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The rapid expansion of Victorian London laid bare public health challenges that various philanthropic movements had recognised but been unable to meet. A growing indigent population was living in rookeries with unreliable water supplies and inadequate sewage disposal.1 Street children, whom Lord Shaftesbury referred to as ‘nobody’s’, suffered from fevers as well as chronic scabies, ringworm and ophthalmia. The introduction of fever hospitals by British cities, principally London, came to meet the needs of sick children on the necessary scale even though they were ultimately to prove redundant and of questionable value to children.
The Metropolitan Asylums Board
Until 1867 provision for London’s sick was the responsibility of nearly 40 different poor law unions; but in that year Parliament created the Metropolitan Asylums Board (MAB) to provide ‘joined-up’care for London’s ill and infirm poor, including children with fevers.2 Up until then, to avoid the spread of infection within the existing voluntary hospitals, febrile patients were mostly excluded even though, as Sir John Simon wrote: ‘I cannot conceive any cases having more claim to hospital treatment than those cases of typhoid fever [and so other fevers] which the rules would rigidly exclude’.3 Those hospitals were anyway in no position to meet the numerical demands made by London’s frequent epidemics.
It was, however, one thing to legislate for fever hospitals, another to get them built. The smallpox epidemic of 1871–1873 set off a prolonged controversy about the aerial spread of infection4 and householders often opposed the local siting of a fever …
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.