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London's 1818 public health crisis

Updated Tuesday 24th July 2018

200 years ago today, the Morning Post shared a report into a health crisis gripping London - and how public health solutions offered a way out of the mess.

The London Fever Hospital Creative commons image Icon Julian Osley under Creative Commons BY-SA 4.0 license The London Fever Hospital in Islington, the successor to The House Of Recovery

REPORT FROM THE SELECT COMMITTEE ON CONTAGIOUS FEVER IN LONDON

The Select Committee appointed to examine into the state of CONTAGIOUS FEVER in the metropolis and and into the commision of the Institution for the Cure and Prevention of the same; and who were empowered to report their Observations thereupon to the house, together with the minutes of the Evidence taken before them. have agreed upon the following.

Your Committee having summoned before them Physicians from the principal hospitals in the Metropolis, proceeded in the first place to inquire into the progress and extent of that conta­gious fever, which, during the last 12 months, has been prevalent.

In order to obtain correct information upon this subject they called for a return of the number of patients who have been admitted into a fever hospital constructed in Pancras Road, and entitled a "House of Recovery."

This establishment had its origin In the year 1692, a period of great sickness among the poorer classes of society; it having been preceded by a scarcity of food for two years.

In the year 1803, 164 patients and in that 1804, 185 were admitted into this hospital.

The return inserted in the evidence of Dr. Bateman, physician to the institution for the last 15 years, shows that the minimum of sickness was 1810, when 30 patients only were admitted, and the average of the three years preceding 1817, when the present epidemic may be considered to have commenced, was somewhat more than 76 per annum; in the year 1817, 126; and from April in that year to the same period in 181, no less than 797 person were patients in this infirmary.

Your Committee then proceeded to inquire as to the prevalence of this contagious fever in the different hospitals of the Metropolis.

Dr. Marcet, who is one of the physicians of Guy's. informed them, that in the year 1817 about 50 patients were admitted with cases of fever and in that ending April 1818, 253.

In the London Hospital, Dr. Yelloly states that the average number off fever patients may be taken at about 30 for the last five years; that in 1017, 97 cases were admitted ; and in.the first three months of this year, no less than 35.

Your Committee have no regular return from St. Thomas's; but, Dr. Currey, physician to that hospital says that the num­ber of fever cases was considerably greater than in the preceding years.

At St. Bartholomews, the increase is also stated to be great, but your Committee have no return of the numbers; for Dr.Roberts informed them, that no register is kept in the hospital to distinguish the different varieties of disease.

At St George's , the same statement is made by Dr. Young; and there, also, no register is kept.

In the Westminster Hospital, Dr Tuthill informed your Committee that the ordinary, average of fever cases may be taken at 25; while, from Lady-day 1817 to 1818, 38 patients labouring under this disease have been admitted.

In the Middlesex Hospital, the average number of contagious fever cases is about 60 per annum; and, last year, the number amounted to 120.

Your Committee having thus ascertained the alarming increase of contagious fevers in the hospitals of the Metropolis, proceeded to examine the physicians of some of the principal dispensaries.

Dr Laird, Physician at the Public Dispensary of Carey Street, informed that in the year 1815, 84 cases of fever were entered into their books; in 1816, 76 cases; and in 1817, 147; and in the four months of the present year, 59 cases of fever have been so registered.

Dr. Clutterbuck also states, that for many years past, not above 12 cases of typhus have been admitted on their books, but in the last year there have been above 200.

Your Committee thought fit to transmit a series of questions to the different Physicians belonging to some of the dispensaries of London, and to the answers of which they beg leave to refer.

Dr. Davies, Physician to the Loudon Dispensary, averages the number of cases of fever in the establishment to which he belongs, for a period of eight years, to be about 100 annually; while in the last year they amounted to 309. I

In the Finsbury Dispensary the mean number of fever cases is 66; but from the 1st of May, 1817, to the same day 1818. 168 cases were regis­tered.

Mr. Burgess, Apothecary at St. Luke's Workhouse, stated that he attends, on an average of common years. about 150 cases of fever; in the last year the number rose to 600.

Dr. Lincoln states. that his parochial patients have increased from the ordinary average of 40 and 50 to 250 and 300.

Your Committee, having thus been informed of the extent of this epidemic, and the severity with which it has fallen on the poorer classes of society proceeded to inquire into the nature and extent of the means afforded, in the way of medical relief, to those afflicted with this calamity.

The benevolence of some individuals, aided by a considerable grant of money on the part of the Public, have constructed a fever infirmary, called "The House of Recovery," which is capable of containing about 69 patients.

This establishment has arisen to its extent and consequence by slow degrees: it began in a small house in Gray's Inn Lane, which was capable of containing only a very limited number of patients, and its augmented size is a convincing proof of its ac­knowledged value, no less than its being necessary to the in­creasing wants of the metropolis.

It is supported by voluntary contributions, the amount of which may be taken at 450l per annum. This Institution possesses besides, a fund of 2000l. in Exchequer Bills, and 2682l in the three per Cent. consols, the annual income being thus somewhat above 540l per annum.

The expenses of the three years preceding 1816, amounted annually to 573l, while those of the year ending April. 1818. reached the enormous sum of 1,700l. To meet this increase of expenditure above income, the generosity of the public was appealed to, and the sum taken as part of the capital stock of the Hospital, and which is now held in Exchequer Bills, was subscribed at a public meeting summoned for that purpose; to this fund must be added a further grant of 1000l, which has re­cently been paid by the Treasury to this Hospital.

Your Committee have learnt with great satisfaction the na­ture of the excellent arrangements which have been adopted in this Institution. The zeal and assiduity of its medical at­tendants entitle them to the praise and gratitude of all who can estimate the fortitude, the risk, and the active benevolence which characterises the profession to which they belong.

But the objects of this Institution are not limited to attendance on the sick, and to the removing persons from the sphere of con­tagion; a portion of its funds is expended in cleansing the apartments of the poor, who, crowded in close courts and un­ventilated rooms, are assailed by fever. This practice is pecu­liar to this establishment, and in the last year no less than one hundred and fifty-one rooms were thus whitewashed.

Your Committee refer generally to the evidence of Dr. Bateman, to establish the necessity of a speedy removal of the poor from their own dwellings when attacked with contagious fever, as well as to demonstrate the benefits derived in the last year by the existence of this Institution when, from the crowded state of the hospital.. and their known willingness to receive fever cases at all, the greatest danger would have been incurred of the spreading into a larger focus the sphere of this contagious dis­order.

In one house, the disease continued 17 weeks, one family were attacked with it three different times; and it was only arrested by the destruction of all the furniture in the apartment. Thus it may be said, the sufferers became diseased through their own contagion and your committee cannot contemplate without serious apprehension, what might have been the result of this epidemic daily gaining strength, if it had not been checked in ints malignant growth by the efforts of the Fever Institution.

Your Committee wish also to remark, that this establishment is open to all applicants, at all days and hours. A medical certificate of disease is stated to be required; but the practice is to admit all who are attacked by the complaint upon the first application; and the only impediment thrown in the way has been one which it is the aim of your Committee to remove, a want of sufficient room for the admission of patients.

Your Committee wish to observe, that a most salutary system is adopted here, viz the transport of the patients in a litter belonging to the establishment, thereby preventing the use of coaches or sedan chairs; one of the means by which the contagion is circulated unchecked, and they hope the other hospitals will see the necessity of adopting some such arrangement.

Indeed, from the indifference to contagion which seems to exist in some these establishments, it is a matter of surprise to your Committee that more fatal results do not occur.

Your Committee have learnt with great pain, that in all the Hospitals of London a great proportion of patients are weekly refused admission, in most of them from want of room; in one of them (the Middlesex Hospital) from a deficiency of funds.

Any plan, therefore, that would lighten the burden which now weight down these establishments, would, to the minds of your Committee, be of great public usefulness.

But if the entire removal of cases of fever from all the Hospitals, may be considered injurious to them as schools of medicine, the diminution of the number of such admissions might ease the finances of some establishments , and leave room in others for patients suffering under diseases of a different character.

Your Committee have been informed, that it is the practice in all the Hospitals to mix cases of contagious fever indiscriminately with other patients; it has, however, been stated to them by some medical authorities, that, practically speaking, no evil has arisen from their intermixture; but, with due deference to such opinion, the acknowledged fact, that in some hospitals the fever has been generated; that patients admitted under one disease have caught in the hospital another; that the medical practitioners and attendants have been attacked themselves by the disease; and that most fatal effects have been therefrom produced - all these facts fully satisfy your Committee that the practice above alluded to, if not altogether abandoned, ought to be resorted to with great precaution, and to a most limited extent.

As long as fever cases can be diluted through a large ward, with proper attention to ventilation, scarcely any danger of contagion may arise; but in a period of epidemic, such as existed in the late and present year, when all the hospitals were crowded with patients assailed by the prevailing disease of fever, great hazard must be run, and the experience of this year has demonstrated the danger and evil of the system.

As the great preservative against contagion is a free circulation of air, patients labouring under chronic disorders cannoty with propriety be subjected to the same treatment, and a system of medical police which is essential ion the one case to prevent the spreading of the disease, becomes highly prejudicial in the other; besides, a greater prejudice prevails; and your Committee cannot consider it as unfounded, among the poorer classes of society, who are the main objects of these establishments, against either entering themselves or sending their relatives into these hospitals, on account of the hazard of infection to which they are exposed.

The events of the last year are not certainly calculated to weaken these opinions, and your Committee feel assured, that to diminish the number of fever cases in every hospital, by increasing the powers of receiving them in institutions exclusively set apart for that disease, would not only dfo away with the impression on the public mind alluded to, but contribute most materially to the relief and good arrangements of those hospitals, the wards of which are now exposed to be indiscriminately filled with patients labouring under diseases in all their different stages of suffering and malignity.

Originally published in The Morning Post, July 24th, 1818

 

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