Scrofula, Cholera, and Dysentery During the Nineteenth Century

Introduction

Sing Sing Penitentiary in Ossining New York was a hotbed of disease during the 19th century. There were a number of factors that contributed to this, including poor sanitation, poor diet, and inadequate medical care given to the inmates. The prison was densely populated during this time period, which allowed for the rapid spread of illness among inmates. Three of the most common illnesses that affected inmates at Sing Sing during the 19th century were scrofula, dysentery, and cholera. This essay will provide two descriptions of each disease: one description based on the 19th century understanding of the disease and one description based on the modern understanding of the disease. The typical 19th century treatments for these three illnesses will also be discussed.

Scrofula in the 19th century

Scrofula is a disease most notably characterized by large, painless, and growing masses due to irritation in the lymphatic system. These masses most commonly appear on the neck of the person affected, though they can appear anywhere on the body.[i] In 1846, Benjamin Phillips, F.R.S. published Scrofula: Its Nature, Its Causes, Its Prevalence, and the Principles of Treatment. In it, he describes scrofula as a “disease of the constitution,” meaning that the most prominent feature in the development of scrofula is the overall health and physique of those affected.[ii] Phillips discusses the multitude of characteristics that his contemporaries claim could be indicators of a constitution prone to scrofula – these “symptoms” range from things such as “an extreme development of cellular tissue, by which the muscular markings are effaced, and by which a roundness is given to the limbs which may be mistaken for strength” to having “large blue eyes… [and] blond or auburn hair.”[iii] However, not all physicians of the 19th century agreed with these rather loose characterizations of a “scrofulous countenance.” For example, Phillips argues that the most reliable traits indicating predisposition to scrofula are more medically-derived characteristics, such as a lack of muscular development or irregular bowel activity.[iv]

Young man with a typical case of scrofula

Young man with a typical case of scrofula (Figure 1)

Nineteenth century physicians were unsure of the external source of scrofula (aside from a predisposed constitution), but there existed many theories. Some believed that its origins were more environmental, such as a compromised atmosphere or a tropical climate.[v] A relatively new argument at the time was that scrofula and a predisposition to scrofulous episodes were hereditary. However, this theory was largely unexplored due to the lack of general knowledge of genetics during the 19th century.[vi] Other nineteenth century explanations of the source of scrofula were temperature, contagion, consumption of animal-produced foods, and occupation.[vii]

19th c. Scrofula Treatments

An enormous number of treatments for scrofula existed during the nineteenth century; these treatments were not necessarily intended to be curative because scrofula was believed to be inherent to those who were affected. Instead, they were intended to lessen the symptoms of scrofula, most notably the large masses that grew as a result.[viii] Two particularly popular treatments were the use of mercury and iodine. Mercury was thought to induce a specific irritation of the lymphatic system that in turn neutralized the scrofulous irritation of the lymphatic system.[ix] Iodine was another popular treatment for scrofula, though there was no definite evidence supporting the explicit positive effect of iodine on scrofula – though Phillips noted in 1846 that his patients he treated with iodine exhibited improved appetite, healthier excretions, and “cleaner” tongues.[x]

Scrofula diagram (Figure 2)

Scrofula diagram (Figure 2)

Modern Understanding of Scrofula

Scrofula is now understood to be a tuberculosis infection of the lymph nodes. It is most often caused by the bacterium Mycobacterium tuberculosis, which can be spread through the inhalation of contaminated air.[xi] This proves that nineteenth century physicians who classified scrofula as a “disease of the constitution” were wrong; rather, scrofula is contagious infection caused by bacteria. This certainly provides clarity as to why inmates at Sing Sing were affected in such great numbers; cells had poor ventilation and the prison had overall poor sanitation, making Sing Sing vulnerable to the spread of scrofula.

Cholera in the 19th c.

Cholera is a disease that is most commonly associated with excessive vomiting and diarrhea, as well as extreme abdominal pain.[xii] In 1798, William Currie, M.D. published a comprehensive investigation of the symptoms, causes, and treatments of cholera in Of the cholera. According to Currie, cholera patients exhibit “a vomiting and purging concurring together, or frequently alternating with one another,” with the “evacuations both upwards and downwards are manifestly mixed with bile.”[xiii] Other symptoms include “spasmodic” contractions of abdominal muscles and limbs, cold sweats, coldness of the body’s extremities, and fainting.[xiv] Currie also notes the rapidity of the disease in its uptake, noting that a patient can first begin exhibiting symptoms and die in one day.[xv]

The most common factor nineteenth century physicians attributed as the source of cholera was a drastic change in temperature. Supposedly, this weakened the immune system and hindered the function of vital organs.[xvi] In his 1798 work, Currie also notes that an episode of cholera could be induced by “eating too freely of crude vegetables, and such substances as are of difficult digestion.”[xvii]

19th c. Cholera Treatments

The main course of action taken by nineteenth century doctors in the treatment of cholera was the dilution of “the bilious and other acrid matters” that are caught in the cholera-infected body. At the time, this meant patients were told to drink copious amounts of gentle liquids such as chamomile tea or warm water.[xviii] Another common course of action was to treat the patient with opium. Currie notes his routine of administering opium to his patients at least once per hour until they are no longer excreting; in the case of a patient vomiting up the opium given to him, another dose of opium would be given.[xix] Doctors were also instructed to keep their patients warm, either through a warm bath, or swaddling patients in warm, wet strips of flannel.[xx]

Flyer listing some measures to prevent cholera, 1849 (Figure 3)

Flyer listing some measures to prevent cholera, 1849 (Figure 3)

Cholera Epidemics at Sing Sing

Cholera outbreaks at Sing Sing were fatal to many inmates. In his 1835 account of his stay at Sing Sing, Horace Lane recounts how quickly the disease spread during an outbreak:

“I counted nine, and seven, and five or six a day for a fortnight. It was shocking to see the poor fellows carried along to their graves, and to see them taken two or three of a day right along-side of me, and in the night to be awakened five or eight times, by the hammer nailing up coffins; it was a dismal sound in their cells, and to hear them rapping on their iron doors (you know how they rap with their spoons on the door, when they want a keeper,) and groaning when they were taken, how awful a sound! I believe there was some died before the keeper could get to their assistance.”[xxi]

These epidemics occurred in the warmer summer months, and accounted for a large portion of the fatalities of Sing Sing.

Modern Understanding of Cholera

Today, cholera is understood to be a bacterial disease that is most commonly spread through contaminated water.[xxii] Surface or well water were often the sources of the cholera infection; this could be an explanation for why cholera affected so many at Sing Sing, seeing as the prison’s water supply was affected by the runoff of sewage from Ossining, NY.[xxiii] The cholera infection can also be found in grains that have been cooked in contaminated water, which could serve as another explanation for the influence of cholera on Sing Sing.[xxiv]

Dysentery in the 19th c.

Dysentery is a gastrointestinal infection characterized by inflammation of the intestines and bowel, resulting in the excretion diarrhea containing blood or mucus, abdominal pain, and fever. Nineteenth century doctors were unsure as to its causes; many believed that it was a drastic change in temperature (such as working outside in the sun all day and moving into a cold, damp cell immediately afterward), others thought it was caused by the consumption of “unripe and indigestible food” or “irregularity in taking food.”[xxv] In his 1865 publication “A Lecture on Dysentery: Its Symptoms, Pathology, Diagnosis, Prognosis, Causes, and Treatment” A.P. Dutcher, M.D. notes that doctors several years his predecessors theorized that dysentery could be a result of water that has been “contaminated” by limestone.[xxvi] Dutcher also warns of the contagious nature of dysentery – a person could contract it just by using the same restroom as another person infected with dysentery.[xxvii] However, Dutcher also notes that epidemic dysentery is not solely caused by contagion, but that it “owes its origin to some specific morbid agency in the atmosphere,” meaning that extreme outbreaks of dysentery in one area are not simply spread from person to person, but are mainly derived from unhealthy and contaminated air.[xxviii]

19th c. Treatment of Dysentery

Vials of Dr. McMunn's Elixir of Opium, sold in the 1830s (Figure 4)

Vials of Dr. McMunn’s Elixir of Opium, sold in the 1830s (Figure 4)

Dutcher remarks that the most effective types of treatments for dysentery were “antiphlogistics,” also known as anti-inflammatories.[xxix] Dutcher’s antiphlogistic of choice is “blood-letting,” the process by which doctors purposefully cause patients to bleed for a certain amount of time. However, Dutcher notes that not all of his contemporaries believed in blood-letting; some said that the act greatly weakened the patient and thus other anti-inflammatories should be used.[xxx] Other treatments for dysentery included opium which was primarily used to lessen pain, warm baths to soothe the patient’s muscles, and astringents which, when applied, caused body tissues to contract. Dutcher’s astringent of choice is acetate of lead.[xxxi] Dutcher also notes the importance of cleanliness and rest in the treatment of dysentery, stating:

“The patient must go to bed, between carefully aired cotton sheets; woolen would be better, if they are at hand. I most firmly believe that thousands cases of dysentery, especially of the chronic form, have proved fatal because the individuals persisted in attending to business, walking about, or sitting up.”[xxxii]

It is important to note that inmates suffering from dysentery while at Sing Sing did not receive such luxuries; if sick inmates were not deemed sick enough to be admitted to the hospital, they were still sent to work.

Modern Understanding of Dysentery

Doctors now know that dysentery is an infection of the intestines caused by a specific bacteria (shigella) that results in diarrhea containing blood or mucus. In developed nations, dysentery is no longer a pressing issue; however, in nations with poor sanitation, shigella bacteria are often spread through contaminated water or cold, uncooked food. Dysentery is not normally fatal, and in most cases it will cease on its own; however, people with dysentery should remain hydrated, make sure to rest, and stay in bed so as not to spread the disease to others.[xxxiii]

– Abby Wheat

[i] Phillips, Benjamin, F.R.S. “Chapter 2: My Own Ideas of the Nature of Scrofula.” In Scrofula: Its Nature, Its Causes, Its Prevalence, and the Principles of Treatment, 26-38. London: H. Balliere Publisher, 1846. 27.

[ii] Phillips, “Chapter 2,” 26.

[iii] Phillips, “Chapter 2,” 28.

[iv] Phillips, “Chapter 2,” 30-31.

[v] Phillips, Benjamin, F.R.S. “Chapter 9: Causes of Scrofula.” In Scrofula: Its Nature, Its Causes, Its Prevalence, and the Principles of Treatment, 99-242. London: H. Balliere Publisher, 1846. 99-100.

[vi] Phillips, “Chapter 9,” 99.

[vii] Ibid.

[viii] Phillips, Benjamin, F.R.S. “Chapter 10: Treatment of Scrofula.” In Scrofula: Its Nature, Its Causes, Its Prevalence, and the Principles of Treatment, 243-305. London: H. Balliere Publisher, 1846. 255.

[ix] Phillips, “Chapter 10,” 271.

[x] Phillips, “Chapter 10,” 276.

[xi] Vyas, Jatin M., MD. “Scrofula.” MedlinePlus Medical Encyclopedia. December 7, 2014. https://medlineplus.gov/ency/article/001354.htm.

[xii] Currie, William. 1798. Of the cholera. [electronic resource]. n.p.: [Philadelphia : Printed by William T. Palmer, 1798], 1798. Fordham Libraries Catalog, EBSCOhost. 1.

[xiii] William, Of the cholera, 1.

[xiv] Ibid.

[xv] Ibid.

[xvi] William, Of the cholera, 2.

[xvii] Ibid.

[xviii] William, Of the cholera, 3.

[xix] Ibid.

[xx] William, Of the cholera, 4.

[xxi] Lane, Horace. Five Years in State’s Prison; Or, Interesting Truths, Showing the Manner of Discipline in the State Prisons of Sing Sing and Auburn, Exhibiting the Great Contrast between the Two Institutions, in the Treatment of the Unhappy Inmates; Represented in a Dialogue between Sing Sing and Auburn. 4th ed. New York: Luther Pratt & Son, 1835.

[xxii] Mayo Clinic Staff. “Cholera.” Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/cholera/basics/definition/CON-20031469.

[xxiii] Mayo Clinic Staff. “Cholera Causes.” Mayo Clinic. June 16, 2016. http://www.mayoclinic.org/diseases-conditions/cholera/basics/causes/CON-20031469.

[xxiv] Ibid.

[xxv] Dutcher, A. P., MD. “A Lecture on Dysentery: Its Symptoms, Pathology, Diagnosis, Prognosis, Causes, and Treatment.” In The Medical and Surgical Reporter: A Weekly Journal, 441-45. 28th ed. Vol. 12. Philadelphia, PA: Alfred Martien, 1865. 441.

[xxvi] Dutcher, “A Lecture on Dysentery,” 441.

[xxvii] Ibid.

[xxviii] Ibid.

[xxix] Ibid.

[xxx] Dutcher, “A Lecture on Dysentery,” 442.

[xxxi] Dutcher, “A Lecture on Dysentery,” 443.

[xxxii] Dutcher, “A Lecture on Dysentery,” 444.

[xxxiii] “Dysentery.” NHS Choices. February 18, 2015. http://www.nhs.uk/Conditions/Dysentery/Pages/Introduction.aspx.

Images

Figure 1: Bramwell, Byrom. Young Man with a Typical Case of Scrofula. 1893. General Collections, Wellcome Library, London. In Atlas of Clinical Medicine. Vol. 2. Edinburgh: T. & A. Constable, 1892-1896. https://wellcomeimages.org/indexplus/image/L0076911.html.

Figure 2: Phillips, Benjamin. Phillips’s Scrofula. 1846. Royal College of Physicians of Edinburgh, Edinburgh. In Scrofula : Its Nature, Its Causes, Its Prevalence, and the Principles of Treatment. London: H. Balliere Publisher.

Figure 3: Notice. Preventives of Cholera! 1849. New-York Historical Society, New York. In New-York Historical Society Museum and Library. http://www.nyhistory.org/exhibitions/plague-gotham-cholera-19th-century-new-york.

Figure 4: Dr. McMunn’s Elixir of Opium. Digital image. Inspire Malibu. http://www.inspiremalibu.com/blog/drug-addiction/guide-to-drug-scheduling-in-the-united-states/.