Cows, contagion and sanitation and Victorian Dublin by Juliana Adelman

We are back after the summer break! In this month's post, Dr Juliana Adelman writes about her research on the history of animals and public health in nineteenth-century Dublin.

When I began working on the history of animals I was not sure where I would end up.  I was initially interested from the perspective of a historian of science with a focus on the history of natural history. However, it quickly became clear that I was much more interested in  animal-human interactions outside of the laboratory and museum.  Looking at how animals affected and were affected by changes to ideas about health and disease has allowed me to reconnect with my undergraduate experience in a microbiology lab from a totally different angle. 

Medical progress?

Looking at medicine and disease through animals really highlights how social and contingent that knowledge is.  When we look at the history of disease in humans and how society has sought to address it, we can find it difficult to get away from the idea that things are moving forward.  There is no question that human life expectancy is longer, for example, than it was in the past.  We rarely protest against the idea that states have some obligation to the health of their citizens.  Most of us go to a doctor when we feel really sick and expect that they will help us.  While the social history of medicine has made it clear that the system of medicine we have now was in no way inevitable, most of us have fully absorbed the social attitudes that it represents.  

Disease and animal-human relationships

Cattle Market, Dublin (view from North Circular Road towards Prussia St)
Image courtesy of National Library of Ireland: Lawrence Photograph Collection
(L_ROY_08909)

When we look at disease from the perspective of animal-human relationships, however, we are forced to face the ways that our feelings and attitudes about animals have affected and been affected by the course of medicine.  For example, in our age of swine flu and avian flu and BSE we can hardly conceive of not believing diseases to pass between humans and other animals.  Yet, as Anne Hardy has pointed out and Abigail Woods's current project seeks to address, there has been no successful attempt to unite human and animal medicine as a single discipline.  There have been few attempts to address animal disease with practices other than containment by slaughter.  We have pushed animals to the margins of developed society, far away from cities and centres of population, but the ways that we depend on them continue to be highlighted in one food contamination story after another.  

The erasure of animals

So I guess what interests me is how did we get here?  To this place where urban residents depend for subsistence on animals, fear infections spread from animals, yet see themselves as completely separate from the animal world.  You need only look around Dublin to see how thoroughly we have erased their former presence: the site of the former cattle market and city abattoir now contain social housing, the North Circular Road never sees cattle blocking traffic, the Great Western railway terminus (where cattle from the country once arrived in droves) is a bus terminus.  I do not advocate the return of cows to urban Dublin, just a bit more consciousness of their role in our history.

Podcast

Podcast of a lecture 'Cows, contagion and sanitation in Victorian Dublin' by Dr. Juliana Adelman, given at the Centre for the History of  Medicine in Ireland (CHOMI, UCD) Seminar Series, 26 September 2013.

Juliana Adelman is lecturer in History at St. Patrick's College, Drumcondra. To listen to a podcast of a recent paper given by Juliana at the CHOMI Seminar Series, click here and for details of the forthcoming 'Science in the City' event she is organising, click here. Juliana may be contacted at juliana "dot" adelman "at" spd "dot" dcu "dot" ie. 

‘Out of the mouths of babes comes wisdom, and the poor women residing in the slums of Cork’ by Michael Dwyer

During the 1920s, extreme close quarter living conditions took a heavy toll on the health and life expectancy of the residents of Cork city. With a population of 80,000, 18,645 of the city’s inhabitants lived in unsatisfactory conditions with 8,675 inhabitants housed in 719 tenements and small houses. The tenements were generally in a shocking state of repair; crowded together in such a manner as to make it impossible to have fresh air and sunlight around each dwelling. The houses were small and resembled each other merely in their common dilapidation. The alleys, dignified by the name of streets and infused with a conglomerate of odours, said to be ‘almost Neapolitan’, began near the riverbank, in sordidness, and ascended the hills to something like squalor. As bad as the alleys were, the houses were generally worse. As Frank O’Connor succinctly put it, ‘God had abandoned the lanes of Cork city, and so had the Corporation’.

In 1926, a report produced by the Cork Town Planning Association Cork; A civic survey, highlighted the fact that mortality rates were highest in those districts which contained the largest amount of ‘insanitary property’. The survey revealed that the highest mortality rates occurred in dispensary districts three and four, both of which were located west of Shandon Street on the North side of the city. The mortality rates here numbered 2.9 per 1000, per annum and 2.7 per 1000, per annum respectively. Dispensary districts six and seven, located South west of St. Finbarr’s Cathedral, on the South side of the city recorded the second highest mortality rate at 2.4 per 1000 per annum and 2.6 per 1000 per annum respectively. The national mortality rate in 1923 is recorded as been 1.4 per 1000 per annum, making the mortality rate in the Cork Dispensary Districts twice as high as the national average.

The contemporary finger of blame for the high mortality rates, and in particular the high infant mortality rates was directed towards ‘the domestic ignorance of the poor womenfolk in our slum tenements… and to the shocking ignorance of the duties of motherhood’. However, this assertion by Professor Alfred O’Rahilly was roundly challenged by Professor Henry Corby who asserted that;

Out of the mouths of babes comes wisdom, and the poor women residing in the slums of Cork, who through force of circumstances felt compelled to ignore medical advice, have taught me what I consider to be a very valuable lesson.

Ariel view of District Three, on the north-west slopes of Cork city circa 1930. Source: Cork City Council.

'God had abandoned the lanes of Cork city, and so had the Corporation'. View of District Four, taken from the North Cathedral, circa 1930. Source: Cork City Council.

Addressing an article in the British Medical Journal relating to ante-natal care in private practice, Corby lamented that there had been little progress in the field of obstetrics over the previous fifty years to 1924, especially in regard to the preventative treatment of puerperal sepsis; a fatal illness caused by severe infection spread via the bloodstream, and generally contracted after a prolonged hospital confinement. During the 1920s, physicians routinely proscribed between ten and eighteen days post natal bed rest, and as a result, puerperal sepsis had been an all too common cause of death among women, regardless of  social status. Reflecting on his time spent as visiting physician to the Cork Maternity Hospital, Corby noted that he had been ‘forcibly struck’ by two things;

One, was the thorough contempt that the patients of the lanes exhibited for the medical science with regard to the amount of rest that should be taken after a confinement. The other was that puerperal sepsis was unknown among these [Cork] women, though they lived in the midst of squalid poverty and in surroundings which were the reverse of sanitary.

Corby contacted the matron of the Cork Maternity Hospital, and made inquires as to the duration of post natal bed rest taken by women under her care. The matron reported that the majority of women had ‘gotten up and gone about their daily chores on the third day after giving birth’. Furthermore, during her ten year tenure at the Cork Maternity Hospital, the Matron stated that only one case of death caused by sepsis had been recorded. Corby concluded that the adoption and application of the example set by ‘the women of the lanes’ to his own patients ‘resulted in good practical results’.

Similarly, an examination of J.C. Saunders, Typhoid epidemic in Cork city 1920, suggests that high mortality rates in the Cork dispensary districts were not necessarily caused by unsanitary practices among their inhabitants. Saunders account of the typhoid epidemic in Cork, ‘the biggest of its kind in the city and probably of the country also’, found that there had been 243 reported cases ‘but that it was highly probable that this figure represented only a portion of those which actually occurred’. The heaviest incidence was recorded in the northwest ward, that being the congested areas west of Shandon Street, where ‘there were a large number of insanitary and overcrowded dwellings and where the general standard of living is lower than that for the city generally’. The maximum incidence occurred in the eleven to fifteen age group, the youngest victim was three and a half years old and the oldest was seventy two years old.

An investigation focusing on the water supply concluded that it was contaminated with Balantidium Coli (B.coli). B. Coli causes infection when ingested by humans, faecal-oral being the commonest mode of transmission and it usually affects the large-intestine. Symptoms include diarrhoea, nausea, vomiting, fever, and severe fluid loss, a perfect disease to spread rapidly through a community living in extreme close quarters. The source of the contamination was identified as being discharge from Our Lady’s Cork Mental Hospital, which entered the River Lee through a sewage pipe, twenty yards from the pure water basin which supplied the drinking water for the entire city. The focus of the investigation turned to Our Lady’s Hospital, where it was established that typhoid had been endemic for over twenty years previously.  The cause by which the hospital had become ‘a reservoir of infection’ was traced to the institutions milk supply, which was found to be contaminated as a result of unsanitary practices at the production stage.

The overcrowded districts may well have been the ‘breeding ground for disease’ that many contemporary commentators depicted, and lives lived in squalid poverty in unsanitary accommodation presented a daily menace to the health and life of the workers and the poor. However, there is little doubt that the close-quarter habitation, an enforced condition of the physical state of the tenements, intensified the impact of external influences on their captives, who were victims of, rather than creators of their environment.

Michael Dwyer is a PhD candidate at the School of History, University College Cork. His current research relates to the historical significance of diphtheria and the roll-out of childhood immunisation programmes in Ireland. He is the winner of the James and Mary Hogan Prize in History (2011), the Saothar/IHSA Labour History Award (2012), and the Centre for the History of Medicine in Ireland Essay Prize (jointly, 2013). For further information see this link.

Cholera in Belfast in 1832 and 1848/49 by Nigel Farrell

On the 28th of February, 1832 at around midnight, Bernard Murtagh, a 34 year old cooper who resided in a lodging house on Quay Lane Belfast, a narrow street near the River Lagan, became violently ill. Described as a man of irregular habits he had been suffering from diarrhoea for two or three days previously but had not complained of any other symptoms when he went to bed following his usual supper of stirabout and milk. Around midnight his condition worsened and towards morning was accompanied with intense cramps and vomiting, the fluid (from both ends) described as whitish and like milk or meal and water. He was seen by Surgeon McBurney the following morning and was found to be in a state of extreme weakness and collapse, extremely cold and without a perceptible pulse at the wrist. A mustard emetic was administered around midday after which he appeared to revive a little. However, this proved only to be a temporary respite and he died between 7 and 8 p.m. that evening some nineteen hours after becoming ill.

High Street Belfast c.1831. A water cart can be seen to the right of the picture

Source: Ulster Museum IC/High St/831

Murtaugh had become the first recognised victim in Ireland to have died from what was then perceived as a new a frightening disease from the East, Asiatic cholera, though in truth it was new only to the West. Cholera, notable for its severity, rapidity and high mortality had been endemic in India in for some time before spreading throughout Asia after 1817 and Europe after 1829. Its signature symptoms, violent vomiting and diarrhoea resembling rice husks were usually accompanied by agonising cramps, muscular spasms, a weakened pulse, low temperature, and a blue tinge to the nails and skin. They were caused by infection with a microorganism, vibrio cholerae, usually following the ingestion of water contaminated by the excreta of another cholera sufferer, particularly in places where infected sewage was able to seep into the public water supply. In the towns and cities of nineteenth century Ireland where sanitary practices and sewage systems were often rudimentary at best this particular method of dissemination was a common and deadly hazard.

In Ireland alone around 40% of those who contracted cholera between 1832 and 33 would die as a consequence and in some areas mortality rates were as high as 76%. In a second outbreak during 1848/49 mortality rates were even higher, with the disease finding easy prey in the form of a population severely weakened by Famine and its associated illnesses. Belfast’s mortality rate at just 16% was however, much more favourable than anywhere else in the country and was significantly lower than Dublin or Cork who experienced rates in excess of 40%.

A Court For King Cholera. This famous cartoon depicts conditions conducive to the spread of cholera.

Source: Wellcome Images

Nineteenth century Belfast was Irelands only industrialised town and outwardly appeared successful and prosperous. Described by one commentator as looking as if it ‘had money in its pocket and roast beef for dinner’. However, while industrialisation had created opportunity, it also created serious social issues particularly in the provision of housing, water supply and sanitation. Housing for the labouring poor was laid out in a grid pattern of confined and insanitary courts, lanes and alleys, commonly consisting of two story buildings occupied by two or more families. Few houses were provided with piped water and over 7,000 houses were supplied from public fountains, by water carts, or from pumps sunk by landlords. Sewers were often constructed to deposit their effluent directly into the town’s main watercourses and high tides and flooding regularly carried effluvia back onto the streets and into the homes of those who lived in their vicinity, making sanitary conditions and their likelihood of contracting serious illnesses inherently worse.

When cholera came however, Belfast appears to have been as well, if not better prepared to combat the disease than most. The initial response was the remit of the Police Commissioners and of an ad hoc and hastily formed Board of Health. Working closely together, a systematic programme of street cleaning and of whitewashing and fumigating houses was instigated. Temporary hospital accommodation was provided in the grounds of the towns Fever Hospital with Dr Henry McCormac placed in charge. McCormac combined a strict isolation policy with treatments which included bloodletting and the administration of calomel (mercury), opiates and dilute sulphuric acid. Though mortality in the hospital was much higher (22%) than for the rest of the town there does appear to have been less resistance in Belfast to the idea of going to hospital than was the case elsewhere. In Dublin for example, opposition was such that carriages carrying the sick to hospital were occasionally set upon, the patients ‘rescued’ and the carriages thrown in the Liffey.

Cholera Localities Belfast 1832

Source: A.G. Malcolm ‘The Sanitary State of Belfast with Suggestions for its Improvement’

http://www.tara.tcd.ie

By the end of the first epidemic over 400 people had died in Belfast and cholera, as did on-going preventative public health provision, passed quickly from public consciousness. Thus, when cholera returned to Ireland in 1848 practically nothing had changed in the way it was fought. However, during this second epidemic, the efforts of Belfast’s new Board of Guardians, the physician and sanitary reformer Dr Andrew Malcolm and additional sanitary powers granted to the new Town Corporation by town improvement legislation arguably prevented a much higher death toll than was experienced elsewhere. The Guardians, for example acted in defiance of the Poor Law Commissioners when they opened the Belfast Workhouse in 1841 with ten beds for the reception of the sick, rapidly increasing this to 100. The Corporation introduced new housing regulations and were granted additional sanitary powers, giving them more authority to require landlords and property owners to remove nuisances and pave streets. However, by 1848 Dr Malcolm reported that there continued to be a ‘lamentable deficiency’ with regard to the removal of offensive remains. As fears of choleras immanent arrival grew the influential Malcolm rose to the fore to guide the municipal authorities. A Sanitary Committee headed by Malcolm and specifically aimed at dealing with cholera in the first instance was formed in 1848. The Committee published and distributed reports, magistrate’s orders were issued for the removal of nuisances, poor families were provided with straw bedding, houses were whitewashed and new sewers were constructed in some parts of the town.

Despite the preparations however, fatalities were almost treble those of 1832. Though Belfast now had two hospitals capable of receiving cholera patients the willingness of the sick to be admitted had declined decidedly. The Committee of the General Hospital attributed the reluctance to ‘prejudices or perhaps the state of apathy and hopelessness which accompanies this severe malady’ and commented that it was a ‘matter of regret, that that the advantages of the hospital were not more generally or duly appreciated by the poor’. By the end of the epidemic 3,538 cases and 1,163 deaths had been recorded but mortality at 33% was again lower than that of other sizable Irish towns. However, in Belfast’s worst affected areas, poverty and deficiencies in sanitation and hygiene had clearly been instrumental in the spread of the disease. And while the town’s municipal authorities had effected much civic enhancement, major sanitary improvements had not been instigated in the areas of the town where they were most required. Nevertheless, some lasting lessons had been learned and when cholera returned again in 1853 and 1866 mortality rates were almost insignificant by comparison.

Nigel Farrell is a third year PhD student based at the University of Ulster Coleraine and is researching cholera and the development of public health in Belfast between 1832 and 1878. The above post is based on his winning entry to the History of Medicine in Ireland Prize competition.