Friday 30 August 2013

More Fever Hospital


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.


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

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.


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

Wednesday 28 August 2013

Public Conveniences .2

The area covered by this metropolis is so vast that a well-known French political writer could find no fitter term in which to describe its extent than by calling it a province covered with houses. Now, the avocations of many thousands of the inhabitants of this brick-and-mortar province impel them to traverse long distances from their dwellings, and to spend many hours in remote parts of the town. It is one of the features of the internal economy of this province that, different localities of it are appropriated to distinct purposes.
Thus the great centres of the different branches of financial and commercial business lie in the east and central parts of the province; whilst all around these are situated various manufacturing establishments; and, in the suburbs, which are each in themselves equal to considerable towns, are found the dwelling houses of our population. Every morning vast throngs of merchants, clerks, messengers, artizans, and others leave the suburbs, and travel perhaps several miles to the places where their business is transacted. Numbers of these, again, are by the necessities of their pursuits travelling about all day long. It is obvious, on a moment's consideration of the circumstances under which so large a proportion o the busy denizens of this London-province pursue their callings at a distance from their homes, and often in places where they are as absolute strangers to the residents as if they were in a foreign town, that the provision of numerous public conveniences  is a necessity that arises out of the very size, structure, and economy of tho metropolis. We, therefore, feel no hesitation in drawing the prominent attention of our local authorities to a matter of street-reform, daily becoming more and more essential to the public health and comfort. We are glad to observe that Mr. WING—a medical gentleman favourably known as the author of an excellent work on the " Evils of the Factory System"—has brought the subject before the Hammersmith District Board of Works.

There are three grounds upon which a large extension of public urinals and latrines is imperatively required. These are—convenience, public decency, and public health. As regards the public convenience we do not feel called upon to offer a word. Everyone who, after some hours' engagements from home, has found himself in a strange part of the town, must have experienced the inconvenience of traversing street after street, anxiously and furtively prying round corners, into courts and lanes, and meeting at every turn with passers-by, or the unfeeling injunction to "Commit no Nuisance," will readily admit that this ground is amply established. The City, so peculiarly thronged with men at a distance from their homes and places where they are known, is, beyond all other quarters of London, the least provided with public urinals. That public decency demands their formation, is equally clear. All who have occasion to traverse London must be conscious of abundant reasons on this ground. The sanitary argument is, perhaps, less generally appreciated. It is, nevertheless, most important,both in itself and in association with the other grounds. The consequence of the want of properly-constructed conveniences in accessible places has been the creation of a number of
extempore and conventional urinals in spots unprovided with any apparatus for ensuring cleanliness. These spots have become offensive nuisances to the passers-by, and, in many cases, sources of unhealthiness to the inhabitants of the neighbourhood. But even these places fall very far short of the necessity. Cases must be known to most medical practitioners, of persons who have suffered most severely in health, and who have even had to undergo serious surgical operations through the want of proper and timely facilities for relief. Especially in elderly men, the consequence of neglecting, under certain circumstances, even for a short time, a natural call, has been the occurrence of one of the most formidable of surgical accidents, and death itself.
It is not improper to add a word in the name of hospitality. The numerous foreigners who visit this metropolis are subjected to the greatest annoyance and inconvenience. The population, the superficial extent, and the traffic of London are daily increasing. The necessity for providing public conveniences of the kind to which we have referred, is daily growing more urgent. It is incumbent upon District Boards of Works to lose no time in selecting and reserving I appropriate sites for their construction. Such sites are already difficult to find. This difficulty increases with delay ; and the demand is also increasing in an inverse ratio to the supply.

The Lancet 10 May 1856

Public Conveniences


To the Editor of THE LANCET.

Sir,—Having seen in the newspapers of three or four days since an account of a mall's dying in consequence of the privilege of a necessary being denied to him, I am induced to write to you on a subject which has doubtless occurred to the minds of most persons, but which, from some unaccountable feelings of false delicacy, has never been made a subject of public inquiry. I allude to the almost total want of public necessaries, and of skreened places for making water in, in the centres of the great towns of England. In Paris and other continental towns skreens or retired places are most numerous; as, for instance, in the Boulevard des Italiens, where they occur every sixty paces, and the constant requisition to which they are put by all orders testify well to their use; whereas in London a man may walk literally for miles without meeting with a single place to which he can possibly retire. If he walk down any alley or side street which seems favourable for his purpose, the notice of "no nuisance" is sure to meet his eyes, the sanctity of which command is enforced by law. Now, Sir, I appeal to your medical experience whether a much more common disease exists, at least among men of advanced years, than a degree of prostatic irritation, and whether a much greater degree of inconvenience can be imagined than the inability of complying with nature's calls under those circumstances. It is needless to enumerate the various diseases, as gravel, stone, stricture, &c., which act in a similar way on the bladder, and all of which are common.
    I, therefore, am anxious to draw the attention of the public, and more especially of those whose authority in such cases would be first appealed to—the medical public, to the necessity which exists for the construction of public necessaries and skreens in the centres of all large towns, not placed in conspicuous situations, but down small streets and in other convenient places. If an individual were to erect water-closets for the use of gentlemen and ladies, it no doubt would prove a paying speculation ; but there is an absolute duty that necessaries and skreens should be placed by those whose premises the law protects from indiscriminate nuisance. Earnestly submitting this to the notice of yourself and of your readers, I remain your obedient servant,
G. A. May, 1842

The Lancet, 4 June 1842

Tuesday 27 August 2013

Worst.Holiday.Ever. (New Zealand, 1896)



SIR, - During the just-closed Antipodean summer many tourists, mostly Australian, have paid a holiday visit to New Zealand, and it is probable that increasing efforts will be made to bring the undoubted attractions of the Colony prominently before the travelling public generally.

In these circumstances, perhaps you will allow one fresh from the scene to offer a word of caution to English travellers, for if the charms of New Zealand are real, the miseries incidental to viewing them are certainly not less so.

To begin with, there is in practice only one limit to the number of passengers carried by any steamer on the coast, and that is the number of passengers who wish to travel by her. Such trifles as berth accommodation or passenger licence are - or at any rate during last summer have been - entirely outside the consideration. Passengers are shipping and shipped till at night they lie sometimes by the score on the saloon tables, under them, in the alley ways, in the so-called "social hall," everywhere.

For example, on one steamer by which I travelled five mattresses were laid along one of the narrow cabin passages, and upon these slept, or at any rate lay, five lady passengers the night through. This astonishing process was entirely exposed to the general view, and any male passenger or steward who required to pass along the alley had to step upon the mattresses and over and amongst their unhappy occupants. This I witnesses myself, and I have since been assure by other travellers that they have had similar experiences.

On this same vessel, the insect which walketh in darkness, together with the staggering heat, drove me from my cabin, and I spent the night lying with others on the saloon floor at the foot of the companion-way. Whilst there I heard a violent altercation between the chief steward and some furious passengers, who insisted on exchanging into the second class.

There were 27 - some said 30 - lady passengers on board and only one stewardess. The ladies lavatory accommodation was such that, on the admission of the stewardess, very few paid it a second visit, and that on a five days' run.

Before the end of the voyage, I may observe, the fresh meat had mellowed in the heat, and the awful smell which arose when the meat hatch was opened makes one shudder to remember.

Nearly every person to whom I have spoken who this year made the New Zealand summer trip has more or less similar experiences to relate - horses stalled on deck immediately outside the companion, bath-room filled up with bunches of bananas, stewards waiting at dinner in their shirt sleeves, a second dinner announced, and the discovery that nothing remained from the first to place upon the table, tables, floors, and bath-rooms filled with sleeping passengers, and tent accommodation erected for the remainder on deck, and so on, and so on.

A friend told me that not long ago he travelled with his daughter from Auckland to Sydney (five days) and that during the voyage none of the ladies could have a bath, as one lady was sleeping in the bath itself, whilst other two occupied the bath-room floor.

I am aware that such stories must seem incredible to any one who has not travelled about New Zealand within the last year or two, but to the New Zealander himself, such experiences excite little more attention than does a murder in Ireland. Indignant letters have appeared in the Colonial Press, sometimes supported by indignant editorial comments, and in the course of time, the Steamship Companies may awake to the discovery, or have it expensively brought home to them, that their present policy is a mistaken one, so far as any rate as tourist traffic is concerned.

Meantime, the traveller who has any regard for comfort, cleanlinses, and decency on shipboard will do well to profit by the experiences of his English friends who have made the trip, including -

Yours truly, &c.

[editor's note - the 'insect that walketh in darkness' = cockroach]

Sunday 25 August 2013

A Woman's Complaint

An 1890s woman speaks out against poor provision of public toilets on the railway, and elsewhere:


Sir,—The writer of " A Woman's Complaint" deserves the thanks of hundreds of thousands of men and women for drawing attention to out of the greatest evils which disgrace our pseudo-civilization. Savage races which have no false delicacy would never allow such absurdities. It is not too much to say that in England men and women are daily tortured because the subject is tabooed, though vice may be openly discussed, and not only directors but shareholders and many others are to blame because when there is cause for complaint no one will speak out and focus public attention. Whether travelling on distant journeys or merely round London evidence is constantly forthcoming of the absence of the proper accessories of civilization. Several times have I seen women try in vain to open the door of a ladies' room when returning at night from theatres, &c., by train; and even at an exhibition under Royal patronage I have seen the same thing occur, though a cloak-room should obviously be open just before closing time as much as the drinking bars which were then open. Some day a husband or a brother will burst a door open, regardless of concentrating the attention of idlers, and a jury will justify him, it all English spirit has not been drilled out of us by then. I have heard that a passenger can require a train to be detained in case of necessity. Perhaps some lawyer will enlighten us on this point. It might be awkward for the railway companies, but they will have themselves to thank. More is required, however. Proper accommodation and attendance after arrival at a terminus, and also sometimes refreshments at a terminus. We want a few women as well as men invested with autocratic power as Government inspectors, not to attend to the higher politics of railways, but to supervise the minor details which make the real comfort of life to the thousands. The County Council in London has intended to set an example, but is most unfortunate in its methods. The accommodation it provides and labels "Ladies" is practically useless, because it is usually in such a situation, in the middle of a street and often opposite a cab-rank, that respectable women cannot go near the entrance. Who building a house would put the  accommodation for his female servants, to say nothing of visitors, in the middle of a stable yard? The result is that constables are still specially employed to watch the retired streets,and interfere, though with no right to do so, when they are preferred. The subject may not be a select one for public discussion, but there is a crying evil which must be cured sooner or later, and as the subject has been mooted I hope you will allow it to be ventilated - I enclose my card, but beg to subscribe myself
Your obedient servant,

Thursday 22 August 2013

George Jennings and the Public Toilet

Did the well-known Victorian sanitary engineer George Jennings invent the public toilet?

It's a fact that's often repeated on various websites and books, but not really true. Admittedly, he installed his toilets at the Great Exhibition, but the Exhibition's commissioners had been lobbied to take action by a committee of members of the Royal Society of Arts.

It's often said that he installed underground toilets at the Royal Exchange in 1855 but this claim seems to date back to 'The Good Loo Guide' - a comic 1960s publication by Jonathan Routh - which gets the date wrong by some thirty years - 1885 is the correct date (click here for details), and Jennings was not involved in that particular build (not least because he was dead three years earlier), nor his firm.

He did, however, offer at least twice to set up public toilets in the City of London, and came up with the idea of underground public toilets in 1858, which were rejected due to 'English delicacy of feeling' (i.e. public water closets were considered unsavoury and immodest). [I only have an account of this response from Lawrence Wright's 'Clean and Decent' 1960, p.201, which reprints a memoir/letter/comment from Jennings without providing a citation]. Jenning's company, which survived his demise and prospered, would provide fixtures and fittings for many of the public toilets built in the 1880s and beyond, and contracted to manage some of them, in prime locations in London.

I've been mooching around the archives at the LMA (which I love, but the City's sanitary records are the worst-catalogued collection of material in the known universe) and, although I haven't found the City of London's rejection of Jenning's proposal, I have found his original 1858 letter. Here it is, in full:

5 Holland Street, Blackfriars, S.E.
December 13th 1858

To the Honourable the Commissioners of Sewers for the City of London

Gentlemen, I observe in 'The Times' that certain matters of a Sanitary character have been referred to your Engineer.

I think it only right to call attention to the efforts I have made to prevent the defilement of our thoroughfares and to remove those Plague spots that are offensive to the eye, and a reproach to the Metropolis.

Having provided, and fixed the Sanitary appliances at the Exhibition of 1851 and the Dublin Exhibition of 1852, as also those in the present Crystal Palace, I can bear testimony to the Public application of conveniences, suited to the advanced stage of civilization.

I know the subject is a peculiar one, and very difficult to handle, but no false delicacy ought to prevent immediate attention being given to matters effecting the health, and comfort, of the thousands who daily throng the thoroughfares of your City.

Herewith, I send you Lithographed drawings of a 'Halting Place' for a public Crossing: the space proposed to be occupied is not more than is appropriated to the any of the present 'Halting Places' and the design also provides for a Public Lamp & Drinking Fountain.

In the super-structure (which may be extended to any size without in the slightest degree impairing the stability of the thoroughfare above) you will see I show a Public Urinal, similar to those I have so satisfactorily erected for the St. Giles District Board of Works in the Seven Dials, and at the British Museum, as alson on the Great Northern and other Railways.

Water Closets and Lavatories are also shown with a Room for the Attendants. The wall space I propose should be covered with Time Tables from the different Railways; lists of Cab-fares from that particular point, to any part of the Metropolis, and other useful information. You will also observe that every arrangement is made for lighting and perfect ventilation.

In 1851 in connection with the Society of Arts, I spent a considerable sum to promote the establishment of Public Waiting Rooms and in the beginning of 1856, I had elaborate drawings made, showing how the vacant space next to the Royal Exchange might be advantageously employed. These drawings were submitted to the then Gresham Committee.

Public Waiting Rooms - Fountains - Water Closets and Lavatories may by some be considered a little in advance of the times, but they are nevertheless a necessary and would be appreciated accordingly.

As an example - At the Crystal Palace,for want of funds, the Lavatories were nearly excluded. I urged their introduction, but was told "persons would not come to Sydenham to wash their hands." I persisted and ultimately at a nominal cost, fitted the whole of the Waiting Rooms. These Waiting rooms I am told now produce a thousand pounds per annum.

If you consider my arrangements bear the stamp of common sense, I offer through you to supply and fix in any part of the City every Sanitary appliance shown in my drawings free of any charge.

If the cost of Gas-lights Water Supply and respectable Attendants capable of understanding and answering a question, should be considered an expense too great to be encountered, I am willing to take every expense on myself, and carry out every detail, under your Engineer's direction, provided the attendants I furnish are allowed to receive a small gratuity for use of Towels &c. as at the Crystal Palace.

If this (which many would turn a speculation) should prove commercially valuable, I shall be quite ready at any time to resign my trust, or retain it, using the proceeds for the establishment of similar conveniences.

I have the honour to be My Lord & Gentlemen,
Your obedient Servant,
George Jennings

Lithographed Drawings of the proposed 'Halting Place' were laid before the Court, and examined.


That it be referred to the Committee on General Purposes to consider the said proposal and report.