"Cholera in the Middlesex Hospital"

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[This is the report that Stewart alluded to in the letter to the editor published the previous week. When compiling the Weekly Return of Births and Deaths in London, clerks in the Office of the Registrar General assigned all deaths occurring in hospital to the sub-district in which the hospital was located, not where the deceased had resided or, in the case of cholera, where the deceased may have contracted the disease.]

Megan Anderson and Cori Heacock made the following transcription.

By Alex. P. Stewart, M.D.

Assistant-Physician to the Hospital.

Many of your readers are, I doubt not, aware that the Middlesex Hospital has been the receptacle of a very unusual number of the victims of the late epidemic in the Soho district of St. James's parish. Many friends, both Medical and lay, have expressed to me their surprise and regret that no account has yet been given of the remarkable scene which the Hospital presented during the first week of September. Their surprise at the protracted silence of every one connected with the Institution would, I believe, have been even greater than it is had they seen the reality, the report of which would doubtless have "filled the post-horns of all Europe" long ere now, had the scene been laid at Varna or Aladyn, instead of London. That some notice of it has not appeared in "the leading Journal," is not owing to neglect on the part of my colleagues and myself, as we all agreed that an episode so unparalleled, as I suppose, in the more modern history of any of the Metropolitan Hospitals, presented features of some interest, not only to the Medical Profession, but to the public at large. I can but express my regret that the want, on my part, of that distinguished capacity which secures for the [363/364] communications of its "own correspondents" an eager perusal by all ranks and classes of the community, should have closed against me the columns of so influential a Journal. As the Hospital has now returned to its usual routine, and the cases of cholera admitted within the week have been comparatively few, I can now furnish you with the complete statistics of the late fearful outbreak, so far as we have had to do with it.

Thus we have a grand total of 2279 cases of cholera and diarrhœa treated at the Hospital from the beginning of July till the present date. Between one-half and seven-twelfths, or 53.3 per cent of the cases of well-marked cholera have died; but we have not yet known or heard of a single death from choleraic diarrhœa, though some of the cases were of such severity as to be with difficulty distinguishable from cholera itself. This remarkable fact has naturally excited, in the minds of several with whom I have conversed, a feeling of surprise that deaths from diarrhœa should constitute so considerable an item in the Tables of the Registrar-General [the Weekly Returns], and shows how unsafe it would be to found any special pathological conclusions on these returns, in the absence of more minute details.

The tabular statement I have given brings out pretty clearly the fact of a sudden increase in the number of cholera cases admitted on and after the 1st of September, but tells nothing as to the amount of that increase, or the distribution of the cases over the period referred to; nor does it show the weekly rate of increase and decline of the collateral epidemic of diarrhœa. These points are well brought out in the following Table, which has been constructed from accurate data kindly furnished me by Dr. Corfe and Mr. Sibley. In it, a few cases of choleraic diarrhœa which occurred before July are omitted.

During the six weeks, then, preceding September, cases of well-marked cholera dropped in at more or less distant intervals, to the number of 19; the male and female admissions, recoveries, and deaths being nearly as possible equal. On the morning of Friday, the 1st inst., however, the numbers suddenly increased. Above a dozen were admitted in the course of a few hours; and, as it quickly became evident, from the fresh applications that came continually pouring in, that the demand for beds was only beginning, our first care was to discharge as many patients, both Surgical and Medical, as could with any propriety be sent home. Their places were soon filled by patients in all degrees of collapse, who were admitted, to the number of 57, before mid-day of Saturday, the 2nd instant, a very large proportion of these being, on admission, far beyond the reach of remedial skill. Such being the case, it is not wonderful, that of nearly 90 cases admitted during the fifty hours ending at one p.m., on Sunday, the 3rd of September, forty were at that hour already dead. That life, however, was prolonged for two, four, or six hours, in many even of the worst cases, by the warm bath, the mustard emetic, and counter-irritants used in almost every case, does not admit of reasonable doubt. So rapid was the succession of arrivals, that the Hospital gates were besieged early and late by a crowd of onlookers, at times so dense that a couple of policemen were stationed there to keep the passage clear.

The excess of male cases, regard being had to the natural preponderance of females in the general population, is remarkable; and no age has been exempted from the virulence of this epidemic. Infants and children (of whom an unusual number seem to have been fatally attacked), men and women in their prime, and feeble septuagenarians, were brought, though strange to say, some walked, considerable distances to the Hospital, blue, cold, shrivelled, and almost or quite pulseless, and were carried up, with scarcely any intermission by night or day, to wards from which, as constantly, lifeless and decomposing bodies were carried down to the already over-crowded dead-house, which presented a spectacle that baffles description.

It is difficult, without appearing to exaggerate, to convey any adequate idea of the state of the wards during the four first days of September, or of the feelings of admiration with which the House Committee and Medical Officers viewed the noble conduct of all those resident in the establishment. While daylight lasted, the sunshine, though it revealed every minute detail, relieved, by its cheerfulness, some of the horrors of the sad and harrowing sight. But, as night closed in, the dim light shed by a solitary burner, and by the pale moonbeams that struggled through the windows, lent a still more ghastly hue to the livid features, the skinny hands, and deeply-sunk eyes--in general nearly closed, as if in death, but sometimes bloodshot and glaring--of the poor patients, who were screaming in agony or groaning in mortal weakness, on every hand. Add to all this the sobs and shrieks of new-made orphans and widows, and the clank of the shell, as in its ceaseless round it "vexed the drowsy ear of night"--and you have a very feeble representation of a scene before which many a stout heart might have quailed, and by a single glance at which not a few who presented themselves to be engaged as assistant-nurses, were scared away, without so much as entering the wards. Yet hour after hour, and night succeeding day, did all the members of the Hospital staff--Apothecaries and House-Surgeons, Matron and House-Steward, the few pupils who were in town during the College vacation, sisters, nurses, and porters--discharge, without for a moment shrinking from, tasks the most laborious and the most revolting. To understand the whole amount of service rendered by them, and its bearing upon the question of the contagiousness of cholera, it must be borne in mind, that this enormous and unprecedented influx of cases, every one of which required nearly constant attendance, came upon us so unexpectedly, that we were wholly unprovided with the requisite assistance. The whole duties, therefore, overwhelming as they were, from the morning of the 1st till midday of the 2nd of September, fell to be and were discharged by the ordinary staff of the Hospital. To lessen this extraordinary pressure, which, if long continued, must have been attended with disastrous consequences, a large temporary addition was made as quickly as possible to the staff of attendants; and to enable them to bear up under the excessive toil and the many depressing influences to which they were exposed, all, without exception, were at once placed on a very generous diet, which was continued for several weeks. The pleasing result of these measures, and of the admirable ventilation of every part of the building, is, that only two of the inmates have contracted the disease. One of these, after disregarding the premonitory symptoms, which were present for 12 hours before the fatal seizure, [364/365] was allowed to pass into a state of hopeless collapse before advice was applied for. The other, who had had severe diarrhœa for eleven days before she made any complaint, is now completely convalescent. I need only add to this narrative, that, as the Dispensary has been open night and day to all comers with diarrhœa, and as all the cases of cholera and choleraic diarrhœa have been at once admitted without letters of recommendation, the cost to the Hospital of the recent outbreak of cholera cannot be less than 300l. or 400l. [300 - 400 pounds],--an expenditure which, I believe, has been mainly rendered necessary, unless I am greatly misinformed, by the unexampled negligence and apathy of the Guardians of the wealthy parish of St. James. Hence my questions of last week, which, I have reason to know, have attracted attention in official quarters, and may be of service in eliciting the truth. On some future occasion, I may trouble you with some further remarks in reference to that ill-fated district, and the history of the epidemic which has rendered it so notorious. I must defer the few general observations which I had intended to make on the treatment of the disease till next week.