Skibbereen, 1847: Starvation Fever

Although the fever which committed such frightful ravages during the entire of 1847 has in a great degree subsided, yet we cannot, I fear, hope that the enemy is altogether subdued, more particularly as want and misery (to an extreme degree) are likely to be the lot of the majority of our population for the ensuing spring and summer; and the privations of the poor, as regards food, clothes &c., seemed last year to generate that epidemic which, like the rod of Aaron, has swallowed up the memory of its predecessors, and compared with which the pestilence of 1741 (proverbially known as the “year of slaughter”) scarcely deserves notice.
When the sanitary condition of London is attracting so much the attention of the legislature; when commissions are daily held, and reports daily made, upon questions regarding the health of the metropolis; when so much laudable indignation is expressed at having the sinks and cess-pools of St. Giles’s and the borough lead to the annual loss of a few thousand lives, from the exuberant population of the “great wen,” it is remarkable that so little notice has been directed to the subject of fever in Ireland, more particularly that of last year, which (independent of other diseases) has destroyed, at the lowest calculation, five hundred thousand human beings - swept off from among the better classes the most useful and benevolent members of society, and has created an amount of orphanage and widowhood that will for years press down the energies of the industrious. The immense havoc of last year can be best estimated by comparing the mortality with that of 1741 and 1817, years that are chronicled among the melancholy eras of our unfortunate country.
In the pestilence of 1741, 810,000 are said to have died out of a population of 2,500,000. In 1817, 44,000 out of a population of 6,000,000. In 1847, from fever, dysentery and starvation, 1,000,000. Whilst starvation and squalor, the causes that engendered this plague, continue to prevail among the people of this country, it is absurd to think that fever will limit its ravages to the poor, or confine its visitation to Ireland. Generated in the damp, dark cabins of the half-starved peasants, it will reach the mansions of the wealthy despite of stone walls, and iron gates, and sturdy janitors, and will spread to our more fortunate neighbours on the other side of the channel, in defiance of vagrancy acts and quarantine regulations; and in vain will the sewerage of London be improved, and the cellars of Liverpool be rendered less pestilential, unless that the physical and social condition of the Irish people be raised; for so long as their present abject misery continues, so long will the generation of wide-spreading epidemics be perpetuated.
To arrest the spread of Irish fever, the wisdom of the statesman would prove more efficacious than the skill of the physician; and cultivating the waste lands of the country, and exploring the “circling wastes of the sea,” would be found more efficient sanitary measures than even placing hospitals in every townland, and doctors in every hamlet.

Origin and Causes of the Fever of 1846 and 1847:-

The causes that produced the epidemic seemed to be, starvation, want of clothes and cleanliness, overcrowding, &c.
Although the production of fever merely by starvation continues to be a questio vexata, still no one can deny but that, in conjunction with want of cleanliness, overcrowding, and other evils inseparable from a state of destitution, it may become a most active agent in generating pestilence; and from my experience of last year, I am convinced that famine is (per se) capable of creating a febrile disease of a very peculiar character (of a highly contagious nature), and which, when communicated to the well-fed, may induce in them fevers of different types, from the high inflammatory to the low typhoid, according to the constitutional peculiarities of the subjects attacked. The morbid condition to which I allude, and which resulted from insufficient or unwholesome food, exhibited many of the symptoms of fever. There was an offensive effluvia from the body of the patient; the teeth were covered with sordes; the countenance was anxious and febrile; but there was not, as in ordinary fever, a disrelish for food: on the contrary, the appetite was in these cases generally craving, and in scarcely any instance was there any disturbance of the sensorial functions. That this disease was produced by want of food is proved by the facts that it was most general wherever starvation prevailed most, and that food was found to be its best remedy; and as to the contagious nature of this sickness, I can have little doubt of it from the examples that came under my own notice. A poor man, affected as I have described, came to my house (with a crowd of others) to look for soup tickets. His weak state attracted the attention of a strong robust woman, a neighbour of mine, who caught him by the shoulder for the purpose of directing my attention to his case; she instantly complained of the offensive smell from his body, had rigors that night, and was dead of malignant low typhoid fever within five days.
Mr. C., a most zealous and efficient member of the Skibbereen Relief Committee, whilst superintending the distribution of rations to the poor, complained of sickness induced by fetor from one of the famine spectres that were clamouring for food. He was that night attacked with rigors, succeeded by high fever, which required active depletion by bleeding and leeching. It is unnecessary for me to give any more examples of the contagiousness of this disease; it is sufficient to say, that almost every person actively engaged in the administration of relief to the poor was attacked with fever.
It has been already remarked that the famine fever which I have attempted to describe was most prevalent in localities where the poor suffered most from want of food; and as an additional proof that its origin was owing to this cause, I may observe that this peculiar epidemic did not appear until provisions became enormously dear, and starvation general, and that it then spread throughout the kingdom in so sudden and universal a manner, as to clearly prove that it must have diffused itself independent of the slow propagation by contagion.

This item formed part of a longer article by Dr. Daniel Donovan of Skibbereen published in the Dublin Medical Press of Wednesday 1 March, 1848. We are grateful to Mr. Patrick Cleary of Skibbereen for drawing it to our attention.

Response

The above item was sent to Dr. J.H.Thomas of Porthcawl (Glamorgan), a retired doctor and a noted medical historian who sent us the following comment:

: "This description by Dr. Donovan is very interesting and it is noteworthy that he has recognised the simultaneous occurrence of more than one disease despite the similarity of their presentation.
The fetor in the first group, as illustrated by Mr. C, is indicative of Typhus, while the jaundice and relapses in the second group (described in the section on symptoms) are characteristic of relapsing fever – also known as Spirochitosis, Febris Recurrens, Spirillum Fever and Famine Fever (perhaps the last pseudonym was in recognition of Dr. Donovan’s enthusiasm). They were grouped together in those days as continued fevers: indeed they had not been separated from Typhoid and Paratyphoid until much later in the century although ‘Typhoid state’ was used as a descriptive term for ill confused persons picking at the bed clothes.
The fever or fevers had been known for centuries throughout the world. Many epidemics had been described and their association with over-crowding and famine recognised, also their contagious nature. For example, at an Assizes in Oxford in 1577 two judges, a sheriff, two knights, eight squires and justices and others became delirious and died following contact with infected prisoners.
The Registrar General accepted Typhus and Typhoid as separate diseases in 1869, and in Wales in 1870 it is recorded that 223 died of Typhus and 452 of Typhoid. These diseases have different causes; but both Typhus and Relapsing Fever are due to louse-borne agents that are neither bacteria nor viruses. Typhoid is due to a bacterium.
Dr. Donovan talks of the Irish disease as if it was limited to Ireland. In this he was too parochial, because at the time it was also rampant in such places as Merthyr Tydfil which contained many Irish immigrants among its 14,000 population. The births there that year (1847) numbered 1759 and the deaths 1434 of which 385 were in those under a year, 310 in those between 1 - 3 y and 93 in the group 3 - 5y. But he was right in suggesting that ‘the wisdom of the statesman would prove more efficacious than the skill of the physician’ in getting rid of this type of epidemic because with the prevention of gross overcrowding and the ensuring of cleanliness the fevers rapidly diminished – in Wales 233 died of Typhus in 1870, 38 in 1880 and only 4 in 1890.
Famine reduces the resistance to infection but does not give rise to it – spontaneous generation of contagious disease does not occur, though it was the belief in Dr. Donovan’s time. How easy it is to be knowledgeable with hindsight!
In the second paragraph reference is made to the frequent meetings that were being held in London to consider its own medical problems. This was due to the beginning of the second epidemic of Cholera which was a separate entity.
The only point I cannot fathom is the craving for food that some of the patients had. Presumably these were either free from infection, or had an infection in a very early stage – because lack of appetite was an early symptom coinciding with the onset of the fever (or pyrexia).
All in all Dr. Donovan’s contribution must have been very valuable because he successfully intertwined a clear medical description with the social background of his patients."

Published in The Green Dragon No 2, March 1997.

Dr. Thomas has also contributed the following articles:

1. Rhai Agweddau ar Bla y Tatws yn Iwerddon
An article in Welsh discussing the potato blight during the Great Famine in Ireland.

2. Y Tlawd a'r Wyrcws
An article in Welsh about the history of workhouses.

3. James Ebenezer Bicheno
An article in English about the distinguished 19th century lawyer and botanist whose life linked England, Wales, Ireland and Van Diemen’s Land.

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