The old mediaeval Burgh was dirty and unsanitary. Improvements did not start until the 1700s. The infirmary was built in 1777 at a cost of £823 and more than 330 patients were treated during 1789-90. In 1790 there was one physician, 3 surgeons and 4 apothecaries in Dumfries and in 1791 there were 20 'lunatics' resident at the infirmary - a fact that the minister of the time put down to the excessive use of spiritous liquor in the town. The Crichton Institution opened in 1839 and the infirmary's lunatic ward closed in that year. In 1870 it had become the Dumfries and Galloway Royal Infirmary and there were two physicians and two surgeons. It was funded by donations, legacies and annual subscriptions.

Undoubtedly the greatest force for health and hygiene reform in the 19th century was an epidemic whose effects were increased by the overcrowding and poor sanitation that the Industrial Revolution had brought. This was Cholera. The method of spread of this highly infectious disease was still unknown in the early 19th century but it was chiefly working class areas that suffered. Occasionally it spread to the middle class areas of towns and was a considerable interruption to trade and social life. It was considered that an infectious 'miasma' arose in the parts of the town affected, a little like a cloud of disease, and moralists of the time suggested that intemperance and lack of religious faith had led to this divine punishment of the poor.

An epidemic reached North West Europe from its source in India in 1831 and crossed from Hamburg to Sunderland in October of that year. By January 1832 it reached Haddington and Edinburgh and was in Glasgow by February. Dumfries was alerted and on 15th March a rigorous Board of Health was set up to tackle the sanitary condition of the town. Poorer houses were cleansed with hot lime and a soup kitchen for the poor improved health in the winter months. The older tenements and closes were cleaned up. The town's water supply, however, was the sore point; half a dozen or so seepage wells supplied some of the water but the bulk of the supply was taken by the "burn drawers" in their dirty wheeled barrels from just below the main sewerage outlet in the Nith and sold at a penny a bucket. McDowall, in his history, described it as "pleasant to no one except an enthusiast in entomology".

A burn drawer selling river water

Carlisle had a small outbreak of cholera in July and Tongland lost two people in the same month and then on the 15th September an elderly middle class widow, Mrs Mary Paterson, who lived in English Street, took the disease and died the next day. For the next week there was a death every day. Of the 17 cases from the 15th to 24th September 9 were fatal. On the 25th, which was in Rood Fair week with the trades Procession and the Riding of the Marches, 14 new cases and 9 deaths were announced. All the celebrations were cancelled. On the 26th there were 9 new cases and 5 deaths; 27th 37 new cases and 5 deaths; 28th 68 new cases and 19 deaths. 5 extra doctors were brought from Edinburgh and 2 from Castle Douglas. Two Dumfries doctors, William McCracken and John McGhie, caught the disease and died. The infirmary refused cholera cases and so an emergency hospital was established in the old granary at the foot of English Street. The Academy closed and St Michael's church was vacated from fear of the cholera graves.

The effect of this disease on the sufferer was particularly unpleasant. The method of transmission is via water and thereafter by house fleas. The patient has very fixed facial features and suffers from dehydration and salt loss which is generally the cause of death, which may occur in a few hours. Thomas Latta, a surgeon in Leith, argued correctly that lack of fluid was the problem and tried his new treatment of intravenous injections of saline on four cases in Edinburgh, three of whom promptly recovered. His report on his method was noted by the London Board of Health, but was only one of the many other remedies sent to them and this major advance in treatment was laid aside. Cholera scared people and there was a suggestion that fear itself predisposed them to infection by cholera. There were two bodies of opinion, one, the contagionists, who argued that it could pass from person to person directly or via clothing or goods. The supporters of the 'miasma' theory held that infection appeared as a result of harmful effluent from rotting or stagnant material. Certainly the weather in Dumfries in September 1832 was very heavy and overcast and the sky had a peculiar aspect. When the town was viewed from the surrounding heights a dense mass of cloud appeared to hover over it which spectators compared to a vast funeral pall. The effect was increased by the burning of tar in the streets. Of course we now know that good water hygiene is the best prevention.

October 2nd was the worst day of all with 55 new cases and 44 deaths. The next day was market day and the town was virtually deserted, only the rattle of hearses on the cobbles and groups of mourners heading for St Michael's.

This was the zenith of the epidemic and slowly the number of new cases started to decline. No one died on the 30th October and by 27th November the town was declared clear. In total there were 837 cases in Dumfries and 421 deaths. Maxwelltown had 237 cases and 127 deaths. These were the official figures but a higher figure of nearly 700 deaths was calculated by counting the number of coffins made during the attack. Out of a population of 12,000, 6% is a high toll. Most who died are buried in a special plot in St Michael's graveyard - here gangs of gravediggers were busy for weeks piling coffins tier upon tier. The memorial says 420.

There had been proposals to introduce a clean gravitation water supply into the town since 1765. Now the agitation increased but still nothing was done. In 1848 cholera struck again. The infant Scottish Board of Health, with little real power, sent Dr John Sutherland from Glasgow, a man of strong personality. He found corpses lying in the streets and no action being taken at all. The 1832 Board of Health had not been reconstituted and the Town Council said that far too much had been spent in that epidemic and that they had no intention of spending anything this time. The doctor had strong words with these "benighted provincials" as he called them, got a medical board organised, a house cleansing programme under way and immediately tracked the cause to the water supply and cleared up the epidemic, but not before 431 people had died out of 814 cases. This was the final push required for the water supply agitation and in 1851, clean gravitation water from Lochrutton Loch was introduced to the town. The fountain in the High Street was installed to celebrate the event.

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