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.

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    and diarrhoea (Appendix, Case 25), and sometimes jaundice (Appendix, Case 22), Haemorrhage from the bowels has not been observed in the cases on which this description is founded ; but it has been noticed elsewhere.* Sometimes there may occur a remission of all the more distressing symptoms (Case 15, for example); the breathing becomes easier; the colicky pains and vomiting cease; the restlessness and sense of oppression diminish, and a little sleep even may be obtained. The patient and his friends believe that recovery is close at hand. But the profound impression that has been made upon the circulatory system soon manifests itself anew. Perhaps it is suddenly discovered that the extremities are stone cold; or syncope, lasting only a few minutes, may suddenly occur (Cases 28 and 15); cyanosis, before noticeable at the lips -and finger-nails, gradually spreads and deepens ; the indications of cerebral mischief may now become more direct and violent, with spasmodic knitting of the brow, wild delirium and convulsions; or another group of symptoms, referable perhaps to the implication of the spinal cord in the prevailing morbid changes, may be developed ; two cases of tetanic spasms, one commencing with trismus, were described to me, as associated with the other symptoms ; or the sufferer sinks into profound ' coma from cerebral haemorrhage (Appendix, Case 35), from which there is no arousing; or the stages of a typical asphyxia may close the scene. Should the patient survive this stage of full development he may still, as already stated, succumb to inflammatory processes set up during its continuance (Appendix, Autopsies, 22 and 25) ; or apparently a true and fatal relapse may occur (page 31). But recovery after this stage, I am led by this inquiry to believe, is not so rare as hitherto supposed. Besides the abortive cases before referred to, several, running more or less the course I have described, were related to me, where complete recovery super¬ vened (see histories of recent attacks). The convalescence will be long and tedious (the average duration of absence from work averaged between seven and eight weeks in eighteen such cases whose histories I have collected); a tremulous and feeble condition of the muscular system is left; the cutaneous sensations noted in the prodromal stage (numbness, “ furry ” feeling) will very likely continue for a time; muscular cramps may continue to trouble the patient; the epidermis sometimes desquamates, in two of the cases above referred to the finger-nails came off; various eruptions are apt to appear; herpes, boils, and sometimes, it would seem, gangrene. And these latter manifestations may occur during the acute stage.f Finally, judging from the histories I have recorded, it would appear that one attack of this disease successfully overcome confers no immunity from subsequent infection. Pathological Anatomy.—Notes on autopsies are contained in the Appendix. Various' evidences of early decomposition are commonly met with, parts of the body being considerably swollen and discoloured, especially around the neck and about the chest and arms, where, also, there is frequently an emphysematous condition of the sub¬ cutaneous tissues. Besides these early post-mortem changes, various pathological conditions of the skin may be present; petechige being apparently the most common. The heart is often flabby, and its muscular substance dark in colour and containing sometimes minute haemorrhagic extravasations; the blood in its cavities and in the large vessels is generally quite fluid, and of a dark cherry colour, and the endocardium, unless the autopsy be made very early after death, usually shows (owing to early dis¬ integration of the red blood corpuscules and consequent escape of coloring matter) a corresponding tint. There is often a considerable pericardial effusion; and both pleural cavities are often found filled with a straw-coloured serous fluid. The lungs may be normal, or more usually they exhibit signs of considerable hypersemia, com¬ bined, it may be, with oedema. This hypersemic condition may it is probable in later cases go on to a true pneumonia; or metastatic pneumonic processes may be set up, with the formation of numerous small infarcts and abscesses. The lungs, too, like other organs, may be the seat of larger haemorrhages, presenting here the characteristic appear¬ ance of haemorrhagic infarctions. But, while the smaller haemorrhages may depend upon obstruction of vessels by masses of bacilli, it is to be doubted whether the larger ones are always of embolic origin; and, indeed, we can scarcely account for the large and widely pervading haemorrhagic and oedematous effusions that so often characterize the * It occurred in animals that, as I shall presently have to show, contracted the disease in this district from a similar source. | Two deaths, both probably, and one from the history almost certainly, from this disease, were certified as due to “ senile gangrene.” the ages being respectively 55 and 58. In two other suspicious cases the deaths were certified “enteritis, gangrene.” One death that was certainly due to this disease was certified “herpes roster.”