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
and St Mary		 St John and
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
Year Admitted Died Average
mortality.
One in		 Attended Died Average
mortality.
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.

Ages in
Years		 Admitted Died Average
mortality
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.

Localities Deaths from Fever
in Hospitals and
Public Institutions		 Deaths
from Fever
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