CHAPTER II.

FEVER AND DYSENTERY IN IRELAND. The history of the public health in Ireland has been so remarkable that it may be useful to take a continuous view of it in a chapter apart, so far as concerns flux, or dysentery, and typhus with relapsing fever. Ireland is a country which would have given Hume, had he thought of it, the best of all his illustrations of the difficult problem handled in the essay “Of National Characters”--how far the habits, customs, temperaments and, he might have added, morbid infections have been determined by climate, and how far by laws and government, by revolutions in public affairs, or by the situation of the nation with regard to its neighbours. Not only is there something special and peculiar in the actual epidemiology of Ireland, but its political and social history has been apt to borrow the phrases of medicine in a figure. “First the physicians are to take care,” says Burke, “that they do nothing to irritate this epidemical distemper. It is a foolish thing to have the better of the patient in a dispute. The complaint, or its cause, ought to be removed, and wise and lenient arts ought to precede the measures of vigour[410].” And this singular use of the imagery of disease in Irish history might be illustrated from many other passages of the same orator and essayist, just as it may be seen any day in the columns of newspapers in our own time. Giraldus Cambrensis began it, within a few years of the first English conquest of Irish territory by Henry II. Writing of that singular effect upon the English settlers by contact with the native Irish, whereby they became, in the words of another medieval author, _ipsis Hibernis hiberniores_, he resorts to the medical figure of “contagion” as the best way to account for it. So again, to overleap six centuries, Bishop Berkeley in his query “whether idleness be the mother or daughter of spleen[411],” is trying upon the Irish both Hume’s problem of national character and the use of the medical figure. And, to take a modern instance, Lord Beaconsfield used the same figure of the old humoral pathology, and gave his adhesion to a theory of national characters adverse to the sense of Hume, when he ascribed the habits and manners of the Irish, and the course of their national history, to their propinquity to a “melancholy” ocean. As far back as we can go in the history, two diseases are conspicuous--the flux or “the country disease,” and the sharp fever or “Irish ague.” When Henry II. invaded Ireland in 1172, his army suffered from flux, which the contemporary chronicler, Radulphus de Diceto, dean of St Paul’s, set down to the unwonted eating of fresh meat (_recentium esus carnium_), the drinking of water, and the want of bread[412]. Less than a generation after, Giraldus of Wales wrote his “Topography of Ireland,” wherein he remarks that hardly any stranger, on his first coming to the country, escapes the flux by reason of the juicy food (_ob humida nutrimenta_)[413]. At that time Ireland was almost wholly a pastoral country, and a pastoral country it has remained to a far greater extent than England or Scotland. It is to this comparative want of tillage, an almost absolute want when Giraldus was there, that we shall probably have to look in the last resort for an explanation of the two national maladies that here concern us--the “country disease” and the “Irish ague.” The same dietetic reason that the dean of St Paul’s gave in 1172 for the prevalence of flux in the army of Henry II., the want of bread and the eating of fresh meat, can be assigned for the country disease long after, and, in some periods, on the explicit testimony of observers. As to the Irish ague, or typhus fever, Giraldus mentions it in the medieval period; and Higden, copying him exactly, says: “The inhabitants of Ireland are vexed by no kind of fever except the acute, and that seldom”--the word _acuta_ being the original of “the ague,” or, as in another translation of the passage, “the sharp axes[414].” In this pastoral country, according to Giraldus, there was little sickness and little need of physicians; but there is hardly an instance of military operations by the English unattended with sickness among the troops, and famine with sickness among the native Irish. The generalities of Fynes Moryson, a traveller of the time of James I., who included Ireland among the many countries that he visited and described, throw light upon the dietetic peculiarities of the Irish. Having little agriculture, and at that time no general cultivation of the potato (although they adopted it much sooner than the English and Scots), they lived, says Moryson, mostly on milk (as Giraldus Cambrensis also records in the twelfth century), and upon the flesh of unfed calves, which they cooked and ate in a barbarous fashion. “The country disease” is also noted. The experience in Ireland from time immemorial, that a bellyful was a windfall, must have been the origin of a habit observed by Moryson: “I have known some of these Irish footemen serving in England to lay meate aside for many meales to devoure it all at one time.” And again: “The wilde Irish in time of greatest peace impute covetousnesse and base birth to him that hath any corne after Christmas, as if it were a point of nobility to consume all within these festivall dayes.” The Irish slovenliness or filthiness in their food, raiment and lodging was apt, he says, “to infect” the English who came to reside in their country[415]. About a generation after we come to the earliest medical account of the sicknesses of Ireland, by Gerard Boate, compiled during the Cromwellian occupation[416]. The following occurs under the head of The Looseness: The English have given it the name of the Country Disease. The subjects of it are often troubled a great while, but take no great harm. It is easily cured by good medicines: “But they that let the looseness take its course do commonly after some days get the bleeding with it; ... and last it useth to turn to the bloody flux, the which in some persons having lasted a great while, leaveth them of itself; but in far the greatest number is very dangerous, and killeth the most part of the sick, except they be carefully assisted with good remedies.” The other reigning disease is the “Irish Ague,” a continued fever of the nature of typhus: “As Ireland is subject to most diseases in common with other countries, so there are some whereunto it is peculiarly obnoxious, being at all times so rife there that they may justly be reputed for Ireland _endemii morbi_, or reigning diseases, as indeed they are generally reputed for such. Of this number is a certain sort of malignant feavers, vulgarly in Ireland called Irish agues, because that at all times they are so common in Ireland, as well among the inhabitants and the natives, as among those who are newly come thither from other countries. This feaver, commonly accompanied with a great pain in the head and in all the bones, great weakness, drought, loss of all manner of appetite, and want of sleep, and for the most part idleness or raving, and restlessness or tossings, but no very great nor constant heat, is hard to be cured.” If blood-letting be avoided and cordial remedies given, “very few persons do lose their lives, except when some extraordinary and pestilent malignity cometh to it, as it befalleth in some years.” Those who recover “are forced to keep their beds a long time in extreme weakness, being a great while before they can recover their perfect health and strength.” The occasion of Boate’s writing was the subjugation of Ireland by Cromwell, in the course of which we hear from time to time of sickness. The greatest of the calamities was the utter destruction of the prosperity of Galway by the frightful plague of 1649-50, and by the suppression of the Catholics, who had brought the port of Connaught to be a place of foreign commerce[417]. Cromwell’s troops in 1649 incurred dysentery through the hardships of campaigning. On 17 September, 1649, the Lord General writes from Dublin to Mr Speaker Lenthall after the storming of Tredah or Drogheda: “We keep the field much; our tents sheltering us from the wet and cold. But yet the country-sickness overtakes many: and therefore we desire recruits, and some fresh regiments of foot, may be sent us.” And on 25 October, “Colonel Horton is dead of the country-disease[418].” Another general reference to the “country disease” of Ireland, by Borlase, is very nearly the same as Boate’s. It is introduced early in the history, on the occasion of the death in 1591 of Walter, Earl of Essex, earl marshal of Ireland: “The dysentery, or flux, so fatal to this worthy person, is commonly termed the country disease; and well it may, for it reigns nowhere so epidemically as in Ireland; tainting strangers as well as natives. But whether it proceeds from the peculiar disposition of the air, errour in diet, the laxity and waterishness of the meat, or some occult cause, no venomous creature living there to suck that which may be thought (in other countries) well distributed amongst reptilious animals, I shall not determine, though each of these circumstances may well conduce to its strength and vigour. Certain it is that regular diet preserves most from the violence, and many from the infection of this disease; yet as that which is thought very soveraign--I must say that the stronger cordial liquors (viz. brandy, usquebeh, treacle and Mithridate waters) are very proper, or the electuaries themselves, and the like[419].” From the Restoration to the Revolution little is known of epidemics in Ireland. It is probable that Dublin and the other considerable towns fared much the same as English towns. A Dublin physician writing to Robert Boyle on 27 February, 1682, speaks of a petechial fever, marked by leaping of the tendons, which had been fatal to very many in that city for these twelve or fourteen months[420]. With the Revolution the troubles of the country begin again, and enter on their peculiarly modern phase. For our history, two characteristic incidents come at the very beginning of the new period of disorder among the Irish--the sicknesses of the siege of Londonderry and the unparalleled havoc of disease among the troops of Schomberg in the camp of Dundalk. In both, the old “country disease,” which had affected Cromwell’s troops, was the primary malady, occurring, of course, in circumstances special enough to have bred it anywhere; in both, the dysentery was attended or followed by typhus fever, the old “Irish ague;” and although the epidemics of Londonderry and Dundalk in 1689 are properly examples of war sickness, yet the circumstances of each may help to realize the connexion between dysentery and typhus in the ordinary history of the Irish. Dysentery and Fever at Londonderry and Dundalk, 1689. The siege of Londonderry[421] by the Catholic Irish army of James II. began in April and ended on 28 July, having lasted 105 days. On 19 April the garrison numbered 7020 men, and the total of men, women and children in the town was estimated at 30,000, a number which included refugees from the neighbouring country and would have been more but for many Protestants at the beginning of the siege leaving the city and taking “protection” at the hands of the besiegers. On 21 May, a collection was made for the poor, who began to be in want. Sickness is heard of on 5 June, when several that were sick were killed in their beds by the enemy’s bombs. The dread of the bombs in the houses caused the people to lie about the walls or in places remote from the houses all night, so that many of them, especially the women and children, caught cold, which along with the want of rest and failing food, threw them into fluxes and fevers. The pinch of hunger began to be felt before the middle of June, about which time and for six weeks after the fluxes and fevers were rife. A great mortality spread through the garrison as well as the inhabitants; fifteen captains and lieutenants died in one day, and it was estimated that ten thousand died during the siege, “besides those who died soon after.” The want, the dysentery, the fever and the vast numbers of dead every day must have produced a horrible state of things; when, on 2 July, five hundred useless persons were put outside the walls, to disperse as they best could, the besiegers are said to have recognized them when they met them “by the smell.” About the middle of June large quantities of provisions were found in cellars and places of concealment under ground; after that the garrison had always bread, although the allowance was small. An ingenious man discovered how to make pancakes of starch and tallow, of which articles there was no lack; the pancakes not only proved nutritious, but are said to have been an infallible cure of the flux, or preservative from it. At length, on 28 July some of the victuallers and ships of war which had been in Lough Foyle since the 15th of June, sailed up to the head of the Lough on the evening flood tide, finding little resistance from the enemy’s batteries and none from “what was left of” the tide-tossed boom of logs across the mouth of the river. Provisions poured in, and the siege was raised; but it is clear that the infection continued for some time after, having been found among such of the released garrison as repaired to Schomberg’s camp at Dundalk. The Catholic army is said (by the Protestants) to have lost 8000 or 9000 before the walls of Londonderry, “most by the sword, the rest of fever and flux, and the French pox, which was very remarkable on the bodies of several of the dead officers and soldiers[422].” Not far off, at Dundalk, there began, a few weeks after, an extraordinary outbreak of war-sickness, which, unlike the pestilence in Londonderry, was altogether inglorious in its circumstances. In many respects it resembled the disaster to Cromwell’s troops at the first occupying of Jamaica in 1655-56[423]; but it was worse than that, and it is probably unexampled in the military annals of Britain[424]. Supplies had been voted in Parliament for quelling the Catholic rebellion in Ireland, and an expedition was got together under the illustrious Marshal, Duke of Schomberg. The force consisted of some ten thousand foot, most of them raw levies from the English peasantry, with one regiment of seasoned Dutch troops (“the blue Dutch”), and cavalry. While the bulk of the force was undisciplined, their clothes, food, tents and other munitions of war were bad or insufficient through the fraud of contractors. The expedition embarked at Hoylake on the Dee and landed on the 15th of August, 1689, nearly three weeks after the relief of Londonderry, at Bangor, on the south side of Belfast Lough. Schomberg took Carrickfergus, and began to advance on Dublin; but finding the towns burned and the country turned into a desert, he threw himself into an entrenched camp around the head of Dundalk Bay, nearly a mile from the town of Dundalk. His camp was on a low moist bottom at the foot of the hills. The Irish Catholic army took up a position among the hills “on high sound ground,” not more than two miles distant from the English lines, and, being in superior force, in due time they offered battle, which was declined. Schomberg, who had been joined by the Enniskillen regiments of dragoons and by men from Londonderry, had under him some 2000 horse and not less than 12,000 foot at the time when James II. offered battle. The undisciplined state of his English troops and the suspected treachery of a body of French Protestants were among the causes that held Schomberg back; but he had to reckon also with sickness almost from the moment of sitting down at Dundalk. At a muster on 25 September, several of the regiments were grown thin “by reason of the distemper then beginning to seize our men.” The distemper was dysentery and fever. The two maladies were mixed up, as they usually are in war and famines, the flux commonly preceding the fever, and perhaps affording the virulent matters in the soil and in the air upon which the epidemic prevalence of the fever depends. It was easy to account for the dysentery among the troops at Dundalk; but as to the fever, there was an ambiguity at the outset which Story is careful to note: “And yet I cannot but think that the feaver was partly brought to our camp by some of those people that came from Derry; for it was observable that after some of them were come amongst us, it was presently spread over the whole army, yet I did not find many of themselves died of it.” Where the cause of death is specially named, it is fever, as in the cases of Sir Thomas Gower, Colonel Wharton and other officers on the 28th and 29th October. The fever was a most malignant form of typhus, marked by the worst of all symptoms, gangrene of the extremities, so that the toes or a whole foot would fall off when the surgeon was applying a dressing[425]. It seems probable that most of the enormous mortality was caused by infection, and not by dysentery due to primary exciting causes. The primary exciting causes were obvious, but seemingly irremovable. Schomberg had a great military reputation, but he was now over eighty, and it does not appear that he made himself personally felt in the camp, although he issued incessantly orders to inspect and report. As the mortality proceeded apace during the six or eight weeks of inactivity, murmurings arose against the commander. He was unfortunate in his choice of a camping ground, and in an unusually cold and wet season. The newly raised English troops seem to have been lacking equally in intelligence and in moral qualities. Their foul language and debauchery were the occasion of a special proclamation; their laziness and inability to make themselves comfortable called forth numerous orders, but all to no purpose. The regiment of Dutch troops were so well hutted that not above eleven of them died in the whole campaign; but the English would not be troubled to gather fern or anything else to keep themselves dry and clean withal: “many of them, when they were dead, were incredibly lousy.” The camping ground not only received the drainage of the hills, but, strange to say, the rain would be falling there all day while the camp of the enemy, only a few miles farther inland, would not be getting a drop. On 1 October the tents on the low ground were moved a little higher up. On the same date there were distributed among the regiments casks of brandy--Macaulay says it was of bad quality--which appears to have been the trusted remedy against camp sickness, as in the Jamaica expedition of