt, from which ports ships arrived almost daily at Copenhagen. Previous to its outbreak there, no cases had occurred in other parts of Denmark; it was precisely in the port at which the ships from St. Petersburg arrived that it made its first appearance. No positive evi- dence is, however, forthcoming of the importation of the disease; but once within the precincts of this large city, the proofs of direct infection were easily to be found. Thus, Dr. Bricka tells us of the great number of cases and deaths among the attendants in the cholera hospitals, though here, too, there occasionally were remarkable exceptions. None of the female attendants in the Hospital of Our Saviour fell victims to the disease; indeed, only one was attacked with cholera, though this building was ill placed in a sanitary point of view, and was constantly crowded with cholera patients. Dr. Bricka does not believe in the reputed danger of cholera hospitals as " foci" of infection. Some quarters of the town immediately in the vicinity of these establish- ments remained free from the disease. Nor does our author admit that the epidemic could be referred to a sudden miasm brought across the seas by the wiud, or generated in the town itself. No important changes in the condition of the city had been made for many years. The malady, he observes, crept through the streets like a contagious disorder, and did not burst at once upon the whole city, as is the case with influenza and other true epidemics. But while he denies the production of the malady by local causes, he is fully prepared to admit their important influence on the progress of the disease. Uncleanliness, overcrowding, and bad food are all disposing causes of cholera; but in Copenhagen, as was also the case in Warsaw in 1832, and elsewhere, the malady was by no means the most severe in those localities where these causes were specially in operation. In some newly-built houses the malady was especially virulent, while in others of equally recent construc- tion it made no progress at all. Among ten families living close to the water, and at the mouth of the open town sewer, on the Norrebro, there was not a single case of cholera. The measures taken by the Government and by the medical authori- ties, when the cholera was declared to exist in the town (June 24th), deserve our attention. A sanitary commission was established, and five offices were opened directly in various quarters of the town to receive announcements of cases of cholera.