‘In the month of September 1817, there was a sudden increased of the epidemic fever which prevailed at that time to a considerable extent in Dublin; to provide for this the Government of the country directed additional wards to be opened in Steevens’ Hospital for fever patients. The attic or upper story, which at this time was un-occupied, was allotted for this purpose.’
John Crampton, Medical Report of the Fever Department in Steevens’ Hospital (Dublin, 1819), p. 8.*
No. XI ward c. 1924 (from Kirkpatrick’s History).
John Crampton’s seminal report on the fever epidemic of 1817-1819 provides us with vital information, not only concerning the specific measures taken at Dr Steevens’ Hospital but also of the nature of the disease, its symptoms, and treatment. Crampton (d.1840) had, like so many other physicians and surgeons associated with Dr Steevens’, been educated at Trinity College Dublin. He would later be appointed as Professor of Materia Medica and Pharmacy at the same college from 1804 to 1840. His connection with Dr Steevens’ Hospital began in 1800 when he was appointed as assistant physician to Dr William Harvey (d.1819), and he succeeded Harvey as Physician of Dr Steevens’ in that year – no doubt as a result of the sterling work he had done during the fever epidemic of the previous years.
Crampton was keen to point out that even before the 1817 epidemic Dr Steevens’ Hospital had played a vital role in helping patients suffering from fever: ‘Long before the establishment of the different Fever Hospitals in Dublin, it was the only institution where patients affected with fever could be received.’ Once the Cork Street Fever Hospital was opened in 1804 cases had declined, primarily because Dr Steevens’, as a general hospital, preferred if at all possible to avoid combining infectious and non-infectious cases together. However, when the 1817 fever broke out in Dublin it was clear that their services were once again needed and, as Crampton’s report amply demonstrates, the Governors and staff of Dr Steevens’ rose to the challenge. In all 4778 fever patients were admitted over the period September 1817 to August 1819 and, as Crampton proudly noted, the mortality in Steevens’ Hospital was below that of any of the other hospitals in Dublin for the same period.
Of particular interest are the tables which Crampton provides of male and female patients and the age groups most affected. Though Crawford (1999) rightly states that ‘typhus was no respecter of age, gender or social class’ it is clear from Crampton’s figures that some age groups were more at risk than others. As the following table (Crampton’s Table 1) demonstrates, the age group most at risk were those in the 20s, 30s and 40s:
|Sept 17-Dec 17||9||90||109||45||31||23||7||2|
|Dec 18-Mar. 17||15||87||80||60||39||18||12||3|
|Mar 18, June 17||21||133||115||51||35||26||10||4|
|June 18, Sept. 17||31||211||127||89||45||29||18||1|
|Sept 18, Dec. 17||26||140||128||63||58||16||9||2|
|Dec 18, Mar. 17||15||103||124||62||38||19||10||1|
|Mar 18-Aug 17||27||93||90||57||43||14||17||1|
A similar picture emerges in his table for females for the same period.
|Sept 17-Dec 17||6||40||61||27||20||3||2|
|Dec 18, Mar. 17||14||59||72||31||16||4||3||2|
|Mar 18, June 17||12||75||80||31||12||4||6||1|
|June 18, Sept 1||24||128||79||33||24||17||5||1||1|
|Sept 18, Dec. 17||27||139||149||57||31||15||6||5|
|Dec 18, Mar 17||36||122||111||53||27||12||5||2|
|Mar 18, August 17||23||124||112||56||14||14||18||2|
|1 = 2046|
|Total of both sexes||280||1544||1437||715||433||214||128||23||3|
|1 = 4778|
Though initially male admissions to hospital were higher than female admissions, this trend was soon reversed and by the summer of 1818 Crampton was forced to appropriate one of the male wards for female patients. He provides the reader with a detailed description of the wards for males and females and the procedures adopted to contain infection:
When patients were admitted, their clothes were hung up in an airy place in order to disinfect them, as far as was practicable, by ventilation. The patients themselves were washed in tepid water with soap, their heads shaved, clean linen and a cap supplied; they were put to bed in a cool ward, well ventilated by a constant current of fresh air. A mild purgative medicine was then administered. These measures were generally put in practice before the Physician, who visited daily, saw the patient, as admissions took place at all hours of the day. In many instances this plan, unassisted, was sufficient to ensure recovery. These ablutions were often practiced for several days in succession, whilst the purgatives were repeated. Under this system most of the patients experienced a great amelioration of symptoms, it was therefore the plan pursued with the greater majority of the mild cases.
In more severe cases other measures were resorted to: under William Harvey’s regime ‘the lancet and blisters were resorted to,’ and those with the ‘petechial’ forms of the disease were supplied with either porter or wine, depending on the stage of their fever. While Harvey used ‘calomel purges’ in severe cases Crampton reports that his predecessor was adverse to the use of mercurial purgatives.
When Harvey fell ill and died Crampton took over. His own treatments were as follows:
Shaving the head and the cold affusion after bleeding, rendered the future progress of the fever more tractable; for it was nearly inattainable by any means that were tried with this description of patients, and at the periods they were consigned to treatment, to cut short the fever or bring it at once to a solution; medical assistance went chiefly to prevent destructive changes of structure in important organs. With those, however, who immediately submitted to active treatment, the disease became mild in a few days, and there are a few instances where the symptoms subsided at once.
Purgatives of course were constantly given in this fever, and tepid effusions were practised when the weather was too cold, or where patients at advanced periods were supposed too feeble to withstand the shock of the cold affusion….
When venesection was used during the first few days of this fever the pulse, from having been small and feeble, expanded and became more full and sensible to the touch. If a compromise line of practice was adopted, and if patients were blooded not to the extent that afforded relief, or else if it was practised at periods too advanced for the strength or vital powers to bear, a want of success was the result, and discredit was thus brought on the practice.
A short relapse was often the sequel of this form of fever, and in some instances tedious recurrences of the disease were observed. When a relapse set in with severe symptoms, and that there was no material objection, the lancet according to my experience was the best remedy; and on such occurrences the blood drawn was for the most part buffy, whereas on the first onset of fever it had been free from such appearance. In some instances I had to regret not resorting to this practice in relapses, the termination of which ultimately became either hydrocephalic or pthisical, according to the tendency on predisposition of the individual.
The environment patients were treated in was crucial, as patients who had previously only displayed mild forms of fever could quickly develop into more serious cases if they were placed in hot airless rooms which had been previously housed infected patients.
The principal problem was identifying which type of fever one was dealing with. As Crampton ruefully admitted:
Fever appeared in all the different forms described by those who have written reports on the present epidemic. In many instances the stomach and bowers were disordered; in a great majority of patients the head was affected, especially in fatal cases. Dysentery appeared in complication with fever early in winter 17-18. Catarrh and pulmonic attacks in spring 1818. A great variety and mixture was assembled in these wards, from the simplest ephemeral fever to the most malignant and protracted forms. Petechiae or spots were more observed in the first than in the second quarter.
Given that all those involved in tending the sick (with the exception of Harvey and Crampton) fell ill with the disease, it was clear that they were dealing with a contagious fever. Crampton noted one particular form of fever:
It commenced with giddiness or rather staggering, dull headach, which afterwards became intense, loss of appetite, and a white chalky tongue. Many thus circumstanced apprehended they had merely caught cold, a degree of coryza, or running at the nose, having in some instances occurred; some felt better the next day, on taking a little medicine, and were averse to lie down for a few days; they felt less inconvenience in the erect posture and in the cool ward than in bed: after this preliminary stage a rigor sometimes took place, at other times it was not observed. The pulse was not always accelerated at this stage, but it was small and indistinct; the skin looked sallow, nor were the alvine secretions much disturbed.
After the symptoms just described had continued a few days, a violent degree of reaction took place, with a complete development of febrile excitement; and on the third, or at all events on the fourth or fifth day, a patient thus attacked was not unfrequently beyond the reach of medical treatment; delirium, a fixed and glassy eye, loss of senses, loss of speech and of the power of swallowing, immediately set in. The majority of such patients had petechiae in different forms; either a mottled or marbled skin, or the measley efflorescence, or the distinct dark petechial ecchymosis.
It is clear now that the epidemic was one of typhus. As Crawford (1999) notes, it would prove to be the first of four typhus epidemics in Ireland in the nineteenth century. However, it is unclear whether every case of ‘fever’ at Dr Steevens’ Hospital (or any of the other Dublin hospitals) was a case of typhus. Some of the milder cases may have been ‘relapsing fever’.
Crampton’s report is particularly useful in pointing to the occupations of the afflicted patients of Dr Steevens’ during this time:
The fever pressed most sorely on three descriptions of persons, namely labourers, tradesmen and servants. The other classes of the community afforded but few inmates for our wards. The labourers crowded in both form town and country; they constituted the great majority. Many of them were supplied from the public works, as from the repairs of the Liffey wall, the Custom-house docks, Dunleary and Howth. A tolerable large share were admitted from the distilleries, the breweries, and from the watchmen.
The tradesmen were the next in point of numbers; shoemakers, tailors, bakers, smiths, bricklayers and painters; their journeymen more especially were constantly found in our wards, and constituted some of the worst cases.
Servants in every station were admitted in considerable proportion, those more particularly in the employ of tradesmen, and still more those who were out of place, either from their dissipated habits, or from the general want of employment which then prevailed. Many of the worst cases were also furnished from this class. Some discharged seamen and soldiers were occasionally found in our wards. A very large proportion of the females were servants.
Crampton records that the treatment they received in Dr Steevens’ Hospital, coupled with the disinclination of the Governors to allow dissections of the dead, ensured that Dr Steevens’ Hospital became the hospital of choice for both the urban and rural poor around Dublin.
*All quotations are from Crampton’s Medical Report.
Crampton, John (1819), Medical Report of the Fever Department in Steevens’ Hospital, containing a brief account of the late epidemic in Dublin, from September 1817, to August 1819 by John Crampton, M. D. Physician to Steevens’ Hospital. (Dublin).
Crawford, E. Margaret (1999), ‘Typhus in Nineteenth-Century Ireland’, in Medicine, Disease and the State in Ireland 1650-1940 edited by Elizabeth Malcolm, and Greta Jones (Cork University Press), pp. 121-137.