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