On the Influence of Panic in Propagating Fever
Notice concerning the fever that occurred in the Magdalene Asylum of Edimburgh, in the spring of 1821, as illustrating the influence of panic in propagating contagious diseases, by Robert Hamilton, M.D. F.R.S.E. M.W.S., surgeon to the Asylum.
On visiting the Magdalene Asylum on Monday, the 2d of April 1821, I learned that a girl was indisposed, and in bed. I was informed that in the morning she had gone, in her usual health, to the washing-tub, her general occupation, and that she had scarcely commenced, ere she complained of violent pain in the head, particularly the forehead, attended with giddiness, sickness, cold shivering, and occasional flushings, together with pain in the back, and uneasiness in the limbs. I found the pulse at 96; the tongue foul, and the thirst considerable. Previous to my seeing her, she had taken some opening medicine, which had considerably relieved the head.
Fever was at this time prevalent in the town; and, perceiving the possibility of infection, I directed her to be immediately removed to the sick-room, and there to be kept as isolated as possible; her bed-clothes to be placed in cold-water, her room to be well ventilated, and then locked up. I ordered an emetic to be given immediately, and a smart purge to be administered a couple of hours afterwards.
I again saw her on Tuesday. The medicines had operated powerfully, but without any marked alleviation of symptoms; and now recognising her as labouring under continued fever, I sent her, in conformity to the invariable practice of the establishment in cases of infectious diseases, to the Queensberry-House. I ordered all the linens to be put into cold water, and the sick-room to be fumigated.
Next day (Wednesday), I found that, on the preceding evening, two other girls, oppressed with disease, had betaken themselves to bed. They had all the symptoms of continued fever distinctly but not very violently marked. They were immediately sent to Queensberry-house; and the precautionary measures which had been used in the former case were carefully repeated in the present.
In an institution where there are from forty to fifty individuals, necessarily confined within their own premises, and which is frequently visited by ladies, whom the purest benevolence incites to hold intercourse with the most degraded of their sex, it is particularly necessary to guard against the germ of contagion. These considerations led to the very diligent use of all the means generally regarded as most efficacious in preventing the spread of infection; and the anxious employment of these precautions probably attracted the attention, and awakened the fears of the inmates, who, cut off from intercourse with the world, are peculiarly, alive to all that takes place within the walls of the Institution.
Be this as it may, a very decided alarm now began to spread among the women. This apprehension was heightened, from its being supposed that those already suffering caught their complaints from clothes brought to the house to be washed, and to which a suspicion of infection was attached.
At an early visit (about 11 a. m.) on Thursday, I found that three others had sickened during the preceding evening, and had betaken themselves to the sick-room; and that, during the course of the morning, five more had reported themselves sick. On seeing them, I immediately ordered them off to the hospital; but before this could be effected, three more had fallen under the disease. They were all apparently very ill; some with cold tremors and shiverings, others with flushed face and full pulse; some were overcome with nausea and headache, others with retching and vomiting. The whole, amounting to eleven individuals, left the house at four in the afternoon. I ordered their linen to the tub; directed every room, and especially those which any of the women had occupied, to be fumigated; in short, the whole house to be washed and ventilated in the most thorough manner possible. Next day I visited these cases in the hospital. They all appeared decided cases of idiopathic fever, and were so regarded and treated by the learned Professor of the Practice of Physic.
At my evening visit a few hours afterwards (at 9 p. m.), I found eight more cases already in the sick-room. These appeared quite as ill as those I had seen in the morning. Some were leaning their heads against the cold wall from the violence of the headache; some were retching and vomiting, unable to lie down; some were shivering from cold, with the cutis anserina, and others flushed and burning with heat.
Here, then, in the course of four days, out of a community of less than fifty individuals, there were twenty-two apparently labouring under fever. Some had been ill for several days, and their cases were putting on all the decided features of synochus; and the latter cases appeared even more distressing than the former. The minds of the most stout hearted in the house, not excepting the superintendants, participated in the alarm; and some of the most active and intelligent of the community were prevented from succumbing under their apprehensions and fatigue, solely from the necessity they felt to exert themselves to the utmost.
It now struck me that there was certainly much delusion in all this, and that much must be owing to panic and imitation. Determining, at all events, to act upon this belief, I went to the sick-room, and in very decided language, stated my opinion. I told them that such rapid spread of disease was never heard of, and insisted that the fumigation must have fortified them against the most virulent contagion:—that though I had no reason to suppose that they wished to deceive me, yet I was satisfied they were deceiving themselves;—that they were yielding to their fears alone, and getting ill merely because others had done so before them. I also collected the women that had hitherto remained well, and pointedly stated the same truths to them. I assured them that they were quite fortified against all infection;—that most of those who had taken ill had probably injured themselves by their apprehensions;—that they had thus exposed themselves to the disagreeable process of a long illness that I had seen them in the hospital undergoing a severe treatment, and a painful regimen;—that there was no fear for them, and if they would only keep a good heart, I would insure them against indisposition.
The effects produced were as decisive as I could have wished. The minds of all in the house were immediately re-assured. The tide of opinion set in in the contrary direction: and now they were as confident as formerly they had been desponding. Of the eight patients then in the sick-room, several recovered in the course of the same night. They found that they could sit up, and walk about a little.
Next morning this change in the general mind was still more apparent. Several were going about their usual employments, who were far fitter for their beds; and one girl in particular, who was really oppressed with disease, and threatened with severe typhus, disobeyed my positive injunctions to lie down. With difficulty she was persuaded to take an ernetic and cathartic, which for a time relieved her. After much struggling for two or three days, she was at length forced to yield to the progress of the complaint, and was conveyed to the hospital. The other seven, however, were speedily re-established in perfect health, and in a few days afterwards they were all engaged in their usual occupations.
Of the other inmates of the house, in like manner, none were now taken ill for the period of twenty-three days. By this time several had returned from the hospital, and relapsing, were sent back again. On the 28th of April, the first new case was reported; on the 30th, the second; on the 2d of June, the third; and on the 28th June, the fourth and last; and from that day to this we have had no threatening of continued fever in the Institution.
The change of mind, therefore, which was induced on the evening of the 5th of April, appears effectually to have stopt the progress of the disease in seven incipient cases, and to have entirely checked the fearfully rapid progress which it was every moment making through the house.
From Notice concerning the fever that occurred in the Magdalene Asylum of Edimburgh, in the spring of 1821, as illustrating the influence of panic in propagating contagious diseases, by Robert Hamilton, 1824.