Nottingham Hospitals Archives 2011
Bagthorpe Isolation Hospital
Hospitals for Infectious Diseases
Infectious diseases are spread in a number of ways. Diphtheria, smallpox and tuberculosis are carried on the breath; cholera, dysentery and typhoid (or enteric) fever can be caught through contact with infected faeces; scarlet fever is passed on through contact with infected material; and lapsing fever, scabies and typhus are spread by parasites. Even before these diseases were identified and differentiated from each other and their methods of transmission know, attempts were made to isolate the infected from the healthy in order to give a degree of control over what were often incurable and frequently fatal ailments.
Smallpox, with its distinctive pustules and great virulence, was easily recognised, but diagnosis long remained vague of the numerous other infectious diseases, many of which had a fever as the main symptom. Indeed, until well into the 19th century ‘fever’ was seen as a generalised, non-specific form of disease, spontaneously generated in foul air and putrefying matter. Typhus and typhoid fevers were the first to be separately identified in 1837, followed by relapsing fever in 1843.
Hospitals for infectious diseases needed little special planning. Their purpose above all, was isolation. Usually some attempt was made to prevent cross-infection, particularly at hospitals where more than one type of disease was admitted. Out-patient’s departments were not provided and surgery did not feature in treatment until the early 20th century. In other respects isolation hospitals were closely related to general hospitals, reflecting contemporary developments in design. Unlike general hospitals, however, most were established either by Poor Law guardians as part of the workhouse, or by local authorities. Essentially, the isolation hospital was the poor man’s spare bedroom. Those who could practiced isolation at home and hospitals served the working and lower classes. They were invariably erected in response to specific events, such as epidemics, which were also the spur to a growing body of legislation aimed at containing these devastating and repeated outbreaks.
Hospitals for Infectious Diseases up to the Mid 19th Century
Once outbreaks of the plague ceased to occur in Britain after the 1660's, smallpox caused the greatest fear and repulsion, not least because the disease was so readily identifiable. Pesthouses provided the earliest resort for those suffering from smallpox or other infectious diseases. These were rented or even built by local communities, usually the parish. Of examples of Pesthouses still surviving suggests that they were ordinary houses, commonly of two-room plan with a central staircase. It was not until the mid 18th century that more extensive isolation hospitals were erected, and these were solely for smallpox cases.
Most general hospitals attempted to exclude people with infectious diseases that might spread to and endanger the other patients. Problems inevitably arose because imperfect diagnosis often led to the admission of patients in the early stages of fever, causing infectious disease to develop among existing patients. It was common to be dismissed or boarded out when the nature of their illness was discovered.
The first smallpox hospital in the county was founded in 1746 in London. By the 1750’s it was split between three sites; one building in Shoreditch admitting patients who had been inoculated (and were therefore suffering from the milder form of the disease), another in Islington was for convalescents, and a third in Cold Bath Fields, Clerkenwell, was for the severest cases, who had never been inoculated. Only the last of these was a purpose-built hospital, erected circa 1753 adjoining an obsolescent public house. The Cold Bath Fields building was eventually superseded by a new smallpox and fever hospital erected in 1793-4, near St. Pancras.
Although there was a pressing need for separate hospital to isolate and treat infectious diseases, progress was desperately slow. Many general hospitals were forced to provide fever wards as patients had nowhere else to go. At the Chester Infirmary in 1783 specific wards were set apart for infectious diseases, mainly typhus. They were situated within the main building but separated from other wards. Liverpool Infirmary followed suit in 1787, when the victims of a typhus outbreak were placed in wards improvised in the basement. The Liverpool Fever Hospital, built at Brown Hill in 1801, was the first to be established for infectious diseases other than smallpox. Many of the earliest fever hospitals were known as ‘houses of recovery’. Between 1802 and 1804 such hospitals were established in London, Manchester and Newcastle upon Tyne.
The house of recovery in London first occupied a house in Constitution Row, Gray’s Inn Lane, ‘to the great horror of its neighbours who were threatened indictment and prepared for litigation’. Whether or not as a result of this opposition, the fledgling fever hospital moved in 1815 to a building belonging to, and on the same site as, the Smallpox Hospital at St. Pancras. In the mid 19th century both hospitals were displaced by the development of the new terminus of the Great Northern Railway – now King’s Cross Station. The smallpox hospital then moved to a new building in Highgate and the house of recovery to Islington and became known as the London Fever Hospital.
Urban areas, where epidemics were rife, saw the establishment of a number of isolation hospitals in the first half of the 19th century, but rural districts continued to rely on small pesthouses. By the early decades of the 19th century the maintenance of many of these pesthouses was in decline, and this limited local provision was largely superseded by the workhouse system. Most workhouses had at least nominal hospital accommodation, and many included separate fever blocks.
Following devastating epidemics of smallpox, typhus and typhoid, came cholera. This was not endemic in Britain. It arrived, perhaps from Asia, in 1831, and, despite the ‘Cholera Prevention Act of 1832, there were repeated epidemics of the disease. The worst occurred in 1848-9, claiming the lives of about 50,000 people in England and Wales. And this was only ten yeas after a particularly appalling smallpox epidemic which had killed about 42,000. Early legislation tended to be well-intentioned but was often ineffectual while the erection of hospitals depended upon funds first being raised from the rates. In the midst of each succeeding epidemic local authorities throughout the country accepted that available hospital accommodation was disastrously inadequate, but they had seldom gone father than proposing to take action before the epidemic subsided and the initiative was lost. The cholera epidemic of 1866, for example, prompted the erection of only a few hospitals, although the provisions of the Sanitary Act of 1866 gave town councils and local boards of health the power to provide either temporary or permanent hospitals, and justices of the peace the power to remove patients to them. None of the few cholera hospitals built in the 1860’s now survive. They were all quite small, the largest being of just 21 beds which was the Garrison Hospital, Hull.