CONTAGIONISM IN HISTORY

 

PREVENTING CONTAGION: ADVICE TO THE POOR

John Clark of Newcastle, William Clerke of Bury and Francis Barker of Waterford

 


 

     Dr. John Ferriar apparently wrote his "Advice to the Poor" during the terrible fever epidemic of 1795. It was not distributed for reasons that Ferriar does not explain. Ferriar finally printed it in the "Appendix" of his third volume of essays, Medical Histories and Reflections (1798).

    George Rosen reprinted Ferriar's "Advice" in 1942,  In his introduction to this document Rosen argued that it illustrated Henry Sigerist's claims that the eighteenth-century public health movement broke down because its leaders were "humanitarians and idealists who assumed that education was all-powerful and thus neglected neglected economic factors."[1]  Moreover, they wrote for members of the middle class, not the illiterate peasants and city workers who needed health advice. Rosen claimed that Ferriar's "Advice" represented a unique exception to the limited outreach that Sigerist had delineated. He thought this was due to Manchester's exceptional position as the first industrializing city.      

    In fact Ferriar's "Advice" was not unique: several similar documents have survived, although their authors drew on each other's work.  Moreover, unlike Ferriar's "Advice," several of them apparently were actually distributed to the poor. Below is a selection of some of the shorter examples.  They were part of a national effort to persuade members of the public that certain serious diseases were contagious and that they could reduce their risk significantly by acting on this information.  This effort was not limited to Manchester or to communities experiencing the first wave of industrialization. Other British cities witnessed similar poverty, squalor and disease and similar efforts to stem the tide.  The importance of these documents lies instead in their new emphasis on contagion as a key factor in spreading "fevers" and in the recognition that controlling the spread of contagion required cooperation from everyone in the community. One result of this campaign was the establishment of "fever hospitals" in a few  cities.  I believe their impact has been underestimated but we will never know how effective this campaign was overall in changing lay ideas about the nature of disease or in transforming these new ideas into changed behavior.

    The "fever" that broke out in 1795 seems to have been typhus; a disease that was just coming into clearer focus.  It was still often confused with other ailments including typhoid.  Whereas typhoid usually spreads through contaminated water or food, the typhus bacillus is usually carried by body lice.  Typhus is a severe illness; its mortality is relatively low in healthy children but rises with age, reaching more than sixty percent in people over fifty.[2]  Although typhus is not spread directly from person to person, it behaves like a contagious disease because lice don't fly.  The disease is transmitted by contact with the body, clothing, bedding or possessions of a victim; in addition lice shed contagious feces that are light and can spread through the air. Thus it was probably helpful to stress ventilation and immersing items in water in addition to washing everything that could be washed. For lime wash as an anti-microbial, see M. Michael Miller, "Lime."

Notes:

[1] George Rosen, "John Ferriar's 'Advice to the Poor'" Bulletin of the History of Medicine (1942), 11: 222-227. I am grateful to the Multnomah County Library, Portland, for borrowing this for me.

[2] "Epidemic Typhus," The Merck Manual of Diagnosis and Therapy

 

 

John Clark of Newcastle, "Instructions and Rules," 1791

 

Campaigning against opposition from his colleagues for a fever hospital in Newcastle, John Clark published a series of documents relevant to the dispute.  Among them was a copy of advice that he said had been handed out to patients of the Newcastle Dispensary (where he was a physician).  It is a boiled-down version of the advice that Thomas Percival of Manchester had provided to Sir William Clerke, the Rector of Bury, during a typhus epidemic that struck the region in 1789-90 (see below).

 

Rules for Preserving Health

I. Every day sweep your houses; open the windows, to admit fresh air; and wash your rooms once a week.

II. Keep your persons as clean as possible; and wash your children at least every morning

III. Allow no person from a family affected with a fever, a flux (diarrhea), the small pox, or any other infectious disease, unnecessarily to enter your houses; nor any of your own family to go into any of your neighbors houses, when afflicted with those distempers.

IV. White-wash the walls and ceilings of your apartments twice a year, with quick lime slacked in hot water, which will not only contribute to health and neatness, but, when laid on hot, will effectually destroy vermin.

 

Rules for preventing fevers, and other infectious diseases.

1. As soon as a person is seized with any feverish complaint, let the feet and legs be bathed in warm water; and after drying them well, let the patient go to bed, and encourage sweating by drinking warm gruel, sage, or balm tea.

II. Let the sick person's linen be changed as often as possible; and, when it is taken off, be put immediately into cold water, before it be washed with hot water.

III. If the family have more rooms than one, the sick person should occupy one himself; he should have no more than one, or at most two attendants, and his neighbours should not be suffered to visit him.

IV. Every stool of the sick person should be received in a pan with a little cold water; some more cold water should afterwards be added, and it should then be immediately carried out of the chamber.

V. The apartment of the sick person must be kept very clean; the windows must be frequently opened; and the floor washed with hot water, that it may dry soon.

VI. After the recovery or death of the sick person, all the bed-clothes and furniture of the room should be washed; the walls and the ceiling white-washed with quick lime, slacked in warm water, and laid on hot.

 

Source: John Clark, "Appendix no. III. Instructions and Rules to be Observed by the Patients of the Dispensary.  First Printed in 1791" in same, A Collection of Papers Intended to Promote an Institution for the Cure and Prevention of Infectious Fevers in Newcastle and other Populous Towns.... (Newcastle: 1802).  The various papers in the "collection" are separately paginated.  This appears on pp. 32-4 of the second compilation in the book.

 

William Clerke of Bury, "Prevention and Suppression of Epidemic Fevers," 1790

 

In 1790, The Reverend Sir William Clerke of Bury published a pamphlet which included a lengthy letter of advice on the prevention and management of typhus by Thomas Percival. Clarke abridged this to create his "Rules of Prevention and Suppression of EPIDEMIC FEVERS, for the Use of the Poor of the Townships of Bury and Elton."  This pamphlet is not available through Google books but an early version of Clerke's advice was reprinted by Andrew Duncan, editor of the Medical Commentaries, [also known as Medical and Philosophical Commentaries] (1792) 16: 353-8. Percival's advice was also reprinted, by a review of Clerke's pamphlet that appeared in the Analytical Review (January-April, 1790), 6: 460-462.

Clerke's "Rules" promise a reward for families that adhere to this advice and threaten to withhold aid to those who do not. Clerke was in a position to enforce this because his private committee had collected a substantial fund to sustain its activities. 

I don't know why ingesting mustard seeds was seen as a preventative. Though mustard has been grown in Britain since prehistoric times and at least it was inexpensive, it was usually used externally, as a mustard plaster. Mustard seed was probably less harmful than antimony, in the form of tartar emetic or James's powder, which Percival had recommended as a medicine.

 

Rules of Prevention and Suppression of EPIDEMIC FEVERS

 

An early notice of the attack of fever must be given to the medical person appointed to attend the sick.

The apartment of the sick should be washed with sope [soap] and HOT water, that it may soon become dry.

The sick person should have clean linen both about his person and upon his bed.

 If the bed clothes be dirty or offensive, fresh ones should be provided.

Whenever the  sick person's linen is renewed, which is should often be, what he puts off should be thrown into COLD water, with a portion of sope lye in it, and repeated quantities of cold water poured upon it before it is washed.

The business of washing should be performed in the open air.

When the sick person has occasion to go to stool, the pan which he uses should contain some cold water; and immediately after each stool cold water should again be poured into the pan, which is to be carried out of the chamber with no loss of time.

After the recovery of the sick person, the apartment in which he has been confined should be well aired and whitewashed with lime, fresh slacked, and laid on HOT. The windows to be set open every day.

If the bed has been fouled by the discharges of the sick person, it should be burnt.

The bed clothes must be thoroughly so[a]ked in water, then washed and hung in the open air.

Each member of the family of the sick should take, according to their age, a tea-spoonful or two of unbruised mustard seed at bed time, to prevent the catching of the disorder.

If the family have more apartments than one, that in which the sick person is confined should be frequented only by those who are necessary to attend upon him.

Every member of that family should be precluded from entering into any neighbour's house, and be kept as much as possible from all intercourse with others.

The same rule must be observed with respect to the visiting of neighbours or strangers with that family.

To encourage a strict observance of these necessary regulations, a reward will be paid, at the termination of the fever, by the Committee, to the master or mistress of the house, on producing a certificate from the attending surgeon.

By a strict observance of these rules, we trust, through the blessing of GOD, that the present misery of the poor will be alleviated, the ravages of a malignant and mortal distemper will be checked, and health, enjoyment, and usefulness to our fellow-creatures, be restored.

Temperance and cleanliness to the whole body of poor are here particularly recommended.

And the Committee; painful as it will be to them, will be obliged to withdraw their support from families who disregard the foregoing resolutions.

 

Source: William Clerke Thoughts upon the Means of Preserving the Health of the Poor, by Prevention and Suppression of Epidemic Fevers (London: 1790).

 

Francis Barker, "Advice," Waterford, ca. 1800

 

    Francis Barker, a graduate of Trinity College Dublin and recent M.D. from Edinburgh was commissioned by a group of gentlemen who founded the Waterford Fever Hospital in Ireland to write a report.  Barker's report described the squalid conditions of the Waterford and its environs in detail, discussing  the immiseration caused by typhus and the fact that neighbors avoided the stricken.

    His report included a copy of a handbill that was distributed to the poor.  It explained that even after patients had been taken away to the House of Recovery, infection could remain in their lodgings. Both his report and the handbill were reprinted by the Society for Promoting the Comforts of the Poor which was emulating the better-known London Society for Bettering the Condition and Increasing the Comforts of the Poor.  Both Societies disseminated information to help philanthropists set up and operate effective charities.  Barker's "Rules" refer to cleaning floors with a shovel, evidence of the extent of Irish poverty.  They offer a reward for compliance but do not threaten to withhold support for non-compliance. 

 

The following Hand-bill has been distributed among the Poor by the directions of the House of Recovery

_______________

ADVICE

     Though you have sent your friend to the House of Recovery, yet the infection of the fever may still remain in your rooms, and about your clothes: to remove it, you are advised to use without delay the following means: --

    1st. Let all your doors and windows be immediately thrown open, and let them remain so for two hours.

    2ndly. Let your bed-clothes be put out in the open air for half a day, after which let them be washed.

    3dly.  Let the clothes you wear be aired and washed.

    4thly. If you lie on straw beds, let the straw be immediately burnt, and fresh straw provided.

    5thly. White-wash all your rooms, and the entrance to them, with lime, slacked in the place where you intend to use it, and whilst it continues bubbling and hot.

    6thly. Scrape your floor with a shovel, wash it clean, and also your furniture.

    7thly. Wash clean, every morning for the space of a week, your face, hands, and feet; and during this time remain in the open air as much as you can.

        A reward will be given by the treasurer to any person who can bring a certificate of his having followed these directions.

 

Source: "Extract from an Account of the House of Recovery for Fever Patients, lately established at Waterford; with Observations communicated by Fr. Barker, Esq. M.D." in Reports of the Society for Promoting the Comforts of the Poor (Dublin: 1800-1802), 1-2: 106-7.

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