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Further Remarks On The Present Epidemic Fever 1819
Various extracts from the article titled 'Further Remarks on some recent remarks on some recent publications on the present Epidemic Fever'
It has been established on incontrovertible testimony, that during the period that the practice of blood-letting been generally adopted in the Royal Infirmary, and the Queensberry House Hospital of this city, the deaths have decreased from 1 in 10 and a fraction, (the proportion which they bore to the recoveries in the period from 1812 to 1817) to 1 in 15 the proportion between the years 1817-18, and to 1 in 21, the average rate from January 1818, to the same period in the current year .Nay, farther, for the three first months of 1819, the deaths by fever in both hospitals stand so low as 1 in 31, 1-14th only.
These facts we hold to outweigh a library of opinions, and a host of theoretical opponents, and they have pressed upon our minds so forcibly, and appear to us so completely to comprehend the very end and aim of the medical art, that we have taken this early notice of them, although somewhat out of the regular order followed by the author of the valuable practical work before us.
To revert then to the arrrangement of Dr WELSH's book, we find that like his able and learned predecesssor on the subject of the prevalent epidemic, Dr DUNCAN junior the author dedicates his book to the Managers of the Royal Infirmary, whose unremitting exertions in the cause of humanity, have so justly entitled them to the gratitude and applause of their fellow citizens. It gives us the most sincere satisfaction to be able to add to Dr Welsh's testimony, of the excellent management of the Fever Institution at Queensberry House, our tribute of applause. We have repeatedly witnessed the critical cleanliness, the judiciously regulated ventilation, the comfortable bedding, the whole-some and ample supply of provisions, and the alertness of the domestics, of that establishment. The zeal and skill of the physicians Drs HAMILTON, SPENS, and HOME, and of their assistants, (among whom, Dr WELSH is so conspicuous), are recorded in indelible characters on the annals of the house, and with no small degree of pleasure, we now challenge for the hospital institutions of Edinburgh, not only an equality with, but in many points, a preeminence over those of any other city of the empire.
In Dr WELSH's first pages are detailed the domestic arrangements, which have so much contributed to the latter, the remainder of his work, with the exception of his historical sketch of blood-letting, and a reprint of the meteorological tables kept at the Calton Hill Observatory, shews us the medical means by which the former has been established.
in our former observations on the subject of the epidemic fever, but before entering on this, we shall quote from him a few words ,which we humbly conceive ,with all deference to those who deny the contagious nature of the fever, will set that point completely at rest. After mentioning the attack of his three colleagues, the matron, the apothecaries, the shopmen, a washerwoman, and eight and thirty nurses, &c, he proceeds to state,
"When it begins in a family, we always expect more than one of them to be affected. I could mention instances of four, five, six, and seven, being sent to the hospital, out of one family; eight, nine, and ten out of one room; twenty and thirty out of one stair, and thirty and forty out of one close; and this all in the course of a few months."
Being once affected with the disease, does not, according to Dr WELSH give any protection against a second or even a third attack.
The proportions of the sexes into Queensberry House about 4 females to 3 males; there 62 under 10 years of age, (among whom was one of only 21/2 years) and two of 70 and upwards (76); the greatest number of the patients however, were between 20 and 30; the next period of life at which its attacks appear to have been most severe was from 10 to 20.
Of the deaths the greatest proportion happened among patients from 40 to 50 years of age. From 20 to 30 years old, and from 30 to 40, the deaths occurred in equal numbers.
In the clear and concise little tract of Dr DiICKSON , the importance of houses of recovery are very forcibly pointed out, and he shews that it is the protecting influence, which they extend to all classes of society, that renders them so eminently useful to the public, and interesting to the legislator and philanthropist.
Dr Dickson particularly points out a strange anomaly which is highly deserving of the notice of the legislature, it is this,
"That not only fevers, but infectious diseases generally, are excluded by charter from almost every county and city infirmary in the kingdom; so that the managers and medical practitioners of these admirable institutions are compelled to transgress their own laws, when, in obedience to the dictates of humanity, they receive within their walls those sufferers who are especially entitled to the benefit of some remedial and preventive asylum, whether we consider their individual welfare, or that of the community."
The work of Dr ROGAN, we look upon as by far the most important piece of medical topography, in connection with the epidemic fever of Ireland, which has yet been published.
This physician was distinguished in devising and in carrying into execution the plans pursued by the late ofMarquis of Abercorn, of whom we had occasion to speak with such heartfelt admiration in a former Number. We again strongly recommend the noble Lord's example to all landed proprietors and particularly to the nobility of the sister island; their countryman's book is perspicuous and unincumbered with obscure medical language, it is within the comprehension of everyman, and the picture which it exhibits of the state of the poor in Ireland and of the best means of relieving them, is sketched with a masterly hand.
He notices one circumstance which must very much tend to the propagation of fever in Ireland.
"As in this country", he observes, "no law exists to authorize the imposition of a tax on the inhabitants at large, for the support of those who are incapable of earning a livelihood, they are obliged to travel from place to place in search of subsistence. Most of those, who in plentiful times live by begging, are either persons who, from old age or infirmities, are incapable of earning their bread by labour; or widows with families too numerous to be supported by any effort of industry in their power. In seasons of scarcity, the number of mendicants is greatly increased, many then being forced to betake themselves to begging, who would be capable of earning a livelihood if they could procure employment. Great numbers of labourers, with large families, are then reduced to this state, owing to the poorer farmers becoming unable to defray the usual expences of labour; but still greater numbers of females are, in such times, deprived of support, as the high price of provisions makes it the interest of the farmer to reduce his establishment as low as possible. He, therefore, dismisses the female servants, whom he usually employs in spinning linen yarn, as the profit of their labour seldom exceeds sixpence per day, and often falls short of this sum, so that he would not be sufficiently remunerated for their food. In most farm-houses, one or more womenservants are generally employed in this way, so that, in a season of scarcity, numbers are thus either reduced to beggary, or are obliged to return to their parents, who may be generally ranked amongst the poorest of the community.
To relieve the paupers of Strabane, the place of Dr ROGAN's residence, a soup kitchen was established in favour of 304 poor families, containing 1026 individuals, to whom the soup was distributed gratis, but the multitudes who flocked in from the surrounding country, as the season advanced, and were actually perishing in the streets from want, made it soon indispensable to prepare a larger quantity of broth every day in order to preserve their lives; it was sold at a halfpenny per quart, and afforded a daily wholesome supply to at least 1000 persons.
The inhabitants of Strabane amount to about 4000, and great as the number of paupers must appear when the population of the town is considered, it soon bore a small proportion to those who came from all parts of the surrounding country, in the hope of participating in the relief thus afforded. The streets were thronged with beggars, whose emaciated bodies plainly showed the extent of their sufferings from famine.
As the summer advanced, vegetables, not generally regarded as esculent, were greedily eaten. Nettles, wild mustard, and the leaves of cabbage, were sought for most anxiously; and with a small admixture of oatmeal, formed the chief support of many families, who endeavoured to remain in their cottages. When the begging poor were so fortunate as to get a few potatoes, their impatience to satisfy their hunger, often prevented them from waiting till they were sufficiently boiled, so that they were eaten as soon as they became warm, and cabbage leaves were devoured without any previous cooking.
Can we wonder that under such a disgusting and precarious support of embittered existence, dysentery, dropsy, and fever, soon reared their heads? Of the latter disease alone, 639 cases were noted among the ordinary inhabitants, or nearly one sixth of their number, and one in nine of those attacked, died, while 535 cases, principally strangers not included in the census of the inhabitants, were received into the Fever Hospital, of whom 1 in 28 only, died. This frightful list, which forcibly points out the importance of Fever Hospitals, embraces a period from 22d August 1817 to 1st December 1818. The Hospital was a temporary establishment, supported by private subseription, and a grant from government, and under able and economical management, the expences were defrayed 'for about eleven shillings per patient'.
Every page of Dr ROGAN's book abounds with valuable matter, narrated in a clear and unpretending style, and showing the origin, progress, and decline of the epidemic. For the means adopted we must refer to the publication itself, but we may remark that nothing appeared more powerfully and immediately to stop the progress of the disease 'than the suppression of street-begging -by giving the paupers a certain weekly allowance- confining them to their own homes, and making them look to the produce of their own labour, for at least a part of their subsistence. We may at some future period, again take up the interesting subject, and give more ample details of the Marquis of Abercorn's plans -our limits at present warn us to conclude Fever
1. A Practical Treatise on the Efficacy of Bloodletting in the Epidemic Fever of Edinburgh. by Dr Welsh Edinburgh 1819
2. Observations on the Prevalence of Fever in various parts of the United Kingdom. by Dr Dickson Bristol 1819
3. Observations on the Condition of the Middle and Lower Classes in the North of Ireland as it tends to promote the diffusion of contagious Fever. by Dr Rogan London 1819
