by Sean Martin
The Irish potato crop in 1845 was infected by the fungus Phytophthora infestans. The 1846 crop was wiped out, the 1847 was meagre, and the year following was another wipe-out. As Ireland was heavily dependent on its potato crop for its main source of food, this was catastrophic. The ‘famine fevers’, typhus and relapsing fever, soon began their work, aided by dysentery, diarrhoea and scurvy. The British government’s response was inadequate, probably more by accident than design. The 1846 Fever Act was intended to combat the crisis, but seems to have been ineffectual due to a lack of government spending: there simply weren’t enough doctors or other health workers to deal with the situation. Government intervention in Ireland was further weakened by the need to deal with the outbreaks of typhus in Liverpool and elsewhere. In the eyes of those in Westminster, Ireland was always a dirty, troublesome and insignificant backwater; its problems were always ‘beyond the pale’. Disaster in England always took priority over those in Cork, Clare, Kilkenny and Galway.
The combination of famine, fevers, and an incompetent public health response was a catastrophe that had an incalculable impact on Irish history. Between 1845 and 1851, the population of Ireland dropped from around 8.5 million to 6.5 million. One million died, and another million emigrated, mainly to the US and Canada. It was ‘one of the most dramatic demographic collapses in Western history.’298 It left a lingering collective memory, both among the remaining population, and the diaspora. Many ‘held the British government responsible for the human disaster, perhaps through the inefficiency of its actions to relieve suffering, perhaps (in the minds of angrier Irish memories) through a policy of genocide that deliberately allowed the Irish to starve… [although] few historians would [now] accept the latter version.’299 Anglo-Irish relations would never recover.
The situation in Ireland in 1846 was beyond anything anybody – in government or out – could imagine. The common perception that typhus was contagious – miasma theory was still alive and well – caused many to flee, leaving their dead unburied and unshriven. Many took to the roads, taking their diseases – and their body lice – with them. Food distribution centres and soup kitchens became rife with disease. If the soup kitchens ran dry, some committed crimes so that they would be jailed, knowing they would get a meal in prison. (They would probably also get typhus.) There seemed to be no escape. Even emigration didn’t solve the problem: thousands died in transit to North America; the vessels that bore them became known as ‘coffin ships’.
Many also fled across the Irish Sea to England, Wales and Scotland. So many starving and ill Irish immigrants arrived in Liverpool in the spring of 1847 that it caused an immediate crisis. The need for extra hospital beds was so acute that feverish Irish were given beds in temporary hospital wards set up in dockside warehouses known as fever sheds. Four old prison ships were requisitioned and hastily put to use as hospital ships. At all costs, the ailing immigrants had to be kept out of the city’s wealthier areas, and contained in the ‘fever districts’, which were, in all cases, the poorer parts of the city, with the worst housing and sanitation, among them the wards of Vauxhall, Exchange, Great George, Scotland, Lime Street, Abercromby, St Anne’s and St Peter’s.300 Those who didn’t end up in fever sheds found cheap lodgings in the cellars of the fever districts, but the filthy conditions only served to exacerbate the conditions that typhus, dysentery and diarrhoea thrived in. (Many wanted to avoid ‘capture’ by the hospital authorities in case they were sent back to Ireland after treatment.)
There was little the overworked doctors and hospital staff could do: nearly 60,000 people contracted typhus in Liverpool; at one point, 88 per cent of them were Irish.301 The epidemic became known very quickly as ‘Irish Fever’. Liverpool’s city fathers did not look too kindly on them, as might be expected. The prejudices of the time dictated that the Irish only had themselves to blame: typhus was seen to be the result of ‘over-crowding, drunkenness, and every other kind of vice’.302
Once the epidemic had burned itself out by early 1848, the city fathers, rather than tackle the acute problems of the slums, ‘paid scant attention to sanitary reform: instead, they sought to rectify Liverpool’s “black spot” image through lavish schemes of civic ornament and grandeur, urban “boosterism” befitting the “second metropolis.”’303 The result was, as might be expected, similar troubles when typhus returned, as it did in 1865–6, when it was accompanied by cattle plague (rinderpest) and cholera. The Irish were once again blamed for the epidemic (Irish drovers being apparently responsible for the cattle plague); and the Irish once again suffered the most.
Despite the severity of the 1865–6 epidemic, it didn’t equal ‘Black ’47’, as it quickly became known. 1847 saw 30,000 deaths in total across England and Wales. 60,000 contracted typhus in Liverpool alone. In the view of the city’s Medical Officer for Health, Dr William Duncan, Liverpool became a ‘city of plague’, the year being ‘calamitous’. Historian Frank Neal has calculated that, in Liverpool, 7475 died of typhus in 1847, 70 per cent of whom – around 5,500 – were Irish immigrants.304 This figure, he feels, justifies the Registrar General’s comment from his third quarterly report for 1847, that Liverpool in that year became ‘the hospital and cemetery of Ireland’.305
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Irish immigrants to North America had plenty of experience of poverty and disease well before Black ’47 and the famine years. Typhoid was thought to be ‘like typhus’ since the French doctor Pierre Louis (1787–1872) coined the name in 1829. It was identified as a separate disease by the American doctor William Wood Gerhard (1809–72), who was studying an outbreak affecting mainly Irish immigrants living in Philadelphia in the winter of 1835–36, and even contracted the disease himself. In Britain, William Jenner (1815–98) announced independently of Gerhard in 1850 that typhus and typhoid were distinct diseases; Jenner went one better than Gerhard by managing to contract both diseases in the course of his researches. It still took another ten years or so, and several epidemics, before the theories of Gerhard and Jenner were widely accepted, and the efforts of a third doctor, William Budd (1811–80), before public health policy in Britain was changed.
Typhoid is one of the great diseases of urban filth. Caused by the bacterium Salmonella typhi, it thrives in areas with poor sanitation and infects humans via faecal-oral transmission. In layperson’s terms, if particles of human shit containing the bacteria get into the drinking water, you are likely to get typhoid. Its symptoms include abdominal pain, intense headache, high fever and a distinctive ‘rose rash’ on the chest and abdomen. Untreated it can be fatal in 10–20 per cent of cases. Typhoid is thought to have become a problem whenever there was a need in human settlements to dispose of sewage. Prehistoric facilities were of the ‘bear in the woods’ variety, of course. But as soon as humans invented the cesspit, they were in trouble. Or rather, they were if the cesspool could in any way leak into the drinking water supply. You don’t need a huge city for typhoid to become a problem, as was shown by what happened in the early attempts to establish a colony at Jamestown, Virginia. 105 settlers arrived in April 1607 with the intention of starting a new colony in the name of King James I. When fresh supplies and colonists arrived the following year, only 35 of the original settlers were still alive. Over the next two decades, it is thought that 6,500 out of 7,500 colonists died from typhoid.306 However, at the time Gerhard and Jenner were doing their research, the link with tainted water supplies had not yet been established.
Such was the state of London in the 1850s that diseases of filth were everyone’s problem, not just the poor. In 1858, the city suffered the Great Stink, in which – because of low rainfall and hot weather – the Thames became a vast open cesspool. As the physician William Budd remarked, ‘the sewage of nearly three millions of people had been brought to seethe and ferment under a burning sun, in one vast open cloaca lying in their midst.’307 Another commented a ‘stench so foul, we may well believe, had never before ascended to pollute this lower air. Never before at least, had a stink ris
en to the height of an historic event.’308 People wrote to the Times complaining about the stench, and subscribers to the miasma theory of disease were convinced the smell would produce a terrible epidemic. The House of Commons, enjoying a commanding view of the Thames, was brought to a standstill. Curtains soaked in chloride of lime were hung in the windows, but it did little to reduce the overpowering fumes; ‘politicians choked and retched’309 and threatened to leave London. As the Great Stink didn’t create the feared pandemic, anti-miasmatists like Budd felt vindicated. But momentum to tackle London’s dirt was gathering pace. One of the most notable achievements in this respect was the design by Sir Joseph Bazalgette (1819–1891) of a sewerage system for London, which prevented further ‘great stinks’ by diverting waste out of the city. This also represented a huge step forward in the city’s fight against typhoid and cholera (see below).
Royalty was also regularly inconvenienced by the Thames. Whenever the river rose, the royal cesspits at Windsor Castle disgorged their contents into the castle grounds. Each time this happened, the groundsmen raked the ordure back into the river. By the summer of 1859 Prince Albert was showing signs of illness, suffering from stomach cramps. The prince was plagued by the symptoms over the next two years. He was gravely ill in December 1861, and Royal Physician William Jenner diagnosed typhoid. Albert died on 14 December.
Cholera
At around the time doctors began to talk of ‘tuberculosis’ and ‘typhoid’, a new pandemic came out of Asia. Out of all the filth diseases of the nineteenth century, cholera was one of the deadliest and most feared, and also arguably the disease that most threw into relief the problems of the industrialised, urbanised world. Initially dubbed ‘Asiatic’ cholera, news of its relentless spread westwards in the late 1820s struck terror into European imaginations, a fear that ‘probably exceeded that of any epidemic since the fourteenth-century plague’.310
Cholera reached England in late October 1831, when shipping from Hamburg brought it to Sunderland.311 As with ships bringing yellow fever to the US, attempts were made to quarantine incoming vessels. Business owners panicked, fearing that quarantine would lead to a loss of trade, and a complete collapse of the status quo (shipping was the largest employer in Sunderland – almost everyone had a connection with the docks). As Norman Longmate remarked in his history of the epidemic, those with vested interests put their interests first, and denied that anything untoward was going on in Sunderland at all: ‘Not for the last time in British history a lead in greed and stupidity was given by a member of the House of Lords. The Marquis of Londonderry, who had a financial interest in the coal trade from the port [Sunderland], wrote to the London Standard that the alarm was false.’312 The Marquis’s supporters enlisted ‘the support of what were later described as “some insignificant medical practitioners” who were persuaded to announce that the disease they had seen was only an acute form of the familiar bilious disorder called “English cholera”. A group of anti-quarantine business men then succeeded in gaining control of the Sunderland Board of Health.’313 At a public meeting on 12 November, nearly all the doctors in Sunderland rose one after another to deny that there was any cholera in the town. Their efforts, alas, were in vain. News about the denial spread as fast as news about the impending epidemic, ‘and made Sunderland a target for laughter or abuse throughout the medical profession.’314
There was little laughter when it became clear that cholera had undeniably reached British shores, producing a reaction that was more redolent of the Middle Ages: ‘On 6 February 1832 it was announced that Wednesday the 21st March in England, Wales and Ireland and Thursday the 22nd in Scotland was to be a day of fasting and humiliation, when the nation would acknowledge its sins and plead with God to remove the affliction of the pestilence.’315 The fasting did no good, and within days people were dying. Cholera claimed around 6,000 lives in London over the coming months, and 55,000 in Britain as a whole. The pandemic reached North America in the summer of 1832, arriving with Irish and German immigrants, and also struck Indonesia, the Middle East, the Caribbean and Latin America.
Cholera is an ancient disease, probably originating in the Ganges-Brahmaputra delta in India, where it had been endemic for centuries. Its earliest recorded appearances are in the first millennium BC, when mention is made of the disease in ancient Sanskrit, Chinese and Greek texts. Caused by the free-swimming bacterium Vibrio cholerae, its symptoms include painful convulsions, violent vomiting and uncontrollable ‘rice water’ diarrhoea. (Perhaps unsurprisingly, the name cholera derives from the Greek khol, meaning ‘bile’, and rhein meaning ‘to flow’.) Like typhoid, it is transmitted by the faecal-oral route, either through contaminated drinking water, or food. It can kill within hours and, in severe outbreaks, the death rate can be around 50 per cent.
The first cholera pandemic originated in Jessore, Bengal (now in Bangladesh) in 1817. Usually, the disease would affect the likes of pilgrims bathing in the Ganges, but in this year a combination of circumstances spread the disease from its usual stamping grounds across Asia as far as southern Russia, the Middle East and around the Horn of Africa. The circumstances in this instance were floods, crop failures and the movements of the British army.
The spread of the British Empire had been afflicted with disease ever since the first colonists established Jamestown in Virginia. Like the Spanish before them, the British found themselves often paying for their imperial ambitions with the lives of their troops, usually losing far more to disease than enemy action. As Britain’s ambitions in India grew, so did the number of her troops on the ground, and an increase in traffic between the two countries. But trade routes and armies, as we’ve seen with the Black Death and the Antonine Plague, also function as arteries for disease. Factor in improved methods of travel, in the shape of steam ships and trains, as happened in the nineteenth century, and for the first time, worldwide pandemics became a reality. This was the world cholera became exposed to in 1817, and it didn’t miss the opportunity to move around the Ganges delta with British troops, before hitching a ride out of the Bay of Bengal to the wide world beyond.
From the outset, cholera was linked to imperialism. Hindus thought it was linked to colonial rule, while in Manila people rioted in 1820, ‘convinced that cholera came as a result of a plot to poison the city’s water’ by ‘foreign physicians’.316 In one of their more ironic interventions, the British army helped spread cholera to Oman, but they had gone there with the best of intentions: to abolish slavery.
Tens of thousands died in the first pandemic, but the figures are almost mediaeval in their unreliability. 30,000 deaths were claimed for Bangkok in 1820 alone, while in the Javanese city of Semarang, 1,225 people were said to have died in just one eleven day period in April 1821.317 The pandemic seems to have petered out in the Russian city of Astrakhan, possibly stopped by the severe winter of 1823–4.
By the time the second pandemic reached Europe, therefore, there was a great deal of concern that cholera, having been a ‘storm over Asia’, would be equally calamitous in Europe. Carried by traders, soldiers, sailors, pilgrims, refugees and migrants, cholera first struck Moscow, then moved southwest into Bulgaria, and west into Poland courtesy of the Russian army (Poland then being under Russian control). The Baltic ports were affected, followed by Hamburg, Paris, and London. In Paris, cordons were set up around the city as a preventative measure, and troops were ordered to shoot cordon crossers on sight. Despite these and other precautions, the disease still ran rampant in the city. Parisians rioted. Similar measures in Russia – cordons, quarantine, and restrictions on movement – also caused riots.
In Britain, people rioted too, but more out of fear (or outrage) that doctors were killing people with cholera in order to dissect their bodies in the name of medical research. (This was only a few years after the notorious Burke and Hare had been arrested for murdering people and then selling their bodies on for medical dissection in Edinburgh.) There was also the feeling among disenfranchised rioters acros
s Europe that the disease was a government plot to get rid of troublemakers.318
In America, the pandemic was immortalised by Edgar Allan Poe, who witnessed cholera doing its work in Baltimore in 1832. His story ‘The Masque of the Red Death’ tells of a stranger who appears in the midst of revellers at a masqued ball, whose own mask is that of a corpse, bearing the signs of the ‘red death’. In Paris, polite society remained defiant by holding balls of its own, where the poet Heinrich Heine recorded events that could have come straight from Poe’s story. He records that on 29 March 1832, during the traditional mid-Lent carnival, one of the costumed revellers was suddenly taken ill:
... all at once the merriest of the harlequins felt that his legs were becoming much too cold, and took off his mask, when, to the amazement of all, a violent-blue face became visible.
It was at once seen that there was no jest in this; the laughter died away, and at once several carriages conveyed men and women from the ball to the Hôtel-Dieu, the Central Hospital, where they, still arrayed in mask attire, soon died. As in the first shock of terror people believed the cholera was contagious, and as those who were already patients in the hospital raised cruel screams of fear, it is said that these dead were buried so promptly that even their fantastic fools’ garments were left on them, so that as they lived they now lie merrily in the grave.319
The deployment of armed guards in Paris – who were ordered to shoot cordon-crossers on sight – reflects both the fear of cholera, and also the political uncertainties in the wake of the recent (1830) revolution. The powers that be were taking no chances, especially as the Paris mob was also on the prowl, fearing the epidemic was being spread by undesirables. Heine’s descriptions are reminiscent of Boccaccio witnessing the plague: