As the spread of contagion came to be realized, the ordinary hospitality

to vagrants ceased. Rogan was struck with the apathy which at length arose

towards sick or dead relatives; even parents became callous at the death

of their children (of whom many died from smallpox). “For some time,” he

says, “it has been as difficult for a pauper bearing the symptoms of

ill-health to procure shelter for the night, as it was formerly rare to be

refused it.” In Strabane they extemporised a poor’s fund by voluntary

contributions of £30 a month, by means of which eighty poor families were

kept from begging in the streets. In Dublin there was so much alarm of

infection from the number of beggars entering the shops that trade was

checked. The following, relating to a town in the centre of Ireland, is an

extreme instance of the panic which the idea of contagion at length

caused:

“In Tullamore, when measures were proposed for arresting the progress

of fever, by the establishment of a fever hospital, so little was the

alarm that the design was regarded by most of the inhabitants as a

well-intentioned project, uncalled for by the circumstances of the

community. But when the death of some persons of note excited a sense

of danger, alarm commenced, which ended in general dismay: military

guards were posted in every avenue leading to this place, for the

purpose of intercepting sickly itinerants. The town, from the shops of

which the neighbouring country is supplied with articles of all kinds,

was thus in a state of blockade. It was apprehended that woollen and

cotton goods might be the vehicles of infection, and all intercourse

between the shops and purchasers was suspended. Passengers who

inadvertently entered the town considered themselves already victims

of fever. No person would stop at the public inns, nor hire a carriage

for travelling; in a word all communication between the town and the

adjacent country was completely interrupted. Apprehension did not

proceed in most other places to the same extent as in Tullamore[474].”

Several isolated places escaped the epidemic of typhus, either for a time

or altogether. The island of Rathlin, seven miles to the west of Antrim,

which was as famished as the mainland, had no typhus at the time when it

was epidemic along the nearest shore; the island of Cape Clear, at the

southernmost point of Ireland, had a similar experience. The whole county

of Wexford, where the soil was dry and the harvest of 1816 had been fair,

kept free from typhus until 1818, partly because it was out of the way of

vagrants. The town of Dingle, at the head of a bay in Kerry, with old

Spanish traditions, was totally free from typhus at a time when its near

neighbour, Tralee, was full of it, the immunity being set down to the

well-being of the population from their industry at the linen manufacture

(and fisheries) and their thrifty habits. But the counties of Wexford and

Waterford, and other places more or less exempted in 1817, had a full

share of the epidemic in 1818, which was the season of its greatest

prevalence in most parts of Ireland except Ulster. The harvest of 1817 had

been little better than that of the year before, although the potato crop

was hardly a failure. The fine summer of 1818 brought out crowds of

vagrants who slept in the open, and, when they took the infection, were

placed in “fever-huts” erected near the roads[475]. The harvest of that

year was abundant, and by the end of 1818 the epidemic had declined

everywhere except in Waterford.

The most carefully kept statistics of the sickness and mortality were

those by Rogan for the Strabane Dispensary district, and the adjoining

manors of the Marquis of Abercorn, for each of which a private dispensary

was established under the care of a physician.

Abstract of Returns of the Dispensary district of Strabane, shewing

the numbers ill of fever from the commencement of the epidemic in the

summer of 1817, till the end of September, 1818, the numbers labouring

under the fever at that date, and the mortality caused by the disease

(Rogan, p. 72).

Population Ill of Fever Dead Remaining ill

Town of Strabane 3896 639 59 13

Parish of Camus 2384 685 61 37

" " Leek 5092 1462 96 57

" " Urney 4886 1381 86 42

---------------------------------------------

16,258 4167 302 149

Similar return for those parts of the Marquis of Abercorn’s estates

not within the Dispensary district:

Ill of fever

Manors Population (to Oct. 1818) Dead

Magevelin and}

Lismulmughray} 5548 1666 101

Donelong 3126 1217 71

Derrygoon 2568 1215 90

Part of Strabane 2796 990 75

-----------------------------------

Totals 14,038 5088 337

The proportion of attacks in these tables for a part of Tyrone, one-third

to one-fourth of the whole population, is believed to have been a fair

average for the whole of Ireland. Each attack, with the weakness that it

left behind, lasted about six weeks; cases would occur in a family one

after another for several months; in some cottages, says Rogan, only the

grandmother escaped.

One hundred thousand cases were known to have passed through the

hospitals. Harty thought that seven times as many were sick in their

cabins or houses, making 800,000 cases in all Ireland in two years; Barker

and Cheyne estimated the whole number of cases at a million and a half

(1,500,000). The mortality was comparatively small. It comes out greater

in the tables for the Strabane district than anywhere else in Ireland

except the hospital at Mallow. The following table, compiled by Harty,

shows how widely the fatality ranged (if the figures can be trusted), from

place to place and from season to season:

Proportions of fatal cases of typhus in the chief hospitals of Ireland

1817, 1818 and 1819 (Harty)[476].

1817 1818 1819 Average

One in One in One in One in

Dublin 14½ 24 18¼ 20

Kilkenny 16½ 14⅚ 12⅔ 14¼

Dundalk 20-6/7 54 25 30

Belfast 19⅕ 15⅘ 19 17⅓

Newry 21-1/9 34½ 13½ 26

Cork 29 35 35 33⅕

Limerick 13½ 15⅔ 30⅔ 16½

Waterford 27⅓ 25 23⅓ 24⅗

Clonmel 27 18 18¼ 19⅓

Mallow 22½ 9⅗ 12

Killarney 74 67 33 62

Tralee 20¾ 69 43 39

What this meant to particular places will appear from some instances. In

the parish of Ardstraw, Tyrone, with a population of about twenty

thousand, 504 coffins are stated by the parish minister to have been given

to paupers in eighteen months. The burials were about twice as many as in

ordinary years, according to the register of the Cathedral churchyard of

Armagh:

1815 247 burials

1816 312 "

1817 571 "

1 May-25 Dec. 1818 463 "

Of the 463 burials in eight months of 1818, there were 165 from fever,

180 from smallpox, and 118 from other causes.

Barker and Cheyne make the whole mortality of the two years from fever and

dysentery to have been 65,000; Harty makes it 44,300. But not more than a

sixth part of the latter total were registered deaths, and the estimate of

the whole may be wide of the mark. In the county of Kerry, ten Catholic

priests died of it. Many medical men took it, as well as apothecaries and

nurses, and several physicians died, of whom Dr Gillichan, of Dundalk, a

young man of good fortune, made a notable sacrifice of his life. Everyone

bore willing testimony to the devotion of the Roman Catholic clergy. Some

harrowing incidents were reported, such as those from Kanturk, in county

Cork:

Dr O’Leary visited a low hut in which lay a father and three children:

“There were also two grown-up daughters who were obliged to remain for

several nights in the open air, not having room in the hut till the

father died, when the stronger of the two girls forced herself into

his place. On the road leading to Cork, within a mile of this town, I

visited a woman of the name of Vaughan, labouring under typhus; on her

left lay a child very ill, at the foot of the bed another child just

able to crawl about, and on her right the corpse of a third child, who

had died two days previously, and which the unhappy mother could not

get removed. When the grant arrived from Government, I visited a man

of the name of Brahill near the chapel gate, who with his wife and six

children occupied a very small house, all of them ill of fever with

the exception of one boy, who was so far convalescent as to creep to

the door to receive charity from the passengers.”

Infants rarely took the fever. Dr Osborne, of Cork, stated that in one

instance a physician in attendance on the poor had to separate two

children from the bed of their dead brother, the father and mother

being already in a fever hospital; in another instance, he had to

remove an infant from the corpse of its mother who had just expired in

a hovel[477].

Nosologically the epidemic of 1817-18 presented several features of

interest. It began with dysentery, and ended with the same in autumn,

1818. It was in great part typhus, but towards the end of the epidemic,

in Dublin, at Strabane, and doubtless elsewhere, it changed to relapsing

fever, that is to say, the sick person “got the cool” about the fifth or

seventh day instead of the tenth or twelfth, but was apt to have one or

more relapses or recurrences of the fever. The relapsing type was milder

in its symptoms and was more rarely fatal. The average fatality of typhus

was much less than in ordinary years, while a good many of the fatal cases

came from the richer classes, to whom the contagion reached, the

proportion of fatalities among them being noted everywhere as very high,

up to one death in three or four cases[478]. The fatalities were most

common, as usual, at ages from forty to sixty. A full share of the women

and children took the fever, perhaps an excess of women, allowing for

their excess in the population. The following were the numbers at each

period of life among 18,891 cases treated in the hospitals of Dublin and

Waterford:

Years of age 1-10 10-20 20-30 30-40 40-50 50 and over

Cases 2426 6116 5230 2476 1415 1228

The action of the English Government was thought by some to have been

apathetic. Nothing was done to check the export of corn from Irish ports.

Peel, who held the office of Irish Secretary in 1817, was probably

actuated in this by the same constitutional and economic considerations

which led him, as Prime Minister in 1845, to refuse O’Connell’s demand for

a proclamation against the export of corn.

Carleton says that there were scattered over the country “vast numbers of

strong farmers with bursting granaries and immense haggards,” and that

long lines of provision carts on their way to the ports met or

intermingled with the funerals on the roads, the sight of which

exasperated the famishing people. Several carts were attacked and

pillaged, some “strong farmers” were visited, and here or there a “miser”

or meal-monger was obliged to be charitable with a bad grace; but on the

whole there was little lawlessness, less indeed than in England in 1756

and 1766, or in Edinburgh in 1741. In September, 1817, Peel commissioned

four Dublin physicians to visit the respective provinces and report on the

causes and extent of the epidemic fever. On 22 April, 1818, Sir John

Newport, member for Waterford, for whom Dr Harty had been collecting

information, raised a debate on the epidemic in the House of Commons, and

moved for a Select Committee. The debate, after the opening speech and a

sensible brief reply by Peel, degenerated at once into irrelevant talk on

the inadequacy of the fever hospital of London. The Select Committee was

named, and quickly reported on the 8th of May.

A Bill embodying the recommendations of the Committee received the royal

assent on 30th May. The Act provided for the extension of fever hospitals,

the exemption of lodging-houses, under certain regulations, from the

hearth-tax and the window-tax, and the formation of Boards of Health with

powers to abate and remove nuisances. The Boards of Health were found

unworkable, partly by reason of expense, partly of excessive powers. The

epidemic having visited Waterford somewhat late in its progress, Sir John

Newport again called attention to it on 6th April, 1819, and moved for the

revival of last year’s Committee. Mr Charles Grant, afterwards Lord

Glenelg, who was now Irish Secretary, gave much satisfaction to the

patriotic members both by his sympathetic speech on the occasion and by

his previous action at the Irish Office in the way of pecuniary help to

the fever hospitals or Dispensary district officers. The Second Report of

the Committee remarked that the rich absentee landlords had given nothing.

Another Act, of June, 1819 (59 Geo. III. cap 41), defined the duties of

officers of health, and contained an important clause (ix.) relating to

the spread of contagion by vagrants. By that time the epidemic was over;

nor can it be said that the action of the Government from first to last

had made much difference to its progress.

Vagrancy was the principal direct cause; and behind the vagrancy were

usages and traditions, with interests centuries old, which made the

landlords resolute not to pay poor-rates on their rentals. It was not

until twenty years after that the English Poor Law was applied to Ireland

(in 1839), whereby the pauper class were dealt with as far as possible in

their respective parishes. How far that measure was effective in checking

the spread of contagion will appear when we come to the great famine and

epidemic of dysentery and fever in 1846-49.

It will not be necessary to follow with equal minuteness the successive

famines and epidemics of typhus, relapsing fever and dysentery in Ireland,

to the great famine of 1846-49. After 1817 distress became chronic among

the cottiers and small farmers. Leases had been entered into at high rents

during the years of war prices, and in the struggle for holdings tenants

at will offered the highest rate. When peace came and prices fell, rents

were found to be excessive, not to say impossible. But in Ireland with a

rapidly increasing population it was easier to put the rents up than to

bring them down. Other things helped to embarrass the poor cottager: he

paid twice over for his religion, tithes to the parson, dues to the

priest; and he paid all the more of the tithe in that the graziers, who

were mostly of the established Church and the occupiers of the fertile

plains, had taken care to make potato land titheable (at what date this

innovation arose is not stated) but had used their power in the Irish

Parliament to resist the tithe on arable pastures. Again the cottiers or

cottagers paid, in effect, the whole of the poor rate in the form of alms;

for the dogs of the gentry kept all beggars from their gates.

Famine and Fever in the West of Ireland, 1821-22.

The next famine in 1821-22 is remarkable for two things besides its purely

medical interest. Owing to the number of desperate evicted tenants, it

gave occasion to an increased activity of the secret associations,

especially the Whiteboys of Tipperary and Cork[479]; and it called forth

the first great dole of English charity in the form of princely

subscriptions to a Famine Fund. The English charity in 1822 was prompt and

large-hearted, contrasting with the tardy help from the exchequer in the

much more serious famine of 1817-18. The true explanation of it is,

doubtless, that England on the second occasion had more money to spare.

The trouble in 1821-22 came from the total loss of the potato crop in

Mayo, Galway, Clare and Kerry, and from a partial loss of it in some other

counties of the south and west. There was no corn famine, and no general

dearth. Accordingly it affected the poorest class only, and the most

remote districts chiefly. The planting season of 1821 had not been

favourable, and the yield of potatoes had been poor. But the autumn was so

wet in the west that the floods in some places washed away the soil with

the potatoes in it, and in other places drowned the potatoes after they

had been pitted. The flooded state of the basin of the Shannon was a

natural calamity on the great scale that touched the imagination and

loosened the purse-strings. A Committee was formed at the London Tavern,

which sat through the spring of 1822, and quickly raised an immense sum.

The great mercantile firms of the City and of Liverpool gave each a

thousand pounds; a ball at the Opera House under the patronage of the king

(George IV.) brought six thousand, and from all sources the Committee

found themselves with three hundred thousand pounds at their disposal

(forty-four thousand of it from Ireland), while a fund at the Dublin

Mansion House amounted to thirty thousand more. Much of this was sent to

Galway, Mayo, Clare and Kerry, in time to save many thousands of families

from starvation[480]; it was, no doubt, wastefully given away, and there

was a balance of sixty thousand pounds sterling unused. More tardily in

June, 1822, Parliament voted one hundred thousand “for the employment of

the poor in Ireland,” and in July two hundred thousand to meet

contingencies of the famine. It was generally admitted that the Government

grants were jobbed and misappropriated to a scandalous extent. The towns

had to be made the centres of relief and the depôts of provisions; and yet

the towns were not suffering from famine or fever but only from penury.

The fever hospital at Ennis, the county town of Clare, was constantly

filled by strangers, the townspeople remaining healthy. Kerry was one of

the most afflicted counties, but Tralee and Killarney had no unusual

sickness. Limerick town had hardly more fever than in an ordinary year. In

Dublin the admissions for fever in 1822 were a good deal below the usual

number. On the other hand, Sligo town had much fever, and Galway town had

an altogether unique experience, the history of which, as related by Dr

Graves, will be the best possible view of the peculiar circumstances of

1821-22[481].

In Connemara, where the distress was acute, there were no roads over which

the provisions from England could be carted to the famished districts.

Accordingly a great store was made in Galway, to which crowds flocked from

the country in boats and on foot. Many died a few days after they arrived,

from exhaustion or from the surfeit of food after long hunger. Galway, a

crowded place at best, with narrow streets and lanes, contained thousands

of strangers, who slept about the quays and the fish-market, or in the

lanes and entries, or in crowded lodging-houses four or five in a bed. The

fever began in May, and quickly spread so much that the priests were kept

fully employed by calls to the dying. In June and July the sixty beds of

the fever hospital were filled, principally with the fugitives from

Connemara. Sixty more beds were added, and these by the middle of

September were insufficient. The infection had now spread to many good

houses. When Dr Graves and three other Dublin physicians arrived, on 26

September, they found ropes stretched across the streets to stop the wheel

traffic. The shops of tradesmen were avoided. The town was like a place in

the plague; people passing along the streets put their handkerchiefs to

their noses when they came to a house with fever in it. Yet the number of

cases was not remarkable; on 3 October, there were 404 sick in a

population of 30,000, of whom 130 were in the fever hospital and 274 at

their homes, the new cases occurring at the rate of 29 per diem. At length

it was found practicable to set up depôts of provisions in country places,

and the crowd of strangers left Galway. The fever was mild but tedious

among the poor, more violent and fatal among the well-to-do. In many

country places dysentery and choleraic diarrhœa were prevalent, as well as

fever. In Erris, county Mayo, dysentery and dropsy were more common than

fever, many of the cottiers having subsisted on weeds, shell-fish, or new

potatoes dug six weeks after the seed was planted. In this famine the

people ate the flesh of black cattle dead of disease. Excepting in

Connemara the county of Galway was not so soon affected as some other

parts of Ireland; but, as in 1818, the contagion of fever was spread

abroad by vagrants. After Mayo, Galway, Clare and Kerry, the counties most

affected were Roscommon and Sligo, and next to these Leitrim, Tipperary

and Cork.

Dysentery and Relapsing Fever, 1826-27.

Fever and dysentery decreased to an ordinary level in 1823, but rose

somewhat again in 1824, the summer of which was hot and moist. But it was

in the hot and dry summers of 1825 and 1826 that dysentery became notably

common in Ireland generally and in Dublin in particular. It began in the

capital in June--among the richer class of people. About the middle of

August admissions for dysentery were perceptibly raising the number of

patients in the Cork Street Fever Hospital, and continued to do so

throughout the autumn. At one dispensary three out of four applicants had

dysentery. All those admitted to hospital were over twenty years of age;

of thirty-five cases under Dr O’Brien, nine died, all of which had

ulceration of the great intestine, in one case gangrenous. The mortality

was not nearly so great among the richer classes, in which respect

dysentery reversed the rule of typhus fever. O’Brien had one obvious case

illustrating the curious connexion between dysentery and rheumatic fever,

originally remarked by English observers in the 18th century. A hospital

porter was admitted with “fever of a mixed catarrhal and rheumatic type.”

Having been blooded and subjected to free evacuations, his fever left him

on the fourth day, but he was at once seized with dysentery, which ran its

course[482].

It is to be noted that this epidemic of dysentery began in Dublin in the

hot June weather of 1825 among the richer classes, and that there was no

notable increase of fever while it lasted. It appears to have declined in

Dublin in the early part of 1826. After a cold and dry spring there began

one of the hottest and driest summers on record. The first rain for four

months fell on the 15th of July, 1826, the thermometer rose as high as

86°, and was on a mean several degrees above summer temperature in Dublin.

In the spring labour had become slack, and before long it was estimated

that 20,000 artizans in the Liberties (weavers and others) were out of

work. Early in May there began a most extraordinary epidemic of relapsing

fever, with which some typhus was mixed. By the 9th of May, the 220 beds

of the Cork Street Hospital were full, and applicants were sent away

daily. On 4 August, a temporary hospital of 240 beds was opened in the

garden of the Meath Hospital; on the 18th, the Wellesley Hospital, in

North King Street, was opened with 113 beds; on the 15th, tents to hold

180 patients were erected on the lawn of the Cork Street Hospital, raising

its accommodation to 400; a warehouse in Kevin Street was furnished with

beds for 230 patients, and some increase was made to the beds in Sir

Patrick Dun’s and Stevens’s Hospitals. The whole number of fever-beds in

Dublin hospitals at length reached 1400; but not half the number of cases

was provided for. At a meeting in the Mansion House on 26 October, it was

stated that there were at that date 3200 persons sick of the fever at

their homes, besides the 1400 in the hospitals. Funds were subscribed,

soup-kitchens and dispensaries opened in various districts of Dublin, and

kept open most of the winter, “but they made little impression on the

epidemic, which continued with unabated violence.” In March, 1827, it

began suddenly to decline, and fell rapidly until it was nearly extinct in

May; and that, too, although “the complaints of distress and want are to

the full as loud as at the commencement of the epidemic, and provisions

are dearer[483].” The corresponding sicknesses in Edinburgh and Glasgow

were later--the fever chiefly in 1828, the dysentery in 1827 and 1828.

This great epidemic was mainly one of relapsing fever. The patient “got

the cool,” or passed the crisis of the fever, usually on the evening of

the fifth or seventh day, sometimes on the ninth, the evening

exacerbation, which was to prove critical, being ushered in generally with

a rigor, and passing off in profuse perspiration throughout the night. The

five-day fever was more certain to relapse than that of seven days, the

seven-day fever was more likely to relapse than that of nine days. The

relapses might be one or two or three or more, prolonging the illness for

weeks. The clear interval varied from twenty-four hours to fourteen days.

There were some cases with jaundice which led Stokes and Graves to speak

loosely of “yellow fever[484].” O’Brien saw only four cases with exquisite

icterus in fifteen hundred cases of relapsing fever. There was a small

proportion of cases of ordinary typhus of a severe kind, marked by

unusual delirium or phrensy and the absence of sordes on the teeth or

petechiae on the skin; the typhus cases became more numerous in the winter

season, or, in other words, the original attack lasted to nine, eleven, or

thirteen days, with little or no tendency to relapse. Gangrene was not

uncommon in one part of the body or another, and in four cases the feet

became gangrenous[485].

Even with the admixture of pure typhus cases, and with dysenteric

complications in the autumn and winter, the mortality of the whole

epidemic was small--not more than it would have been among a third part

the number of fever cases in an ordinary year. At the Cork Street Hospital

alone (including the tents) there were 8453 admissions from 4th August,

1826, to 4th April, 1827, with 332 deaths, or four deaths in a hundred

cases. The proportion of recoveries was quite as remarkable in known

instances in the squalid homes of the poor, where two or three would be

found ill of fever on one pallet, or a father and six children in one

room, shunned by the neighbours.

The strangest thing in this epidemic was the sequel of it. In the spring

of 1827, intermittent fever, which had not made its appearance for several

years in Dublin, began to prevail pretty generally; whilst the ordinary

continued fever showed a strong tendency to assume the intermittent and

remittent forms. It is not surprising, therefore, that Dr O’Brien, who had

these varied experiences of epidemic dysentery in 1825, of epidemic

relapsing fever and typhus in 1826, and of intermittent fever in 1827,

should adopt Sydenham’s language of epidemic constitutions, and revert to

the old Sydenhamian doctrine of causes. While the sequence of epidemic

diseases in Dublin was some dysentery in the autumn and winter of 1825 and

relapsing fever on a vast scale during the excessively dry spring and

summer of 1826, in country districts of Ireland, such as Skibbereen,

dysentery became epidemic after the great drought and heat of 1826, while

“fever disappeared altogether,” and indeed all other prevalent forms of

sickness gave way before it, so general was it. Such is the report from

Skibbereen, county Cork, a district that became early notorious, in the

great famine of 1846-47, and was perhaps a kind of barometer of Irish

distress twenty years earlier. The epidemic dysentery of 1826 attacked all

classes there, but chiefly the poorest; it was apt to begin insidiously,

and, as it was often neglected, so it often became obstinate and hard to

cure. Dr McCarthy attributed it to the drought of 1826, the commercial

distress of 1825, the lack of employment for labourers, the overgrowth of

population, and the alarming rise in the prices of food[486]. He uses the

same economic illustrations as O’Connell and Smith O’Brien in the Great

Famine twenty years after, which were, indeed, as old as the time of

Bishop Berkeley[487].

Although little is heard of the fever of 1826-27 except in Dublin, it is

probable that the same causes which produced it there were operative in

other large towns. The admissions to the Limerick Fever Hospital rose

rapidly in the end of 1826. Geary, who was appointed one of its physicians

that year, estimates that about one in twelve of the population of

Limerick (63,310) were treated for fever in 1827 at public institutions,

besides those treated in private practice. It was relapsing fever, as in

Dublin[488].

Perennial Distress and Fever.

According to all the figures of Irish fever-hospitals, and the

generalities of their physicians, fever was now constantly present in the

towns. After the relapsing epidemic of 1826-27 had subsided, there was no

rise above the steady level until the years 1831 and 1832, when a

considerable increase appears in the admissions to the hospitals of

Dublin, Limerick and Belfast. But the fever of 1831-32 was totally

eclipsed by the cholera, and little is heard of typhus in Irish writings

until 1835-36, when an epidemic arose, purely of typhus fever, which is

said to have been as severe upon some districts as that of 1817-18 had

been. This outbreak fell at the time of the Commission presided over by

the Earl of Devon, the report of which is authoritative for the state of

the Irish lower class and the causes of the same. The country cottiers and

the poor of the towns were always on the verge of starvation. Dr Geary, of

Limerick, in 1836 estimated as follows the proportion of poor to the whole

population, “the poor” being taken to mean “those who would require aid if

a Poor Law existed[489]:”

_Proportion of “Poor” in the several Parishes of Limerick, 1836._

St Nicholas St John and

and St Mary St Laurence St Munchin St Michael

Population 14,629 15,667 4,071 16,226

Number of Poor 7,000 6,400 930 2,500

Most of the poor lived in the old town of Limerick in lofty and

closely-built houses which the better classes had abandoned. These

dilapidated barracks were the abodes of misery and filth, two and often

three families occupying a single room: “It is here, as in the decayed

Liberties of Dublin[490], that the indigent room-keeper, the ruined

artisan, the unemployed labourer, and the ejected country cottier, with

their famishing families retreat.” Their degradation, Dr Geary thought,

was owing to the delay of Parliament in giving Ireland the Poor Law. The

sanitary state of the old town was disgraceful. Heaps of manure were

carefully kept in back yards, to be sold to farmers in the spring--“a very

principal source of livelihood” for those who collected it. Certain houses

near these depôts had always fever in them, dysentery was frequent, and

Exchange-lane never free from it[491]. An extensive glue-mill in the Abbey

poisoned the air with the effluvia of putrid animal matters. The following

table shows the number of fever-cases admitted to the Hospital or attended

from the Dispensary in 1827 and in four ordinary years thereafter:

_Limerick:--Table of Hospital Cases of Fever and Cases at their Homes

attended from the Dispensary._

Hospital Cases Dispensary Cases

Average Average

mortality. mortality.

Year Admitted Died One in Attended Died One in Total

1827 2781 137 20 2800 80 35 5581

1828 854 37 23 960 22 39 1714

1829 506 23 22 640 18 35 1146

1830 806 34 23½ 910 25 36 1716

1831 1015 65 15½ 920 31 29 1935

-----------------------------------------------------

Totals 5962 296 20 6130 176 34 12092

From 1831 to 1836 the admissions to hospitals were as follows:

Year Admitted Died

1832 1028 57

1833 824 42

1834 906 55

1835 1484 121

1836 3227 235

The last lines show the epidemic increase, which began in the autumn of

1835. It will appear from the following (by Geary) that it was largely an

epidemic of young people, and that the fatality was by far the greatest

among the comparatively small number of persons attacked at the higher

ages--a well-known law of typhus of which this Limerick demonstration was

perhaps the first numerically precise:

_Table of the Numbers admitted to Limerick Fever Hospital at stated ages

of five years, with the deaths, from 6 Jan. 1836 to 6 Jan. 1837._

Average

Ages in mortality

Years Admitted Died per cent.

1-5 81 2 2¼

5-10 489 13 2½

10-15 762 18 2¼

15-20 701 37 5¼

20-25 362 22 6

25-30 304 27 8¾

30-35 100 12 12

35-40 203 45 23¼

40-45 70 13 18½

45-50 82 22 27

50-55 23 5 21½

55-60 36 12 33¼

60-65 2 1 50

65-70 10 5 50

Over 70 2 1 50

------------------------------

Total 3227 235 7¼

One-sixth of these Limerick hospital cases, to the number of 567, came

from the county, chiefly from the damp, boggy districts five to sixteen

miles from the city. The whole admissions were rather more than the same

hospital received in the famine year, 1817. But, although 1836 was not a

year of special scarcity, there must have been some cause at work to

raise the perennial typhus to the height of an epidemic, not only in

Limerick, but in Dublin, Cork, Waterford, Ennis, Belfast, and other towns.

In the country, an epidemic outburst during the months of March, April and

May, 1836, in the parish of Donoughmore, Donegal, is perhaps only a sample

of others unrecorded: it was remarkable in that nine-tenths of the cases

of fever had as a sequel large boils on various parts of the body, but

principally on the limbs[492].

In Dublin, the influenza of the first months of 1837 seemed to check the

prevalence of typhus for a time; but the latter increased greatly when the

influenza was over, so that the admissions to the Cork Street Hospital

until the end of 1838 nearly equalled those of the worst epidemics since

the hospital was opened in 1804[493]. Females in typhus were admitted

greatly in excess of males; a large proportion (1847 in two years) were

under fifteen years of age; the fever rarely relapsed, so that it was

mostly typhus, as in England and Scotland at the same time. In twelve

months of the same period (Oct. 1837 to Sept. 1838) there were 1786

admissions for fever at Cork, 1840 at Limerick, and 1706 at Belfast[494].

In Dublin, as in London, Edinburgh and Glasgow, the continued fevers of

the “thirties” were distinctively spotted typhus, which was a new

constitution. Graves, lecturing at Dublin in November, 1836, said: “We are

now at a point of time possessing no common interest for the reflection of

medical observers. It is now nearly two years since my attention was first

arrested by the appearance of maculated fever, of which the first examples

were observed in some hospital cases from the neighbourhood of Kingstown.

This form of fever has lasted ever since, prevailing universally, as if it

had banished all other forms of fever, and being almost the only type

noticed in our wards[495].”

This increase of fever in Ireland, as well as the change in its type,

corresponded closely to the great epidemic outburst in Scotland and

England. The census of Ireland, taken in June, 1841, for the ten years

preceding, gave a somewhat loose return of the causes of death in each

year of the decennial period[496].

The worst years for fever were 1837 and 1840, the best year 1841. The

deaths from fever in ten years were 112,072, being 1 in 10·59 of the

deaths from all causes. The counties with highest fever mortality were

Cavan, Mayo, Galway and Clare; the worst towns were Belfast, Kilkenny,

Dublin, Limerick and Carrickfergus. Of these deaths from typhus-like

fevers, 14,501 occurred in 86 fever-hospitals, which were open, or which

kept records, for more or less of the decennial period. The following

table shows the proportions of rural, urban and hospital fever-deaths in

each of the four provinces:

_Deaths from fever in ten years, 1831-41._

Leinster Munster Ulster Connaught

Rural fever-deaths 16,159 23,718 21,616 19,319

Urban 4,626 4,878 3,183 1,262

Hospital 9,030 5,465 2,439 386

-----------------------------------------------

29,815 34,061 27,238 20,958

Rural population }

in 1841 } 1,531,106 2,009,220 2,160,698 1,338,635

Ratio of do. per }

sq. mile } 247 332 406 386

The following detailed table for the province of Leinster shows the

enormous preponderance of fever-deaths in the cottages or cabins[497].

Only Dublin and Kilkenny have most of the deaths in their fever hospitals

or public institutions; it was not until near the end of this decennial

period, the year 1839, that workhouses, with their infirmaries, began to

be provided for all the poor-law unions:

_Fever Mortality in Leinster, 1831-41._

Deaths from Fever Deaths

in Hospitals and from Fever

Localities Public Institutions at home Total

Carlow County 202 891 1093

Drogheda Town 1 238 239

Dublin County 111 1248 1359

Dublin City 6393 2369 8762

Kildare County 276 1068 1284

Kilkenny County 114 2378 2492

Kilkenny City 487 204 691

King’s County 126 1754 1880

Longford County 3 1265 1268

Louth County 1 1201 1202

Meath County 294 2151 2445

Queen’s County 84 1763 1847

Westmeath County 54 1550 1604

Wexford County 637 1736 2373

Wicklow County 280 1002 1282

--------------------------------------

9063 20,758 29,821

The Great Famine and Epidemic Sicknesses of 1846-49.

The great epidemic of relapsing fever, typhus, dysentery, anasarca and

purpura, which arose in Ireland in the end of 1846 or spring of 1847 and

lasted until the beginning of 1849, had for its direct antecedents the

more or less complete loss of the potato-crop through blight in two

successive autumns, 1845 and 1846, while the state of distress and

sickness was prolonged by the potato disease in 1847 and 1848[498]. The

potato-blight, which caused so much alarm in Ireland for the first time in

September, 1845, had been seen in Germany several years before, in Belgium

in 1842, in Canada in 1844, and in England about the 19th of August, 1845.

Shortly after the last date, it attacked the Irish potato-fields, first in

Wexford, and before the end of the year it was estimated that one-third to

one-half of the yield, which was a fifth larger than usual from the

greater breadth planted and the abundant crop, was lost by absolute

rottenness or unfitness for food, the process of decay being of a kind to

make great progress after the tubers were pitted. The loss to Ireland was

estimated at about one pound sterling per head of the population. Sir

Robert Peel was keenly alive to the magnitude of the calamity which

threatened the Irish peasantry. His first step was to summon to his aid a

botanist, Dr Lindley, and a chemist, Dr Playfair; the latter went down to

Drayton Manor, and joined the prime minister in examining samples of the

diseased potatoes. The question was whether some chemical process could

not be found to arrest the decay of the tubers. Sir Robert Peel, in a much

talked-of address at the opening of the Tamworth Reading-Room in the

winter of 1840, had hailed the rising sun of science and useful knowledge.

It was only in reference to morals and religion that Peel’s deliverance

called forth criticism, more particularly the memorable series of letters

to the _Times_ by John Henry Newman. But one of Newman’s gibes was in a

manner prophetic of Peel’s attitude in approaching the material distress

of Ireland: “Let us, in consistency, take chemists for our cooks, and

mineralogists for our masons.” The two professors proceeded to Ireland,

but could only confirm the fact, already known, that one-third, or

one-half, of the potato-crop would be lost.

Botany and chemistry being powerless to stay the effects of the

potato-blight, the appeal was next to economics. Ireland produced not only

potatoes but also corn. But for the most part the cottiers and cottagers

tasted little of the oats or wheat which they grew; as soon as the harvest

was gathered, the corn was sold to pay the November rents, and was

exported. Ireland was still in the paradoxical condition which Bishop

Berkeley puzzled over a hundred years before: “whether our exports do not

consist of such necessaries as other countries cannot well be without?”

The industry and trade of Irish ports was largely that of corn-milling and

shipping of oatmeal, flour and other produce; thus Skibbereen in the

extreme south-west, where the horrors of famine were felt first, had

several flour-mills and a considerable export trade in corn, meal, flour

and provisions. The Irish corn harvest of 1845 had been abundant:

O’Connell cited the _Mark Lane Express_ for the fact that 16,000 quarters

of oats from Ireland had arrived in the Thames in a single week of

October; on the 23rd of the same month the parish priest of Kells saw

fifty dray-loads of oatmeal on the road to Drogheda for shipment. Ireland

paid its rent to absentee landlords in corn and butter, just as a century

before it had paid it largely in barrelled beef, keeping little for its

own use besides potatoes and milk. In the face of the potato famine, the

measure approved by the Irish leaders of all parties, O’Connell and Smith

O’Brien as well as ducal proprietors, was to keep some of the oatmeal at

home. A committee which sat at the Dublin Mansion House were of opinion,

on 19 November, 1845, that the quantity of oats already exported of that

harvest would have sufficed to feed the entire population of Ireland.

O’Connell’s plan was to raise a million and a half on the annual revenue

of the Irish woods and forests (£74,000), and to impose a tax on

landlords, both absentee and resident, and with the moneys so obtained to

buy up what remained of the Irish corn harvest for use at home. In the

ensuing session of Parliament, both he and Smith O’Brien protested that

Ireland had no need of English doles, having resources of her own if the

landlords were compelled to do their duty.

About the same time Lord John Russell, leader of the Opposition, was led

by the danger of famine in Ireland to pronounce for the repeal of the Corn

Laws of 1815; and at the meetings of the Cabinet in December, Peel urged

the same policy upon his colleagues for the same reason. The political

history does not concern us beyond the fact that the threatened Irish

distress caused by the first partial potato-blight of 1845 was the

occasion of the Corn and Customs Act of June, 1846, by which the Corn Laws

were repealed, and that an Irish Coercion Bill, brought in on account of

outrages following an unusual number of evictions, was made the occasion

of turning out Peel’s ministry at the moment of its Free Trade victory, by

a combination of Tory protectionists, Whigs and Irish patriots.

The direct effects of the potato-blight of 1845 were not so serious as had

been expected. The Government quietly bought Indian meal (maize flour) in

America without disturbing the market, and had it distributed from twenty

principal food-depots in Ireland, to the amount of 11,503 tons, along with

528 tons of oatmeal. This governmental action ceased on the 15th of

August, 1846, by which time £733,372 had been spent, £368,000 being loans

and the rest grants. The people were set to road-making, so as to pay by

labour for their food, the number employed reaching a maximum of 97,000 in

August. The Government, having been led by physicians in Dublin to expect

an epidemic of fever, passed a Fever Act in March, 1846, by which a Board

of Health was constituted. But no notable increase of sickness took place,

and the Board was dissolved. There was a small outbreak of dysentery and

diarrhoea at Kilkenny (and possibly elsewhere) in the spring of 1846,

which the physician to the workhouse set down to the use of the Indian

meal “and other substitutes for potatoes[499].”

It was the total loss of the potato crop in the summer and autumn

following, 1846, together with a failure of the harvest in England and in

other countries of Northern Europe, that brought the real Irish distress.

A large breadth of potatoes had been planted as usual, but doubtless with

a good deal of the seed tainted. An ordinary crop would have been worth,

according to one estimate, sixteen millions sterling, according to

another, twice as much. The crop was a total loss. The fields looked well

in the summer, but those who dug the early potatoes found them unusually

small. About the beginning of August the blight began suddenly and spread

swiftly. A letter of the celebrated Father Mathew, the temperance

reformer, brings this out:

“On the 29th of last month (July) I passed from Cork to Dublin, and

this doomed plant bloomed in all the luxuriance of an abundant

harvest. Returning on the 3rd instant (August) I beheld with sorrow

one wide waste of putrefying vegetation. In many places the wretched

people were seated on the fences of the decaying gardens wringing

their hands and wailing bitterly the destruction that had left them

foodless[500].”

The relief-works and distribution of Indian meal, which had been estimated

by the Government to last only to August, 1846, at a cost of £476,000

(one-half of it being a free grant), were resumed under the pressure of

public opinion, in the winter of 1846 and spring of 1847, a cost of

£4,850,000, one-half of the sum being again a free grant. Before the

distress was over, other free grants and advances were made; so that, on

15 February, 1850, Lord John Russell summed up the famine-indebtedness of

Ireland to the Consolidated Fund at £3,350,000, (which was to be repaid

out of the rates in forty years from that date). Allowing an equal sum

freely gifted from the national exchequer, the whole public cost of the

famine would have been about seven millions sterling.

The short crops in Britain in 1846 were an excuse for not interfering with

the export of oats from Ireland. The imports of Indian meal were left to

the ordinary course of the market, and the distribution to retail traders.

The corn merchants of Cork, Limerick and other ports made fortunes out of

the American cargoes, and the dealers throughout the country made large

profits.

To encourage the influx of foreign food-supplies, and to lower freights,

the Navigation Laws were suspended for a few months, so that corn could be

carried in other than British bottoms. When Parliament met in January,

1847, the distress in Ireland occupied the greater part of the Queen’s

Speech.

Lord George Bentinck proposed that sixteen millions should be advanced for

the construction of railroads, so as to give employment and wages to the

starving multitudes. The Government, however, objected that such relief

would operate at too great a distance, in most cases, from the homes of

the people; and it was urged by independent critics that a State loan for

railways would really be for the relief of the landlords more than of the

peasantry. The large sums actually voted were spent in road-making and in

procuring food and medical relief. A Board of Works directed the

relief-works. A Commissariat, with two thousand Relief Committees under

it, directed the distribution of food. A Board of Health provided

temporary fever-hospitals and additional physicians. It was not to be

expected that this machinery would work well, and, in fact, the public

relief was costly in its administration and often misdirected in its

objects. Private charities, especially that of the Society of Friends,

gave invaluable help, money being subscribed by all classes at home and

sent from distant countries, including a thousand pounds from the Sultan

of Turkey. On one day, the third of July, 1847, nearly three millions in

Ireland received food gratuitously from the hands of the relieving

officers. In March, 1847, the public works were employing 734,000. The

number relieved out of the poor rates at one time reached 800,000.

Workhouses were enlarged, and temporary fever-hospitals were built to the

number of 207, which in the two years 1847 and 1848, received 279,723

patients.

Emigration to the United States and Canada, which had averaged 61,242

persons per annum from the last half of 1841 to the end of 1845, rose

steadily all through the famine until it reached a total of 214,425 in the

year 1849, the passage money to the amount of millions sterling having

come largely from the savings of the Irish already settled in the New

World.

The grand effect of the famine upon the population of Ireland was revealed

by the census of 1851. The people in 1841 had numbered 8,175,124; in 1851

they numbered 6,515,794. The decrease was 28·6 per cent. in Connaught,

23·5 per cent. in Munster, 16 per cent. in Ulster, and 15·5 per cent. in

Leinster. In many remote parishes the number of inhabitants, and of

cabins, fell to nearly a half. The depopulation was wholly rural, so much

so that there was a positive increase of inhabitants not only in the large

county towns, but even in small towns such as Skull and Kanturk, situated

in Poor Law unions where the famine and epidemics had made the greatest

clearances all over[501]. Our business here is with the epidemical

maladies, which contributed to this depopulation; but a few words remain

to be said on the subject at large.

Malthus had been prophetic about this crisis in the history of Ireland.

Criticizing Arthur Young’s project to encourage the use of potatoes and

milk as the staple food of the English labourer instead of wheat, so as to

escape the troubles of scarcity and high prices of corn, Malthus says:

“When, from the increasing population, and diminishing sources of

subsistence, the average growth of potatoes was not more than the

average consumption, a scarcity of potatoes would be, in every

respect, as probable as a scarcity of wheat at present; and when it

did arrive it would be beyond all comparison more dreadful. When the

common people of a country live principally upon the dearest grain, as

they do in England on wheat, they have great resources in scarcity;

and barley, oats, rice, cheap soups and potatoes, all present

themselves as less expensive, yet at the same time wholesome means of

nourishment; but when their habitual food is the lowest in this scale,

they appear to be absolutely without resource, except in the bark of

trees, like the poor Swedes; and a great portion of them must

necessarily be starved[502].”

The forecast of Malthus was repeated in his own way by Cobbett, although

neither of them foresaw the potato-blight as the means.

“The dirty weed,” said Cobbett in a conversation in 1834, “will be the

curse of Ireland. The potato will not last twenty years more. It will

work itself out; and then you will see to what a state Ireland will be

reduced.... You must return to the grain crops; and then Ireland,

instead of being the most degraded, will become one of the finest

countries in the world. You may live to see my words prove true; but I

never shall[503].”

This is what has come to pass in a measure, and will come to pass more and

more. Only in some remote parts do the Irish cottiers now live upon

potatoes and milk. It has come to be quite common for them to grow an

Irish half acre of wheat, and, what is more to the purpose, to consume

what they thus produce instead of selling it to pay the rent. Doubtless

the enormous imports of American, Australian and Black Sea wheat have made

it easier for the Irish to have wheaten bread. But, whatever the reason,

they have at length adopted the ancient English staff of life, a staple or

standard which they were in a fair way to have achieved long ago, had not

their addiction to “lost causes and impossible loyalties” given an

unfavourable turn to the natural progress of the nation[504].

We come at length to the purely medical side of the great famine of

1846-47[505]. The distress in the latter part of the year 1846 was felt

first in the west and south-west--in the districts to which the famine of

1822 had been almost confined. It happened that the state of matters

around Skibbereen, the extreme south-western point of Ireland, was brought

most under public notice; but it is believed that there were parts of the

western sea-board counties of Mayo, Galway, Clare and Kerry from which

equally terrible scenes might have been reported at an equally early

period. It was in Clare that relief at the national charges was longest

needed.

Dr Popham, one of the visiting physicians to the Cork Workhouse, wrote as

follows:

“The pressure from without upon the city began to be felt in October

[1846], and in November and December the influx of paupers from all

parts of this vast county was so overwhelming that, to prevent them

from dying in the streets, the doors of the workhouse were thrown

open, and in one week 500 persons were admitted, without any

provision, either of space or clothing, to meet so fearful an

emergency. All these were suffering from famine, and most of them from

malignant dysentery or fever. The fever was in the first instance

undoubtedly confined to persons badly fed or crowded into unwholesome

habitations; and as it originated with the vast migratory hordes of

labourers and their families congregated upon the public roads, it was

commonly termed ‘the road fever’[506].”

It was the same in the smaller towns of the county, such as Skibbereen; in

the month of December, 1846, there were one hundred and forty deaths in

the workhouse; on one day there were fifteen funerals waiting their turn

for the religious offices. Still farther afield, in the country parishes,

the state of matters was the same. The sea-board parish of Skull was a

typical poor district, populous with cabins along the numerous bays of the

Atlantic, but with few residential seats of the gentry. On the 2nd of

February, 1847, the parish clergyman, the Rev. Traill Hall (himself at

length a victim to the contagion), wrote as follows:

“Frightful and fearful is the havock around me. Our medical friend, Dr

Sweetman, a gentleman of unimpeachable veracity, informed me yesterday

that if he stated the mortality of my parish at an average of

thirty-five daily, he would be within the truth. The children in

particular, he remarked, were disappearing with awful rapidity. And to

this I may add the aged, who, with the young--neglected, perhaps,

amidst the widespread destitution--are almost without exception

swollen and ripening for the grave[507].”

They were “swollen” by the anasarca or general dropsy, which was reported

from nearly all parts of Ireland as being, along with dysentery and

diarrhoea, the prevalent kind of sickness before the epidemic fever became

general in the spring of 1847. The same had been remarked as the precursor

of the fever of 1817-18. In the end of March, Dr Jones Lamprey, sent by

the Board of Health, found the parish of Skull “in a frightful state of

famine, dysentery and fever.” Dysentery had been by far more prevalent

than fever in this district, as in many others. “It was easily known,”

says Dr Lamprey, “if any of the inmates in the cabins of the poor were

suffering from this disease, as the ground in such places was usually

found marked with clots of blood.” The malady was most inveterate and

often fatal. It must have had a contagious property, for the physician

himself went through an attack of it[508].

In the Skibbereen district the dead were sometimes buried near their

cabins; at the town itself many were carried out in a shell and laid

without coffins in a large pit[509]. Along the coast of Connemara for

thirty miles there was no town, but only small villages and hundreds of

detached cabins; this district is said to have been almost

depopulated[510].

Besides the dysentery and dropsy, which caused most of the mortality in

the winter of 1846-47, another early effect of the famine was scurvy, a

disease rarely seen in Ireland and unknown to most of the medical men. It

was by no means general, but undoubtedly true scurvy did occur in some

parts: thus in the Ballinrobe district, county Mayo[511], it was very

prevalent in 1846 for some months before the epidemic fever appeared,

being “evidenced by the purple hue of the gums, with ulceration along

their upper thin margin, bleeding on the slightest touch, and deep

sloughing ulcers of the inside of the fauces, with intolerable

foetor”--affecting men, women, and children. In some places, as at

Kilkenny early in 1846, there was much purpura[512]. These earlier effects

of the famine (dysentery and diarrhoea, dropsy, scurvy and purpura), were

seen in varying degrees before the end of 1846 in most parts of Ireland.

The counties least touched by them were in Leinster and Ulster, such as

Down, Derry, Tyrone, Fermanagh and some others, where the peasantry lived

upon oatmeal as well as on potatoes. But even these were invaded by the

ensuing epidemic of fever, the only place in all Ireland which is reported

to have escaped both the primary and the secondary effects of the famine

having been Rostrevor, on the coast of Down, a watering-place with a rich

population, which was also one of the very small number of localities that

escaped in 1817-18.

According to the following samples of admissions to the Fever Hospital of

Ennis in the several months, the summers were the season of greatest

sickness, a fact which was noted also in the epidemic of 1817-18:

Year Month Patients

1846 November 93

" December 224

1847 June 757

1848 February 210

" May 705

" November 400

The almost uniform report of medical men was that the epidemic of fever

began in 1847, in the spring months in most places, in the summer in

others. Relapsing fever was the common type. It was usually called the

famine fever for the reason that it was constantly seen to arise in

persons “recovering from famine,” on receiving food from the Relief

Committees[513]. It was a mild or “short” fever, apt to leave weakness,

but rarely fatal. Dr Dillon, of Castlebar, reports that he would be told

by the head of a family: “We have been _three times down_ in the fever,

and have all, thank God, got through it.” Dr Starkey, of Newry, “knew many

families, living in wretched poverty on the mountains near the town, who

were attacked with fever, and who without any medical attendance, and but

little attendance of any kind, passed through the fever without a single

death.” The doctor of Bryansford and Castlewellan, county Down, (where

there was no famine), declared that the recoveries of the poor in their

own cottages destitute of almost every comfort, were astonishing. In the

Skibbereen district, Dr Lamprey was “often struck with the rarity of the

ordinary types of fever among the thousands suffering from starvation.” In

some of the most famine-stricken places, such as the islands off the

coast of Mayo and Galway, and in Gweedore, Donegal, not more than one in

a hundred cases of relapsing fever proved fatal. In Limerick the mortality

was “very small.” In many places it is given at three in the hundred

cases, in some places as high as six in the hundred. When deaths occurred,

they were often sudden and unexpected,--more probable in the relapse than

in the first onset. At Clonmel it was remarked that a certain blueness of

the nose presaged death; in Fermanagh it was called the Black Fever, from

the duskiness of the face. The report from Ballinrobe, Mayo, says that it

was attended by rheumatic pains, which caused the patients to cry out when

they stirred in bed[514]. It was mostly a fever of the first half of life,

and more of the female sex than of the male. One says that it was

commonest from five to fifteen years of age, another from ten to thirty

years.

Relapsing fever was the most common fever of the famine years, in the

cabins, workhouses and fever hospitals, in the country districts as well

as the towns and cities. Dr Henry Kennedy says of Dublin: “Cases of

genuine typhus were through the whole epidemic very rare, I mean

comparatively speaking.” But everywhere there was a certain admixture of

typhus, and in some not unusual circumstances the typhus was peculiarly

malignant or fatal--many times more fatal than the relapsing fever. The

poor themselves do not appear to have suffered much from the more

malignant typhus, unless in the gaols and workhouses. When the doors of

the Cork workhouse were thrown open in December, 1846, five hundred were

admitted pell mell in one week; the deaths in that workhouse were 757 in

the month of March, 1847, and 3329 in the whole year. In the Ballinrobe

workhouse, county Mayo, “men, women and children were huddled together in

the same rooms (the probationary wards), eating, drinking, cooking, and

sleeping in the same apartment in their clothes, without even straw to lie

on or a blanket to cover them.” Typhus at length appeared in that

workhouse, said to have been brought in by a strolling beggar, and the

physician, the master and the clerk died of it. Wherever the better-off

classes caught fever, it was not relapsing but typhus, and a very fatal

typhus. At Skibbereen the relapsing fever “was not propagated by

contagion; but in persons so affected, when brought in contact with the

more wealthy and better fed individuals, was capable of imparting fevers

of different types[515].” There were many opportunities for such

contact-in serving out food at the depôts, in superintending the gangs

working on the roads, in attending the sessions, in visiting the sick. The

crowds suffering from starvation, famine-fever or dysentery exhaled the

most offensive smells, the smell of the relapsing fever and the anasarca

being peculiar or distinguishable[516]. There appeared to be a scale of

malignity in the fevers in an inverted order of the degree of misery. The

most wretched had the mildest fever, the artizan class or cottagers had

typhus fatal in the usual proportion, the classes living in comfort had

typhus of a very fatal kind. This experience, however strange it may seem,

was reported by medical observers everywhere with remarkable unanimity.

One says that six or seven of the rich died in every ten attacks, others

say one in three. Forty-eight medical men died in 1847 in Munster, most of

them from fever; in Cavan county, seven medical men died of fever in

twelve months, and three more had a narrow escape of death: two of the

three physicians sent by the Board of Health to the coast of Connemara

died of fever[517]. Many Catholic priests died as well as some of the

Established Church clergy; and there were numerous fatalities in the

families of the resident gentry, and among others who administered the

relief. Yet a case of fever in a good house did not become a focus of

contagion; the contagion came from direct contact with the crowds of

starving poor, their clothes ragged and filthy, their bodies unwashed, and

many of them suffering from dysentery. The greater fatality of fever among

the richer classes had been a commonplace in Ireland since the epidemic of

1799-1801, and is remarked by the best writers[518]. At Loughrea, in

Galway, Dr Lynch observed that “in the year 1840 the type of fever was

very bad indeed, and very many of the gentry were cut off by it.” He

reckoned that ordinarily one in six cases of fever among the richer class

proved fatal, one in fifteen among the poor[519]. But in the great famine,

six years after, the fever of the poor assumed the still milder type of

relapsing, fatal perhaps to one in a hundred cases, or three in a hundred,

while the fever which contact with them gave to those at the other extreme

of well-being became a peculiarly malignant typhus, fatal to six or seven

in ten cases, as Dr Pemberton of Ballinrobe found, or to three or four in

ten cases, as many others found. Of course it was the peasantry who made

up by far the greater part of the mortality in the years of famine; but

they were cut off by various maladies, nondescript or definite, while the

richer classes died, in connexion with the famine, of contagious typhus

and here or there of contagious dysentery.

Even in the crowded workhouses and gaols, more deaths occurred from

dysentery than from fever. But in some of the gaols great epidemics arose

which cut off many of the poor by malignant infection. That was an old

experience of the gaols, studied best in England in the 18th century; the

worst fevers, or those most rapidly fatal, were caught by the prisoners

newly brought to mix with others long habituated to their miserable

condition. The gaols in Ireland during the famine were crowded to excess,

not so much because the people gave way to lawlessness--their patience and

obedience were matters of common complimentary remark--but because they

committed petty thefts, broke windows, or the like, in order to obtain the

shelter and rations of prisoners. The mortality in the gaols rose and fell

as follows[520]:

Year Deaths in gaol

1846 130

1847 1320

1848 1292

1849 1406

1850 692

1851 197

Most of the deaths in these larger totals came from two or three great

prison epidemics in each of the series of years--at Tralee,

Carrick-on-Shannon, Castlebar and Cork in 1847, at Galway in 1848, at

Clonmel, Limerick, Cork and Galway in 1849, the highest mortality being

485 deaths in Galway county gaol in 1848. Descriptions remain of the state

of the gaols at Tralee and Castlebar in 1847, from which it appears that

they were frightfully overcrowded and filthy. Dr Dillon, of Castlebar,

says that the county gaol there in March, 1847, had twice as many

prisoners as it was built for, “those committed being in a state of

nudity, filth and starvation.” He expected an outbreak of typhus, and

applied to the magistrates to increase the accommodation, which they

declined to do. In due time, very bad maculated typhus broke out, of which

the chaplain, matron and others of the staff died. This contagious fever

is said to have proved fatal to forty per cent. of those attacked by it.

The deaths for the year are returned at 83 in Castlebar gaol, those in

Tralee gaol at 101, and in the gaol of Carrick-on-Shannon at 100.

No exact statistical details of the mortality in the great Irish famine of

1846-49 were kept. Ireland had then no systematic registration of deaths

and of the causes of death, such as had existed in England since 1837.

Information as to the mortality was got retrospectively once in ten years

by means of the census, heads of families being required to fill in all

the deaths, with causes, ages, years, seasons, &c., of the same, that had

occurred in their families within the previous decennial period. This was,

of course, a very untrustworthy method, more especially so for the famine

years, when many thousands of families emigrated, leaving hardly a trace

behind, many hamlets were wholly abandoned, and many parishes stripped of

nearly half their inhabited houses. When a certain day in the year 1851

came round for the census papers to be filled up, a fourth part of the

people were gone, and that fourth could have told more about the famine

and the deaths than an equal number of those that remained. However, the

Census Commissioners did their best with the defective, loose or erroneous

data at their service. Much of the interest of the Irish Census of 1851

centered, indeed, in the Great Famine; and the two volumes of specially

medical information compiled by Sir William Wilde, making Part V. of the

Census Report, are a store of facts, statistical and historical, of which

only a few can be given here[521].

_Table of Workhouses and Auxiliary Workhouses in Ireland during the

Famine._

No. of Numbers Numbers Ratio of deaths

Year Workhouses relieved that died One in

1846 129 250,822 14,662 17·11

1847 130 332,140 66,890 6·92

1848 131 610,463 45,482 13·4

1849 131 932,284 64,440 14·47

1850 163 805,702 46,721 17·74

During the ten years from 6 June, 1841, to 30 March, 1851, the deaths from

the principal infective or “zymotic” diseases in the workhouses were as

follows:

Dysentery 50,019

Diarrhoea 20,507

Fevers 34,644

Measles 8,943

Cholera 6,716

Smallpox 5,016

Besides the workhouses, there were during the famine 227 temporary fever

hospitals, which received 450,807 persons from the beginning of 1847 to

the end of 1850, of whom 47,302 died.

According to the Census returns, the deaths from the several causes

connected with the famine were as follows in the respective years:

Dysentery

Year Fever (with Diarrhoea) Starvation

1845 7,249 ------ -----

1846 17,145 5,492 2,041

1847 57,095 25,757 6,058

1848 45,948 25,694[522] }

1849 39,316 29,446[523] } 9,395

1850 23,545 19,224 -----

According to this table, fever caused more deaths than dysentery. But

there are reasons for thinking that the deaths from dysentery, anasarca

and other slow effects of famine and bad food really made up more of the

extra mortality of the famine-years than the sharp fever itself. In the

returns from the workhouses, dysentery is actually credited with about

one-half more deaths than fever. It is known that most of the mortality at

the beginning of the famine, the winter of 1846-47, was from dysentery and

allied chronic forms of sickness. Dysentery also followed the decline of

the relapsing-fever epidemic of 1847-48. Dillon, of Castlebar, says that

many, who had gone through the fever in the autumn of 1847, fell into

dysentery in 1848, during which year it was very prevalent. Mayne says

that dysentery often attacked those recovering from fever, and proved

fatal to them[524]. In the General Hospital of Belfast the fatality of

fever-cases was 1 in 8, “but this included dysentery.” Probably the same

explanation should be given of the high rates of fatality in the Fever

Hospital of Ennis, the chief centre of relief for the greatly distressed

county of Clare: 1846, 1 in 12½; 1847, 1 in 5¾; 1848, 1 in 5½.

It will be noticed that some thousands of deaths were put down to

starvation in the Census returns. Perhaps a more technical nosological

term might have been found for a good many of these, such as anasarca or

general dropsy. But even if physicians had made the returns, instead of

the priests or relatives, they would have put many into a nondescript

class, for which starvation was a sufficiently correct generic name.

Scurvy was another disease of malnutrition which was far from rare during

the famine; the deaths actually set down to that cause were some hundreds

over the whole period.

The deaths from all causes in the decennial period covered by the Census

of 1851 were 985,366. But these returns were made, as we have seen, on a

population which had been reduced by a fourth part in the course of ten

years, so that they fall considerably short of the reality. If the

population of Ireland had multiplied at the same rate as that of England

and Wales from 1841 to 1851, namely, 1·0036 per cent. per annum, it should

have been 9,018,799 in the year 1851; but it was only 6,552,385.

Emigration beyond the United Kingdom had averaged 61,242 persons per annum

from the 30th of June, 1841, to the 31st December, 1845; next year, 1846,

it rose to 105,955, in 1847 it was “more than doubled,” in 1848 it was

178,159, in 1849, 214,425, in 1850 it was 209,054, and in 1851 it touched

the maximum, 249,721. Nearly a million emigrated in the six years

preceding the date of the Census, and there was besides a considerable

migration to Liverpool, Glasgow, London and other towns of England and

Scotland. It is probable that emigration accounts for two-thirds of the

decrease of inhabitants revealed by the Census of 1851; but the extra

mortality of the famine years, or the deaths over and above the ordinary

deaths in Ireland during a decennial period, can hardly be estimated below

half a million.

Decrease of Typhus and Dysentery after 1849.

The potato famines of 1845-48 were a turning-point in the history of

Ireland. From that time the population has steadily declined and the

well-being of the people steadily improved. By the Census of 1871 the

population was 5,386,708, by that of 1881 it was 5,144,983, by that of

1891 it was 4,704,750. Registration of births and deaths, which began in

1864, shows the following samples:

Year Births Deaths

1867 144,318 98,911

1871 151,665 88,720

1880 128,010 102,955

1888 109,557 85,892

The enormous amount of pauperism which followed the great famine was at

length brought within limits: from 1866 to the present time it has been

marked by a steady increase of out-door relief, and by some increase in

the numbers within the Union Workhouses; the out-door paupers have

increased from 10,163 on 1 Jan., 1866, to 53,638 on 1 Jan., 1881, the

absolute number of indoor paupers having remained, on an average of good

and bad years, somewhat steady in a declining population.

The public health has been undisturbed by great epidemics since the potato

famine, although the effects of that calamity did not wholly cease until

some years after. It is best estimated by the mean annual average of

deaths among a thousand inhabitants, a ratio which has been low for the

provinces of Connaught and Munster, and not excessive for the provinces of

Ulster and Leinster. The following tables are of the death rates in two

sample years, 1880 and 1889 respectively[525]:

1880 1889

Connaught 15·3 12·4

Munster 19·5 15·1

Ulster 20·0 16·8

Leinster 23·3 18·3

_Four healthiest counties_:

1880 | 1889

Mayo 14·5 | Galway 11·8

Sligo 15·3 | Kerry 12·1

Galway 15·6 | Leitrim 12·1

Roscommon 15·8 | Cavan 12·2

_Four unhealthiest counties_:

1880 | 1889

Dublin co. 31·7 | Dublin co. 24·5

Waterford co. 24·9 | Antrim 21·2

Louth 22·6 | Down 18·6

Antrim 21·9 | Armagh 17·0

The higher death rates of some counties are chiefly owing to their greater

urban populations. The health of the cottier districts is remarkably good,

and is rarely if ever disturbed by any _morbus miseriae_. The cabins,

except in a few remote parts, are more comfortable than they used to be,

the diet is better, the clothing is better, the education of the children

is better. The present happier lot of the Irish peasantry can be measured

not unfairly by the statistics showing the decrease in the number of

cabins of the lowest class, and the increase of dwellings in the higher

classes.

The history of fever and dysentery in Ireland subsequently to the great

epidemics of 1846-49 has few salient points. Dysentery, the old “country

disease,” has steadily declined to about a hundred deaths in the year,

while the considerable mortality from diarrhoea, nearly two thousand

deaths in a year, is nearly all from the cholera infantum or summer

diarrhoea of children in the large towns. The history of the continued

fevers is made complex by the modern identification of typhoid or enteric

fever. According to the testimonies of several, it played but a small part

in the epidemics of 1846-49, even in Dublin itself[526], and it can hardly

be doubted that its recent increase in that city is not apparent but real.

The following table from the year 1880 to the present time will show how

the deaths from continued fever are now divided in the registration

returns:

Simple

Year Typhus continued Enteric

1880 934 1073 1087

1881 859 774 813

1882 744 657 844

1883 810 593 853

1884 628 572 693

1885 505 443 716

1886 394 380 772

1887 405 385 740

1888 362 330 741

1889 359 250 968

1890 391 231 855

1891 266 183 859

1892 268 210 714

This decline of typhus in a country where for many generations it seemed

to be a national malady is a remarkable testimony to the influence of the

changed conditions which have made typhus rare everywhere.

There are some interesting points in connexion with Irish typhus since

1849. After the subsidence of the great epidemic of relapsing and typhus

fevers (1847-49), says Dr Dennis O’Connor, of Cork, “intermittent fever

made its appearance, and, as long as it lasted, scarcely a case of

continued fever was seen. As soon as the last cases of intermittent

disappeared, the present epidemic broke out (1864-65), and still rages

with much severity. This alternation of continued and intermittent fever

is remarkable. Indeed it might have been observed that the fever of 1847

passed first into a remittent form, and gradually into the intermittent

which prevailed more or less for ten years subsequently[527].” The same

succession of relapsing fever by intermittent fever was observed after the

epidemic of 1826 by Dr John O’Brien, of Dublin[528]. The epidemic of fever

which Dr O’Connor describes for Cork in 1864-65, appeared in Dublin about

the same time--the latter half of 1864. It was of the nature of typhus in

both cities, cerebro-spinal in part, but probably not typhoid[529]. At

Cork it had some peculiarities--a croupous-like exudation on the tongue,

resembling thrush in the mouth, and a dark mottled rash (rubeola nigra),

or fiery red spots on a dark red ill-defined base. “The true typhoid rash

has been seen but seldom, and the petechiae of genuine typhus, so frequent

in former epidemics, have been equally rare. The latter I attribute to the

improved condition of our poor in good clothing and the ventilation of

their dwellings.” The intellect was little disturbed in this fever, there

was usually a crisis about the fourteenth day, and there were no relapses.

The sequelae were peculiar--“great nervous debility, leading to a

semi-paralysed state of the limbs,” congestion of the lungs, sometimes

solidification, or gangrene or suppuration of them. It occurred at a time

“when the food of the people is most abundant and of the best quality.”

There had been three bad harvests in succession from 1860, but it may be

inferred from a Dublin article of August, 1863, that no epidemic of typhus

had arisen in Ireland down to that date, although there was much typhus in

England, especially in Lancashire owing to the “cotton famine.” When the

epidemic did arise in Dublin, Cork, and doubtless elsewhere in Ireland, in

the latter part of 1864, to continue throughout 1865, it was not connected

with scarcity or distress among the common people. On the other hand, Dr

Grimshaw, of Dublin, found that it was subject to influences of the

weather, as if the infective principle had been a soil poison like that of

plague, yellow fever, cholera, or enteric fever. Taking the Cork Street

Fever Hospital for his study, he made out that there was a very close

correspondence, from the 29th of May to the 31st of December, 1864,

between the fluctuating pressure upon its accommodation and the periodic

rises in the atmospheric moisture and heat, the crowd of patients being

always greater when a high temperature coincided with a large

rainfall[530]. One would not have been surprised to find some such law as

that in enteric or typhoid fever, although a correspondence from day to

day is subject to many sources of fallacy; but, by all accounts, the

disease was typhus, the last of the considerable outbreaks of it in

Ireland hitherto, and an outbreak that seemed to require, both at Cork and

Dublin, the language of Sydenham’s epidemic constitutions for its adequate

description. For a good many years, the continued fever of Dublin has been

chiefly enteric or typhoid. As late as 1862 a physician to the Fever

Hospital, unconvinced by the method of Sir William Jenner, believed that

he observed a transition from the old typhus into the new enteric: “The

change at first seemed to be to the gastric type; to which was shortly

added diarrhoea in nearly every instance; and this latter, again,

occurring in a large number of cases which presented all the characters of

typhus, including a dense crop of petechiae[531].” Assuming that there had

been a mixture of cases of enteric and typhus fevers, the latter must have

had diarrhoea among the symptoms, as they often had in special

circumstances (as well as tympanitis). Since that time the species of

typhus has greatly declined, and the species of typhoid has considerably

increased. The remodelling which Dublin has undergone, like all other old

cities, explains the one fact. The notorious Liberties have been in great

part rebuilt, and the conditions of typhus, as well as its actual fomites,

to that extent removed. On the other hand, something has happened to

encourage the soil poison of enteric fever. It is not easy to say what are

the conditions that have favoured the enteric poison in modern towns; but

there can be little doubt about the fact in general, or that Dublin and

Belfast are among the best fields for the study of the problem[532].