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‘Tropical’ cases admitted to the Albert Dock Hospital in the early years of the London School of Tropical Medicine
TRANSACTIONS
OF THE ROYAL
SOCIETY
OF TROPICAL
MEDICINE
‘Tropical’ cases admitted to the Albert Dock Hospital in the early years of the London School of Tropical Medicine G. C. Cook The Wellcome Institute for the Histoy Medicine, 183 Euston Road, London NW1 2BE, UK
of
Keywords: tropical medicine, London School of Tropical Medicine, Albert Dock Hospital, Seamen’s Hospital Society records, UK
The London School of Tropical Medicine (LSTM) (which should be clearly differentiated from the London School of Hygiene and Tropical Medicine-the latter opened in 1929) opened its doors for teaching and research on 2 October 1899 (i.e., 100 years ago) (COOK, 1992). The clinical component ofits major activities was based at the Albert Dock (Branch) Hospital, under the
AND HYGIENE
(1999) 93,675-677
auspices of the Seamen’s Hospital Society (SHS) (Fig. 1); this institution was situated between the Royal Albert and Royal Victoria docks in east London. The hospital had been opened by the Prince and Princess of Wales on 24 June 1890; it was rebuilt in 1937-38, and totally demolished in 1995. In May 1892 Dr (later Sir) Patrick Manson (who had recently returned from China-where he had carried out his pioneering work on lymphatic filariasis) was appointed Visiting Physician to the SHS with attachment to the Branch Hospital (COOK, 1992). Contemporary SHS reports give details of the diagnoses ofpatients admitted to the Albert Dock Hospital in the early years of that institution (ANONYMOUS, 1897a, 1899, 1900, 1901, 1902, 1903, 1904, 1905, 1906; SMITH, 1892, 1893, 1894, 1895). Between 1891 and 1896, the General Reports record numbers of cases admitted with the causes of death. In 189 1 for example, there were 217 medical and 287 surgical admissions; 6 cases had been brought in dead, demise being caused by: drowning (2), fractured skull (2), enteritis (l), and ‘heart disease’ (1). There were 2419 out-patients that year. Beginning in 1897, ‘tropical cases’ (67 that year) were categorized separately; deaths resulting from these diseases were however included under medical admissions. From 1898 until 1905 it was decided to publish a
Fig. 1. The Albert Dock (Branch) Hospital, which was opened by the Prince and Princess of Wales in 1890 (from the Illustrated London News, 28 June 1890, p. 819).
0 1890
1895
1900
1905
Year
Fig. 2. Admissions to the Albert Dock (Branch) Hospital, each year for which records are available.
189 1- 1905. Total ‘tropical’, medical, and surgical admissions are shown, for
G. C. COOK
676
Table 1. Annual diagnoses Hospital, 1899-1905
of ‘tropical’
admissions
to the Albert
Dock
Date (year)
Viral Hepatitisiperihepatitis
1899
1900
-
-
-
1901
1902
2
2
1
1
-2
1
-8
-4
2 6
6 22
12 12 -
4 12 -
34 3
26
TO
5 6
1
6
1 -
-2
2 -
-2
i
Bacterial/protozoan Dysentery Acute Chronic ‘Amoebic’
15 11 -
20 5 -
15 12 -
1: -
24 -
32 -
37 -
41 2
1
32 2 2 1
1
-4
6
1 -
2
2
1905
6
2
Helmintic Ancylostoma duodenale Filariasis Guinea worm Schistosoma spp. Taenia solium Hydatidosis (of lung)
1904
3
Bacterial ‘Malta fever’ Plague Leprosy Relapsing fever Tropical sprue
Protozoan ‘Malaria’ Kala-azar Trypanosomiasis Hepatic abscess
1903
2
-
3 1 5
1 1
; -
-3 4 2 -
-
Nutritional Beri-beri scurvy
13 4
16 -
23 -
Total
75
6 9
1
6
1 1 1
-
-
1 1
26 -
23 -
1
16 89
-
“Includes 1 case of ‘tricophyton’ infection. “Includes 1 case of ‘granulomatous disease’.
LSTM. Table 1 summarizes the diagnoses of the ‘tropical’ cases during the 7 years from the opening of the LSTM; Table 2 gives contemporary diagnoses of cases of Plasmodium spp. infection. From these statistics it is clear that the amount of ‘tropical medicine’ at the Albert Dock Hospital was exceedingly limited (this hospital dealt first and foremost with injuries sustained in the docks); during the 7-year
‘breakdown’ of the diagnoses of the ‘tropical’ cases; in 1898 (i.e., the year before the LSTM opened) 35 admissions were due to malaria, 20 were caused by dysentery, 12 by beri-beri, and 11 resulted from a miscellany of causes; phthisis and ‘enterica’ (typhoid fever) fell under the umbrella of ‘medical cases’. Figure 2 summarizes ‘tropical’, medical, and surgical admissions from the opening of the Albert Dock Hospital, and during the early years (1899- 1905) of the Table 2. Annual
diagnoses
of Plasmodium
period
spp. admissions
under
surveillance
to the Albert
the mean admission
Dock Hospital,
rate for
1899-1905
Date (year)
‘Malignant’ [I? falciparum] Blackwater fever Benign tertian [I? vivax] Double benign tertian Benign tertian + ‘malignant’ Double benign tertian + ‘malignant’ ‘Benign quartan’ Triple quartan Double benign tertian + ‘quartan’ Post-malarial jaundice Malarial cachexia Unclassified History, but no parasitological confirmation No details provided Total
1899
1900
1901
1902
1903
4
15 2 3 2 -
12 2 4 5 -
5 6
s 7 -
1 3 6 -
2 2 5 5 -
13 2 8 5 1 1 :
24
32
37
Yi -
1
4 2
1
2
1904
1905
11
11
2 9 4
1; -
-
-
-
1
1 2 6 -
1
6
-
3 7
2 -
-
41
32
34
26
ADMISSIONS
TO THE ALBERT
DOCK
HOSPITAL
677
‘tropical’ cases was < 2 per week, which must have been extremely disappointing from a teaching/research viewpoint. The scenario was dominated by Plasmodium spp. infection (Table 2), beri-beri (rarely encountered now), and dysentery (most cases of which did not have a ‘laboratory diagnosis’). The mean annual number of Africans admitted to the Albert Dock Hospital during the years of 1899- 1905 was 15 (range 1O-l 8), while that of ‘Asiatics’ was 111 (range 93- 129). Corresponding mean annual number of landsmen (i.e., men working in the vicinity of London’s dockland) was 228 (range 209259). These low figures for the admission rate of ‘tropical diseases’ probably justify, retrospectively, the opinion of several of Manson’s leading opponents (COOK, 1995) that the Royal Victoria Hospital, Netley (COOK, 1992), which contained much ‘clinical material . afforded by invalided soldiers from India, China, and other tropical and sub-tropical stations in all parts of the world’ (&VONYMOUS, 1897b), or possibly the Royal (Naval) Hospital at Haslar, would have been more suitable venues for the creation of the LSTM (!WONYMOUS, 1897b, 1898). Manson had been appointed to the staff of the Albert Dock Hospital 7 years before the LSTM was opened. In the light of this information, it is possible to understand better the acrimonious correspondence which developed between Manson [who had Joseph 1994) backing] and his oppoChamberlain’s (MARSH, nents (COOK, 1992,1995). Was the decision in favour of this venue therefore in the best interests of the newly developing discipline, ‘tropical medicine’? References Anonymous (1897a). Branch Hospital, Royal Albert Docks. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1895 and 1896. Greenwich: E. G. Berryman & Sons, pp. 19 and 38. Anonymous (1897b). Instruction in tropical diseases. Lancet, ii, 1266. Anonymous (1898). Netley as a school for tropical medicine. Lancet, ii, 1805-1806. Anonymous (1899). Branch Hospital, Royal Albert Docks. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1897 and 1898. London: E. G. Berryman & Sons, pp. 20 and 35-46. Anonymous (1900). Branch Hospital, Royal Albert Docks. In: Tables ofCases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1899. London: E. G. Berryman & Sons, pp. 21-32. Anonymous ( 190 1). Branch Hospital, Royal Albert Docks. In: Tables of Cases under Treatment at the Hospitals and Dispensaries
9th International
Congress
of the Seamen’s Hospital Society in 1900. London: E. G. Berryman & Sons, pp. 21-30. Anonymous (1902). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1901. London: E. G. Berryman & Sons, pp. 20-32. Anonymous (1903). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1902. London: E. G. Berryman & Sons, pp. 26-38. Anonymous (1904). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1903. London: E. G. Berryman & Sons, pp. 25-36. Anonymous (1905). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1904. London: E. G. Berryman & Sons, pp. 25-34. Anonymous (1906). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1905. London: E. G. Berryman & Sons, pp. 25-33. Cook, G. C. (1992). From the Greenwich Hulks to Old St Pancras: a History of Tropical Disease in London. London: Athlone Press, p. 338. Cook, G. C. (1995). Doctor Patrick Manson’s leading opposition in the establishment of the London School of Tropical Medicine: Curnow, Anderson, and Turner. JournalofMedical Biography, 3, 170- 177. Marsh, P. T. (1994). Joseph Chamberlain: EntrepreneurinPolitics. New Haven, London: Yale University Press, p. 725. Smith, W. J. (1892). BranchHospital, Royal Albert Docks. In: A General Report of the Cases Under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital’Sociey Together with an Analysis of the Medical and Surgical Cases. Greenwich: E. G. Berryman & Sons, p. 25. Smith, W. J. (1893). BranchHospital, Royal Albert Docks. In: A General Report of the Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society Together with an Analysis of the Medical and Surgical Cases. Greenwich: E. G. Berryman & Sons, p. 26. Smith, W. J. (1894). Branch Hospital, Royal Albert Docks. In: A General Report of the Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society Together with an Analysis of the Medical and Surgical Cases. Greenwich: E. G. Berryman & Sons, p. 24. Smith, W. J. (1895). BranchHospital, Royal AlbertDocks. In: A General Report of the Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society Together with an Analysis of the Medical and Surgical Cases. Greenwich: E. G. Benyman & Sons, p. 23. Received 9 April 1999; revised 12 July publication 14 July 1999
on Infectious
1999; accepted for
Diseases
Buenos Aires, Argentina 1 O-13 April 2000
This meeting is organized by the International Society for Infectious Diseases in collaboration with the Panamerican Association of Infectious Diseases, Argentinian Society for Infectious Diseases and Latin American Society of Pediatric Infectious Diseases. For further information please contact the 9th ICID Congress Secretariat, Congresos Internacionales S. A., Moreno 584, piso 9, (109 1) Buenos Aires, Argentina; fax +54 11 433 10223 or 433438 11. L-
OF THE ROYAL
SOCIETY
OF TROPICAL
MEDICINE
‘Tropical’ cases admitted to the Albert Dock Hospital in the early years of the London School of Tropical Medicine G. C. Cook The Wellcome Institute for the Histoy Medicine, 183 Euston Road, London NW1 2BE, UK
of
Keywords: tropical medicine, London School of Tropical Medicine, Albert Dock Hospital, Seamen’s Hospital Society records, UK
The London School of Tropical Medicine (LSTM) (which should be clearly differentiated from the London School of Hygiene and Tropical Medicine-the latter opened in 1929) opened its doors for teaching and research on 2 October 1899 (i.e., 100 years ago) (COOK, 1992). The clinical component ofits major activities was based at the Albert Dock (Branch) Hospital, under the
AND HYGIENE
(1999) 93,675-677
auspices of the Seamen’s Hospital Society (SHS) (Fig. 1); this institution was situated between the Royal Albert and Royal Victoria docks in east London. The hospital had been opened by the Prince and Princess of Wales on 24 June 1890; it was rebuilt in 1937-38, and totally demolished in 1995. In May 1892 Dr (later Sir) Patrick Manson (who had recently returned from China-where he had carried out his pioneering work on lymphatic filariasis) was appointed Visiting Physician to the SHS with attachment to the Branch Hospital (COOK, 1992). Contemporary SHS reports give details of the diagnoses ofpatients admitted to the Albert Dock Hospital in the early years of that institution (ANONYMOUS, 1897a, 1899, 1900, 1901, 1902, 1903, 1904, 1905, 1906; SMITH, 1892, 1893, 1894, 1895). Between 1891 and 1896, the General Reports record numbers of cases admitted with the causes of death. In 189 1 for example, there were 217 medical and 287 surgical admissions; 6 cases had been brought in dead, demise being caused by: drowning (2), fractured skull (2), enteritis (l), and ‘heart disease’ (1). There were 2419 out-patients that year. Beginning in 1897, ‘tropical cases’ (67 that year) were categorized separately; deaths resulting from these diseases were however included under medical admissions. From 1898 until 1905 it was decided to publish a
Fig. 1. The Albert Dock (Branch) Hospital, which was opened by the Prince and Princess of Wales in 1890 (from the Illustrated London News, 28 June 1890, p. 819).
0 1890
1895
1900
1905
Year
Fig. 2. Admissions to the Albert Dock (Branch) Hospital, each year for which records are available.
189 1- 1905. Total ‘tropical’, medical, and surgical admissions are shown, for
G. C. COOK
676
Table 1. Annual diagnoses Hospital, 1899-1905
of ‘tropical’
admissions
to the Albert
Dock
Date (year)
Viral Hepatitisiperihepatitis
1899
1900
-
-
-
1901
1902
2
2
1
1
-2
1
-8
-4
2 6
6 22
12 12 -
4 12 -
34 3
26
TO
5 6
1
6
1 -
-2
2 -
-2
i
Bacterial/protozoan Dysentery Acute Chronic ‘Amoebic’
15 11 -
20 5 -
15 12 -
1: -
24 -
32 -
37 -
41 2
1
32 2 2 1
1
-4
6
1 -
2
2
1905
6
2
Helmintic Ancylostoma duodenale Filariasis Guinea worm Schistosoma spp. Taenia solium Hydatidosis (of lung)
1904
3
Bacterial ‘Malta fever’ Plague Leprosy Relapsing fever Tropical sprue
Protozoan ‘Malaria’ Kala-azar Trypanosomiasis Hepatic abscess
1903
2
-
3 1 5
1 1
; -
-3 4 2 -
-
Nutritional Beri-beri scurvy
13 4
16 -
23 -
Total
75
6 9
1
6
1 1 1
-
-
1 1
26 -
23 -
1
16 89
-
“Includes 1 case of ‘tricophyton’ infection. “Includes 1 case of ‘granulomatous disease’.
LSTM. Table 1 summarizes the diagnoses of the ‘tropical’ cases during the 7 years from the opening of the LSTM; Table 2 gives contemporary diagnoses of cases of Plasmodium spp. infection. From these statistics it is clear that the amount of ‘tropical medicine’ at the Albert Dock Hospital was exceedingly limited (this hospital dealt first and foremost with injuries sustained in the docks); during the 7-year
‘breakdown’ of the diagnoses of the ‘tropical’ cases; in 1898 (i.e., the year before the LSTM opened) 35 admissions were due to malaria, 20 were caused by dysentery, 12 by beri-beri, and 11 resulted from a miscellany of causes; phthisis and ‘enterica’ (typhoid fever) fell under the umbrella of ‘medical cases’. Figure 2 summarizes ‘tropical’, medical, and surgical admissions from the opening of the Albert Dock Hospital, and during the early years (1899- 1905) of the Table 2. Annual
diagnoses
of Plasmodium
period
spp. admissions
under
surveillance
to the Albert
the mean admission
Dock Hospital,
rate for
1899-1905
Date (year)
‘Malignant’ [I? falciparum] Blackwater fever Benign tertian [I? vivax] Double benign tertian Benign tertian + ‘malignant’ Double benign tertian + ‘malignant’ ‘Benign quartan’ Triple quartan Double benign tertian + ‘quartan’ Post-malarial jaundice Malarial cachexia Unclassified History, but no parasitological confirmation No details provided Total
1899
1900
1901
1902
1903
4
15 2 3 2 -
12 2 4 5 -
5 6
s 7 -
1 3 6 -
2 2 5 5 -
13 2 8 5 1 1 :
24
32
37
Yi -
1
4 2
1
2
1904
1905
11
11
2 9 4
1; -
-
-
-
1
1 2 6 -
1
6
-
3 7
2 -
-
41
32
34
26
ADMISSIONS
TO THE ALBERT
DOCK
HOSPITAL
677
‘tropical’ cases was < 2 per week, which must have been extremely disappointing from a teaching/research viewpoint. The scenario was dominated by Plasmodium spp. infection (Table 2), beri-beri (rarely encountered now), and dysentery (most cases of which did not have a ‘laboratory diagnosis’). The mean annual number of Africans admitted to the Albert Dock Hospital during the years of 1899- 1905 was 15 (range 1O-l 8), while that of ‘Asiatics’ was 111 (range 93- 129). Corresponding mean annual number of landsmen (i.e., men working in the vicinity of London’s dockland) was 228 (range 209259). These low figures for the admission rate of ‘tropical diseases’ probably justify, retrospectively, the opinion of several of Manson’s leading opponents (COOK, 1995) that the Royal Victoria Hospital, Netley (COOK, 1992), which contained much ‘clinical material . afforded by invalided soldiers from India, China, and other tropical and sub-tropical stations in all parts of the world’ (&VONYMOUS, 1897b), or possibly the Royal (Naval) Hospital at Haslar, would have been more suitable venues for the creation of the LSTM (!WONYMOUS, 1897b, 1898). Manson had been appointed to the staff of the Albert Dock Hospital 7 years before the LSTM was opened. In the light of this information, it is possible to understand better the acrimonious correspondence which developed between Manson [who had Joseph 1994) backing] and his oppoChamberlain’s (MARSH, nents (COOK, 1992,1995). Was the decision in favour of this venue therefore in the best interests of the newly developing discipline, ‘tropical medicine’? References Anonymous (1897a). Branch Hospital, Royal Albert Docks. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1895 and 1896. Greenwich: E. G. Berryman & Sons, pp. 19 and 38. Anonymous (1897b). Instruction in tropical diseases. Lancet, ii, 1266. Anonymous (1898). Netley as a school for tropical medicine. Lancet, ii, 1805-1806. Anonymous (1899). Branch Hospital, Royal Albert Docks. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1897 and 1898. London: E. G. Berryman & Sons, pp. 20 and 35-46. Anonymous (1900). Branch Hospital, Royal Albert Docks. In: Tables ofCases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1899. London: E. G. Berryman & Sons, pp. 21-32. Anonymous ( 190 1). Branch Hospital, Royal Albert Docks. In: Tables of Cases under Treatment at the Hospitals and Dispensaries
9th International
Congress
of the Seamen’s Hospital Society in 1900. London: E. G. Berryman & Sons, pp. 21-30. Anonymous (1902). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1901. London: E. G. Berryman & Sons, pp. 20-32. Anonymous (1903). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1902. London: E. G. Berryman & Sons, pp. 26-38. Anonymous (1904). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1903. London: E. G. Berryman & Sons, pp. 25-36. Anonymous (1905). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1904. London: E. G. Berryman & Sons, pp. 25-34. Anonymous (1906). Branch Hospital, Royal Albert Dock. In: Tables of Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society in 1905. London: E. G. Berryman & Sons, pp. 25-33. Cook, G. C. (1992). From the Greenwich Hulks to Old St Pancras: a History of Tropical Disease in London. London: Athlone Press, p. 338. Cook, G. C. (1995). Doctor Patrick Manson’s leading opposition in the establishment of the London School of Tropical Medicine: Curnow, Anderson, and Turner. JournalofMedical Biography, 3, 170- 177. Marsh, P. T. (1994). Joseph Chamberlain: EntrepreneurinPolitics. New Haven, London: Yale University Press, p. 725. Smith, W. J. (1892). BranchHospital, Royal Albert Docks. In: A General Report of the Cases Under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital’Sociey Together with an Analysis of the Medical and Surgical Cases. Greenwich: E. G. Berryman & Sons, p. 25. Smith, W. J. (1893). BranchHospital, Royal Albert Docks. In: A General Report of the Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society Together with an Analysis of the Medical and Surgical Cases. Greenwich: E. G. Berryman & Sons, p. 26. Smith, W. J. (1894). Branch Hospital, Royal Albert Docks. In: A General Report of the Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society Together with an Analysis of the Medical and Surgical Cases. Greenwich: E. G. Berryman & Sons, p. 24. Smith, W. J. (1895). BranchHospital, Royal AlbertDocks. In: A General Report of the Cases under Treatment at the Hospitals and Dispensaries of the Seamen’s Hospital Society Together with an Analysis of the Medical and Surgical Cases. Greenwich: E. G. Benyman & Sons, p. 23. Received 9 April 1999; revised 12 July publication 14 July 1999
on Infectious
1999; accepted for
Diseases
Buenos Aires, Argentina 1 O-13 April 2000
This meeting is organized by the International Society for Infectious Diseases in collaboration with the Panamerican Association of Infectious Diseases, Argentinian Society for Infectious Diseases and Latin American Society of Pediatric Infectious Diseases. For further information please contact the 9th ICID Congress Secretariat, Congresos Internacionales S. A., Moreno 584, piso 9, (109 1) Buenos Aires, Argentina; fax +54 11 433 10223 or 433438 11. L-