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