On the pathology and treatment of dysentery : being the Gulstonian lectures delivered at the College of Physicians, in February 1847 / by William Baly, M.D.

  • Baly, William, 1814-1861.
Date:
[1847]
Catalogue details

Licence: Public Domain Mark

Credit: On the pathology and treatment of dysentery : being the Gulstonian lectures delivered at the College of Physicians, in February 1847 / by William Baly, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    28/39 (page 26)
    20 the prevalence of bowel complaints in the establishment here referred to has not been caused by the poorness of the diet. During the summer of the year 1842,1 visited many prisons, workhouses, barracks, and lunatic asylums, in various parts of England, with the view of gaining information which might throw light on the origin of the disease pre- vailing at Millbank. And I found that the degree of prevalence of bowel complaints in the different establishments bore no constant relation to the poorness of the diet, any more than it did to defective ventilation, or impurity of the water which the inmates drank. Dysentery and diarrhoea prevailed in barracks and lunatic asylums where the dietary was abundant, and were absent from prisons in which the allowance of fpod was scanty. In many instances, too, where a salutary effect had been produced by an increase of the dietary, the bowel complaints, before rife, had only been rendered less prevalent; they had not disappeared. It seemed, therefore, impossible to believe that poorness of the diet was the primary and essential cause of the disease. On the other hand, I found that the frequency of bowel complaints in the different establishments I visited did bear a relation to the character of their sites. Where those complaints were of frequent occurrence, there the site of the building was low, the ground around it damp or imperfectly drained, and the sub- soil often formed of peat or clay. Where bowel complaints were infrequent, the site was elevated, the soil dry, and the subsoil generally composed of gravel. The conclu- sion, therefore, I arrived at respecting the origin of bowel complaints in these different institutions was, that they were really caused by malaria, and that their frequency and severity had been affected by the diet only in so far as poorness of the diet had in some cases produced a great susceptibility of the influence of the malaria, and the subsequent increase of the diet diminished this suscepti- bility. The second objection to the theory which ascribes the bowel-complaints preva- lent in the Penitentiary to the influence of malaria, is that the inhabitants of the imme- diate neighbourhood do not suffer in a similar way. This is true. Even the private fami- lies residing in the Penitentiary are seldom at all affected with the prevalent bowel complaints, and very seldom indeed affected in a severe degree. But surely this is no valid objection. For it must be remem- bered that these free persons are living under conditions very different from those which surround the prisoners. They arc not con- stantly confined to the atmosphere of the locality ; they commonly drink in the course of the day some fermented liquor, as well as other stimulants of the nervous system, such as coffee and tea ; their bodies are kept- in a healthy state by active and voluntary^ exercise, and their minds by cheerful and varied trains of thought. The prisoners- have none of these advantages. It mightI be expected, therefore, that the former clas8^ of persons would be insusceptible of diseaser from causes which might affect the prisoners- very generally. There is, indeed, nothing: wonderful or remarkable in one class of' persons enjoying a comparative immunity! from the effects of morbific agents which i prove hurtful, and even destructive, to those' of another class. During the prevalence oft almost every epidemic malady, we see that: the poor are cut off, while the rich generally • escape. And this has been especially ob- • served of dysentery when it has been most: destructive to our troops, not only in mili- tary campaigns during war, but also in time • of peace, when the barracks have had un- healthy sites. The officers have been far less affected than the private soldiers.* The consideration of these objections, I then, tends by no means to weaken my conviction that the bowel complaints preva- lent in the Penitentiary have been caused by malaria. On the contrary, it seems to me to render this theory more probable, since it shows why the effects of malaria on the prisoners have been so well marked, though the neighbourhood of the Penitentiary has not manifestly the features of a malarious locality. For it has been asked, whence comes the malaria ? There is, indeed, no marshy ground near the prison, no considerable extent of stagnant water : there are none of the more obvious sources of miasm. Still, if we examine closely the state of the ground around the Penitentiary, we find in it many points of resemblance to those tracts near the borders or mouths of rivers where dysentery is so often an endemic disease. The tracts of country to which I allude are low, and have a damp alluvial soil, contain- ing much organic matter. Now such, in a less degree, is the character of nearly all the open ground around the Penitentiary. The building itself stands upon an artificial hill, but the surface of the surrounding ground is below the level of high water in the river. The soil is loose, and contains much organic matter, and the subsoil is formed in most parts of an imperfect clay, beneath which are alternate strata of peat-earth, marl, and sand. The ground has hitherto been im- perfectly drained. But the chief defect of the site seems to consist in the beds of sand just mentioned being full of water, derived, in all probability, from rain which had fallen on distant and higher grounds. In rainy * Pringle, Diseases of the Army; Tulloch, Reports of the Health of the Troops; Anueslev,, Diseases of India.