More Fever Hospital

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