Infirmary

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Chester has had several hospitals of which the most significant in the history of medicine was possibly the Infirmary (1755-1993). The military hospital of Roman Chester (Valetudinarium) is believed to have been on the west side of upper Bridge Street. The two medieval hospitals treating the sick and diseased, St. Giles's leper house at Spital Boughton (hence the name) and St John's Hospital outside the Northgate, both survived the Dissolution but had ceased to provide medical care by 1537 and the early 17th century respectively. In 1602–5 and 1647–8 the Assembly built plague cabins on the edge of the Roodee, between the Water Tower and the river. A charity dispensing medicines to the poor was set up in 1721 with an endowment of £100 under the will of Peter Cotton. Its apothecary and surgeon were appointed by the city corporation, and it still existed in 1757, when the governors of the newly established Infirmary pressed the corporation to transfer the endowment to them.

The Infirmary was founded in 1755 following a bequest by Dr William Stratford, who had died two years earlier. It was funded by public subscriptions, and was free to patients who were recommended by the subscribers. It was originally housed in temporary accommodation in part of Bluecoat School (St John's Hospital). Construction of the permanent building was started in 1758, and was completed in 1761. It was designed by William Yoxall, and the interior was remodelled in 1830 by William Cole, junior. Cooke describes it as follows:


 * "On the west side of the Shambles is Parsons lane or Princes street leading to a pleasant and airy range of building called St Martin's in the Fields opposite to which adjoining to the walls stands in a most delightful and salubrious situation - the Infirmary - a very spacious and elegant building erected in the year 1761 the comfortable retreat of disease and penury from every part of the county the city and North Wales." (in Cooke a printers error renders 1761 as 1701).

Hemingway (1836) describes the layout as follows:


 * "The plan of the building is that of a quadrangle of four stories with an area of 54 feet by 42 in the centre. The sunk or basement story consists of a series of arched cellars and other apartments with fire places, but being badly lighted drained and ventilated they have hitherto been of little use. The ground floor is occupied by offices defended from the weather by a corridor or open gallery running round the interior of the building where the first and second floors are appropriated for lodging the sick and hurt. The principal wards lie to the north and south and run the whole length of the infirmary which is 100 feet. Each ward contains 24 beds ranging along the opposite sides and as for the east and west sides of the quadrangle they are taken up with stair cases chapel and four small rooms for nurses &c looking into the area."

This is a peculiar description and might suggest that Hemingway had not visited the Infirmary for some time before his 1836 book. Matters are made even more confusing by the fact that in Hemingway's 1831 "History of the Cisty of Chester" he gets the description of Coles changes to the layout, as decribed below, correct. Hemingway gives before-and-after plans of the wards and the explanation appears to be that Hemingway's second-published book of 1836 was actually written earlier (before 1831) but only published after his "first" book.

Despite the governors' complacent view in 1807 that the building was 'spacious and convenient', there was growing dissatisfaction with it, led by Dr. George Cumming, honorary physician 1804–6 and thereafter a governor. A report in 1824 concluded that the infirmary was 'essentially defective' in comparison with more recent hospital buildings. After much controversy, alterations were completed in 1830 by the county architect William Cole junior. He divided the long wards into smaller rooms, lowered the ground level on all sides except the south in order to allow the basements to be used, and inserted two new blocks within the central courtyard, narrowing it on the north and south. The courtyard blocks contained nurses' rooms, bathrooms, and W.C.s, and incorporated a corridor running round the inner side of the original building, permitting better use of the east and west ranges. Both original staircases were removed and a single staircase in the east range was substituted; Cole added a canted bay to the projecting eastern bay and moved the chapel into it on the first floor. It was now possible to make small day rooms as well as separate wards for different categories of patient, including surgical, medical, convalescent, accident, and ophthal mic cases. The same number of beds was provided as before, but the total space per bed was increased by over half. At the same time the rooms on the ground floor were rearranged to accommodate a separate suite for the dispensing department.

Over the years, extensions were built, and by 1902 the hospital had 118 beds. The appellation "Royal" was added in 1914 when George V opened the Albert Wood wing, which contained six new wards. This wing was designed by W. T. and P. H. Lockwood, as was a further extension in 1931. During the 1990s patients were transferred to new facilities provided by the Countess of Chester Hospital, and the infirmary closed. Other than the original building, all the later extensions were demolished in 1998. The original hospital building has been converted into apartments. One notable feature (which many recalled into the 2000's having been in the hospital as children) were three stained-glass windows in the north wing depicting a child patient, morning, noon and night. These are mentioned in the Heritage listing and were apparently removed when the building was converted into appartments but their current whereabouts is uncertain.



The land upon which the infirmary later stood was anciently known as Lady Barrow's Hey, Hey being a Saxon name for a field enclosed with hedges. Earlier still, the land was used by the Romans as a graveyard which would have been outside of the city walls prior to their extension in post-Roman times. Many graves were uncovered when the hospital was being built and enlarged. Chester historian Frank Simpson recorded that, in 1858 workmen discovered several Roman tombs, which contained such articles as terra-cotta lamps, clay vessels and coins of the period of Domitian.

The remains were described as follows in Annals of Archaeology and Anthropology (Liverpool, 1914, vol. vi, pp. 121-67) - as referenced by "Roman Britain in 1914", by Professor F. Haverfield


 * Prof. Newstead describes and illustrates fully the thirty-five graves found in 1912-3 in the Infirmary Field, Chester, of which I gave a brief account in my Report for 1913 (p. 14). Save for a few first-century remains in one corner, the graveyard seems to be an inhumation cemetery, used during the second half of the second century—rather an early date for such a cemetery. I do not myself feel much doubt that some at least of the tombstones extracted in 1890-2 from the western half of the North City Wall were taken from this area. They belong to the first and second centuries and suggest (as I pointed out when they were found) that the Wall was built about A.D. 200. That, however, is just the date when the cemetery was closed; the seizure of the tombstones for the construction of the Wall would explain why the Infirmary Field has yielded no tombstones from all its graves. By the kindness of [42] Professors Bosanquet and Newstead I can add some illustrations of the graves themselves, from blocks used for Prof. Newstead's paper. Fig. 17 shows two of the simpler graves, fig. 18, two built with tiles. Fig. 19 illustrates some curious nails found with the bodies.

Why Jenner and not Haygarth?


The eradication of smallpox stands as one of the greatest achievements of medical science. When it was finally achieved in 1977 it was based on three principles:
 * find every case;
 * isolate the infected individual;
 * immunise all their contacts.

These proved to be sufficient to eliminate the disease because the incubation period of 10-14 days after exposure gave time to mount a defence, and because smallpox only spread by very close contact between infectious individuals, or contaminated materials, and susceptible individuals. However, the crucial features of smallpox, and the possibility of eradicating the disease, were not 20th century innovations, they can be traced directly to John Haygarth (1740 – 10 June 1827) an important 18th-century British physician who discovered new ways to prevent the spread of fever among patients and reduce the mortality rate of smallpox. Chester Infirmary hosted John Haygarth from 1767 to 1798.

In 1774, as part of a census Haygarth administered in Chester, he asked residents about their medical history. From this information he concluded that fever patients should be separated from others and his discovery that only a tiny fraction of the population of Chester had never had smallpox led him to focus his energy on prevention. He wrote up these findings in a paper, "Observations on the Population and Diseases of Chester". In 1778 Haygarth helped found "A Society for Promoting General Inoculation at Stated Periods and Preventing Natural Smallpox in Chester"; the group advocated inoculation, an unpopular position at the time, and tried to educate the populace so as to avoid casual contraction of the disease. This attempted to persuade those too poor to participate in a general inoculation by paying a reward. After some debate, the Society’s donors agreed that the inducement should be 5 shillings for the first child, 3 shillings for the second, and 1 shilling for each succeeding child, to compensate the parents for the time and trouble involved in looking after their inoculated children. An additional 5 shillings would be paid to the inoculator for his services, but the doctors of Chester united in refusing this fee and agreed to provide the operation for no charge.



Inoculation differs from vaccination. In inoculation the subject is infected with the disease itself, whereas in vaccination a "safe" material is used. Two forms of the disease of Smallpox were recognised, now known to be due to two strains of the Variola virus. Those contracting Variola Minor had a greatly reduced risk of death – 1–2% – compared to those contracting Variola Major with 30% mortality. Thus inoculation with Variola Minor greatly reduced the chances of dying. Inoculation was already a standard practice, but involved serious risks. Lady Mary Wortley Montagu observed smallpox inoculation during her stay in the Ottoman Empire, writing detailed accounts of the practice in her letters, and enthusiastically promoted the procedure in England upon her return in 1718. Voltaire, writing of this, estimates that at this time 60% of the population caught smallpox and 20% of the population died of it.] Voltaire also states that the Circassians used the inoculation from times immemorial, and the custom may have been borrowed by the Turks from the Circassians.

Although Haygarth advocated a general inoculation every two years and wanted to encourage the well off to postpone their own treatment until then, the poor would not co-operate. ‘In Cross-gun entry in Forrest Street the inhabitants deliberately spread the disease’ by exposing their children to an infected child. Families did not take up the reward for following the rules for prevention for several reasons. Despite the good intentions of the Society, many remained ignorant of the existence of a financial benefit, or were put off by the fact that it was only paid after the disease had completely cleared, and it often took several weeks before the virus had run through a whole family. Also, the inspector wasn’t particularly welcome or efficient. Often he turned up several days after the pocks appeared and by then it was too late for the family to observe the rules even if they had wanted to. The only real success for Haygarth’s inoculation scheme was to prevent smallpox spreading through the Workhouse. Other towns, such as Leeds and Liverpool, adopted the Society's methods. They were assisted by Haygarth's "Inquiry how to Prevent the Small Pox (1784)" which included statistical calculations supported by John Dawson. The book was translated into French and German and made Haygarth an internationally-known figure. Haygarth further elaborated his ideas in "Sketch of a plan to exterminate the casual small pox from Great Britain and to introduce general inoculation" (1793). Unfortunately, the plan to inspect homes and provide general inoculation was resisted in the increasingly conservative 1790s



In 1765, Dr John Fewster published a paper in the London Medical Society entitled "Cow pox and its ability to prevent smallpox", but he did not pursue the subject further. In the years following 1770, at least five investigators in England and Germany (Sevel, Jensen, Jesty 1774, Rendell, Plett 1791) successfully tested a cowpox vaccine in humans against smallpox. For example, Dorset farmer Benjamin Jesty successfully vaccinated and presumably induced immunity with cowpox in his wife and two children during a smallpox epidemic in 1774, but it was not until Edward Jenner's work some 20 years later that the procedure became widely understood. Indeed, Jenner may have been aware of Jesty's procedures and success. Noting the common observation that milkmaids were generally immune to smallpox, Jenner postulated that the pus in the blisters that milkmaids received from cowpox (a disease similar to smallpox, but much less virulent) protected them from smallpox. On 14 May 1796, Jenner tested his hypothesis by inoculating James Phipps, an eight-year-old boy who was the son of Jenner's gardener. He scraped pus from cowpox blisters on the hands of Sarah Nelmes, a milkmaid who had caught cowpox from a cow called Blossom, (whose hide now hangs on the wall of the St George's medical school library in Tooting). Phipps was the 17th case described in Jenner's first paper on vaccination.

Hemingway comments as follows, at first praising the climate and then having one of his usual, rather snobbish digs at the "lower class of poor":


 * The inhabitants of Chester enjoy advantages which scarcely any other place of equal magnitude possesses; peculiarly favoured by Providence, the situation is as pleasing as the air is salubrious. The late Dr Haygarth, a gentleman of high professional talents, with whose residence here, the city was long favoured, in his observations on the population and diseases of Chester, published in 1774 has shewn, that it was in a very extraordinary degree, more healthy than most other towns and cities, and that during a period of ten years preceding, the proportion of deaths annually had been only one in forty, and within the walls, exclusively of the suburbs, only one in fifty eight. He attributes the healthiness of Chester to its elevated situation; its being built on a loose rock which quickly absorbs moisture; and its being surrounded by the Dee. The Doctor observes also that the air is uncommonly clear. there having been but six foggy. and thirty two hazy mornings during the four years then preceding; and he considers the opportunities for taking air and exercise afforded, even to invalids, by the rows and walls well adapted to preserve and restore health. Dr Aikin, in his history of the country round Manchester truly remarks, "that the small proportion of deaths when compared with the number of inhabitants at Chester is in part owing to the much less proportion of the lowest class of poor than in manufacturing towns".

Other Infectious Diseases (see: Pandemic for more)
Plague victims of 1603 had been put in huts by the Watertower, but never been placed in a general hospital. Until 1868, the infirmary turned away cases of infectious disease, but outbreaks of cholera in 1848 and 1866 demonstrated the urgent need of such a hospital. In 1865, a legacy of five hundred pounds had been left by Mrs Henry Wood to provide a hospital for smallpox and other infectious diseases. Sailors would arrive in the port of Chester sick with typhus: one in ten died - and there were frequently "fevers" rife in Chester itself.

In an experiment starting in 1785 had Haygarth turned some lumber out of a long attic, got windows open and make a fever isolation ward. As typhus/typhoid (Enteric Fever) is transmitted by lice or rat-fleas, it was essential that floors were scrubbed, clothes and linen washed or disposed of and that all utensils were marked for use in this ward alone. Unfortunately, no-one would come and work there. Eventually a male patient who had had surgery volunteered to look after men, but he caught fever and died. Presently a nurse, Lowry Thomas, came forward. She served men and women for eleven years. Four times she contracted fever, the fifth time she died. There was also Jane Bird, catching fever twice in four years and then resigning. Haygarth complained they had done too much. Most patients survived, the spread of diseases was reduced and no-one in the rest of the hospital caught an infection.

The 1848 epidemic occured at the same time as a typhus epidemic which killed over 10,000 people in England and Wales and particularly affected Lancashire and Cheshire. It has been proposed that the typhus epidemic was caused by large-scale emigration from Ireland due to the potato-blight famine which was accompanied by a typhus epidemic in Ireland. Chester was a major port for travel to/from Ireland and many Irish settled in Boughton and along Canalside (Stephen Street in Boughton was already over 95% Irish in 1841). A Sanitary Committee was formed under "Nuisance Removals and Disease Prevention Acts of 1848.

The 1866 Cholera epidemic followed a cattle plague the previous year. At the time people believed that this was due to drinking water being contaminated by surface drainage from places where dead cattle had been buried in haste. At a meeting of the Assembly in May 1866 it was decided to provide two places for Cholera wards within the City in case the outbreak reached Chester. One of these was located in a disused farmhouse on the land which was to become Grosvenor Park. The heftiest women from the local workhouse were selected as potential nurses but there was some concern that they were neither honest nor sober, had no training and that it was unwise to put them in charge of either patients or medicines. Fortunately Frances Wilbraham (1815-1905) of Kings Buildings (King Street), a wealthy member of the local gentry volunteered to oversee them. The first two case of cholera appeared on 1st September 1866. One was a woman from a tenement in Goss Street the other Alderman John Trevor, a former mayor and editor of the Chester Chronicle: both were dead within days. The ward in the park was soon full of the sick and dying, but Francis Wilbraham nursed them tirelessly and by November the outbreak began to abate. The Duke of Westminster called Frances Wilbraham the "Florence Nightingale of Chester". The farmhouse was demolished before Grosvenor Park was opened.

A further outbreak of typhoid occured in the years 1887-89. The area with the highest number of cases was Newtown, a poorly-drained area with blocked and badly drained sewers, while the fewest cases occured in Upper Northgate Street, a well-drained, well-to-do and elevated area. One theory at the time was that the city water supply, drawn from the River Dee, was being contaminated by sewage dischared downstream being carried over the weir by the Dee bore at spring tides. As a consequence the waterworks ceased to draw water from the river during bore tides and for a few hours thereafter. This was investigated and found not to be the case. Although the Chester Improvement Act of 1845 had prevented the building of further "slum courts", many were still in occupation. Some, such as those converted from the stable blocks of coaching-inns comprised exceptionally small and squalid accomodation - said to be worse than a cell in the jail. Sanitary arrangements consisted of often common ash-pits or ash-pits where the only way to remove the contents required it to be carried through the house. As the Sanitary Authority charged to remove the filth from the ash-pits the poor tended to wait until the ash-pits were overflowing before having them emptied. Even by 1914 most working-class Cestrians lived in 19thC terraced housing with tiny back sculleries, outside lavatories, small back yards, and front doors opening on to the street. In the city centre, conditions in the courts of Princess Street, Goss Street, and Crook Street remained below even that standard into the 1930s. In Princess Street (next to the Town Hall) alone there were 224 houses, of which 140 were damp and 120 verminous; 103 shared lavatories, 118 had no suitable washing accommodation, and 108 lacked a sink or internal water supply.

Separate wards for smallpox patients were opened in the grounds east of the old building in 1868. They were in use until the city's isolation hospital was opened in 1899 at Sealand Road, to meet statutory obligations to provide treatment for patients with certain notifiable infectious diseases, among which scarlet fever, diphtheria, and typhoid were the most common. The isolation hospital was designed by Harry Beswick with an administration block and four separate pavilion wards, accommodating 46 patients in all. It cost £21,300. In 1900 the corrugated-iron buildings at Infirmary field were moved to an even more remote site off Bumper's Lane, south of the isolation hospital, and arranged as two wards for up to 12 smallpox patients. Besides cases from the city, the hospital took in patients paid for by neighbouring local authorities, including Hoole. The hospital usually had between 10 and 20 patients at any one time, and coped with more serious outbreaks by putting up temporary accommodation. When smallpox infected 67 people in 1903, for example, the council's public health committee put up tents near the smallpox wards.

"The Pox"
Haygarth's careful record keeping has also enabled historians to study the prevalence of "venereal distemper" for the three consecutive years, 1773, 1774 and 1775 of which there were around 174 cases. For those with infection by the bacterial spirochaete, Treponema pallidum, which is today known to cause the STI defined as syphilis (then known simply as "the pox"), there was some hope of treatment: as John Haygarth himself put it after several decades of medical practice in Chester,


 * "Except Mercury in the Syphilis, there are few or perhaps no examples where a remedy can produce such speedy relief and perfect recovery in so formidable a disease."

The treatment typically consisted of 5-7 weeks of continuous supervised mercurial infusion, ingestion or injection. This caused quite serious side-effects. The rates based on the Infirmary records are surprisingly high: among the Chester population c.1774, 7.851% of females and 7.411% of males had been treated for "the pox" (syphilis) in Chester Infirmary by the time they reached age 35. Corrections need to be made for those who would have sought treatment at the Workhouse, those who avoided treatment (or only resorted to "quack therapies") and those of the "gentile classes" who were treated privately. Studies which have attempted to correct for the missing genteel fraction of society seem to put the overall infection rate at about 8% for those under 35. The estimated rate outside of the city was significantly lower, a little under 1%.

Placebo effect
In 1799, by which time he had retired to Bath, Haygarth investigated the efficacy of medical instruments called "Perkins Patent Tractors" (patented 19th Feb, 1796). These were a pair of 3-inch metal pointers which were supposedly able to "draw out" disease. They were sold at the extremely high price of five guineas (supported by the claim that they were a special alloy), and Haygarth set out to show that the high cost was unnecessary. He did this by comparing the results from dummy wooden tractors with a set of allegedly "active" metal tractors, and published his findings in a book "On the Imagination as a Cause & as a Cure of Disorders of the Body". The wooden mock-ups just as useful as the expensive metal ones, showing: "to a degree which has never been suspected, what powerful influence upon diseases is produced by mere imagination". While the word "placebo" had been used since 1772, this was the first real demonstration of what was later to become known as the "placebo effect".

Elisha Perkins himself went on to invent a "quack" cure for Yellow Fever, which he demonstrated on himself during an outbreak in 1799. He contracted the fever and died of it.

Haygarth and some othere associated with the Infirmary were commemorated in the epilogue of the Chester Pageant 1937. The others included Dr W.M. Thackery, the Misses Wilbraham, and Jane Bird. Dr William Makepeace Thackery - the uncle of his more famous novelist namesake (although he spelled his name Thackeray) - the author of "Vanity Fair", "The Virginians", "Barry Lyndon" and many more. Thackerty was a doctor who worked at the Infirmary from its founding in the St John's Hospital through to long after it was established in its own purpose-built premises. The names of both of these establishments are inscribed upon his stone. He is actually buried in the Cathedral, but his monument remains a dominant feature in the centre of Overleigh Cemetery.

Hauntings
As befits the "most haunted city" - when the Royal Infirmary was still standing, the ghost of "Soldier Mackenzie" was well known. He was reputed to be a Scottish soldier admitted with serious wounds during the 1914-18 war. He died of his wounds, and is said to have been buried in a hospital shroud instead of his uniform - and more importantly his kilt. As a consequence, he is believed to be carrying out an eternal search for his missing uniform.



Related Pages

 * Medical Museum;
 * Asylum;
 * Workhouse;
 * Pandemic;
 * Georgian Chester;

Online

 * Infirmary on British History Online;
 * A very detailed history of health services in and around Chester;
 * Virtual Stroll on The Infirmary
 * John Haygarth, FRS (1740-1827): A Physician of the Enlightenment, by Christopher Charles Booth
 * John Haygarth's Inquiry
 * Another page on the Infirmary;
 * An article by Miss H E Boulton;
 * More on Haygarth
 * More on the Infirmary by Harry Reynolds (1993);
 * Listed building data;
 * The Good Physician and the Godly Doctor: The Exemplary Life of John Tylston of Chester (1663-99;
 * Treatment Rates for the Pox in early modern England: a comparative estimate of the prevalence of syphilis in the city of Chester and its rural vicinity in the 1770s;
 * Chester and North Wales Medical Society paper;