The General Dispensary in Aldersgate Street having been started in 1770 with one physician, Lettsom was chosen additional physician in 1773, and threw himself into the work with great zeal[242]. In the first twelvemonth he saw many cases of fever, as in the following table:
_Lettsom's practice in Fevers at the Aldersgate Dispensary._
Febris April May June July Aug. Sept. Oct. Nov. Dec.
hectica 2 2 4 13 4 2 3 4 9 inflammatoria -- -- -- -- -- -- -- 1 1 intermittens 3 1 7 1 1 1 1 -- 2 nervosa 4 3 4 14 7 11 4 5 1 putrida 14 19 14 25 14 21 34 22 11 remittens 6 10 5 4 3 6 7 3 12 simplex vel -- 2 1 6 2 5 4 5 -- diarium
1774 Total in Febris Jan. Feb. March 12 months Died
hectica 12 18 13 86 3 inflammatoria 1 -- 2 5 -- intermittens 1 2 2 22 -- nervosa 1 5 4 65 3 putrida 6 7 5 192 8 remittens 13 10 3 82 -- simplex vel -- -- 4 29 -- diarium
The nervous, putrid and remittent fevers, belonging, to the same group, make up the bulk of the fevers. The hectic fevers were almost all of children. The fatal cases of fever were fourteen, the fatal cases in all diseases for the year having been forty-four. What these putrid, nervous and remittent fevers were, will now appear from some of Lettsom's descriptions. Fevers with symptoms of putrescency were marked by nausea, bitter taste, and frequent vomiting, by laboured breathing and deep sighing, offensive breath, sweats offensive and sometimes tinged with blood, almost constant delirium, the tongue dry, the tongue, teeth and lips covered with black or brown tenacious foulness, thrush and ulceration in the mouth and throat, the urine with a dark sediment, the stools excessively nauseous and foetid, and blackish or bloody, the eyes horny or glassy, with the whites often tinged of a deep blood colour, spots on the skin like fleabites, or larger haemorrhagic vibices, bleeding from the gums, nose or old ulcers, hiccup near death, often a cough through the fever. Lettsom's treatment consisted in good liquors, Peruvian bark, and above all fresh, or "cold" air: "When it is considered that putrid fevers originate in close unventilated places, the introduction of fresh air seems so natural a remedy that I have often admired its aid should have been so long neglected[243]." Accordingly he persuaded the poor people to open their windows, and dragged the sick out of doors as soon as it was safe to do so; the effects, he says, were wonderful. His fifty-one cases are most valuable illustrations of the perennial fever in the crowded parts of London: