No. CXXXVII
An Extract from a further Account of the London Fever Institution by THOMAS BERNARD,
Esq.
In the preceding year, ending the first of May 1807, there were 93 fever patients admitted into the House of Recovery in Gray's Inn Lane.* [
* This statement is taken from the annual Report of the Institution] During the months of August
and September, 1806, febrile infection was
more prevalent than it had been for some time in the metropolis. Above a third of the
fever patients of the year were admitted
in those two months: but in the majority of
those cases, the symptoms were mild, and
the termination favourable. After that period, however, and more especially in the early part of the present year 1807, fevers,
tho less numerous, were more malignant; extending rapidly to all who were exposed to the influence of the contagion; and if neglected,
or injudiciously treated in the commencement, proving
very frequently fatal,
notwithstanding every subsequent attention.
By this cause, and by another that will be
stated, the proportion of mortality upon the
fever cases in the house, has been much increased.
Eighty patients have been
recovered and restored to their friends; and
14 have died in the preceding year.
In one instance, a whole family, consisting
of five persons, the father, mother and two
children, and the nurse who had been sent
by the parish to attend them, were admitted
at the same time. The father and mother
had been ill 10 or 11 days, and both died
within two days after admission; the two
children and the nurse, who had been recently
attacked, recovered. It will probably
occur to the reader, that if, instead of sending
a parish nurse to the family, the parish officer had procured the two parents immediate
admission to the House of Recovery,
the lives of the father and mother, and the sickness and sufferings of the nurse and children,
would have been saved, at the same
time, the danger of the diffusion of febrile
contagion in the parish would have been
prevented, and (what is of less moment) a
considerable part of the expense avoided.
In another instance five young people in one family had been seized with fever. Two
of them had died, before any application was
made to the Institution: of the others, two
were admitted, and recovered. In a third
instance, a family of six persons, a father,
mother, and four children, all occupying one
room in a dirty court in the Strand, were
found labouring under fever at the same
time, having been successively attacked within
a few days of each other. The father and
one child were in a state of convalescence:
the mother and the three remaining children
were received into the house, and restored to
health.
Cases, however, of contagious fever have
not been confined to the habitations of the poor. Four of the patients in contagious
fever, received during the preceding year,
were the domestics of persons in a respectable
rank of life; one of them a servant in a
family in one of the great squares of the
metropolis. Many other instances, in which
contagious fever has found its way into the
mansions of the opulent, have come within
the notice of the Institution. Its utility therefore is not confined to the poor. For it not
only contributes to stop the progress of contagion
from its source; and, by cleansing and
purifying the habitations of those who are
most subject to it, to prevent its diffusion among the other classes of the community;
but it also affords the higher ranks an open
and comfortable asylum for their domestics,
when attacked by contagious fever, and thus ensures the safety of the family and connections.
The purification of the houses of the poor
from febrile infection, by lime-washing and
fumigation, is one of the most important benefits
of the Fever Institution. This cannot be properly and effectually done, without the
removal of the patients either into the House
of Recovery, or to some other place. The
lime-washing has been sometimes objected
to by the occupiers, or the landlords, and in
some few instances has been thought to be
unnecessary. It has however been applied
whenever permission was given, and any
contagion was apprehended. Thirty houses
have been lime-washed by the Institution in
the preceding year; and these and all the
other habitations of fever patients have been
cleansed and fumigated.*
[* It may not be improper to describe the process of fumigation, which is extremely simple, and easily performed. Take an equal quantity of powdered nitre and strong vitriolic acid, or oil of vitriol, (about six drams of each is sufficient); mix them in a tea-cup, stirring it occasionally with a tobacco-pipe, or piece of glass; the cup must be removed occasionally to different parts of the room, and the fumes will continue to arise for several hours. The oil of vitriol should be in quantity, not weight. ] The success of
this process has been equal and unvaried.
No second application for admission into
the House of Recovery, has ever been made from any apartments, where the lime-washing. cleansing, and fumigation have been
completely applied.
While we endeavour to appreciate the
value of this part of the preventive system,
and consider that it has been found, that,
upon an average every patient in fever, where
no attention is paid, infects five other persons,
it is to be lamented that applications to
the House are seldom made in the
early part of the disease. Many persons have been
admitted during the preceding year, in a
state quite hopeless; the chief object being
to save the rest of the family, by removing
the cause of infection. It is thus that the
average mortality of the fever patients lately
admitted has been increased, and the period
of convalescence for those who have recovered,
have been extended to an alarming
degree. This dilatory conduct of the poor is caused in part by a desponding apathy,
which claims our most affectionate commiseration:
but it has its source also in an unfounded and destructive prejudice which we should labour to counterwork: that
the disease must take its course, until its power is
spent. Whereas hardly any thing is more
brief in its duration, more mild in its effect,
or more exempt from danger, than common
febrile contagion, if the patient is free from
other disease, and a remedial process is immediately
and properly employed. A single
affusion of cold or tepid water has been found
entirely to extinguish the infection, and to restore health to the patient, if applied on the second or third day of fever.
The reader should be apprized that there
is no assurance of a speedy cure, in the cases
of confirmed dram-drinkers; for with them contagious fever generally terminates fatally:
nor yet in those cases, happily not frequent,
of a peculiar rnalignancy of contagion, which
baffles all the efforts of human skill. But in
the great number of instances, if an application
were sent to the House of Recovery
immediately on the discovery of infection,
and the family removed and the habitation
purified, and, in addition to this, if landlords and parish officers would make a little more inquiry into the state of the: habitations of the poor in the metropolis and afford some improvement to the means of cleanliness and
ventilation, we should have little to apprehend from infectious fever in London.
The costs of the benefits which the Fever Institution has conferred on the metropolis in the preceding year has amount to £510 13s 4d.; while the annual income of the year, with all the exertions of the Treasurer and other friends (including benefactions and two parochial payments) has only reached to £537 18s; being twenty seven pounds four shillings and ten pence more than its necessary and economical expenses. This seems to imply, either that the rich are not very attentive in this instance to the sufferings of the poor, or to their own safety; or which, I verily believe is the case, are not aware of the usefulness and excellence of the Institution. The contribution of a guinea would hardly be withheld by
any househkeeper of moderate fortune in the metropolis, who duly appreciated the value of the establishment, and the advantages resulting from it; and knew how much the safety and welfare, not only of the labouring class, but of all other members of the community depend upon it. To the helpless and
insulated poor its, doors are open constantly
and gratuitously: and when a parish pauper
is sent in by the overseers, there is a parochial contribution of two guineas; being the. average extra expense of each patient; an expense (including all considerations of danger) much, less than any patient in fever can ever
cost the parish. It is referred to the consideration of those families, whose servants
are admitted into the house, whether, unless they are subscribers, they should not adopt the parochial precedent, and acknowledge the admission by a donation of two guineas
for each patient.
There are two reasons, one or other of
which may have had effect with some·individuals,
to prevent their subscriptions to the Fever Institution. The.first, and the operative one, seems to be, that the economical plan on which this institution is formed, and,
the impartiality with which it is administered,
exclude all PATRONAGE. There are no earnest
calls to be expected for a Governor's
vote and
interest, or for his
proxy, - to exonerate
some opulent individual from the support of a superannuated and helpless
dependant; and there is, therefore, less of
personal consequence and
personal interest, to
be acquired by a subscription to this charity. This objection, however, I trust will not
weigh with my readers. And, even if it did,
it is so creditable and so useful a feature of this
institution, that, in good truth, I do not wish
is to be removed. The lives which have been saved, the infection which has been checked,
and the habitations which have been purified,
in the metropolis in the preceding year, for
the sum of £510 13s. 2d. would have required above three times that amount, had the charity been put upon the PATRONAGE ESTABLISHMENT.
Another cause has been supposed by some to have operated, as an impediment to subscriptions. It is that Parliament has lately voted the sum of £3000 for the purpose of laying the basis of a permanent establishment of this kind in the metropolis, either by parochial arrangement or by preparing a local establishment, which may be the object of individual subscriptions. This, however, if properly considered, should rather operate as an inducement for benevolent individuals to come forward and coopreate with government, by giving present and immediate support to a charity, so essential to the welfare of the community; and leaving the other fund to be applied in the only mode in which it can be properly applied, to perpetuate the advantages of the fever institution in the metropolis, and to secure its future existence.
By the speedy removal of persons affected by contagious fever, and by their apartments, clothes, and furniture, being cleansed, and fumigated, two very important advantages are obtained, which are not within the regulations of other public hospitals. The first is that patients being*
[It is requested that notice of cases of fever be sent, without loss of time, to the physician, when the patients ill be visited. If they have already been attended by a medical practitioner, a certificate from him, stating the case to be typhus, will ensure immediate admission.] admissible at all times, without a recommendation being required, the disease may thereby be checked in its commencement, and speedily removed :-the other, that, by the care which the Institution extends to the infected apartments of the sick, those who are not alrearly infected may escape the contagion; - and those who, in restored health, return from the House of Recovery to their. families, will avoid the danger of renewed infection on their return home.
As benevolent individuals who may interest themselves in the present subject, may wish to know the Regulations of the Institution, I proceed to state, that the qualification of a Governor of the Establishment is the subscription of a guinea a year, or of 10 guineas in one sum: that poor persons labouring under infectious fever and resident in the metropolis, are freely and gratuitously admissible at all times into the House of
Recovery: and that upon notice of any such fever patient to the Physician of the Fever Instituton (DR. BATEMAN, No. 16, Featherstone Buildings, Holborn, or to the House of Recovery, No.2, Constitution Row,Gray's Inn Lane,) the patient may be immediately admitted by Dr. Bateman's order. For the removal of fever patients to the House of Recovery, and for preventing the danger (hitherto very general and often destructive) of spreading the infection by removing perssons with contagious fever in hackney coaches, a chair of a peculiar construction, and fitted up with a moveable lining, is provided; in which persons, ordered to be removed into the house, are ca'rried there at the expense of the Institution. To this brief account of
the Regulations it may not be improper to add that, in cases where the Physician may find the removal of a fever patient to be unnecessary, tho every apparent symptom of fever may have ceased in any dwelling, proper precautions, however, are not neglected; but (if the occupier permits) the apartments are always cleansed and whitewashed, the infected bed clothes and apparel purified or destroyed, and all other proper measures adopted for stopping the progress of contagion, and for preventing the renewal of its malignant and
fatal effects.
OBSERVATIONS.
We have unexceptionable authority*
[* See the certificate of the Physicians of Hospitals and
Dispensaries in London. Vol. III. Appendix, No.8] for stating that the infectious and malignant fever has not only been a prevalent and fatal evil among the poor of the metropolis, but has, at almost all periods, insinuated its baneful
poison into the habitations of the higher
orders. In order to prevent this danger
(from which no class of the community can
claim exemption) HOUSES of RECOVERY have
been lately established in different parts of the United Kingdom. Their history is to be
found in the preceding Reports*
[See Reports, No. 13, 58, 92, and 108; and several papers in the Appendix.] of the Society. To Dr. Haygarth of Chester, and
Dr. Percival and Dr. Ferriar of Manchester
we are indebted for the first example of this
useful charity, produced in the town of Manchester,
in the year 1796. For its extraordinary
effects in checking the progress of contagion,
and in diminishing the proportionable
mortality by infectious fever, I must refer the
reader*
[See the Reports already referred to: and also the notes in Appendix to Volume II. and III. and the papers No.8 and 9, in Appendix to Vol. III. and No. 3, 13, and 14. in Appendix to Vol. V.] to the papers already published in
the Reports.
The average number of deaths by fever in
the metropolis in the preceding century, has
considerably exceeded 3,000 annually. In
some years above 4,000 persons have perished,
within the bills of mortality, by this disorder;
but since the establishment of the
Fever Institution, this fatal calamity has been
considerably diminished. The six years of
the present century have produced an average
of only 1966: and in the preceding year
1806, the number has been reduced to 1354. As to the comparative mortality of Fever Patients, it appears to have been as high as one in four*
[* See the papers before referred to.] prior to the establishment of Houses of Recovery. In the
Houses of Recovery it has
since been from one in eleven to one in eighteen. In the preceding year the mortality in the House of Recovery has been increased by the peculiar malignancy of the febrile infection during the winter months, and by delay in the application to the
House; some fever patients having been admitted
in the very last stage of disease; not
from any hope of recovery, but merely with
*The mortality by fever in London during the present century is as follows
In 1801 - 2908
In 1802 - 2201
In 1803 - 2326
In 1804 - 1702
In 1805 - 1307
In 1806 - 1352
In the first nine months of 1807 - 750
This regular diminution of deaths by this disorder, since the establishment of the Houses of Recovery, is curious and striking.
the desire of preventing the diffusion of febrile
infection.
We may however confidently
our countrymen on an evident and important
diminution in the prevalence of contagious
fever, having been produced in the metropolis,
during the last six years; and tho it
would be injustice not to consider the Fever
Institution, as having been instrumental in
producing those beneficial effects, yet there
are other favourable causes, which call for
our serious and grateful consideration. The
removal of the infected patient in the first
stage of the disorder, the purifying of his habitation, and his restoration to health and to the comforts of an healthy dwelling. must
have produced considerable effects among
the poor: and the cleansing systematically
and effectually some of the most infected
parts of the metropolis, from whence the
House of Recovery had previously experienced
a regular influx of fever patients, a measure which was adopted and executed six
years ago, may be reasonably supposed to have potently operated in securing the metropolis
febrile contagion.
Besides this, the instruction which the poor
have received by benefits thus conferred on
them, the printed directions that have been
generally circulated as to the treatment of
fever patients, and also as to the separation of
them from other families, and from the other
branches of their own family, and the
cleansing and purifying of their dwellings,
furniture and clothes, where the contagion
of fever may have existed, these, and the charitable co-operation of benevolent individuals
in various parts of the metropolis,
must all have contributed to the diminution
of febrile infection.
There are however, I repeat, other causes upon which the serious mind will meditate
with devotion and gratitude; a succession
of healthy and kindly seasons, and of rich
and abundant harvests, and THE FAVOUR OF HEAVEN, mercifully bestowed on a nation, unworthy indeed of the blessings it enjoys, yet, I trust, daily improving in religious and moral feelings and habits. Cold, indeed,
and insensible must those creatures be, who
are not moved and affected by the contemplation
of these awful events, - from which, while the fairest parts of Europe
have been desolated and laid waste, our own
happy Island has been hitherto miraculously
preserved.
15th October, 1807
The reports of the Society for Bettering the Condition and Increasing the Comforts of the Poor.
Vol.5 (1805) pp.177-195
