Disease and Health Care in the Port of London by Sheila Dobner

On Monday Sheila talked to us about the development of health management in the Port of London.  We have previously heard about the hospital ships, which took smallpox patients from the population of London to isolate them on the river down at Dartford. They were not dealing specifically with those who worked the port.  The ships finished in 1904 due to the high cost of maintenance and limitations of space, and the service was brought ashore to the Joyce Green Hospital. Along with the Orchard and Long Reach Hospitals these were known as the River Hospitals, which were used as fever hospitals and for casualties in two world wars. They were demolished in 2000.

Services for Seamen

Dreadnought Hospital (source: Portcities)

The Dreadnought Hospital at Greenwich was set up to treat seamen and also began as a ship in 1821, originally named the Grampus.  The hospital came ashore in 1870, inhabiting the vacant infirmary building of the Royal Naval College. It housed around 250 patients and also handled urgent medical cases from the local community. The policy of the hospital was to provide help and care for “all distressed seamen”. This included seamen of all nationalities passing through including Indians, Swedes, Norwegians, Africans, Chinese and Americans. In 1877 the hospital opened one of the country’s first training schools for nurses. The Devonport Nurses Home still stands in Greenwich. The hospital was funded through charitable donations and subscriptions so fundraising events and flag days were an important source of income. Illnesses which the hospital treated included broken bones, dysentery, typhoid, ulcers, wounds, rheumatism and venereal disease. During the construction of the Blackwall Tunnel in the 1890s the Dreadnought acted as unofficial first-aid post for labourers injured during the building works. The building company Pearson later acknowledged that support by helping to raise £400 towards the hospital’s funds. After the First World War the society opened its first convalescent home at Cudham in Kent. A major sanatorium for seamen who had tuberculosis (TB) was built in Hampshire in 1921. As shipping on the Thames declined in the 20th century, the hospital fell out of use and finally closed in 1986. The building more recently became the library of the University of Greenwich (building work at the moment). The Dreadnought Medical Society however still exists, based at Guys and St Thomas’s and is part of the NHS, providing special services for merchant seamen and their families.

The focus of the port had moved away from Greenwich so the foundation stone for a new hospital for the care of merchant seamen was laid on 15th July 1889 by the Prince of Wales (later King George V). The Royal Albert Dock Hospital was officially opened on 24th June 1890 by the Prince of Wales (later Edward VII).  It was a branch of the Dreadnought Seamen’s Hospital.  The Hospital had two general wards of 5 beds each, a 2-bedded isolation ward and 2 single rooms, an Out-Patient Department, dispensary, kitchen, post-mortem room and an ambulance house.  Located in Connaught  Road, near the western entrance to the Royal Albert Docks, it was managed by the Seafarer’s Hospital Society and was open to the general public.  However, it dealt mainly with injuries acquired by dock workers.  The dockside buildings suffered from subsidence, with the foundations collapsing, so in 1937 the Hospital moved to new premises, built at the cost of £68,100, at a site donated by the Port of London Authority in Alnwick Road, Custom House.  It was officially opened by Queen Mary in 1938.  The new Hospital had 55 beds and an Out-Patients Department, including a fracture clinic, a rehabilitation centre and a VD unit.  A Nurses’ Home had also been built.  In 1948 it joined the NHS and became known as the Albert Dock Seamen’s Hospital.

Tropical Diseases

The Albert Dock Seamen’s Hospital has an important role in the history of the London School of Hygiene and Tropical Medicine as it was here that it was founded by Sir Patrick Manson, the Director of the Hospital, in 1899. It was set up to treat British colonial administrators for malaria and other diseases. In 1920 it moved to Endsleigh Gardens in central London, moving in 1929 to its present site off Gower Street, where it is renowned for its postgraduate teaching and research into diseases such as HIV/aids, Malaria, TB, Ebola, and Zika.

Quarantine

The “Lima” quarantine flag. Source: Wikipedia

When a ship was known to be carrying a disease or was arriving from a port where an epidemic had broken out, it was delayed the disembarkation of passengers, or the unloading of cargo until the ship seemed to be free of disease. It was first used to keep out the plague after the Black Death hit Europe, also cholera, yellow fever. The term comes from the Italian quarante from the period of 40 days for which ships were detained.

The first quarantine station on the Thames was at Stangate Creek, near Sheerness. Ships flying the quarantine flag were detained here under guard. Quarantine  at the time had only limited effect, for a number of reasons.  Chief amongst these were that bacteria and viruses were not discovered until the late 19th century so transmission of disease was little understood; quarantine was not enforced well enough; inspections were carried out by customs officials rather than doctors; and healthy people on board were at risk of infection.

In 1872 the Port Sanitary Authorities (PSAs) were created to increase the effectiveness of quarantine measures. They had the power to inspect incoming vessels and their cargoes, and the duty to investigate any health problem connected with the port. The City of London took on this responsibility for the Port of London. The area covered included the whole of the Tidal Thames from Teddington Lock in the west and the lower Medway -94 miles in all.

In the beginning, the PSAs concentrated on disease control, as infectious diseases were still a very serious threat to public health. With the increase in numbers of immigrants, the PSAs carried out medical inspections of new arrivals (especially those the authorities described as ‘low-class aliens’).  As with the earlier quarantine ships, the Port of London PSA carried out much of its work lower down the Thames. In 1883 the Corporation built an isolation hospital for sick and quarantined seamen at Denton in Gravesend. Neither the patients nor the ship owners was charged for care and treatment.

Quarantine continued until 1889, when the Infectious Diseases Prevention Act was passed, giving medical officers the authority to board and inspect the ship’s crews and passengers.  The Act also introduced regulations to deal with cholera, yellow fever and plague.  Vessels arriving from a foreign port (most European ports were exempt) were subject to inspection.  Any persons with an infectious disease were removed, together with their belongings and bedding, and taken by launch to Denton (a pier and pontoon were added later to the site, so that the Hospital was accessible at all stages of the tide).  In 1905 some 36 patients were treated at the Hospital.

A Samaritan Fund was set up to help destitute seamen whose clothes and possessions had been destroyed during the disinfection process. The Hospital was maintained by the Port Sanitary Authority (whose title was changed to the Port Health Authority by the Public Health (London) Act, 1936) and funded by the Corporation of London from its corporate funds until 1920, when its costs were defrayed by the rates and an Exchequer grant.

The hulk Hygeia, moored off Gravesend since 1922, from which all incoming ships were inspected, was used as a quarantine station and a base for the launches. She also contained accommodation for the boarding medical officers, who provided a service 24 hours a day. (The wooden ship was replaced in 1935 by an Admiralty lighter made of steel which had been built in 1918.  She was renamed the Hygeia.)

Port of London Isolation Hospital 1954. Source: Dartford Hospital Histories

During the 1930s the Hospital was enlarged and, by the end of the decade, consisted of various one- and two-storey buildings.  The administration block  also contained the Medical Officers’ quarters, 12 rooms for the nurses (including one for Matron), and accommodation for the kitchen and laundry staff.  The wards consisted of a cubicle block with 8 cubicles, each for two patients; a typhoid block of two wards – one with 18 beds and one with 6 beds; and a smallpox block of two wards with 6 beds each for sea-borne cases of smallpox, with accommodation for two nurses.  The disinfecting station contained two baths and three showers, with a laundry and equipment for steam disinfection.  A caretaker’s cottage and an outbuilding for the gardener’s stores completed the campus.  The staff employed were a part-time Medical Officer, a Matron, 3 nurses, a cook, 4 maids, a caretaker, a laundress and a gardener.  The Hospital was normally under the control of the Deputy Port Medical Officer of Health.  Between 1930 and 1936 about 50 to 60 patients a year were admitted.  The patients were not only seamen, but also passengers (male and female), dockers, stevedores and any others working ashore in the Port Health Authority’s territory.  Diseases treated included chickenpox, measles and German measles, diphtheria, smallpox (only 2 cases during the 1930s, in 1935), mumps, malaria, bubonic plague, typhoid, scarlet fever, enteric fever, dysentery, scabies, tonsillitis, pyrexia, septic throat, impetigo, hepatitis, colitis, angina, jaundice and eczema.

During WW2, the Hospital suffered serious bomb damage in 1940 and was closed for bed cases, although the disinfection unit remained open.  In February 1942 the Admiralty requisitioned the site for use as a treatment centre for servicemen with venereal disease and parasitic infections (scabies).  Two Nissen huts were built in the grounds for this purpose.

The Hospital reopened in August 1947, when it had 32 beds.  In the same year the City of London Corporation applied for it to be disclaimed from the National Health Service on the grounds that it provided a unique service, while the Seamen’s Hospitals did not admit women or dock workers, only professional sea-farers.  The application failed and the Hospital joined the NHS in 1948, grouped with the Seamen’s Hospitals under the control of the South East Metropolitan Regional Hospital Board.  Patients were still brought to the Hospital by ambulance launch.  The Medical Officers had various quarantine launches at their disposal – the  Howard Deighton, the Alfred Roach, the Alfred Robinson and the Frederick Whittingham.  The Humphrey Morris, bought in 1962, had a consulting room, with accommodation for two stretcher cases and three ambulant patients.  By 1966 the Hospital had 20 beds and, by 1971, 8 beds.  It closed in 1976.  Services moved to Joyce Green Hospital.

This wonderful video from 1948 shows a Port of London Authority. Health Ship P.L.A. health ship meeting an infected ship and offering assistance, fumigating the ship with cyanide.
http://www.britishpathe.com/video/p-l-a-health-ship/query/port+of+london

The Port Health Authority Today

The London Port Health Authority is the largest port health authority in the UK. They are responsible for all port health functions on the Thames, including the ports at London Gateway, Tilbury, Thamesport (Isle of Grain, formerly Port Victoria), Sheerness and  London City Airport.  Functions include:

  • imported food and feed controls
  • infectious disease controls
  • food safety and hygiene, including water quality
  • environmental controls, including noise, refuse, and industrial emissions
  • a 24-hour standby service for infectious disease control available every day of the year

The staff of the London Port Health Authority work at various offices in the district, together with launch crew who operate the Authority’s launches, Lady Aileen and Londinium III, a Rigid Inflatable Boat (RIB), a smaller RIB and a work boat. Staff include the Port Health and Public Protection Director who is based at Walbrook Wharf in the City of London, local Port Health Managers, Port Health Officers, official veterinarians, technical officers, Port Health Assistants, and Support Assistants.  They  use the services of public analysts, consultants in communicable disease control and Boarding Medical Officers, together with the services of Public Health England.

Dockers and their families

Albert Dock Seamen’s Hospital. Source: Wikipedia.

Dock work was always dangerous and relied largely on muscle power. In the port, safety was a low priority and accidents were common. Manoeuvring large, heavy objects between ships and shore via narrow gangplanks which might be slippery with ice and muck was fraught with danger. Men could be drowned or crushed, falling between the hull of the ship and the dock.  The dock area was often a chaos of men and vehicles. Grappling hooks were dangerous implements being swung around. Cargoes could fall from nets or slings being winched to and fro. Cranes, winches, tractors, locomotives and platform trucks were further hazards.  Cargoes were often of dangerous substances. Bags containing asbestos, iodine, phosphates, guano, lead or cement, would frequently burst, showering the men with their noxious contents. Within the holds of the ships, barrels and chests would be dislodged, crushing men beneath them. There was little in the way of protective clothing.

With increased competition in the 19th century, corners were cut. Dockers were on low wages often paid by quantity of goods shifted and dock owners were piling on the pressure. New labour coming in from the countryside and from Ireland was inexperienced in handling cargoes. The work was dangerous, dirty and tiring and accidents were inevitable. One more recent docker recalls “I’ve had chaps working with me down a ship’s hold that never handled a hook or done a job down a ship’s hold in their lives. On one occasion, put on sugar, and I gave him a hook…And said “now put your hook in there”, and I’m saying that, as he did so he went literally – bashed his hook right through the middle of me hand. I’ve still got a little hole there now. Almost pinned me hand to the bag of sugar.”  Neither the wharfingers nor the dock companies provided any health care for their workers. Most port workers had no income if they were unable to work at any time. A permanent injury or fatal accident could put the whole family in the workhouse, or leave them with the option of begging or crime.

The first casualty hospital in Poplar was built in the 1850s, thanks to the Quaker banker and philanthropist Samuel Gurney and William Money Wigram, partner in a shipping line. Gurney decided to set up the hospital after the notorious death of a labourer injured at the East India Docks. The man died on the way to the London Hospital at Mile End, the nearest hospital to the docks. It was clear that many deaths could have been avoided had medical facilities been available on the spot.  The former Custom House, across the road from the entrance to East India Dock entrance was purchased and transformed into the new Poplar Hospital in 1855/8? At first it catered only for the male workers at the port, but it was later expanded to provide general facilities for the Poplar district. A new wing, including wards for women, was added in 1891-4. At one point, it was estimated that a dozen new cases were being treated at the hospital every hour of the day and night, and the hospital bore a plaque “in grateful recognition of the splendid services rendered by the Hospital to the Staff of the London and India Dock Company, since the Hospital was established”.

Poplar Borough Council published its Official Guide to the Metropolitan Borough of Poplar in 1927, and reported that: “Accidents in the Port of London, in the docks and shipping, amongst the factories and the engineering works, are of frequent occurrence, and often of the most terrible character … immediate attention to the injured is often a vital consideration.”

The hospital suffered bomb damage in 1941 but didn’t close until 1975. In 1982 it was demolished to make way for new houses – the old Victorian buildings and limited space no longer suitable for the demands of modern medicine, though the people of Poplar would miss their local hospital. But by then of course, the docks were all but dead and the NHS had taken over.

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