Origins of the Fever Hospital

No. XCII. Extract from an Account of the Institution to prevent the Progress of the Contagious Fever in the Metropolis.* By THOMAS BERNARD, Esq.

[*This paper was originally prepared for the Reports; but its insertion has been deferred on account of its having been printed separately, and distributed by the desire of the Committee of the Fever Institution.]

THAT the Poor of every populous  town are peculiarly liable to the attacks of contagious distempers, is a fact which has been stated by Dr. Murray in a late publication, and of which a variety of melancholy evidence may be adduced. To those only, who have been led to explore the recesses of poverty and disease in the metropolis, can it be known how many circumstances there I are, both within and without the dwellings of the poor, contributing to the generating and spreading of infection; - fatal and ruinous in their effects, tho easily corrigible by the attention of the other classes of society.

By physicians of the dispensaries it had long been lamented that, among the close and unhealthy courts and alleys of the metropolis, the power of medicine has proved inadequate to check the progress of contagious fever, while parents and their children were, in all cases, to remain within their infected walls. Even if health were restored by medical skill and attention, still the habitation remained subject to the acquired contagion, for want of that purification, the expense and trouble of which, tho inconsiderable in themselves, were beyond the scope and extent of the funds of institutions, often pressed upon by a number of claimants, exceeding their means of relief.

It had therefore been the anxious of some of the Directors of those charities, that an adequate remedy might be adopted for this evil. In the mean time, in May, 1796, there had been formed at Manchester* [*It should be noticed that fever-wards for preventing the spreading of infectious fevers had been proposed by Dr. Haygarth in 1775; and had been established by him in Chester, as early as 1783.] the dignified and exemplary establishment of HOUSES OF RECOVERY to check the progress of the infectious fever among the poor. The members of the Society for bettering the Condition of the Poor have contributed to make known the regulations of this charity, and its extraordinary and beneficial effects, in alleviating one  of the greatest calamities, to which our necessitous brethren are subject. For detailed information on this subject, the reader is referred to a recent Letter of Dr. Haygarth's on the prevention of Infectious Fevers,* [* The practical conclusions  in Dr. Haygarth's letter on the prevention of infectious fevers, are so deserving of attention that I insert them as a note. 1st. Medical, clerical and other visitors of patients in infectious fevers, may fully perform their important duties with safety to themselves. 2d. In any house, with spacious apartments, the whole family, even the nurses of a patient ill of a typhous fever, may be preserved from infection. 3d. Schools may be preserved from febrile infection. 4th. In an hospital infectious fevers ought never to be admitted into the same wards with patients ill of other diseases. 5th. When an infectious fever is in a small house, the family cannot be preserved from it, unless the patients are removed into a separate building. ] - to the three volumes of Dr. Ferriar's  Medical Histories and Reflections, to Dr. Willan's Reports on the Diseases in London, - and to the above mentioned pamphlet of Dr. Murray's, which has been lately published by the desire and at the expense of the Society. In their Reports * [* See the Society's Reports, Vol. I. p. 98, and Vol. II. p. 224. and p. 95 of Appendix.] there will be found some account of the Institution at Manchester, from whence I have selected the following circumstances.

1st. As to the comparative number of contagious fevers in Manchester, for three years previous to the establishment of the House of Recovery in May, 1796, and in one year succeeding its establishment, it appears to have been as follows: From Sept. 1793, to May. 1796, - 1256 From May, 1796, to May, 1797, - 26

2d. With regard to its effect on general health, as ascertained by the number of fever cases admitted into the Manchester Infirmary, before and after the establishment of the House of Recovery, there. were.

Fever patients in January 1796, 226
in January 1797, 57

3dly. As to the total of patients in the Manchester Infirmary, tho before the establishment of the House many cases were refused on account of the greater press and claim of fever patients, there were,
From June 1795, to June 1796, - 2880
From June 1796, to June 1797, - 1759
From June 1797, to June 1798, - 1564

4th. In order to shew the comparative in the House of Recovery, upon the fever cases admitted into it, I proceed observe that, from 19th of May, 1796 to 1st of January, 1797, there were admitted 274; of these there died 21; admitted in 1797, 349; of these there died 27; admitted in 1798, 381; of these there died 21. The proportion of deaths in the House of Recovery, for these years, will therefore appear to be as follows: in 1796, not quite 1 in 11: in 1797, about 1 in 13: and in 1798, less than 1 in 18. It is no small gratification to observe the progress of success in the Manchester House of Recovery; a success which maybe imputed to two circumstances; 1st, that the Poor do now apply more early and more willingly; and 2dly, that they apply with more hope and confidence of recovery.

5th. The limits of the Manchester House of Recovery were, at first, necessarily confined to a few streets in the vicinage. They are now extended, without distinction, not only to all Manchester, but also to all its neighbourhood for three miles round, as far as patients can conveniently be brought: and yet with all this enlarged scope of benevolence, and with the admission of every fever patient to be found in those extensive limits, the number of patients in the House of Recovery were, when I visited it August, 1798, nineteen; and when I visited in October, 1799, eleven.

6th. To facts, tending to the benefits of such an institution in checking the progress of infection, and in diminishing the general proportion and prevalence of disease and mortality to which our nature is subject, I will add a statement of the relative bearings of expense and effect; and observe that the fever patients cured in the Manchester House of Recovery, in the year 1798, were three hundred and sixty; all of whom had their and property cleansed, and purified from contagion, the progress of infection completely stopped. The expense of this boon to human nature amounted to SEVEN HUNDRED POUNDS.

Impressed by these circumstances, and by other corroborating facts, for the detail of which the reader may refer to .their Reports, and to Dr. Haygarth's and Dr. Ferriar's publications, the Society has directed its attention to the subject; and in the early part of the preceding winter, at the request of their Committee, Dr. Murray, one of the physicians to the Public Dispensary in Carey-street, prepared and published his "Remarks on the Situation of the Poor in the Metropolis, as contributing to the Progress of Contagious  Diseases; with a Plan for the Institution of Houses of Recovery, for Persons infected by Fever." The pressure of the existing scarcity had delayed for a few the progress of any active measures on the subject. A meeting, however, was at length called for the first of May, to take measures for forming the institution in the metropolis.

The attendance at this meeting was such as, from the nature of the subject, might have been expected. The Duke of set, the Earl of Pomfret, the Bishop of London, and the Bishop of Durham (who, by desire of the meeting, took the chair) together with respectable inhabitants of the metropolis, (after the certificate from several physicians of hospital and dispensary in London, as to the prevalence of infectious fever, had been read) adopted unanimously upon the motion of Lord Sheffield the resolutions that it appears to this meeting, by a certificate from the physicians of the hospitals and dispensaries in London, that the contagious malignant fever been for some time past, and now is, prevalent in the metropolis: and it been occasioned by individual infection, which, with proper care, might have been immediately checked - or has been produced, or renewed, by the dwellings of the poor not having been properly cleansed and purified from contagion, after the fever has been prevalent in them:- that it appears that this evil (the injury and danger of which extend to every part of the metropolis) might be prevented, by cleansing and purifying the clothes, furniture, and apartments, of persons attacked by this disease, and by removing them from situations where, if they remain, the infection of others is inevitable:- and that a SUBSCRIPTION be immediately set on foot, for the purpose of forming an Institution for checking the progress of the contagious malignant fever in. the metropolis,* [*
Previous to the opening the House of Recovery in Gray's Inn Road, a reference was made to the Medical Committee, and the following Report was  made and signed by Sir Walter Farquhar, Dr. Garthshore, Dr. Latham, Dr. Lettsom, Dr. Cooke, Dr. Willan, Dr. Stanger, and Dr. Murray, being dated Nov. 17, 1801.
      From the experience of Chester, Manchester, Waterford, and other places where houses for the reception of persons in fever have been established, we are satisfied that the number of contagious fevers has been greatly diminished, not only in towns, but in the very district and neighbourhood, where Houses of Recovery have been situated. From this circumstance, therefore, as well as from our own know ledge, and the statement of those who have the best means of observation; we are of opinion, that, the proper and necessary regulations for the internal management of the House in Gray's-Inn-Lane-Road being adopted, there will be no reasonable ground of apprehension on the part of the neighbouring inhabitants. On the contrary, we believe that there will be much less danger of the atmosphere in that neighbourhood being infected by the proposed House of Recovery, than there now is in the populous districts of the town, from the prevalence of fever in workhouses, or in the habitations of the poor. 
    At the same time, we cannot help suggesting to the committee, that the present establishment will not, in itself, be adequate to the general relief of our extensive metropolis, although the measure is, in our opinion, of the utmost importance and necessity ; and is imperiously called for by the present situation of this great city; yet we conceive that it cannot be effectually carried into execution without the assistance of government, in aid of private donations, and of such parochial contributions, as the good sense, or particular, circumstances, of some parishes may induce them to supply. In a national as well as a municipal view, there is hardly any object of more consequence, or which ought, in our opinion, to be more generally the concern of all ranks of people, of the rich as well as the poor, than the adoption of measures for checking the progress of infectious fever, so as to prevent its diffusing itself from unknown and unexamined sources, and spreading desolation through the whole town; and thereby unavoidably affecting many parts of the kingdom at large. The preservatives against this calamity are now generally and practically known; experience has afforded the most unequivocal and satisfactory evidence in their favour: and while other places within the British isles, with far more limited resources, have successfully adopted means of remedy and prevention against this evil, we cannot but express our confident hope that the opulent cities of London and Westminster will not be backward in imitating so wise and so benevolent an example]  and for removing the causes of infection from the dwellings of the poor, upon a plan similar to that which has been adopted with great success and effect at MANCHESTER.

OBSERVATIONS

It is a curious and interesting fact that the establishment of one solitary House of  Recovery at Manchester, with an expense not exceeding  £700. a year, should have nearly put an end to the contagious fever in that place; a place where the cotton mills and a variety of other circumstances, aided by extreme population, furnish so abundant a supply for the renewal of infection. That, in one year, the average of fever should be diminished from 471 to 26, - the fever cases of the general Infirmary to one fourth - their other patients to nearly half, - and the proportion of mortality under the fever from a ninth to an eighteenth, afford a pleasing example of what may be done by active and intelligent benevolence, - labouring for the benefit of its fellow creatures. This, however, has been attended with many other advantages, in the diminution of the general mortality of that and in the improvement of the domestic comfort and well-being of the poor,

In the common cases of infectious fevers, if we suppose that only one in eight dies (and the proportion is sometimes one in four) yet we must take into the consideration, that of the other seven, many are nearly ruined in health and circumstances. and hardly any have the infection entirely removed from their houses. Such is the condition of parts of the metropolis, from whence the infection of fever, tho occasionally suspended by a frost, has not for years been effectually removed; and:in which, when the sad tale of indigence and mendicity is unfolded, the infectious fever so frequently occurs as the original cause of their calamity.

Whatever may have been the call for this charity in Manchester, the circumstances of London do still more imperiously demand it; and I shall not willingly believe, that the energy and liberality of the metropolis will not be adequate to the increased sphere of action. If we can commence our operations only in a limited district, we may hope, even in a few months, gradually to extend its sphere, as has been rapidly and effectually done at Manchester, and soon embrace the whole metropolis. The position,- the local situation,- being once obtained, and the advantages pursued, the whole operation may be easily effected.

It has been said, that all the relief that is wanted, may be supplied by the existing medical hospitals. The evil is not recent, nor unknown to the faculty; nor is the remedy a matter of theory or of speculation. Five years experience have been supplied by the well-directed philanthropy of the inhabitants of Manchester. Yet, in all that time, no movement has been made in the metropolis; nothing has been done, And, indeed, it should seem, that before any effectual remedy for contagious fevers can be applied by our medical hospitals, the regulation, which confines the time of admission to one day in a week, must be given up. Those patients, who are the proper objects of such an institution, must be sought for in their wretched habitations,and brought in at all times, not as a mere boon, or personal favour, not upon the interest of a governor, but as an act of free benevolence; applying its operations, upon a general system of municipal policy, for the benefit of the whole of the metropolis; and extending those operations from the roof of the hospital into the dwelling of the patient, so as to remove the very vestiges of infection.

In one way, indeed, the medical hospitals may both assist, and receive benefit from, this object; by appropriating some of their vacant wards exclusively for fever patients: a measure that not only might increase their funds, and their means of being useful, but would, if we may judge from what has passed at Manchester, eventually relieve them by diminishing the number of patients.

Before I conclude, I should observe that, tho the mild weather of the two preceding winters has, at present, augmented the contagious fever* [The following curious table of the annual average number of deaths from fever (including the articles   in the metropolis, yet it has • The following curious table of the annual average number of deaths from fever (including the articles malignant fever, scarlet fever, spotted fever, and purples), in each period of ten years, from the beginning of the last century, has been compiled by Dr. Willan, from the London Bills of Mortality
Average of ten years from 1701 to 1710 - 3230
1711-1720 - 3656
1721-1730 - 4037
1731-1740 - 3432
1741-1750 - 4351
In the year 1750 - 4294
Average of ten years from 1751-1760 - 2564
1761-1770 - 3521
1771-1780 - 2589
1781-1790 - 2459
1791-1800 - 1988
In the year 1800 - 2712
In the first quarter of 1801, 725 deaths, equal to an annual account of 3096
Annual average of the first 50 years - 3951
last 50 years - 2424
whole century - 3188] not been in a state of increase for some years back. From the period when it raged under the name of the plague* [* The want of air and cleanliness appears to be the great cause both of the plague, and of the malignant fever. There seems to be a considerable degree of affinity between these two diseases. In a late publication on the increase and decrease of different diseases, and particularly of the plague, Dr. Heberden, junior, has given a very curious detail of information on the subject. Many circumstances, and among others, that of the malignant fever preceding and following the plague, seem to prove that the plague is merely an aggravated malignant fever. Dr. Haygarth observes that the plague is a species of fever; and that it does not render the atmosphere infectious farther than a few feet from the patient or the poison. Dr. Haygarth's Letter, page 157.] London, and spread general and havock, a gradual diminution ( appears by the bills of mortality) had taken place at the end of the 17th century. Between that and the year 1750, it had again considerably increased; and we then find, that the deaths by fever, in that year, amounted to 4,294, being almost a fifth of the whole mortality of London. The improvements , in the edifices of the metropolis, and the attention to domestic and personal cleanliness which was then awakened, have since I reduced the mortality by fevers, except at  the present time, to less than half its average in the year 1750; yet there has always existed abundant reason for deploring, on the score both of humanity and of policy, the individual misery and public loss occasioned by the ravages of contagion. The increased mortality from this cause within the last 18 months, has more especially evinced the necessary of measures being adopted for remedying this extensive evil. Whatever difficulties may obstruct the attainment of so great and so desirable an object; I trust that the friends of human nature will not shrink from their duty; but will proceed in the confidence, that by the united efforts of medical skill and active philanthropy, we shall soon check the progress of the contagious malignant fever in the metropolis, as effectually and beneficially as has been done at Manchester.

8th May 1801

Reports of the Society for Bettering the Condition and Increasing the Comforts of the Poor,
Vol. III (1802) p.271-288