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Fever hospital

The London Fever Hospital
Smallpox hospital ships moored at Long Reach. They are (L–R) Atlas, Endymion and Castalia. The latter had two hulls on which hospital buildings were constructed.

A fever hospital or isolation hospital is a hospital for infectious diseases such as Scarlet fever, Tuberculosis, Lassa fever and Smallpox. Their purpose is to treat affected people while isolating them from the general population. Early examples included the Liverpool Fever Hospital (1801) and the London Fever Hospital (1802).[1]: 13  Other examples occurred elsewhere in the British Isles and India.

The hospitals became common in England when laws were passed at the end of the 19th century, requiring notification of infectious diseases so that public health officers could ensure that the patients were isolated. During the 20th century, immunisation and antibiotics reduced the impact of these diseases.[2] After the introduction of the National Health Service in 1948, the hospitals were wound down so that, by 1968, there were few left.[1]: 27 

As a result of the COVID-19 pandemic a number of temporary isolation wards within existing hospitals were established as well as several temporary hospitals,[3] such as the nightingale hospitals in England which were little used in many countries with the notable exception of China.[4]

It has been suggested that creating modern isolation hospitals might be an effective way of managing highly infectious diseases as was shown in China during the COVID-19 pandemic.[4] however the lack of staff to operate these facilities, the large costs for no ongoing direct patient benefit and the inability to use other hospital facilities to provide care for patients have been cited as the key reasons why fever hospitals are not appropriate in modern healthcare.[5]

England and Wales

The first hospital specifically for smallpox was the London Smallpox Hospital, founded in 1741. The first specialist hospital for other infectious diseases was the Liverpool Fever Hospital which was founded in 1801. Fever hospitals or "houses of recovery" were then established in other major cities – Chester, Hull, London, Manchester, Newcastle upon Tyne and Norwich. These were mainly for the treatment of typhus which was common.[6] By 1879, isolation hospitals of some sort were established in 296 local authorities, out of a total of 1,593 – about 18.5%. As the germ theory of disease and nature of infection became established, more fever hospitals were established so that, by 1914, they were the most common sort of hospital.[1]: 20  The numbers and sizes of the different sort of institutions at that time were[1]: 20 

Institution Average size (beds) Number in England and Wales
Fever hospital 41 755
Poor Law infirmary 134 700
General hospital 53 594
Smallpox hospital 22 363
Specialist hospital 62 222

After the London Fever Hospital was established in 1802, six more hospitals were established in London by the Metropolitan Asylums Board. These were designed with two separate buildings – one for smallpox patients and one for sufferers from other infectious diseases: cholera, diphtheria, dysentery, measles, scarlet fever, typhoid fever, typhus and whooping cough.[7]: 23 

In London, there were protests and legal action against fever hospitals by residents who were concerned about the risk of infection. Precautions were taken, such as disinfection of ambulances, but it was found that the incidence of smallpox increased near smallpox hospitals. Siting of the hospitals next to rivers, so that transport of patients could be limited to ambulance steamers was found to reduce this. Ships, moored on the Thames at Long Reach, were also used as isolation hospitals.[8]

Notification

The UK Infectious Disease (Notification) Act 1889 (52 & 53 Vict. c. 72) required that local authorities be notified of the occurrence of such infectious diseases. The medical officer of health was then empowered to isolate the patients to prevent spreading. Well-to-do patients could be isolated at home but poorer people lacked the facilities and space for this. The requirement for isolation thus drove the need for provision of hospitals for this purpose. These measures were compulsory in the London area and were made compulsory in the rest of the country by a similar act of 1899.[9]

Cross infection

Cross-infection was a significant issue because patients with different diseases might be put in the same ward and share facilities such as towels. Isolation hospitals were then criticised as places "where a person goes in with one infectious disease and catches all the rest."[9]: 4  Patients returning from such hospitals might then spread the acquired infections to members of their families. These were called return cases and they could result in complaints and lawsuits. A major difficulty was a lack of understanding of scarlet fever, which was the most common disease at that time. The nature of the disease and how it was transmitted was uncertain. To prevent return cases, hospitals tried extending the period of isolation and giving patients disinfectant washes with formalin or Lysol when discharging them.[9]

List of hospitals

England

India

Ireland

China

See also

References

  1. ^ a b c d Margaret Currie (2013), Fever Hospitals and Fever Nurses, Routledge, ISBN 9781134265268
  2. ^ Carl Heneghan; Tom Jefferson (15 May 2020), "Let's bring back Britain's fever hospitals", The Spectator
  3. ^ Campos, Afonso Teberga; dos Santos, Carlos Henrique; Gabriel, Gustavo Teodoro; Montevechi, José Arnaldo Barra (2022-03-01). "Safety assessment for temporary hospitals during the COVID-19 pandemic: A simulation approach". Safety Science. 147: 105642. doi:10.1016/j.ssci.2021.105642. ISSN 0925-7535. PMC 8692075. PMID 34955606.
  4. ^ a b Wang, Jiangshan; Zong, Liang; Zhang, Jinghong; Sun, Han; Harold Walline, Joseph; Sun, Pengxia; Xu, Shengyong; Li, Yan; Wang, Chunting; Liu, Jihai; Li, Fan; Xu, Jun; Li, Yi; Yu, Xuezhong; Zhu, Huadong (2020). "Identifying the effects of an upgraded 'fever clinic' on COVID-19 control and the workload of emergency department: Retrospective study in a tertiary hospital in China". BMJ Open. 10 (8): e039177. doi:10.1136/bmjopen-2020-039177. PMC 7440187. PMID 32819955.
  5. ^ Singh, Shalendra; Ambooken, George Cherian; Setlur, Rangraj; Paul, Shamik Kr; Kanitkar, Madhuri; Singh Bhatia, Surinder; Singh Kanwar, Ratnesh (2021-02-01). "Challenges faced in establishing a dedicated 250 bed COVID-19 intensive care unit in a temporary structure". Trends in Anaesthesia and Critical Care. 36: 9–16. doi:10.1016/j.tacc.2020.10.006. ISSN 2210-8440. PMC 7647395.
  6. ^ "History of Fever Treatment in London", Nature, 132 (3343): 816, 25 November 1933, Bibcode:1933Natur.132R.816., doi:10.1038/132816b0
  7. ^ a b c Veronika & Fred Chambers; Rob Higgins (2014), Hospitals of London, Amberley, ISBN 9781445638270
  8. ^ Geoffrey Rivett (11 November 2019), "Smallpox and Fever Hospitals", The Development of the London Hospital System
  9. ^ a b c John M. Eyler (1987), "Scarlet Fever and Confinement: The Edwardian debate Over Isolation Hospitals", Bulletin of the History of Medicine, 61 (1): 1–24, JSTOR 44433660, PMID 3548849
  10. ^ Catherine-de-Barnes history, Solihull Metropolitan Borough Council, 2018, archived from the original on 2017-09-29, retrieved 2020-05-17
  11. ^ "Eastern Hospital", Lost Hospitals of London
  12. ^ Tom Jefferson; Carl Heneghan (11 May 2020), COVID-19: 'Fever Hospitals', Centre for Evidence-Based Medicine
  13. ^ Peter Higginbotham (2020), The Northern Convalescent Fever Hospital, Winchmore Hill
  14. ^ Peter Higginbotham (2020), The Western Fever Hospital, Fulham
  15. ^ "The National Archives". www.nationalarchives.gov.uk.
  16. ^ K. Shiva Shanker (11 February 2020), "When viral fever's the problem, Fever Hospital is the solution", The Hindu
  17. ^ Fergus Brady (March 2015), Cork Street Fever Hospital and Cherry Orchard Hospital (PDF), Royal College of Physicians of Ireland
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Fever hospital
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