As was anticipated, fever rose to a fearful height in 1847. And, say the Commissioners of Health, "the state of the medical institutions of Ireland was, unfortunately, such as peculiarly unfitted them to afford the required medical aid, on the breaking out of the epidemic. The county infirmaries had not provision for the accommodation of fever patients. The county fever hospitals were destitute of sufficient funds; and dispensaries, established for the purpose of affording only ordinary out-door medical relief, could, of course, afford no efficient attendance on the numbers of destitute persons, suffering from acute contagious diseases in their own miserable abodes, often scattered over districts several miles in extent."
In January, fever complicated with dysentery and small pox became very rife in Belfast, and accounts from various other places soon showed, that it had seized upon the whole country. The week ending the 3rd of April, the total number of inmates in Irish Workhouses was 104,455, of whom 9,000 were fever patients. The deaths in that week were 2,706, and the average of deaths in each week during the month was twenty-five per thousand of the entire inmates—a death rate which would have hurried to the grave, every man, woman, and child in the Workhouses of Ireland, in about nine months! but it gradually decreased, until in October it stood at five per thousand in the week.
On the 19th we read that, "the number suffering from fever in Swinford is beyond calculation." Some idea of the dreadful mortality now prevalent in Cork, may be found from the fact, that in one day thirty-six bodies were interred in the same grave; the deaths in the Workhouse there from the 27th of December, 1846, until the middle of April—less than four months—amounted to 2,130. At this period, dropsy, the result of starvation, became almost universal. On the 16th of April, there were upwards of three hundred cases of fever in the Carrick-on-Shannon Workhouse, and the weekly deaths amounted to fifty. Again: every avenue leading to the plague-stricken town of Macroom has a fever hospital; persons of all ages are dropping dead in the streets. In May, it is announced that fever continued to rage with unabated fury at Castlebar. "Sligo is a plague spot; disease in every street, and of the worst kind." "Fever is committing fearful ravages in Ballindine, Ballinrobe, Claremorris, Westport, Ballina, and Belmullet, all in the county of Mayo." From Roscommon the news came, that the increase of fever was truly awful; the hospitals were full, and applicants were daily refused admission; "no one can tell," says the writer, "what becomes of these unfortunate beings; they are brought away by their pauper friends, and no more is heard of them." "Seven bodies were found inside a hedge," in the parish of Kilglass; the dogs had the flesh almost eaten off. Under date of the 18th of May, I find this entry; "Small pox, added to fever and dysentery, is prevalent at Middleton, County Cork; and, near Bantry Abbey, 900 bodies were interred in a plot of ground forty feet square." From the autumn of 1846 to May, 1847, ten thousand persons were interred in Father Mathew's cemetery at Cork—he was obliged to close it. On the 12th of June, the number of fever patients in the hospitals of Belfast was 1,840. "Awful fever," "Fearful increase of fever," were the ordinary phrases, in which the spread of the disease was announced from every part of Ireland.[270]
"Of the extent of the epidemic in Dublin, it would not be easy to give any very correct idea. The hospital accommodation of the city amounted to about 2,500 beds, a greater amount by 1,000, I believe, than were opened in any previous epidemic. It may give some idea of the vast amount of sickness, to state, that, at the Cork Street hospital, nearly 12,000 cases applied during a period of about ten months. At one period there were upwards of 400 outstanding tickets; and as many as eighty applications for admission have been made in one day. Still it may be safely stated, that all this would give a very imperfect idea of the real amount; for all who had to go amongst the poor at their own houses, were well aware, that vast numbers remained there, who either could not be accommodated in hospital, or who never thought of applying. It was quite common to find three, four, and even five ill in a house, where application had been made but for one. I think the very lowest estimate which could be arrived at cannot make the numbers who sickened in Dublin short of 40,000. The greatest pressure on the hospital took place in the month of June, from which time the fever gradually declined, till the month of February, 1848, when the epidemic may be said to have ceased."[271]
In February, 1847, fourteen applications were made to the Board of Health, for providing temporary hospital accommodation; in March, they received fifty-one such applications; in April, fifty-three, in May, fifty-two; in June, twenty-two; in July, sixty; in August, forty-eight; in September the number was ten, and in October only eight. The applications to the Board of Health for temporary fever hospitals in 1847 were 343; the entire number of such applications up to 1850, when the Board closed its labours, were 576, of which 203 were refused.
Relapse was a remarkable feature of this famine-fever. "Relapses were so common," writes Dr. Freke from a western county, "as to appear characteristic of the epidemic; in several cases they have occurred so frequently as three, or even four times in the same individual." At Nohaval, Kinsale Union, out of 250 cases 240 relapsed.
The cases received into the permanent and temporary fever hospitals of Ireland in the year 1845, were 37,604; in 1846 they increased to 40,620; and in 1847 they rose to the enormous amount of 156,824 cases![272] of which, according to the Report of the Board of Health, 95,890 were admitted into temporary hospitals,[273] in which the percentage of deaths was ten two-fifths; more males dying than females, the percentage of deaths among males being eleven one-fifth, and among females nine six-tenths. But the mortality in the fever sheds sometimes rose to fifteen, twenty, twenty-five, and in a few instances to twenty-eight and twenty-nine per cent.; the cause being previous dysentery (on which cholera sometimes supervened) and starvation. In Eyrecourt, Ballinrobe Union, the death-rate rose to twenty-nine one-third per cent.; in West Skull to twenty; and in Parsonstown to twenty-nine five-eighths. The principal complications of this famine-fever, according to the Commissioners of Health, were dysentery, purpura, diarrhoea, and small-pox; and they further say of it that it was, perhaps, unparalleled for duration and severity.[274]
The average weekly cost of each patient in the temporary hospitals, including the salary of the medical officer, was four shillings and one halfpenny.
"Some approximation to the amount of the immense mortality that prevailed may be gleaned from the published tables, which show that within that calamitous period between the end of 1845 and the conclusion of the first quarter of 1851, as many as 61,260 persons died in the hospitals and sanitary institutions, exclusive of those who died in the Workhouses and auxiliary Workhouses. Taking the recorded deaths from fever alone, between the beginning of 1846 and the end of 1849, and assuming the mortality at one in ten, which is the very lowest calculation, and far below what we believe really did occur, above a million and a-half, or 1,595,040 persons, being one in 4.11 of the population in 1851, must have suffered from fever during that period. But no pen has recorded the numbers of the forlorn and starving who perished by the wayside or in the ditches, or of the mournful groups, sometimes of whole families, who lay down and died, one after another, upon the floor of their miserable cabins, and so remained uncoffined and unburied, till chance unveiled the appalling scene. No such amount of suffering and misery has been chronicled in Irish history since the days of Edward Bruce, and yet, through all, the forbearance of the Irish peasantry, and the calm submission with which they bore the deadliest ills that can fall on man, can scarcely be paralleled in the annals of any people."[275]
An unusual disease on land, scurvy, appeared during the Famine. The Commissioners of Health attribute its appearance (1) to the want of variety of food: the potato being gone, they say, the people did not understand the necessity for variety, and men, such as railway porters, who had wages enough to buy food, took scurvy for want of this variety, coffee and white bread being their common dietary. (2) Another cause was the eating of what was called "potato flour," got from rotten potatoes; it was not flour at all, and did not contain the elements of the potato, but consisted wholly of starch as foecula. (3) The use of raw or badly cooked food also brought on scurvy; and the Commissioners of Health, therefore, strongly recommended the giving of food in a cooked form.[276]