Mr John Spear's report to the local government board upon the so-called "Woolsorters' Disease" as observed at Bradford and in neighbouring districts in the west Riding of Yorkshire.

  • Spear, John.
Date:
1881
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Licence: Public Domain Mark

Credit: Mr John Spear's report to the local government board upon the so-called "Woolsorters' Disease" as observed at Bradford and in neighbouring districts in the west Riding of Yorkshire. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    of the face, which may appear congested or pallid, usually the former; sleep is restless or there is sleeplessness. The respiratory centres are commonly early involved in this nervous disturbance; there is a sense of constriction of the chest, accompanied by shortness of breath, frequent sighing and yawning, and later, perhaps, by cough. Aching of the limbs is usually complained of, perhaps cramps in the calves ; and there may be peculiar feelings of numbness or formication in the extremities; or less commonly loss of power and staggering gait. Not quite so commonly perhaps as some of these other symptoms, but still frequently, there is headache, slight pain or stiffness in the neck, dizziness, nausea, and vomiting; and vomiting may indeed be the initial symptom. Should the disease progress, in a variable time, sometimes in a few hours, more com- monly perhaps in from two to five or six days, these symptoms, especially the sense of weariness and prostration, increase, or others more alarming present themselves, so that the patient finds himself incapacitated from work. In other cases it seems that distinct intermissions occur; and if we could be sure that in the histories of such attacks the first symptoms were rightly ascribed to the specific cause, and if we could eliminate the possibility of a fresh or intermediate infection, it would appear that weeks might intervene with intermittent prodromata before the final stage was reached. The fre- quency of distinct remissions at this time is unquestionable. In the case just mentioned (Case 35) the man only complained in the evening, when probably the nervous system was exhausted with the day’s work ; periods too of excitement may alternate with those of lassitude and weariness. Thus it not unfrequently happens that when a man has given up work and taken to bed feeling utterly prostrate, he will think he can, and sometimes does, return; and he may thus work again for a few hours before his final discontinuance of active exertion. The Stage of full Development.—Although prodromal symptoms may have bee prolonged, the actual commencement of the stage of full development is usually sudden and unexpected. The prostration and restlessness become more marked ; the face may be deeply flushed or pallid; the respirations are almost always greatly accelerated, to 30 or 40 perhaps, while the pulse rises to 100 to 130 or 140 per minute, and is usually weak and compressible. The temperature is reported to show in several cases no considerable rise above the normal, and to be moreover very variable, not only in different individuals, but irregularly so in the same patient; but further thermometrical observations are required.* At this early period, 12 to 24 or 48 hours after appearance of urgent symptoms, whilst normal respiration may still be heard, but with increasing precordial anxiety and dyspnoea, with signs of less and less complete filling of arteries, with coldness of surface, and deep cyanotic hue of skin, the patient may sink into a state of fatal collapse. Or, apparently, a similar condition, or perhaps one of asphyxia, may be induced at this time quite unexpectedly, with a previous temperature only moderately high, and a cardiac weakness not excessive, from the rapid pouring out of a vast serous effusion into the pleural cavities (Case 30, and perhaps 28, for example, with autopsies, in Appendix A.). But the case is usually a little more prolonged; some reaction takes place, and the symptoms above enumerated are supplemented or accompanied throughout by others- There may be more marked and continued fever, with a temperature rising to 104° or 105°; but always accompanied seemingly by a tendency to irregular downfalls, and the breaking out of more or less profuse perspirations. The symptoms of the prodromal stage are all increased ; violent headache, incessant vomiting, increased restlessness and excitement, vigilance, delirium or somnolence; or, perhaps more frequently, the sufferer retains his mental faculties, only comparatively impaired, until the end. Often quite early in the disease symptoms of various acute local congestions arise. The lungs are specially apt to be affected; and the physical signs of that condition, with the occurrence of a copious frothy blood-stained expectoration, are noted; and a fatal oedema may supervene (Case 20, with autopsy); or more copious haemoptysis, as might be expected from the pathological conditions, may occur. Similarly, more or less severe gastro-intestinal symptoms may appear. From the first there has probably been loss of appetite, with a moist furred tongue ; now colicky pains may trouble the patient, with vomiting (probably of different significance to that of the initial stage). * Or heat may, of course, with approaching collapse, be irregularly distributed : case of Dr. Bells (“ Lancet,” June 5, 1880) ; temperature (day before death), axilla, 97°’6 F.; under tongue, 980,1 ; in rectum, 102u,2. Day of death ; axilla, 960-6, rectum, 102o,5. See also Case 24, and in Appendix, Case 11.