CONTAGIONISM IN HISTORY
PREVENTING CONTAGION: ADVICE TO THE POOR
John Ferriar, John Clark of Newcastle, William Clerke of Bury and Francis Barker of Waterford
Dr. John Ferriar apparently wrote his "Advice to the Poor" during the terrible fever epidemic of 1795. It was not distributed for reasons that Ferriar does not explain. Ferriar finally printed it in the "Appendix" of his third volume of essays, Medical Histories and Reflections (1798).
Open access digital versions of the 1798 version appear to be unavailable, but since I wrote the first version of this page, the National Library of Medicine has digitized its copy of the first American edition, 1816, which is reproduced below (it has a cc license)
George Rosen reprinted Ferriar's "Advice" in 1942, In his introduction to this document Rosen argued that it illustrated Henry Sigerist's claims that the eighteenth-century public health movement broke down because its leaders were "humanitarians and idealists who assumed that education was all-powerful and thus neglected neglected economic factors." Moreover, they wrote for members of the middle class, not the illiterate peasants and city workers who needed health advice. Rosen claimed that Ferriar's "Advice" represented a unique exception to the limited outreach that Sigerist had delineated. He thought this was due to Manchester's exceptional position as the first industrializing city.
In fact Ferriar's "Advice" was not unique: several similar documents have survived, although their authors drew on each other's work. Moreover, unlike Ferriar's "Advice," several of them apparently were actually distributed to the poor. Below is a selection of some of the shorter examples. They were part of a national effort to persuade members of the public that certain serious diseases were contagious and that they could reduce their risk significantly by acting on this information. This effort was not limited to Manchester or to communities experiencing the first wave of industrialization. Other British cities witnessed similar poverty, squalor and disease and similar efforts to stem the tide. The importance of these documents lies instead in their new emphasis on contagion as a key factor in spreading "fevers" and in the recognition that controlling the spread of contagion required cooperation from everyone in the community. One result of this campaign was the establishment of "fever hospitals" in a few cities. I believe their impact has been underestimated but we will never know how effective this campaign was overall in changing lay ideas about the nature of disease or in transforming these new ideas into changed behavior.
The "fever" that broke out in 1795 seems to have been typhus; a disease that was just coming into clearer focus. It was still often confused with other ailments including typhoid. Whereas typhoid usually spreads through contaminated water or food, the typhus bacillus is usually carried by body lice. Typhus is a severe illness; its mortality is relatively low in healthy children but rises with age, reaching more than sixty percent in people over fifty. Although typhus is not spread directly from person to person, it behaves like a contagious disease because lice don't fly. The disease is transmitted by contact with the body, clothing, bedding or possessions of a victim; in addition lice shed contagious feces that are light and can spread through the air. Thus it was probably helpful to stress ventilation and immersing items in water in addition to washing everything that could be washed. For lime wash as an anti-microbial, see M. Michael Miller, "Lime."
 George Rosen, "John Ferriar's 'Advice to the Poor'" Bulletin of the History of Medicine (1942), 11: 222-227. I am grateful to the Multnomah County Library, Portland, for borrowing this for me.
 "Epidemic Typhus," The Merck Manual of Diagnosis and Therapy
John Ferriar, “Advice to the Poor” (1795)
In the paper subjoined, No. I, are contained some rules for the preservation of the poor from contagious fevers,
which Were originally drawn up, for the purpose of being distributed by the Board of Health. Circumstances, which
it would be uninteresting to mention, prevented its publication through that channel, and I insert it in this place,
because it contains observations, which may be found useful, in other manufacturing towns. I have accommodated
the language, to the persons for whose benefit it was de signed. . . .
ADVICE TO THE POOR,
YOU are requested to read the following paper with attention, by persons who are endeavouring to relieve you
from the misery and fatality of fevers, and other infectious diseases. A great deal has been done by the
establishment of the fever-wards, the good effects of which you daily experience; but much depends upon your
own conduct, for preventing the first occasions of sickness. We can only stop the progress of diseases after they
have once begun, but it is greatly in your power to prevent them from beginning at all, by attending to the
simple directions which follow.
Avoid living in damp cellars: they destroy your constitutions, and shorten your lives. No temptation of low
rents can counterbalance their ill effects. You are apt to crowd into the cellars of new buildings, supposing them
to be clean. This is a fatal mistake. A new house is always damp for two years, and the cellars, which you inhabit
under them, are generally as moist as the bottom of a well. In such places, you are liable to bad fevers, which
often throw the patient into a decline, and you are apt to get rheumatic complaints, that continue for a long time,
and disable you from working.
If you cannot help taking a cellar, be attentive to have all the windows put in good repair, before you venture
into it, and, if possible, get it whitewashed. If you attempt to live in a cellar with broken windows, colds and fevers will be
the certain consequences.
In many parts of the town, you sleep in back-rooms, behind the front-cellar, which are dark, and have no proper
circulation of air. It would be much more healthy to sleep to the front: at least, when you have large families, which is often
the case, you ought to divide them, and not to crowd the whole together in the back-cellar.
Keep your persons and houses as clean as your employments will permit, and do not regret the loss of an hour's
wages, when your time is occupied in attending to cleanliness. It is better to give up a little time occasionally, to
keep your houses neat, than to see your whole family lying sick, in consequence of working constantly, without
cleaning. It would be of great service, if you could contrive to air your beds and bed-clothes out of doors, once
or twice a-week.
Always wash your children from head to foot with cold water, before you send them to work in the morning.
Take care to keep them dry in their feet, and never allow them to go to work without giving them their breakfast,
though you should have nothing to offer them but a crust of bread, and a little water. Children who get wet feet,
when they go out early fasting, seldom escape fevers, or severe colds.
If you know that any of your neighbours are in a starving condition, apply to some opulent persons in the neighbourhood; get
them recommended to the overseer; or, if they are sick, to the Infirmary. Want of necessary food produces bad fevers; and
many of you may uffer from neglecting poor distressed persons, whom timely relief would have preserved from the disease.
When you know, or have reason to believe that any ofyour neighbours are afflicted with fevers, and that they
have not taken care to procure the assistance afforded by the Infirmary, you ought, both from a regard to them and
to yourselves, to give immediate information to the physicians, or some trustee of the. Infirmary, or to Mr. Bellot, Secretary
to the Board of Health. The Board allows the sum of two shillings, for every well-founded information of this kind.
You ought to be very cautious in purchasing old clothes, or second-hand furniture; as they may be brought
from houses infected with fever, and you may introduce the infection with them, into your own dwellings. Every
article of this kind ought to be stoved or ventilated, before it is admitted into your houses.
Your sick neighbours, when the fever gets into their houses, may often require assistance from you. It would be cruel to
refuse them, yet it is hard that you should be obliged to expose your health, and that of your family. You ought
never to visit them from idle curiosity. But when they require your help in making their beds, washing, or turning the sick,
you may preserve yourselves from being infected, by tying a handkerchief across your face, just below the eyes, to
prevent the exhalations from the bodies of the sick from entering your mouth and nostrils. As soon as you return
to your own house, wash your hands and face in cold water, and avoid touching any of your family, for half, or three quarters
of an hour.
Your health will always be materially injured by the following circumstances; living in small back buildings, adjoining to
the open vaults of privies; living in cellars,where the streets are not properly soughed, or drained: living in narrow by-streets,
where sheep are slaughtered, and where the blood and garbage are allowed to stagnate and corrupt; and, perhaps, more
than all, by living crowded together, in dirty lodging-houses, where you cannot have the common comforts of light and air.
It should be unnecessary to remind you, that much sickness is occasioned among you, by passing your evenings at alehouses, or in strolling about the streets, or in the fields adjoining to the town. Perhaps those who are most apt to expose themselves in this manner, would pay little attention to dissuasive arguments of any kind. However, those who feel an interest in your welfare, cannot omit
making the remark.
There is another subject of great importance to you, on which you seem to want information. A great number of children die of the natural small-pox, almost every year. This mortality must be imputed, in a great degree, to your own negligence; for the faculty at the Infirmary offer to inoculate your children, and give public notice of the proper time for making your application, twice a-year. The next period for inoculation will be in March; the succeeding period in September. The chance of recovery from the small-pox received by inoculation, is so much greater than the chance of recovery from the natural kind, that you ought to consider yourselves as performing a duty to your children, and to the public, in bringing those who have not yet had the small-pox, to be inoculated at the Infirmary.
You ought to be informed, that there is scarcely anything more injurious to the health of children, than allowing them
to work at night in the cotton-mills. It may not always be in your power to prevent their being employed
in this manner, but you should be made acquainted with the danger to which you expose them. There is no hazard
incurred by their working during the day, in clean, well-managed cotton mills.
It is also proper to inform you, that you may be infected with fevers, by working in the same place with persons
who have just recovered from fevers, or by people who come from infected houses, where they are at no pains to
keep themselves clean. It is a fact well-known to this Board, that infectious fevers have been conveyed from
Manchester to neighbouring towns, and cotton-mills, by persons going from infected houses. You had better collect something
among yourselves, to support such persons for a fortnight after their recovery, than expose
yourselves to the risk of catching a fever, by their returning too early to work.
People who are discharged from the fever-ward, bring no infection out with them; their clothes being aired and
cleaned, during their stay in the house of Recovery.
Source: John Ferriar, Medical Histories and Reflections, (Philadelphia: 1816), 4 vol. in 1, 403-6, digital copy from the National Library of Medicine http://resource.nlm.nih.gov/2554012R, reformatted and rpt. with Ferriar's prefatory note.
John Clark of Newcastle, "Instructions and Rules," 1791
Campaigning against opposition from his colleagues for a fever hospital in Newcastle, John Clark published a series of documents relevant to the dispute. Among them was a copy of advice that he said had been handed out to patients of the Newcastle Dispensary (where he was a physician). It is a boiled-down version of the advice that Thomas Percival of Manchester had provided to Sir William Clerke, the Rector of Bury, during a typhus epidemic that struck the region in 1789-90 (see below).
Rules for Preserving Health
I. Every day sweep your houses; open the windows, to admit fresh air; and wash your rooms once a week.
II. Keep your persons as clean as possible; and wash your children at least every morning
III. Allow no person from a family affected with a fever, a flux (diarrhea), the small pox, or any other infectious disease, unnecessarily to enter your houses; nor any of your own family to go into any of your neighbors houses, when afflicted with those distempers.
IV. White-wash the walls and ceilings of your apartments twice a year, with quick lime slacked in hot water, which will not only contribute to health and neatness, but, when laid on hot, will effectually destroy vermin.
Rules for preventing fevers, and other infectious diseases.
1. As soon as a person is seized with any feverish complaint, let the feet and legs be bathed in warm water; and after drying them well, let the patient go to bed, and encourage sweating by drinking warm gruel, sage, or balm tea.
II. Let the sick person's linen be changed as often as possible; and, when it is taken off, be put immediately into cold water, before it be washed with hot water.
III. If the family have more rooms than one, the sick person should occupy one himself; he should have no more than one, or at most two attendants, and his neighbours should not be suffered to visit him.
IV. Every stool of the sick person should be received in a pan with a little cold water; some more cold water should afterwards be added, and it should then be immediately carried out of the chamber.
V. The apartment of the sick person must be kept very clean; the windows must be frequently opened; and the floor washed with hot water, that it may dry soon.
VI. After the recovery or death of the sick person, all the bed-clothes and furniture of the room should be washed; the walls and the ceiling white-washed with quick lime, slacked in warm water, and laid on hot.
Source: John Clark, "Appendix no. III. Instructions and Rules to be Observed by the Patients of the Dispensary. First Printed in 1791" in same, A Collection of Papers Intended to Promote an Institution for the Cure and Prevention of Infectious Fevers in Newcastle and other Populous Towns.... (Newcastle: 1802). The various papers in the "collection" are separately paginated. This appears on pp. 32-4 of the second compilation in the book.
William Clerke of Bury, "Prevention and Suppression of Epidemic Fevers," 1790
In 1790, The Reverend Sir William Clerke of Bury published a pamphlet which included a lengthy letter of advice on the prevention and management of typhus by Thomas Percival. Clarke abridged this to create his "Rules of Prevention and Suppression of EPIDEMIC FEVERS, for the Use of the Poor of the Townships of Bury and Elton." This pamphlet is not available through Google books but an early version of Clerke's advice was reprinted by Andrew Duncan, editor of the Medical Commentaries, [also known as Medical and Philosophical Commentaries] (1792) 16: 353-8. Percival's advice was also reprinted, by a review of Clerke's pamphlet that appeared in the Analytical Review (January-April, 1790), 6: 460-462.
Clerke's "Rules" promise a reward for families that adhere to this advice and threaten to withhold aid to those who do not. Clerke was in a position to enforce this because his private committee had collected a substantial fund to sustain its activities.
I don't know why ingesting mustard seeds was seen as a preventative. Though mustard has been grown in Britain since prehistoric times and at least it was inexpensive, it was usually used externally, as a mustard plaster. Mustard seed was probably less harmful than antimony, in the form of tartar emetic or James's powder, which Percival had recommended as a medicine.
Rules of Prevention and Suppression of EPIDEMIC FEVERS
An early notice of the attack of fever must be given to the medical person appointed to attend the sick.
The apartment of the sick should be washed with sope [soap] and HOT water, that it may soon become dry.
The sick person should have clean linen both about his person and upon his bed.
If the bed clothes be dirty or offensive, fresh ones should be provided.
Whenever the sick person's linen is renewed, which is should often be, what he puts off should be thrown into COLD water, with a portion of sope lye in it, and repeated quantities of cold water poured upon it before it is washed.
The business of washing should be performed in the open air.
When the sick person has occasion to go to stool, the pan which he uses should contain some cold water; and immediately after each stool cold water should again be poured into the pan, which is to be carried out of the chamber with no loss of time.
After the recovery of the sick person, the apartment in which he has been confined should be well aired and whitewashed with lime, fresh slacked, and laid on HOT. The windows to be set open every day.
If the bed has been fouled by the discharges of the sick person, it should be burnt.
The bed clothes must be thoroughly so[a]ked in water, then washed and hung in the open air.
Each member of the family of the sick should take, according to their age, a tea-spoonful or two of unbruised mustard seed at bed time, to prevent the catching of the disorder.
If the family have more apartments than one, that in which the sick person is confined should be frequented only by those who are necessary to attend upon him.
Every member of that family should be precluded from entering into any neighbour's house, and be kept as much as possible from all intercourse with others.
The same rule must be observed with respect to the visiting of neighbours or strangers with that family.
To encourage a strict observance of these necessary regulations, a reward will be paid, at the termination of the fever, by the Committee, to the master or mistress of the house, on producing a certificate from the attending surgeon.
By a strict observance of these rules, we trust, through the blessing of GOD, that the present misery of the poor will be alleviated, the ravages of a malignant and mortal distemper will be checked, and health, enjoyment, and usefulness to our fellow-creatures, be restored.
Temperance and cleanliness to the whole body of poor are here particularly recommended.
And the Committee; painful as it will be to them, will be obliged to withdraw their support from families who disregard the foregoing resolutions.
Source: William Clerke Thoughts upon the Means of Preserving the Health of the Poor, by Prevention and Suppression of Epidemic Fevers (London: 1790).
Francis Barker, "Advice," Waterford, ca. 1800
Francis Barker, a graduate of Trinity College Dublin and recent M.D. from Edinburgh was commissioned by a group of gentlemen who founded the Waterford Fever Hospital in Ireland to write a report. Barker's report described the squalid conditions of the Waterford and its environs in detail, discussing the immiseration caused by typhus and the fact that neighbors avoided the stricken.
His report included a copy of a handbill that was distributed to the poor. It explained that even after patients had been taken away to the House of Recovery, infection could remain in their lodgings. Both his report and the handbill were reprinted by the Society for Promoting the Comforts of the Poor which was emulating the better-known London Society for Bettering the Condition and Increasing the Comforts of the Poor. Both Societies disseminated information to help philanthropists set up and operate effective charities. Barker's "Rules" refer to cleaning floors with a shovel, evidence of the extent of Irish poverty. They offer a reward for compliance but do not threaten to withhold support for non-compliance.
The following Hand-bill has been distributed among the Poor by the directions of the House of Recovery
Though you have sent your friend to the House of Recovery, yet the infection of the fever may still remain in your rooms, and about your clothes: to remove it, you are advised to use without delay the following means: --
1st. Let all your doors and windows be immediately thrown open, and let them remain so for two hours.
2ndly. Let your bed-clothes be put out in the open air for half a day, after which let them be washed.
3dly. Let the clothes you wear be aired and washed.
4thly. If you lie on straw beds, let the straw be immediately burnt, and fresh straw provided.
5thly. White-wash all your rooms, and the entrance to them, with lime, slacked in the place where you intend to use it, and whilst it continues bubbling and hot.
6thly. Scrape your floor with a shovel, wash it clean, and also your furniture.
7thly. Wash clean, every morning for the space of a week, your face, hands, and feet; and during this time remain in the open air as much as you can.
A reward will be given by the treasurer to any person who can bring a certificate of his having followed these directions.
Source: "Extract from an Account of the House of Recovery for Fever Patients, lately established at Waterford; with Observations communicated by Fr. Barker, Esq. M.D." in Reports of the Society for Promoting the Comforts of the Poor (Dublin: 1800-1802), 1-2: 106-7.
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