Health Preparations for an Epidemic….. In 1832

We often look back at history and think that there was no medical care in the past, that people, and more specifically the poor, were left to suffer from the myriad diseases that circulated in pre-Famine Ireland. The dominant political ideology in 18th and early 19th century Ireland and Britain was one of minimalist intervention in medical and social affairs. Disease and poverty were seen as the lot of the poorer classes, their care left to charitable and philanthropic foundations. But by the opening decade of the 19th century, the enlightened ideas of social reformers such as Jeremy Bentham, caused a change in how disease and the poor were treated, not least because of the public threat of infectious outbreaks. Vaccination against smallpox in Ireland began in 1800, and quickly became widespread, and a substantial network of voluntary medical charities were operating infirmaries, mendicity institutions and lying-in hospitals throughout the country by 1832. 

The Central Board of Health: Satire of the corruption and uselessness of public health officials, by George Cruikshank

​The Irish Typhus epidemic of 1816-19, in which up to 65,000 may have died, was instrumental in changing the State’s relationship with health and disease, and signalled a more interventionist role from government.  County Infirmaries had been established in 1766, under an Act of George III, when an infirmary was established in each county. They were designed to ‘restore the health of His Majesty’s subjects’, and to promote labour and increase productivity. They were financed by a mix of Grand Jury presentments, parliamentary grants, charitable subscriptions and donations.  By 1832 there were 31 of these Infirmaries in Ireland, as well as a network of almost 500 free dispensaries for the poor. Fever Hospitals were legislated for in 1818, being erected in areas more ‘susceptible to high incidents of fever’; they were fewer in number, with only six in Connacht by 1832. The Act allowed for the setting up of Local Boards of Health, primarily to deal with local outbreaks of fever and contagious disease. 

In 1831, as the Cholera pandemic raged, it was realised that it was only a matter of time before it spread to Ireland. Cholera provoked greater fear and thus more intervention, due to the fact that it was a hazard to all classes. In preparation for an epidemic, the government re-activated the Irish Central Board of Health in October 1831.  Members were chosen for their background in bureaucratic matters and organisational skills. Regulations and advice were issued similar to their English counterparts, with an emphasis on sanitary precautions. The Board, - often called the ‘Cholera Board’ - used legislation enacted during the typhus epidemic, which it felt was adequate for prevention measures.  The Central Board oversaw the Local Boards, and distributed grants.  This system was preferred by the government, as much of the costs could be borne locally by raising a poor-rate, and supplemented by voluntary subscriptions.  This Board has echoes today, in that its role was to act as a ‘medical watchdog’, collect statistics about local health conditions, and to advise where local committees of health should be set up to combat occasional epidemics. This endeavour marks the beginning of the centralisation of health and medicine in Ireland  

Sligo County Infirmary, 1818. Original Architectural sketch. Source: IAA

By January 1832, numerous Local Boards of Health were operational, and were authorized to take all steps necessary to ‘prepare for the onslaught of the disease’. This included the cleaning of the houses and lanes of the poor, burning of unclean bedding, the whitewashing of houses, and the setting up of cholera or auxiliary hospitals.  They could  borrow funds from the Central Board to finance these measures.  The Cholera Board issued a detailed proclamation on 13th April 1832, to be publicly displayed all over Ireland. ‘Everyone affected is to seek medical attention or run the risk of death'. This may seem obvious to us today, but was not necessarily so in a period when mistrust of doctors was running high.   

In an eerie echo of today’s Coronavirus regulations, the Cholera Board issued robust ‘Notices and Regulations’, and local officers of health were to be appointed to implement these. Existing fever hospitals and county infirmaries were not to be used for infected persons. Suspected cases were to be removed immediately to a temporary cholera hospital, and special accommodation should be set up for that purpose in each town. If no buildings were to be found, improvised premises or tents should be erected. Medical depots were to be established in larger areas, to assure the supply of medicine and equipment. Weekly reports and statistics of the progress of the disease were to be kept, and published in the local newspapers. Those who had suffered from Cholera were ordered to isolate for 14 days after they recovered. The Central Board also sent experienced doctors to places that had severe outbreaks and not enough medical staff. The cost of these men had to be met by the local boards of health.  There was a huge emphasis on cleanliness and fumigation, and paradoxically, on the importance of ‘pure water’, along with temperance, and physical exercise. Manure heaps were to be removed, and streets and insanitary lanes swept and washed.  Special carriages were constructed to transport the sick or dying to a cholera hospital.  Public gatherings were discouraged, (with little success), and wakes and funeral services were halted. 

Extract from the Board of Health Proclamation April 1831. Echos of our own time.

Preparations were varied throughout the country. In Kilkenny, there was a ban on the selling of second-hand clothes in the city by March 1832, and a cartload was burned.  There was a huge trade in used clothing, imported from England, and there was a justifiable fear that cholera could be harboured in these garments. In Ennis, the local board of health paid 48 men to remove nine cart-loads of manure heaps from the streets. Insanitary privies – dry toilets, - were a particular source of concern, and in Dublin there was the innovative proposal to erect mobile privies, which could be moved and emptied at night. Centuries of exposure to fevers and disease had left the Irish people with a unique knowledge of how contagion and transmission worked, even if they did not understand our modern terms of aetiology and vectors of disease, and preferred to think of infection as originating as a ‘miasma’ or foul air.  In Thurles, following the death of a young girl, her clothes were burnt and the house was fumigated by the Board, but a fearful mob burned the house down, inadvertently destroying the house next door. In Drogheda, clean straw for bedding was issued to 2,000 families, and over 540 yards of linen were made into bed ticks, stuffed with straw for the cholera hospital.

Proportionate distribution of Board of Health Grants. Source: CSO Papers

The Sligo Board received £300 from the central Board in between March and 15th August 1832. The monies advanced were used to finance the cholera hospital, to pay doctors and other medical attendants, and to compensate people for clothes or furniture destroyed. By late August, a further £300 was advanced from the Central Board in recognition of the horrifying state of affairs in the town. A very significant expense was the cost of hiring a ‘large medical staff of porters and nurses’ at the Fever Hospital.   Board of Health Grants were subject to repayments at a later date. This had the effect of smaller amounts being granted to poorer parts of the country, as there would be no ‘matching funds’ from voluntary or private subscriptions, raised mainly from the landed classes.  While many Irish landlords and monied classes were notable donors, those in Mayo were apparently unmoved by the plight of the sick poor, where fever and distress in 1831 had already left over 200,000 in want of relief. 
 
In all, the Central Board of Health made grants to the local boards, totalling £148,103 Sterling, equal to about £14 million today, illustrating that large amounts were spent on combating the pandemic in Ireland, as compared to previous epidemics.  Dublin City and County received the most monies, with Cork, Clare, Mayo, Tipperary, Limerick City and Antrim all receiving more than £5,000 in 1832-3. It was still not enough.  But given the nature of the disease, and the then confused scientific understanding of cholera’s pathology and epidemiology, further spending would not necessarily have lessened the death toll. 

Sample of Grants from the Cholera Board. Source: Cholera Papers