By Lydia Amend
Diphtheria killed thousands and its vaccine “had a greater impact on human mortality reduction and population growth than any other public health intervention” (Baker, 2000). In order to stop the spread of the disease, isolation hospitals were created to separate those who had already contracted it from those who hadn’t. Isolating cases of diphtheria was really important for communities because diphtheria was a major cause of illness and death among children. A person who is infected but has not been treated is infectious for up to three weeks and it spreads from person to person. These are the main reasons why people with diphtheria, or someone who shows signs of diphtheria, were quickly removed from their home. However, there was controversy over this, some saying that the towns that isolated people who showed signs of having diphtheria actually ended up having more cases and a higher mortality rate than those who used different methods to stop the spread (E.H. Snell M.D., 80-90). This was because there was a “lack of knowledge of the cause and transmission” of diphtheria (Museum of Health Care, 2011).
Diphtheria got its name “from a Greek word signifying membrane, a false membrane being formed at the upper and back part of the throat, impeding deglutition and respiration” (MOH: Whitechapel, 1858). This disease spread very quickly and had a high mortality rate which is why isolation was very important. As a “general rule” every case is “removed at once to the Isolation Hospital and the house of the infected person disinfected within a few hours” (MOH: East Barnett Valley, 1920). Being efficient was really important because having the infected person removed quickly helped prevent the spread in a household. In Mile End it wasn’t until 1888 when the Local Government Board approved to have patients with diphtheria moved to the Asylum Board Hospital because of how contagious it is (MOH: Mile End Old Town, 1988). Moving patients out of the isolation hospitals was also very important, in Romford after a patient was released the room that they were in was “disinfected by the Sanitary Inspector” (MOH: Romford, 1906).
Isolation also included removing children from school and adults from work (MOH: East Barnett Valley, 1920). School nurses regularly “examined and re-examined children at schools: as a way of taking precautionary measures against diphtheria (MOH: Tottenham, 1919). It was important for infected people to be taken to the hospital but many schools were closed while the spread of diphtheria was high. In East Barnet Valley in 1920 there were many children excluded from attending school because “either themselves suffering from infectious diseases or were ‘contacts’” (MOH: East Barnett Valley, 1920). The reason why closing schools was so important is because “a large proportion of them are capable of attending school while suffering from slight attacks” and children were the most likely to get diphtheria (MOH: London County Council, 1904). The borough of Romford did a similar thing after it was found that “attendance of a child at school with an unrecognized sore throat was followed by the occurrence of cases of Diphtheria amongst children attending the same classroom” (MOH: Romford, 1906). Once Romford caught on to this, they closed the school for a brief period and checked to be sure nobody else was showing signs of the disease. Schools were also told to pay extra attention to “children who have been absent without known cause, or who show evidence of pallor, enlarged, glands, or sore noses’”(MOH: Wimbledon, 1909). This was done to help catch any cases of diphtheria that could spread in the school before they spread.
Isolation hospitals were not just made to isolate people with diphtheria, but isolate people with other contagious diseases as well. The Medical Officer of Health report for Walthamstow in 1909 explains how the “efficient and economical isolation of mixed and doubtful cases” was valuable (MOH: Walthamstow, 1909). This is one of the few reports that discusses these doubtful cases and explained that these cases are “moved to the convalescent wards as soon as possible”(MOH: Walthamstow, 1909). In another report in Romford the doctors at the Isolation Hospital would “obviate the removal of others which could be safely isolated at home” which was done to save hospital money (MOH: Romford, 1906). In the burrow of East Barnet in 1910, a “vehicle has lately been procured by the Joint Isolation Hospital Committee”, which helped quickly transport items to be disinfected to the hospital and then returned to the home (MOH: East Barnett, 1920). This is done for two reasons, to make room for more cases and to prevent infection from one area of the hospital to another. This report in East Barnet also showed the complexity of determining if a patient at this hospital even had one of the diseases being treated.
There were not only isolation hospitals in London but also in Canada and in the United States. In 1894 Brookline Massachusetts saw the need for an isolation hospital for diphtheria as well as other “dangerous contagious diseases” (Lincoln, 133-135). The town built multiple “suitable buildings for the isolation and care of persons ill with dangerous contagious diseases” (Lincoln, 133-135). This is different than the town of East Barnett, which had separate sections of a single building designated to different diseases. Even though they were built differently, they both served the same purpose during this time of fear.
Baker, J. P. 2000. “Immunization and the American Way : 4 Childhood Vaccines.” American Journal of Public Health 90 (2): 199–207.
Chase, H. Lincoln. “The Brookline, Massachusetts, Isolation Hospital.” The American Journal of Nursing 1, no. 2 (1900): 133–35.
Museum of Health Care. “A Brief History of Isolation and Infectious Disease.” Museum of Health Care Blog, August 30, 2011.
“The Utility of the Hospital Isolation of Diphtheria, by E. H. SNELL, M.D., Medical Officer of Health, Coventry (FELLOW).” Journal of the Royal Sanitary Institute 36, no. 2 (1915): 80–90.