ANNUAL MEDICAL REPORT OF THE HOUSE OF RECOVERY, AND FEVER- THE annalist of this hospital, in which the occurrences of each successive year have a characteristic resemblance, cannot well deviate from accustomed recital: his province is confined chiefly to simple narration, and to such inferences as are deducible from recorded facts. Though the advantages, public and private, to be obtained by the system of prevention as applied to fever, are now very generally known, yet to advert to them at this time may not be without its use. The prin cipal object is to abate the violence of contagion, and to contract its sphere of action within the narrowest possible limits. For this end, a prompt and complete separation of the affected persons from all others, whose attendance is not necessary, furnishes means the most effectual. Such seclusion the affluent can readily command in their own houses; but to the poor it is unattainable, except by a removal from their habitations and families, to receptacles properly adapted to this especial purpose. From ordinary hospitals they are generally shut out, and for very obvious reasons. Houses of recovery, then, afford the only asylums for the poor, when attacked by contagious fever, and constitute, at the same time, the strongest bulwarks for the protection of the wealthy against the ravages of a pestilential disease. Through the operation of such establishments, contagious fever would appear to have been suspended, if not altogether eradicated, in some places where other circumstances seemed by no means favourable. In an extensive district of London, for instance, including St. Gile's, Bloomsbury, and Saffron-hill, and compriz ing a dense population chiefly of the lowest class, common fever was seldom or never observed in the latter part of 1809, and the early months of 1810.* In Dublin, during the same period, it was of much less frequent occurrence than formerly; and this decrease was justly attributed to the Fever-hospital system. These and similar facts, afforded some ground for a hope, at one time entertained by certain ardent philanthropists, that the propagation of fever by contagion might be altogether prevented. An object so desirable we think cannot be attained: but much has been done, and more may still be effected. + as In the progress of this year (1810), the prevailing fever assumed an pect so formidable, and a range so extensive, that great and well founded alarm was excited in many parts of Ireland, but especially in this city, where among the poorer inhabitants every cause that in our climate and local position could combine to disseminate infection, existed in full vigour-An overthronged population, depressed and debilitated by want of employment, and want of food, enervated more or less by previous habits of intemperance, uncleanly in their persons and apartments; of many, the, whole mode of life reckless or despondent: A gleam of joy, or even the tranquil smile of well-fed content is seldom seen to play on the countenance of the Dublin manufacturer, but at * For this information, so truly gratifying, the reporter is indebted to his friends Dr. Bateman, of the Fever-hospital, Gray'sInn Road, and Dr. Laird: both gentlemen are physicians to the Carey-street dispensary. Their opportunities for extensive observation are unquestionable; their accuracy and judgment require no commendation. + For proof of this assertion, several documents in our former reports may be consulted. this melancholy period all was gloom. -At the same time, whiskey, that bane to industry, health, and morals, became on a sudden cheap and abundant. To the purchase of this poisonous liquor, the finances of the poor were instantly and very generally devoted; the scanty stipend of casual labour, even the pittance bestowed by the hand of charity, to relieve urgent want, was converted into the means of self-destruction. A culpable inattention to medical police, exhibited in the numberless depositions and collections of every kind of filth, in almost all the close situations, where disease and indigence are concealed from passing notice. Such were the most obvious causes which, in this metropolis, concurred to call into baleful activity, that epidemic constitution, the effects of which we are now to trace. During January and February, the number of patients stood nearly at what had been the usual average for many months; and fever appeared in its ordinary form of the sea son. In March and April, our admission-list increased with a rapidity unexpected. Some anticipation of a malignant epidemic were indeed entertained early this year, from observing that many of the prevalent febrile affections were accompanied by quinsies, strikingly resembling that species called cynanche maligna. Several well marked cases of that disease, attended with scarlatina-efflorescence more or less disor less distinct, occurred: but, in general, the combination of symptoms was anomalous, as to lead rather to conjectural opinion, than to scientific foresight. This state of vague apprehension was soon changed into awful certainty, for as the spring advanced, the number of fever patients was augmented by more than SO above that of the seven months Though the efficacy of the system of prevention cannot be established this year, by direct evidence, yet from the proofs adduced in the former reports of this hospital-from the experience of similar institutions in Cork, Waterford, Limerick, Chester, Liverpool, Manchester, and London, we are warranted in expressing a conviction, that at no former period was the utility of such a system less questionable, or its benefits more extended and salutary-But for such interposing protection, pestilence and death must have stalked, without controul as to human means, through the humbler ranks of our fellow-citizens; and there can be little doubt, that, in the progress of a disease so virulent, the higher classes would have been deprived of their wonted immunity. the pro On this point, no calculation can be made which shall be accurately conclusive. If, according to the opinion of an accomplished physiian (the late Dr. Currie of Liverool), we say, that " every single emoval into the house of recovery, robably prevents on an average 2 r 3 cases of the disease," (and obrvation among the poor of Dublin ould induce us to take the greater verage), then 5322 are able number preserved from fever, y the removal of 1774 to this hospi1. This rate of exemption is perips far too low:-for, in the first ace, 1774 may fairly be consideras the minimum of cases that could ve presented themselves, under e influence of the existing epideic; inasmuch as on its first appearce, and throughout its whole urse, the hospital system was in l activity. Again, of the 5322 no on our calculation escaped disse, each individual would have, it were, a new central point from ich fresh contagious effluvia must ye emanated; and thus the pro pagation of the evil have gone on to an indefinite extent. Such, indeed, is the actual history of malignant fever, when it becomes epidemic, in large cities where the plan of prevention has not been adopted. Or if, in concurrence with Dr. Haygarth of Bath, (who has investigated the laws of infection with a discernment and precision never surpassed), it may be asserted, that of 23 persons exposed to febrile contagion, under circumstances favouring its susceptibility, not more than one escapes; we are furnished with another mode of estimating the preventive power of the house of recovery this year: thus, for each of the 1774 patients admitted into the hospital, it may be assumed, that had they remained with their families, 4 other persons, at the least, must have undergone complete exposure to contagion-deducting then the proportion of one to twentythree, we should have had 6788 additional sufferers.* The number of persons previously ill is marked in the hospital registry at 100. With respect to these no inference has been attempted, because it is believed that many, if not the greater part, have afterwards appeared in the columns of admission among the gross number 1774. The relative numbers on the north and south sides of the river, are as under: A fact so remarkable cannot be satisfactorily explained on any data of which we are yet in possession. Can it arise from the habits of the lower class of females in this city becoming daily more similar to those of the other sex, especially in the abuse of spirituous liquors? The fluctuation in the comparative mortality of the sexes, in different months, would seem equally unaccountable on any general or fixed principle. It seems worthy of remark that the greatest number of deaths happened during two months wherein the relative number of patients differed so materially as in June, when the admissions amounted to 216, the mortality stands as 1 in 7, and in December the admissions were 105 only, yet the deaths were 1 in 74. In July, during which the epidemic was at its 71 or I in 11 103 or 1 in 1277 92 or 1 in 16, | 1 in 1123 96 or 1 in 11 83 or I in 125 83 154 or 1 in 111 in 114 height, the mortality rates as 1 in 9 This part of our subject may alrea appear to have been treated with much prolixity, yet nothing can m forcibly evince the malignant nat and extensive progress of the epi mic, than a comparison of Janu with June. In the former mo only 71 patients were admitted, whom two died, the proportion 1 35. In the latter (June) 216 sou refuge in the hospital, of whom died, the proportion 1 in 7. The first two months of this y as has been mentioned, were not racterised by any unusual appeara In March and April, sporadic cas scarlatina were met with; intermit were very rare; rheumatic and p monic affections infrequent; typ fever began to predominate bey all former observation. The rep noted among his own patients a er number of instances of unmixed typhus, several of the very worst kind, than he remembers to have seen during five years preceding. In May, scarlatina had a slight increase; but soon all other forms of fever merged in the epidemic character of Typhus gravior, or of Synochus speedily becoming typhoid, accompanied by all the most dangerous symptoms which denote that type, and demanding the utmost attention and vigour on the part of the physician. Where local determinations occur red or supervened, the head and bowels were the chief seats of attack, the lungs also frequently suffered, especially in autumn, and on the approach of winter. To combat this congestion, or tendency to inflammation, blood-letting, general or topical as the case required, was practised with evident advantage. In no one instance did it appear to be injurious. Gentle purgatives were very freely employed (as indeed they have always been since the opening of the hospital) with the most salutary effects. To enter here into minuteness of description, or of practice, would be inconsistent with the design of this report: nevertheless the above general experience derived from so large a scale of treatment cannot but be acceptable, and perhaps instructive to the medical public. Of the residents in the hospital, ten were attacked by fever during the year-five of this number, viz. the housekeeper and four nurses were necessarily exposed to the influence of contagion: the remaining five had probably not been sufficiently cautious in their intercourse with the sick, one fell a victim to the disease, a young man who frequently volunteered his services in assisting the apothecary. Scarlatina, though of a dangerous kind, presented itself so seldom (18 cases) that it has been blended in the BELFAST MAG. NO. xxxvi. gross numerical account of fever, as being equally contagious. It deserves little further notice here than after May it entirely disappeared. Another fact respecting it is worthy of record, namely, that of the whole number of cases (101) received into the hospital since the year 1107 not one proved fatal. The death reported in 1807 was the consequence of hydropic effusion affecting the brain;, the symptoms of scarlatina had gone off some time previous to the patient's admission. Such, in faint outline, is a sketch of the transactions of the fever hospital department. By its efficient system much distress, otherwise irremediable, has been alleviated, much prevented. Were this the time or the occasion we could present such groups of wretchedness as must arouse apathy from its torpor, and elicite some generous sparks front the cold heart of avarice itself. Where active benevolence abounds, an appeal to feelings less noble would be at once unnecessary and ungracious. Enough has been said in proof of the diffusive benefits of this institution. On public utility must ever rest its strongest claim to public protection. R. GAMBLE, M. D. To the Proprietors of the Belfast Magazine. YOUR magazine cannot be justly charged with plagiarism, by inserting the following remedy for the sting of a Bee, extracted from the last number of the London Mothly Magazine; it may be of use to some of your readers. "On opening one of the leaves of a book hive, in which I keep Bees, according to the French method, for the purpose of taking the honey without destroying the labourers, one of the inhabitants resented the offence by deep 2 |