Chapter II: Fever and Dysentery in Ireland (4)

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 1849. After the subsidence of the great epidemic of relapsing and typhus fevers (1847-49), says Dr Dennis O’Connor, of Cork, “intermittent fever made its appearance, and, as long as it lasted, scarcely a case of continued fever was seen. As soon as the last cases of intermittent disappeared, the present epidemic broke out (1864-65), and still rages with much severity. This alternation of continued and intermittent fever is remarkable. Indeed it might have been observed that the fever of 1847 passed first into a remittent form, and gradually into the intermittent which prevailed more or less for ten years subsequently[527].” The same succession of relapsing fever by intermittent fever was observed after the epidemic of 1826 by Dr John O’Brien, of Dublin[528]. The epidemic of fever which Dr O’Connor describes for Cork in 1864-65, appeared in Dublin about the same time--the latter half of 1864. It was of the nature of typhus in both cities, cerebro-spinal in part, but probably not typhoid[529]. At Cork it had some peculiarities--a croupous-like exudation on the tongue, resembling thrush in the mouth, and a dark mottled rash (rubeola nigra), or fiery red spots on a dark red ill-defined base. “The true typhoid rash has been seen but seldom, and the petechiae of genuine typhus, so frequent in former epidemics, have been equally rare. The latter I attribute to the improved condition of our poor in good clothing and the ventilation of their dwellings.” The intellect was little disturbed in this fever, there was usually a crisis about the fourteenth day, and there were no relapses. The sequelae were peculiar--“great nervous debility, leading to a semi-paralysed state of the limbs,” congestion of the lungs, sometimes solidification, or gangrene or suppuration of them. It occurred at a time “when the food of the people is most abundant and of the best quality.” There had been three bad harvests in succession from 1860, but it may be inferred from a Dublin article of August, 1863, that no epidemic of typhus had arisen in Ireland down to that date, although there was much typhus in England, especially in Lancashire owing to the “cotton famine.” When the epidemic did arise in Dublin, Cork, and doubtless elsewhere in Ireland, in the latter part of 1864, to continue throughout 1865, it was not connected with scarcity or distress among the common people. On the other hand, Dr Grimshaw, of Dublin, found that it was subject to influences of the weather, as if the infective principle had been a soil poison like that of plague, yellow fever, cholera, or enteric fever. Taking the Cork Street Fever Hospital for his study, he made out that there was a very close correspondence, from the 29th of May to the 31st of December, 1864, between the fluctuating pressure upon its accommodation and the periodic rises in the atmospheric moisture and heat, the crowd of patients being always greater when a high temperature coincided with a large rainfall[530]. One would not have been surprised to find some such law as that in enteric or typhoid fever, although a correspondence from day to day is subject to many sources of fallacy; but, by all accounts, the disease was typhus, the last of the considerable outbreaks of it in Ireland hitherto, and an outbreak that seemed to require, both at Cork and Dublin, the language of Sydenham’s epidemic constitutions for its adequate description. For a good many years, the continued fever of Dublin has been chiefly enteric or typhoid. As late as 1862 a physician to the Fever Hospital, unconvinced by the method of Sir William Jenner, believed that he observed a transition from the old typhus into the new enteric: “The change at first seemed to be to the gastric type; to which was shortly added diarrhoea in nearly every instance; and this latter, again, occurring in a large number of cases which presented all the characters of typhus, including a dense crop of petechiae[531].” Assuming that there had been a mixture of cases of enteric and typhus fevers, the latter must have had diarrhoea among the symptoms, as they often had in special circumstances (as well as tympanitis). Since that time the species of typhus has greatly declined, and the species of typhoid has considerably increased. The remodelling which Dublin has undergone, like all other old cities, explains the one fact. The notorious Liberties have been in great part rebuilt, and the conditions of typhus, as well as its actual fomites, to that extent removed. On the other hand, something has happened to encourage the soil poison of enteric fever. It is not easy to say what are the conditions that have favoured the enteric poison in modern towns; but there can be little doubt about the fact in general, or that Dublin and Belfast are among the best fields for the study of the problem[532].