Statistics of the Barony Parish Fever Hospital of Glasgow in 1847-48

Art. VI.?-Statistics of the Barony Parish Fever Hospital of Glasgow in 1847-48. By James Paterson, House-Sur- v geon and Superintendent of the Hospital.

During the year 1847, fever, which had for several months of the previous year assumed, in most parts of the country, an epidemic form, prevailed so much as to raise in the minds of all very considerable alarm. In Glasgow, the first noted increase of the disease was in autumn 1846, from which time it became more and more prevalent, till it reached its maximum in the summer of the following year. The only public accommodation in this city, previous to 1847, was that afforded by the wards of the Royal Infir- mary, and in these the number of beds scarcely exceeded 200. As might have been expected, this amount of accommodation was found, even before the close of 1846, to be insufficient, accordingly, the managers of the Infirmary rented the Lock Hospital, then recently erected, and capable of affording accommodation to seventy or eighty persons. But as this auxi- liary hospital was too inconsiderable to render very efficient service in an increasing epidemic, the managers resolved that they should themselves build another on ground already in their possession; but so strong was the opposition of the neigh- bouring inhabitants and proprietors to this proceeding, that the design was relinquished. They then purchased a building in Bridgeton, one of the eastern suburbs of the city, but before it could be furnished to receive patients, opposition, as in the former instance, was brought forward, and in such a way as to de- lay the employment of the building in the manner contemplated. 358 Mr Paterson's Statistics of the Barony Parish

Urged by the increasing demand for accommodation, and the pos- sibility of their being obliged to quit the building they had rented, they reluctantly adopted a measure which they had previously re- jected, viz,, that of erecting on the Infirmary grounds a temporary shed. This was completed in June, and afforded accommodation to 140 patients. At about the*same time, the Parochial Board of the City Parish, impressed with a conviction of the necessity of separating the sick from the healthy, obtained and fitted up the Old Town's Hospital for the accommodation of persons belonging to their own parish. They began to receive patients in the early part of July, and before long, their inmates numbered upwards of 600. With a similar feeling, and for a similar purpose, the Barony parochial authorities shortly afterwards made arrangements for the erection of a temporary hospital, the results of treatment in which, the details which follow are intended to illustrate. The wooden sheds first erected contained 150 beds, but the admissions were so numerous, that, a separate erection with 100 beds was soon afterwards added. The ground on which they were built was in the burgh of Anderston, one of the western suburbs of the city, and which forms part of the scattered parish, whose sick the hospital was to accommodate. There was already in existence on the spot selected, a building which had formerly been occupied as a private residence, and which, although somewhat inadequate in culinary and other arrangements to the require- ments of an hospital, was found so far suitable for such purposes as to preclude the necessity of erecting any new building. The hospital was opened for the reception of cases on the 5th of August, and in ten days it was filled. Thus, from the be- ginning of autumn 1847, there were no fewer than three separate hospitals in Glasgow; and in the Royal Infirmary there was extra accommodation to the number of 140 beds. The epidemic was at this time rather on the decrease, yet the number of patients in hospital, towards the close of August, and for some time subsequently, could not have averaged less than 1000. In the Barony Parish Hospital, the admissions, most numerous at its opening, decreased more or less rapidly till the middle of the present year, when the managers finding that accommodation could now be obtained as formerly in the wards of the Royal Infirmary, and having got the sanction of the Board of Supervision to the conversion of the premises into a temporary hospital for paupers and those labouring under chronic diseases, thought it unnecessary to appropriate it longer to the reception of fever cases. Accordingly, after the 20th of June no cases of fever were admitted; and by the 5th of July, or eleven Fever Hospital of Glasgow in 1847-48. 359 months after the opening, the whole of the fever cases had been treated to a termination. With reference to the erection of such temporary buildings during the prevalence of an epidemic, and which can be made avail- able only while the epidemic lasts, the false economy of the measure will be at once perceived by every one who reflects on the great cost of these erections, and their generally utter uselessness after the epidemic which called them into existence has passed away. In a city of such extent as Glasgow, with a population of upwards of 350,000, we need not expect to remain long free from epidemic visitations ; and although the permanent hospital accommodation already provided is amply sufficient during seasons of comparative healthfulness, its utter inadequacy during times of sickness, the past year, in common with many others, abundantly proves. What, then, can be said of the policy of remaining inactive until the tide of sickness and misery has risen with such overwhelming force as to render feeble and unavailing those efforts which, begun before its approach, might have warded off its severest shocks ? However much men may differ in their views as to the best mode of preserving the sana- tory condition of a large city, whether by small hospitals in each district, or by larger ones removed from the bulk of the people, there can be but one opinion regarding the propriety of effect- ing, by some method, the separation of the diseased from the healthy. Nothing contributes more to the spreading of any infectious epidemic than the crowding together of the healthy and the sick, even although filth and want of ventilation had no influence in its propagation. And are these influences wanting? The answer is found by ascertaining the state of the dwellings in the wynds, vennels, and almost interminable closes of the city and suburbs. In these, apartments of about eight feet by six, where ventilation is an impossibility, and where the light of heaven scarcely enters, have often to contain eight or ten individuals, of both sexes and of all ages,?more frequently, too, belonging to four or five different families than to one. Disre- garding all other influences, and these are not few, one might be inclined to ask whether it be possible that, in such a place, one could become the subject of a contagious fever, and the rest escape. This is a subject which demands the highest attention of those who have control in such matters. To look at the subject only in a pecuniary point of view, what can be more opposed to the spirit of economy than, during a severe epidemic, to support at a great expense the poor in their own hovels?a system which tends directly to the increase of the disease?and, when its force has become almost spent, to erect, at a cost of some thousands of pounds, buildings which, when the rage of the disease has ceased, are all but useless ? It is a 360 Mr PutersorTs Statistics of the Barony Parish subject of much satisfaction, that the parochial authorities, both of the City and Barony parishes of Glasgow, have in contempla- tion the erection of hospitals in connection with workhouses, and in their near vicinity, which will be at all times ready to accommodate many hundreds of patients. With such means of speedy separation from the healthy of those that become the subjects of contagious disease, future epidemics will, in all pro- bability, be the cause of much less apprehension than hitherto. The statistical details which follow form a summary of a series of tables constructed on the plan adopted by Dr Orr, in his statistics of the Royal Infirmary of Glasgow for 1844, 45, and 46, successively, and which were published in this Journal, vol. lxviii. The number of patients admitted and treated to a termination during the eleven months that the building was occupied as a fever hospital, was 2639 ; of whom 1374 were males, and 1265 were females. Of this number, 303 died; and of these, 193 were males, and 110 were females ; so that, among the former the mortality amounted to 13*93 per cent., among the latter to 8*77, and among both to 11*48. It has been already mentioned that the admissions were most numerous at the opening of the hospital, and that they became less each succeeding month. The number admitted during the first four months, (although in August the accommodation, compared with subsequent periods, was only as 2 to 3), exceeded that during all the other months by 429; and the number admitted during December and January very nearly equalled that during the succeeding five months. The mortality also varied very considerably in the different months In August it was 16*39 per cent.; in September, October, and November it averaged 7*9; in December it rose to 22 39, falling in January to 10*5 ; thereafter the greatest was 15*1 in March, and the lowest 7*62 in April. The difference between the mortality of the two sexes has been greater in this hospital than usually occurs. The most ordinary ratio is 11 deaths among males to 8 among females; here it has been about 13 to 8. The high mortality in December was caused by a great number of individuals, chiefly those labouring under typhus, becoming the subjects of various disorders of the respiratory organs, asthenic bronchitis, pleuritis, pneumonia, &c., which in very many instances proved fatal. The following are the principal diseases under which the patients laboured :? Total Cases. Cured. Died. Fever with relapse, . 1145 1113 32 Typhus fever, 1370 1134 236 Common continued fever, 30 28 2 Febricula, 13 13 Rubeola, 3 3 Varicella, 2 2 Fever Hospital of Glasgow for 1847-48. 361 The above list contains all the cases except 76, who were affected with other diseases, which either so much simulated fever as to have been mistaken for it by those sending the patients into the hospital, or occurred after this disease in those who had recently been inmates. Of the 303 deaths occurring among all the cases, 77 were clearly attributable to other diseases than fever, or to complications attending it, and 34 persons were moribund at admission.

Mortality, including death from all causes, . ] 1*48 per cent. Do. excluding moribund cases, or those dying within 16 or 20 hours after admission,?34 in number, . 10*32 Do. excluding moribund cases, 34, and those dying from other diseases than fever, 77; total, 111, . . 7*54

Much has been said about the impropriety of treating any but convalescent fever patients in wooden sheds, the reasons alleged for such an opinion being, that the openness and want of comfort of such buildings, render patients in the acute stage liable to suffer from various maladies which in more substantial buildings they might have escaped; but the results of treatment in this hospital, if they are not too limited to have any weight, add nothing to the support of such views. Some may fancy that the very high mortality in December, when the influences above named might be supposed to have greatest power, contradict this; but in the Royal Infirmary, the fever wards of which are remarkably comfortable, the mortality during the same month was higher than above stated by 3*31 per cent. No doubt the erections here are capable of affording a considerable degree of comfort, for the wooden walls are all doubled, and have between them a layer, many inches thick, of sawdust; yet it cannot be supposed that buildings hastily constructed of rough planks, showing occasional apertures, and furnished with rudely- made, and still more rudely-fitting, windows, should be capable of affording a near approximation to the comfort of a stone building. The relative proportion of the two principal forms of fever varied much at different periods of the hospital's history. At its opening, the number of cases of fever with relapse doubled that of the typhus cases. At the close of the year they were nearly equal; and during and after February, the number of the typhus cases doubled that of the relapse cases. The difference between the mortality of these fevers is another inte- resting consideration, being ]7"22 per cent, among the typhus cases, and only '2*79 among the relapse cases. A low mortality has always been a distinguishing feature in this latter disease. At 362 Mr Paterson's Statistics of the Barony Parish its first appearance in 1843, the mortality in the Royal Infirmary was little above four per cent., and in subsequent years it was still less. At different periods of its progress it was attended by a great variety of symptoms, and some of these, at its commencement, were so rarely absent, as to have been by many considered essential. To this class belongs the jaundice, which in 1843 was so constantly present, as to give rise to some of the names by which the disease was known, such as icteric fever, mild yellow-fever, &c.; but, during the past year, icteric symptoms occurred almost as rarely as in any other form of fever. In 1843, rheumatic symptoms were very common, and, in this respect, the fever of last year differed only in being less frequently accompanied by these. In the winter months, the relapse occurred with very great regularity, happening usually on the fourteenth day from the commencement, or seven days after the first crisis, and declining pretty regularly at the termination of the third day from its acccession. But towards March it occurred less certainly and less regularly, being in many cases absent, and in others not appearing until the ninth or tenth day after the first crisis, or seventeenth from attack. A remarkable circumstance was observed in the case of a considerable number of children, viz. the occurrence of the first crisis on the sixth day from attack, and of the relapse six days later, viz. on the twelfth day, or two days earlier than usual. It was also noticed, that, in several cases of adults and youths, the first crisis happened on the tenth day, and the relapse after ten days more. This epidemic, whether it be regarded with reference to its peculiar relapse, and the changing symptoms above alluded to, or to its extremely low mortality, affords a remarkable instance of the varying forms and entirely new cha- racteristics which disease may assume. When an inquiry is instituted regarding the ages of the persons who have been the subjects of the two forms of fever, it is found that considerably more than one-fourth of those who have suffered from typhus, and nearly one-fourth of those who have suffered from fever with relapse, were between the ages of 20 and 30. This is not a singular occurrence, but one which statistical data of other hospitals and of other years have proved to be almost uniform. It may be in some measure accounted for by the fact, that a very large proportion of persons of this age live in lodging-houses, and are consequently the most likely to become the inmates of an hospital when seized with any contagious disease. In extending the inquiry to the mortality at the various ages, it is found that, at the earlier periods of life, excluding probably the very earliest, it is lower than at the more advanced periods, and that the ratio rises with the age. Fever Hospital of Glasgow for 1817-48. 363 The following is the mortality per cent., at the various ages, among the typhus cases :? Under 10 year?, 5 66 per cent. 10 to 15, 714 15 to 20, lilt 20 to 30, 15-66 30 to 10, 21 94 40 to 50, 28-57 50 to 60, 4677 60 and upwards, 38 09 At the age last mentioned, the cases being only 21, they must be regarded as much too small a number from which to draw general conclusions. In the fever with relapse may be seen the same change in the mortality according to the more or less advanced age of the sufferer; but the differences, as might have been expected in so mild a disease, are not nearly so great. The number of cases of typhus in which the occurrence of com- plication was noted, was 109, and the chief complicating diseases were fever with relapse, bronchitis, erysipelas, dysentery, and gangrene. In the fever with relapse, the complications were forty-six, and were chiefly typhus, bronchitis, dysentery, and erysipelas. It has been already mentioned that the bronchitis occurred principally in December, and was generally of the asthenic type. The erysipelas was most prevalent at the close of last year and during the first two months of the present year, and very generally made its appearance as an erysipelatous blush on the mucous membrane of the pharynx, fauces, or mouth, gradually extending to the skin adjoining the lips, and thence to the other parts of the face and head. Some- times it never appeared externally, the patient complaining merely of pain with some heat in the throat, which gradually subsided. A concomitant not unfrequent, was parotitis ending usually in suppuration. The number of cases where the one fever is recorded to have followed the other is only fifteen; in nine the typhus was followed by fever with relapse, and in six the reverse. The patients were indiscriminately placed in the same ward, and no attempt was ever made to classify and separate them. Hence it would seem that, at all events, for the time during which the one disease lasts, there is no likelihood of a patient becoming the subject of the other; and since, in the fifteen cases just mentioned, the residence of almost all was verv much prolonged, for various reasons, it would also ap- for some pear that this seeming power of resistance continues period after convalescence. The mortality of the complicated typhus cases was 47*7 per cent., and of the complicated relapse cases 39*1, both very high, but in the latter instance most 364 Mr Paterson's Statistics of the Barony Parish strikingly so, seeing that over the whole of this class of cases it does not exceed 2'79 per cent. These facts show that in nearly one-fourth of the fatal typhus cases, and in one-half of the fatal relapse cases, death was caused not so much by the fever as by superadded disease. With regard to the period of death in both the forms of fever, it is found that not much more than one-half died in what may be considered the period of active fever, i. e. before the termination of the twenty-first day, and that nearly one-fourth of all the deaths occurred between the tenth and fourteenth days inclusive. Having considered these matters connected with the diseases, mortality, &c., it may be of interest to turn now to others; and first, to the consideration of the nations to which the patients belonged; and in so doing, we begin to tread upon ground which has afforded room on many occasions for much ebullition of feeling. The numbers from each country are the following :? ocotch, 1301 Irish, 1293 English, 36 F oreigners, 5 Unascertained, 4

2639 Thus, only 49*29 per cent were natives of Scotland, while so many as 48'99 per cent, were natives of Ireland, notwithstand- ing that a very large number of children born in Scotland, but of Irish parents who have no claim to parochial relief, has been added to the list of Scotch. Of those treated in the other two hospitals of this city, the proportion is higher by, in the one case 10 per cent., and in the other 11 per cent. Now, on in- stituting an inquiry into the proportion of this large number in which parochial relief has been legally due, it is found that, excluding 158 from whom no account could be obtained, no .more than 10 per cent, had been so long in the city as to have acquired a parochial settlement; in other words, 39 per cent, were supported during fever without having been entitled to relief. But the proportion must be actually higher; for it is well known that the poor, from interested motives, state their residence in town as having been'more than five years, while it may have been less; and, further, although they have been longer than this period in town, they may not have acquired a settlement in any parish by their frequent removals from one to another. To say that one-half of all the sums expended on hospital support during the past year has gone to provide for the wants of strangers, is to understate the truth. Fever Hospital of Glasgow for 1847-48. 365 The next subject to engage our attention is, to inquire into the relations which the number of patients brought from the various districts bear to the population of these places, and to the habits and state of the people; and such an examination may be expected to place in a clear light the causes which influence the propagation of fever and other infectious diseases. The districts and the numbers from each are the following :? Anderston, . . 664 Mortality per cent., 11*74)' Bridgetown and Mile End, 446 Calton, . ? . 775 : : : : l3,^? Other districts, . . 754 . 10 34 The disease does not seem to have prevailed more in one district than in another, as the relation existing between the population of the above places is much the same as that between the numbers of patients brought from them. The disparity appears chiefly when the numbers from the different streets of the same district are compared. In Anderston more than one- half come from three or four streets, and although these are densely-peopled, the proportion of patients to population is very much greater than in the other streets. Further, although none of the inhabitants, generally speaking, are in such circumstances as to afford to pay for medical attendance at their own houses, a considerably larger proportion has been derived from the back dwellingsof the closes than from the larger habitations of the front lands. The streets themselves are not very filthy, nor are they ill- ventilated ; indeed all of them in the latter respect are privi- leged beyond many in otherwise more favoured localities, but of the hovels in many of the back buildings words could scarcely convey a description. In Bridgeton and Mile-end the streets are almost all wide and well-ventilated, but here and there, as in other parts of the city and suburbs, are to be found the same pestilential hot-beds of disease. In Daimarnock Road and Main Street, Bridgeton, there are a few places from which almost all of the cases?*200 in number?from these two streets have been brought. Of Calton a similar account may be given, with this difference, that, whereas the streets in Anderston and Bridgeton are open, those in Calton are narrow, and shut in by buildings, so as to be in many places as much deprived of ventilation as can well be imagined. Add to this that filth is more common, and that the crowding together of human beings is still more general than in most other places. It will not, there- fore, be surprising that many of the streets in this suburb should stand pre-eminent as examples of the influence of overcrowding and filth in propagating disease. Such being the state of matters, what seems the best course to follow in order to diminish, as much as possible, the evil ? vol. lxx. no. 177. a a 366 Mr Paterson's Statistics of Barony Parish Fever Hospital. The first object which demands attention in a proposal to remedy any evil, is to remove its cause; and that, in the present instance, the cause is chiefly what has been above mentioned, few will be disposed to doubt. A very large proportion of the poor supported by the parishes, live in lodging-houses, in each of which, probibly, ten or a dozen are boarded for a small monthly sum for each person. Here, then, is one of the first and most im- portant elements of the evil we are speaking of. The keeper of the house, in endeavouring to make as much profit out of the business as she possibly can, huddles a large number of individuals into a hovel hardly fit for human beings, and provides them with food the cheapest?which is generally the worst? that can be procured. She has no interest whatever in attending to the comfort of her boarders, as she receives their board-wages directly from the parochial authorities, and consequently puts herself to little trouble in the maintenance of cleanliness. But great as this evil is, there is another which is not much less so. Every year thousands of the poor Irish flock into Glasgow, for the purpose of obtaining employment; and whether they obtain it or not, they are forced to betake themselves for shelter to the houses in the wynds, &c., and thus increase to an alarming extent an evil which already existed in too great a degree 5 for they do not merely add to the crowding, but, since they much more readily than others become seized with any disease which may be prevalent at the time, they also contribute more to its propagation. This is the reason why so many Irish have been treated in our hospitals ; and until full and efficient measures be put in operation by our civic and parochial authorities, the evil cannot be expected to diminish. When an epidemic is rising, a great outcry is usually made about fumigation, whitewashing with lime, and a great many other supposed active measures, but comparatively little attention is given to those matters about which chiefly the greatest solicitude should be shown. Let the crowds of inhabitants be scattered, let workhouses accommodate those who can do nothing for their own support, and then, but not. till then, let there be preparations made for disinfecting the dwellings. Such steps seem a mockery when employed in a state of matters like that which at present exists. If, in connection with work-houses, there be hospitals which can at any time receive patients labouring under contagious disease, one of the most powerful influences in its propagation is removed. Hence, though to erect several hospitals seems a weighty matter, yet, such a measure, the experience of many years has proved, would be the most economical of any that could be adopted. In matters of this kind, half measures have invariably ended in disappointment. Edin f Med. & Sur. .Tourn/. _LXX. AT?J

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