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Lecture D J M Wright Imperialauthor College, London Onlineby © ESCMID Smallpox : 17th Century yVariola not an infection ‐ Library Sydenham Lecture yNot a problem: Disease author of the poor (despite Mary II and LouisOnline XVby dying of the disease) © yEstablished smallpox ((p+pla gue ) houses. FirstESCMID house in Windmill St. off Tottenham Court Road Hospital Movement for the Poor 17th Century y General (Teaching) Hosp ital Library referral by letter of recommendation, GLGovernors Lay Lecture

y Specialist Hospital medical author Onlineby referral, Governors medical© y New Fever //pSmallpox HospitalESCMID referral parish/medical, Governors medica l and l ay Febrile illnesses y SSllmallpox y Scarlet fever Library y Epidemic fever y Relapsing fever Lecture y Endemic fever y enteric ,typhus, chhloleraauthor ((dand perhaps oth er form of febrileOnline gastroby ‐enteritis) y Continued Fever © y Camp or goal fever (g),(meningitis), p,pneumonia, ESCMIDsepticaemia and erysipelas. y Unknown cause y Visitation of God Admissions to London Fever Hospital (1869) y Typhus* 1260 (half the previous y)year) Library 18.6% died [70 from same street] y Enteric 368 Lecture y Relapsing fever* 769 y Scarlet fever 641 author y Undiagnosed Onlineby dyspepsia 36, starvation© 10, hysteria 1, melancholia 1,balance undiagnosed y TotalESCMID 3411

*These were mainly destitutes or tramps Smallpox Library 1796 Nelmes inoculated by Jenner 1798 J’Jenner’s IIinquiry iLecturento SSllma llpox 1853 Vaccination Act [paymentauthor of doctor for vaccinatingOnline a childby © 1880 Compulsory childhood vaccination 1893ESCMID Notification Prevalence of Smallpox in London

1779 – 1800 36,000 Parish Records Library 1801 –188818 22,000 PihParish RRdecords

Outbreaks 1842 10,274 Registrar General (WilliamLecture Farr ) 1863 2,052 Registrar General 1870 582 Metropolitan Asylum Boardauthor 1871 13,148 MetropolitanOnline Asylumby Board 1872 –1873 2,362 Metropolitan©A sylum Board 1874 191 Metropolitan Asylum Board 1877 – 1878 11,274 Metropolitan Asylum Board 1879 ESCMID60 Metropolitan Asylum Board 1881 – 1887 c5,000 Metropolitan Asylum Board 1893 1,900 Metropolitan Asylum Board 1961 27 Ministry of Health London Population and Legislation Library 1800 900,000 population 1801 London Fever Hospital Kings Cross, Smallpox Hospital. Greys Inn Lane 1834 Poor Law Amendment Act. Workhouses, infirmaries and cemeteries discouraged outreach support Lecture 1867 Metropolitan Asylum Act (William Gayton). Built three fever hospitals 1870 –1873 3,000,000 populliation author 1872 Overflow hospital shipOnline “ Dreadnought”by 1884 3 more convalescent ships© and river ambulances 1880s 6 more fever hospitals, outskirts of London 1897Royal Commission on Vaccination 1900ESCMID 5,000,000 population 1902 1,000 bed Joyce Green Fever Hospital in Dartford (300 fever hospitals in UK) Early London Fever Hospitals (1802‐65) y London Fever Hospital 1802) Library Battle Bridge ‐ Kings Cross y Bought b y Great Northern Railway (1848) ‐ like St Lecture Thomas’s. Replaced by: y Highgate Hill Hospital author (Whittington Hospital)Onlineby y Liverpool Roa d Hospita© l, Islington y ChildESCMIDren ’s HitlHospit al ‐ GtGreat Ormond Street. 34 beds (1856) Later London Fever Hospitals (1867‐ 1875) Metropolitan Asylum Board built three 300Library bed hospitals (1870 ‐ 71) 1. Hampstead (NW) Hospital catchment area forLecture 793,000 persons 2. Homerton (Eastern) Hospital author catchment Onlinebyfor 967,000 persons 3. Stockwell (SW) Hospital© catchment for 1,276,000 persons All 3 MilesESCMID equidistant from Central London, 6 miles apart. 4. Dreadnought Hospital Ship as an overflow (1872) Homerton: Smallpox / Fever Library

Lecture author Onlineby © ESCMID Later London Fever Hospitals (1876‐ 1890) y Fulham (()Western) Hospital ‐ 1877 Library y Datcham (SE) Hospital ‐Old Kent Road ‐1877 y Hampstead Hospital closed (1881)Lecture ‐ possible spread of smallpox cases from hospital to local community? y Closure after successful litigationauthor and compensation (1881) y Patients transferred toOnline Claire Hallby ,South Mims and Darenth Asylum. y Deptford hospital (1881), Plaistow© Hospital (1884) y River Ships (1884) moored at Deptford then Long Reach, Orme Farm HospitalESCMID (1884) y Ambulance river service (()1893) Smallpox Hospitals Library y London, transferred… … to Dartford

Lecture author Onlineby © ESCMID Library Ship Hos pital (4)(1884) JJyoyce Green ((91909)

Lecture author Onlineby © ESCMID Hampstead Fever Hospital y Wooden built in one month at cost of £8,000 ((ycurrentlLibraryy equivalent to €1m) y Coped with relapsing fever (743 cases) in 1869. Interval of 7months. y Then two outbreaks of small pox (1871‐2 & 1876‐7). 25% of patients vaccinated. Lecture y Permanent walled structure cost £55,000.author 300 beds, 11 wards y [6 wards for smallpox , 2 Onlinefor scarletby fever, 2 for enteric and 1 for special cases,] © y Admin and nursing quarters. Designated delivery area. Special fever nurses y Cost of nursingESCMID each patient/day , including clothing change 6p (= €07)0.7) y Patient transport to hospital (fever carts) and dedicated funeral arrangements Hampstead Hospital Library

Lecture author Onlineby © ESCMID Rules for visitors (1878) 1. Nearest relative or intimate friend. One visitor /day, not more than 15 minutes and permission to visit from Medical Superintendent (MS).Library 2. NiNotice sent to relilative when pat ient was in danger, wihith copy of regulliations. 3. Daily list of patients on danger list sent to MS 4. All viitisitors at riiksk shldhould be proper ly vaccLectureitdinated as were residen ts of viitisitors home. 5. Visitors advised not to enter ward if weakauthor or exhausted, to eat with patient, avoid touching patient, exposingOnline themselves to patients breath and sit some distance from the patient and not bytouch bedclothes. 6. Visitors wear wrapper over dress,© wash hands and face in carbolic and then soap and water on leaving. 7. UdUrged ESCMIDnot to enter a bus or tram or other public vehic le idilimmediately after leaving. 8. All patients accompanied to and from wards Relapsing Fever (Clinical) y 1770: John Rutty first recognised relapsing fever inLibrary Dublin y 1843 Dominic Corrigan in Dublin held that relapgpsing fever was due to famine Lecture y 1866 Charles Murchison in his bookauthor on “Fevers” supported the idea thatOnline relapsing fever was due to starvation and destitution. Henceby no need for isolation! © y 1870 John Parry showed that articles of clothing worn by relapsingESCMID fever patients could transmit infection y 1869‐ 70 All relapsing fever patients were isolated in the London Fever Hospitals Relapsing Fever (Bacteriology) y 1834 Christian Ehrenberg identified theLibrary first spirochaete : S.plicatis y 1842 FFlielix DjDujar din dibddescribeLectured chhtitiaracter istic movements y 1866 ‐73 Otto Oberme ier fdfounauthord spihtirochaetes in the blood of relapsingOnline feverby patients y 1873 Gregor MhMunch s©hhdowe d spihtirochaetewas infectious by self inoculation y 1873ESCMID JJhoseph MtkkMoczu tkowskyconfirme d above b y inoculation of spirochaetes into uninfected subjects Hampstead Fever Hospital: Local residents objections to siting of Hospital Library 1875: Parliamentary Enquiry investigated objections:Lecture not upheld 1. Depreciation of value ofauthor surrounding property 2. Alternative sitesOnline possibleby © 3. Spread of smallpox to neighbourhood from HospitalESCMID Spread of Infection from Hospital y Prevalence of disease in relation to hospital fell off concentrically in the surrounding environs.Library Suggested tiitransmission from the nurses, the amblbulance didrivers, escaped patients y Alternatively suggested aerialLecture transmission (H. Powers’ Report) District cases not related to prevailing wind plumes. Alexander Collie’s evidence.author Not so at Homerton but Purfleet cases Onlinefrom windby spread across the River Thames from DtfdDartford©HitlH ospitals y 1879 Sir Rowland Hill whose house was opposite the HospitalESCMID sued for compensation and won. Decision upheld on appeal. House purchased by MAB and Hospital closed. Library

Fever hospitals remained in suburban London Lecture Smallpox hospitals removed fromauthor centres of population Onlineby What happened© to the fever hospitals? ESCMID 16th Century Painting of La Colombaia Library