by Nigel Farrell, Ulster University
I feel persuaded that epidemic diseases are not the necessary heritage of mankind. Like other terrestrial phenomena, they have certain causes or precursors. It is frequently a difficult problem to ascertain what these are, although it is a matter of the utmost importance to do so; for without a knowledge of this kind, how can we devise means for arresting the progress or preventing the inroads of epidemics?
Henry McCormac, Observations on Spasmodic Cholera, Its Origin, Nature and Treatment; With Remarks on Epidemic Diseases Generally (Belfast: Hodgson, Archer and Jellett, 1832), p. 3.
As Ireland’s only industrialised large town, Victorian Belfast was, for much of the period, outwardly prosperous and the town displayed a noticeable sense of civic pride, which in 1842 led the English novelist William Makepeace Thackeray to remark that Belfast appeared ‘hearty, thriving and prosperous as if it had money in its pocket and roast beef for dinner.’ However, like similar British industrial towns, Belfast had a much less refined underbelly and an urban infrastructure that was largely unfit to cope with a rapidly growing population.
Adjoining many of its main thoroughfares was a network of confined backstreets, entries, courtyards and alleyways, where scenes of deprivation, overcrowding, and poor sanitation could readily be found. Such conditions saw illnesses like fever, dysentery, tuberculosis and many others regularly break out in epidemic proportions; and in February 1832, following months of distressing reports from Europe, Asiatic cholera, a new contagion unfamiliar in most of world outside areas of the Indian subcontinent where it had originated made its first appearance in Belfast. Three further cholera epidemics would follow in 1848-49, 1854 and 1866, themselves part of deadly pandemics that swept the globe, all of them influential in altering the world’s public health landscape.
Everywhere it struck cholera terrified, and with good reason. While its pandemics approached slowly and could be observed and predicted, limited medical understanding meant that cholera in this period could not be reliably avoided, prevented or cured. It could appear suddenly, spread rapidly and be deadly, infecting rich and poor alike. Its signature symptoms, acute diarrhoea and vomiting, accompanied with agonising stomach and muscle cramps caused catastrophic and rapid dehydration, leaving its comatose corpse-like victims with shrivelled blue-grey skin, and often killing them in just a matter of hours. In some places mortality rates approached those of plague and in Ireland alone around 40% of those who contracted cholera between 1832 and 1833 would die as a consequence; in some areas rates were as high as 76%. In 1848/49 mortality rates were even higher, with the disease finding easy prey in the form of a population severely weakened by the impact of the Great Famine and its associated illnesses; and while morbidity rates generally dropped in the outbreaks of 1854-5 and 1866, for most places, Belfast included, mortality rates remained shockingly high.
Image: High Street, Belfast c.1831. Ulster Museum, IC/High St/831.
The Public Health Response in Belfast, 1831-32
Though public health matters were seen as very much the responsibility of local rather than national administrations, in September 1831, with Belfast’s Corporation deemed a largely ineffectual body, the first response to cholera in the town was driven by a hastily formed but ambitious Board of Health, comprised of prominent doctors, magistrates and clergymen. The Board, whose formation had ignored the directions of Dublin’s General Board of Health (who wanted cholera to be confirmed to their satisfaction prior to the establishment of local boards) was a supervisory body in the first instance but it quickly assumed responsibility for preparing Belfast for the inevitable arrival of cholera. Beginning by immediately urging those responsible for cleaning the town – the Commissioners and Committee of Police – to step up their efforts, the board also split the town into manageable medical districts with visitors employed to report on the condition of streets and the health of residents. The Belfast Charitable Society was canvassed for assistance, but only agreed to supply coffins as required.
A campaign to secure extra hospital accommodation commenced, eventually raising £700 to construct temporary facilities at the rear of the Frederick Street Fever Hospital. A building in Lancaster Street, opposite the hospital, was also acquired to act as a lazaretto in order to house those who had suffered direct contact with cholera victims or were showing symptoms. Initially under the direction of Dr William Duncan, this ‘Cholera Hospital’ was subsequently transferred to the formidable Dr Henry McCormac who spearheaded the medical response, employing a strict isolation policy with treatments which included bloodletting and the administration of calomel (mercury), opiates and dilute sulphuric acid. The latter, a method which McCormac claimed was both inexpensive and effective. It seemed, therefore, as Dr Andrew Malcom would recall in 1851, that the early actions of the board meant that ‘no town of the same magnitude was placed in more effective defence.’
Cholera’s first case in Belfast occurred on 28 February 1832 in a lodging house in Quay Lane, a narrow street near the River Lagan. Most likely contracting the illness from travellers that had arrived from Scotland, and stayed in the same lodgings, Bernard Murtaugh first showed symptoms around midnight and despite the best efforts of local doctors he died just nineteen hours later. The Board of Health, anxious not to cause undue alarm, was careful not to publicise the death but took strong precautions, burning Murtaugh’s bedding, fumigating and whitewashing the house and installing a guard of constables. However, within days several more cases occurred. In Johnny’s Court (off Talbot Street), the deaths of George McKeown and his son, ‘a stout young man’ of 27 along with two others, all of them linked in the Belfast Newsletter to the Quay Lane case, forced the board to publicly acknowledge the presence of cholera. Between then and the time of the release of the board’s final statistics in November 1832, 2831 cases and 418 deaths were recorded, a mortality rate of just under 15%, considerably lower than any other large town in Ireland, (Dublin and Cork for example, experienced rates which exceeded 30%). The relative success in managing the crisis was widely praised and attributed principally to the early actions of the Board of Health, its effective cooperation with the town’s main sanitary bodies and to the management of the cholera hospital by its medical and ancillary staff.
The Guard Slips
After 1832, new cases were relatively rare, consequently, cholera and on-going preventative public health provision seemed to pass quickly from public consciousness. Medically, few advances had been made in bacteriological understanding, so when cholera re-emerged in the West after 1847 practically nothing had changed in the way it was fought. However, in Britain and Ireland public health administration had begun to evolve. Thus, the efforts of the new Board of Guardians, the physician and sanitary reformer Dr Andrew Malcolm and additional sanitary and housing powers, granted to the corporation by town improvement legislation, drove forward the response to Belfast’s public health emergencies. The Guardians, for example, acted in defiance of the Poor Law Commissioners when they opened the Belfast Workhouse in 1841 with ten beds in place for the reception of the sick, rapidly increasing this to 100. They also helped the town’s medical dispensaries, agreed terms with the General Hospital to accept cholera patients and issued an open letter to local mill and factory owners urging them to release employees who showed cholera symptoms. (Their actions were justified when thirty-three cases and nine deaths occurred among workers at Ewart’s Mill on the Crumlin Road in early February 1849).
The driving force that guided the response of the municipal authorities was undoubtedly Dr Malcolm. During a town meeting in March 1848, he had pointed out numerous public health issues and proposed the formation of the Belfast Sanitary Committee. This body, headed by Malcolm and comprised of prominent community representatives, clergy and local doctors was specifically aimed at dealing with cholera in the first instance. The Committee revived the 1919 Contagious Diseases Act, appointed Officers of Health and published and distributed reports which gave advice on methods of preventing cholera and better hygienic practice. Magistrates’ orders were routinely 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.
Still, some areas where similar sanitary actions were more than warranted remained neglected by the authorities. They included parts of the Smithfield, College and Cromac wards, all of them highlighted in a damning report from the committee in 1849. Each were some of the most notorious seats of cholera, the latter two, the report declared, was due to their proximity to the notoriously unsanitary Blackstaff River, which for some time had been little more than an open sewer that Malcolm called a ‘foul and open tortuous stream.’ As cholera raged in July 1849, notable deaths in Cromac included the eminent Wesleyan Minister Rev. Matthew Langtree and in tragic circumstances his wife, who took ill as his remains were being taken for interment. She died shortly after her children returned from the funeral. By mid-October, almost a year after it had commenced the epidemic had run its course. There had been 3,538 cases and 1,163 deaths resulting in a mortality rate (33%) that was more than double that of 1832 but Belfast had still managed to avoid the significantly higher tolls recorded in Dublin, Cork and elsewhere.
Image: Map of Belfast’s Cholera Localities, 1832. Ulster Museum, IC/High St/831.
Were Lessons Learnt?
Following the end of the epidemic the ensuing decade saw some aspects of health care in Ireland improve. Under the ‘Medical Charities (Ireland) Act’ (1851) for example, the dispensary system was taken over by the Poor Law Commission, itself restructured to incorporate improved public health administration. Still, complicated sanitary issues would continue to plague Belfast. The Blackstaff nuisance was not addressed and housing and sanitary practices, particularly in the poorest areas of the town had been neglected following the end of the previous epidemic. Warning of the threat of another imminent cholera outbreak, Malcolm, speaking to the British Association in 1852, said; ‘Are we prepared? We fear not.’ But when cholera did return to Belfast in 1854 all the town’s municipal bodies made a concerted effort to mitigate its impact. Despite this, Belfast was one of the worst affected large Irish towns. The epidemic began in March 1854 with cases reported in Smithfield and in Washington Street and came to an end in October/ November. Accurate statistics are difficult to ascertain, but the Poor Law Commissioners recorded 1,871 cases and 677 deaths, (36% mortality). When cholera struck Belfast for the final time in 1866 it could scarcely be considered to have been an epidemic. The official returns recorded just 28 cases of Asiatic cholera with 15 deaths, but the true figure was almost certainly appreciably higher.
Though occasional alarms were raised, cholera did not return to Ireland in epidemic form after 1866. The decades that followed were dominated by scientific enquiry and efforts aimed towards gaining a better understanding of cholera and other contagious illnesses. This helped significantly change the global medical and public health landscape and by the end of the century many of the mysteries of epidemic disease had begun to be solved.
Image: Cholera Poster, Belfast, 1832. Royal College of Physicians of Ireland, BMS/19.
© The Author(s) 2021. Published by the Epidemic Belfast team on behalf of Ulster University.
Any unauthorised broadcasting, public performance, copying or re-recording will
constitute an infringement of copyright.