“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.