Plague Houses and Pandemics – Some comparisons between 1665 and 2020

Charles ll issued an edict in 1665 that every parish should identify a shed, a tent or a house to accommodate those identified with the plague. Alison Wall looks at the role of such isolation in times of pandemic.

19th century lithograph of old plague houses in bleak setting

Pest houses Tothill Fields, Westminster, London, lithograph 1840, Wellcome Collection

Plague, pest or pestilence houses – the terms can be used interchangeably – were buildings set apart as places to isolate those suffering plague and smallpox. It seems that there was often a favourable outcome and people survived.

There were five pest houses in London, accommodating about 600 sufferers, and there are houses still standing across the country, some Grade ll listed.

Was there a degree of restraint for those confined to the pest house? There may well have been if we look at Samuel Pepys’s comments, in his diary of 1665: “A mayde having run away was taken back to the pest house in the pest coach.”

What was the pest coach? It was a special sedan chair painted black, with black curtains, so it was clear what its function was.

Then and now, the most important difference between the 21st and the 17th centuries was the realisation in the 17th century it was wrong to admit plague and smallpox sufferers into the general hospitals or hospitiums, as they were initially called. The latter were there to serve the poor and suffering and give general shelter and care.

Charles II looked back in history and understood the importance of isolation and care in the pest houses. Sadly, our equivalent Nightingale hospitals were erected in a very reactive and uncoordinated fashion. In our time, how many people were admitted into the general hospitals with some acute or chronic condition, unrelated to Covid but caught Covid in hospital and died? Many health professionals also died in the early days of Covid.

Another, if less significant contrast, is that in the time of the Great Plague in 1665, thousands of stray cats and dogs were slaughtered, as people believed they carried dirt and fleas. The cat population could have helped reduce the numbers of black rats that were carrying the plague carrying fleas. Conversely, during the Covid lockdown many people homed cats and dogs for companionship.

The spread of Covid across the world has had a massive impact. The isolation that plague victims must have experienced – and sometimes tried to escape – has echoes in that endured during lockdown in the period of Covid. Isolation causes huge psychological and emotional impacts, with greater understanding of this post Covid.

Inevitably there will be future pandemics. We need to reflect and plan for the future, remembering the value of those parish pest houses.

Alison Wall is a retired nurse, midwife and health visitor. She is the author of “Plague Houses and Pandemics”. Before her retirement she worked in Camden and Islington as a public health strategist.

Woman in pink dress with figure in red cloak and plague masque.

Alison Ward with a figure wearing plague masque

References and further reading

  1. https://www.nationalarchives.gov.uk/education/resources/great-plague/
  2. Byrne, J. Encyclopedia of the Black Death. Bloomsbury. 2024. p.217
  3. https://onlinelibrary.wiley.com/doi/abs/10.1111/nuf.12001
  4. Latham, R.C. & Matthews, W. (ed) 1885. The Diary of Samuel Pepys, Vol. Vl. p.120
  5. Boyd, D. Plagues and Pandemics. Pen and Sword. 2021. p. 67

One-way systems to keep patients separate

Eastern Dispensary, Bath Photo: William Rogers, britishlistedbuildings.co.uk

The Corona virus pandemic prevention measures were not the first one-way system in British health care, as William Evans explains.

One feature of the measures imposed or encouraged by the UK government to stop Corona virus spreading was one-way systems for human traffic. In premises such as doctor’s surgeries, one-way systems aimed to reduce close contact between people and avoid transmission of the virus.

One-way systems are not new. We are familiar with them in the management of road traffic. Although fewer accidents and a reduction in personal injuries are some results, the main aims are to relieve traffic congestion and reduce conflict among road users. Another example comes from the household goods sector. The retailer Ikea makes customers follow a prescribed route through its stores. In this case, the aim is not safety, but more sales by bringing to customers’ attention all the goods offered, not just those the customer may be interested in.

There is a historic precedent for a one-way system in a medical context from the Eastern Dispensary in Cleveland Place East, Bath. Opened in 1845, it was designed by the local architect, Henry Edmund Goodridge (1797-1864). The external design is neo-classical: the entrance at the front through a portico with columns and a pediment. Inside, the design was innovative. On entering, patients were directed into one of two waiting rooms at either side of the building (one for women, one for men?). In each waiting room, the patients sat on, and moved along, benches. The first bench was attached to the left side wall, the next one to the right, and so on.

As a result, patients moved along the benches in queue until they were summoned to rooms at the back of the building where they were seen by an apothecary or surgeon or went into a dressing room. They then left the building by a back door from the room where they were seen or treated.

Plan of the dispensary The Builder, (1849) 160

The purpose of that layout may have had much to do with keeping order in what could otherwise have been a melee, but no doubt it also helped to limit the transmission of infectious or contagious diseases. Goodridge’s radical design was commended by The Builder magazine as a model for future dispensaries. It would be interesting to know whether his Bath layout was followed elsewhere.

After it ceased being used as a dispensary, the building housed various activities: in the 1910s, for example, colleges and pharmacies. It is now a bistro.

References

Plan of the dispensary: Bath & NE Somerset Council Archives, 0033

The Builder, (1849) 160; https://archive.org/details/gri_33125006201806/page/160/mode/2up?view=theater

Michael Forsyth, Bath, in the Pevsner Architectural Guides series, Yale UP 2003

For Goodridge: HM Colvin, A biographical dictionary of British architects 1600-1840, Yale UP 1997

For dispensaries: Michael Whitfield, The dispensaries: healthcare for the poor before the NHS, Author House 2006

William Evans is treasurer of Avon Local History & Archaeology, the umbrella group for local history in the Bristol and Bath area.

Recycling Penicillin from Urine in Post-War Germany

Limited supplies of penicillin and Allied restrictions on German access to the drug in the immediate aftermath of World War II led to its recovery from the urine of treated patients. Susanne Krejsa MacManus explains.

German research on penicillin started only in 1942 and then on a very small scale.[1]  Gerhard Domagk (1895-1964), the German scientist who in 1935 had developed sulfonamides, had advised the Nazi government to concentrate on improving of “his” type of antibiotics instead of trying to get its own penicillin production going.

It took Germany till the end of 1943 to really understand the importance of penicillin, but because of the efforts of the Allies to restrict information and materials,[2] German scientists were not able to learn about the right mould, nor could they develop the process to get a good supply.

From autumn 1945, British and American forces increased the amount of penicillin flown into hospitals in Berlin – mostly for their own soldiers as a treatment for sexually transmitted diseases. But the occupying forces faced a dilemma: on one hand, they had to look after the health of the population of the occupied areas; on the other hand, there was a hostile atmosphere against the German population – at least in the first months after the end of the war. Germany was categorised as a “defeated enemy” – in contrast to Austria which was categorised as a “victim”.

There was even a third aspect. The German pharmaceutical industry was known as being innovative and effective. The occupying forces hoped for “penicillin made in Germany” and encouraged companies like I.G. Farben, Hoechst and Chemie-Grünenthal to start such an undertaking.

The USSR did not have penicillin production of its own, although they claimed two of their scientists had invented the antibiotic long before Alexander Fleming. As early as early May 1945, Soviet forces who were eager to get penicillin as part of German reparations were pushing the German company Schering .[3]

Since one of Schering’s production sites lay in British territory, the company got support from the British element of the occupation forces for building laboratories and getting raw material (as this ad shows.).[4] 

Salzburger Nachrichten, 9/1/1946  Schering AG produces penicillin Berlin,  As the British broadcast has reported, the Germany pharmaceutical company Schering AG in Berlin will manufacture penicillin for Germany. The British military government has promised its support to the company in procuring the laboratory and the necessary material, so far as it is available in Germany.

But sufficient output was not available before the end of 1946/the beginning of 1947.

Two-thirds excreted

During their struggle to set up a production site, scientists at Schering recalled that two- thirds of penicillin given by injection left the body very quickly, so quickly that injections had to be repeated every few hours.[5] “If we could get the urine of patients treated with penicillin”, the scientists speculated, “we might be able to reclaim and concentrate this substance.”

The British and American forces permitted them to collect the urine from their hospitals on the condition that they got their share of the recycled substance. From March 1946, Schering’s scientists organised milk-churns and bicycles and went from hospital to hospital to collect patients’ urine. The recycling process was successful, and in spring 1947 it was extended into American and British areas of West Germany. In April 1949, nearly 5000 liters of urine from 3153 patients were collected from hospitals. This activity lasted till 1950, when the manufacturers’ penicillin production was sufficient to meet demand.

Recycling penicillin from urine was not a new idea, but its use on this scale was was exceptional. It showed that the German researchers had clearly understood the character of penicillin being excreted from the organism so quickly. Secondly, the process of recycling penicillin purified the substance, which at the initial injection had produced sharp and unpleasant feelings for the patient. And third, it shows how Schering’s researchers could act on their own initiative, without having to ask boards and committees for permission as they would have to do today.

Susanne Krejsa MacManus PhD is an independent journalist, author and archivist in Vienna. She is a member of the History of Medicine/Medical Humanities working group of the Commission for History and Philosophy of the Sciences at the Austrian Academy of Sciences (ÖAW).

References

[1] I. Pieroth: Penicillinherstellung – Von den Anfängen bis zur Großproduktion, Heidelberger Schriften, 1992, p. 103.

[2] P. Rostock: Die Wunde, Berlin: De Gruyter, 1950, p. 290.

[3] J.-P. Gaudillière, B. Gausemeier: Molding National Research Systems, OSIRIS 2005, 20:180-202.

[4] Schering A.G. Berlin produziert Penizillin, Salzburger Nachrichten, 9. 1. 1946, p. 2.

[5] J.H. Humphrey: Excretion of Penicillin in Man, Nature 3920, 1944, 765.

 

 

Being right is not enough

Scientific debate can be soured by the tendency for evangelical pioneers to see any questioning as opposition bordering on evil.   Their aggressive attitude can delay innovation, a lesson perhaps for our own times and a reason for studying history, says Mike Davidson.  

Ignaz Semmelweis

My wife and I saw the production “Dr Semmelweis” at the Bristol Old Vic. At last, a chance to experience live theatre with a full audience; it also fulfilled my interest in the history of medicine. The writers, Mark Rylance and Stephen Brown, were influenced by the 1952 biography Semmelweis (1818-1865) by Louis-Ferdinand Céline, a work I am unfamiliar with.

Their play is a dramatic interpretation of the work of Ignaz Semmelweis (1818–1865) on puerperal sepsis and his failure to convince his contemporaries of the need for ward hygiene to control the disease. This was in no small part a result of his uncompromising personality and ability to alienate even his strongest supporters and allies.

Semmelweis proposed the practice of washing hands with chlorinated lime solutions in 1847 while working in Vienna General Hospital’s First Obstetrical Clinic, where doctors’ wards had three times the mortality of midwives’ wards. His observations brought him into conflict with many within the contemporary scientific and medical establishment.

The play records Semmelweis’s descent into madness, haunted by the ghosts of the women he has not saved. The ghosts are portrayed as dancers and musicians on stage and within the audience, as he recollects events. Much of the narrative takes the form of flashbacks acted out for his wife. The opportunities for engagement squandered by Semmelweis due to his lack of understanding of human nature are highlighted.

Rylance’s performance as Semmelweis was central and powerful and the cast provided strong support. I found two female performances poignant, Thalissa Teixeira, as his wife Maria, and Jackie Clune, as nurse Muller. The female characters provide a more balanced view of history than concentrating on male pioneers.

Muller is a senior midwife who helps Semmelweis with his introduction of hygiene methods and provides clinical data to support his thesis. His lack of empathy for her guilt in accidentally causing an outbreak of sepsis that contributed to her ultimate suicide speaks volumes of the single-mindedness and unforgiving attitude of Semmelweis.

There is a very pertinent observation by Rylance in an interview published in the Financial Times on 12 January 2022: “He wasn’t just a victim. He was also a very difficult person: someone who got very angry about people not understanding him and became his own worst enemy. Which maybe a lot of pioneers are — they’re people who cut through and are not the most polite or politically savvy people.”

The production at Bristol has now ended but given the enthusiastic reception it got there, it may be staged again.

I recommend the play not only for a medical history enthusiast but for anyone who wants to experience a thought-provoking performance by a talented cast, playwrights, dancers and musicians.

Mike Davidson is President of the British Society for the History of Medicine.

There is death in the pot

On the bicentenary of chemist Freidrich Accum, J.D. Dayan and A.D. Dayan discuss how his public-health legacy to expose ‘food adulteration’ has been largely forgotten…

Portrait of chemist Friedrich Accum (1769–1838). Source: Edgar Fahs Smith Collection (P/AC25 M).

The essential importance of using new scientific discoveries in the public interest is a belief that has long been preached, but few have had the drive and understanding to put it into practice.

Some innovators must make great sacrifices in return for ephemeral headlines, whilst others achieve international fame in their lifetime, only to have their names and vital legacies forgotten.

Friedrich Accum is such a scientist, whose contributions to both public and governmental awareness about the extent of food adulteration, its risks to health in the early 19th century and the widespread fraud on consumers have gone tragically neglected, even as we grow ever more concerned about what is in our food.

From Hanover to London

Accum was born on 29th March 1769 in Bückeburg, a small town in the state of Hannover, to a Jewish father who had become a committed Christian[1]. Young Accum’s life was marked by tragedy as his father died when he was only three years old, and his mother was left to raise her large family alone. Instrumental to their fortunes was the family soap business which gave Accum exposure to practical chemistry and no doubt influenced his decision to emigrate to England in 1793 to work for Brande pharmacies in London[2].

By 1800 Accum’s career as a young(ish) scientist was starting to flourish, and he set up a base of operations at 11 Old Compton Street, which he turned into “a unique establishment”[3]. From here Accum took on a diverse range of tasks, from offering commercial chemical analytical services to inventing and producing novel scientific instruments and later offering classes in practical chemistry.

In the early 19th century he became deeply involved in the pioneering installation of gas lighting in London, conducted analyses of natural spring waters and common medicines, as well as acting as an expert witness in legal actions. His frequent scientific work on behalf of the government and growing role as a public intellectual made him nationally known, and he increasingly wrote on matters of general, as well as scientific, interest.

‘A Treatise of Adulterations of Food, and Culinary Poisons’

It was with this background of firmly established respectability that Accum launched into arguably the most important and ultimately most controversial part of his wide-ranging career. Drawing on his scientific abilities as an analyst and his skills as a writer he analysed many samples of the foodstuffs being sold in London, such as bread, milk, flour and sweets and published the findings in his magnum opus, A Treatise of Adulterations of Food, and Culinary Poisons, in 1820, a book better known from its subtitle ‘Death in the Pot’ (II Kings 4:40).

This was not an example of an obscure academic text being amplified into the public consciousness by the excitable media of the day, but rather a skilled scientific communicator and self-publicist scoring a public bullseye with a precisely aimed work. This is exemplified by the biblical quote which Accum deployed, that has since been used as a metonym for the publication itself: “There is death in the pot”.

The core of this explosive work was stated simply by Accum himself at the very beginning when he wrote that he was trying to “exhibit easy methods of detecting the fraudulent adulterations of food, and of other articles, classed either among the necessaries or luxuries of the table; and to put the unwary on their guard against the use of such commodities as are contaminated with substances deleterious to health.”[4]

This was not the first time that Accum had attempted to raise the alarm about poor quality food.  Indeed from almost the start of his time in England he had spoken out against the dangers of adulteration[5], but he now had a firm grasp on its nature and industrial practice.

The reading public agreed, and within a month the entire first print run of 1000 copies had been sold. That did not mean that those who could respond in print accepted his findings and their implications for the health of every consumer and the honesty of manufacturers, importers and retailers.

Critiques and legal issues…

Few of the dissenters refuted his central argument, but some disagreed about the extent of the adulteration crisis, and others believed that his remedy, the deployment of analytical chemistry to detect fraud and dangerous additives, was wildly impractical.

One of the most critical responses appeared in the Quarterly Review which lambasted Accum for being a highly intelligent, snake-oil salesman on the make[6].

Accum’s life after this point is veiled in mystery. What can be said with certainty is that he was accused of having ripped out pages from books in the Royal Institution’s library, and this led to him being embroiled in a series of legal troubles that ended with him jumping bail and returning to Germany.

There he continued writing on the application of analytical chemistry to a diverse range of food related topics, from brewing beer to making bread.

Public opinion appears to have swung quite violently with regards to his guilt, and although his refusal to attend his trial and decision to abscond certainly did his reputation no good, there were nevertheless persistent rumours that he had been framed by those he had accused of introducing ‘Death into the pot’.

Accum’s Legacy?

Whatever the truth of his predilection for page-stealing, there is no doubt that Accum was hugely influential in the rise of campaigning scientists in early 19th century Britain. In many ways Accum’s true successor was Arthur Hill Hassall, the doctor-turned-analyst who, with Henry Letheby, a physician-chemist, acted as chief scientist to the Lancet enquiry in the mid-1800s.

Hassall’s statement in 1855, to the parliamentary committee about the scale of the problem surrounding food adulteration and its significant ‘sanitary bearings’ and possible “remedies for their suppression”, caused such a public outcry that Parliament was no longer able to look the other way on the subject[7].  In 1860 the Act to Prevent the Adulteration of Food and Drink was passed, containing many of Hassall’s suggestions.

From then on, and especially in the era of Gladstonian liberalism, the state would always take a close interest in the quality of food, and the idea of having permanent government chemists review its safety went from a radical novelty to become a standard rule.

What Accum did that was so important was to combine rigorous scientific methods with a pugilistic style and in doing so, whatever his other faults, he helped to pave the path for his intellectual descendants to defend and expand the public good.

Why have we overlooked the bicentenary of Accum’s work when ensuring the quality of foods and medicines has become such an important factor in our lives? It is not too late to celebrate his achievements even if his reputation remains clouded in ignominy.

Words by J. D. Dayan and A.D. Dayan

 

[1] C. A. Browne, ‘Recently Acquired Information concerning Frederick Accum, 1769-1838’, Chymia, Vol. 1, (1948), p.2.

[2] C. A. Browne, ‘The Life and Chemical Services of Frederick Accum’, Journal of Chemical Education, Vol. 2 No. 10, (1925), p.833.

[3] R. J. Cole, ‘Friedrich Accum (1769-1838). A biographical study’, Annals of Science, Vol. 7 No. 2, (1951), p.129.

[4] F. Accum, A Treatise of Adulterations of Food, and Culinary Poisons, Project Gutenberg, (2006), p.iii.

[5] C. A. Browne, ‘The Life’, p.1028.

[6] J. Sumner, ‘Retailing Scandal: The Disappearance of Friedrich Accum’, (Re)creating science in nineteenth-century Britain, Cambridge Scholars Publishing, (2007), p.4.

[7] A. Hassall in ‘Adulteration of Food, Drink, And Drugs. Being the Evidence taken before the Parliamentary Committee’, London, (1855), Googlebooks, p.1.