In the decade that followed serious outbreaks of famine and fever occurred and the admission figures for the Cork Street hospital soared.
The total number of patients admitted was 32,275. Unfortunately there are no complete set of records available for these years and no gender breakdown is available. The period was notable for an attempt to analyse the admission records by parish. Twenty three parishes were included in the report. Over a four year period the parish of St Catherine’s accounted for18.25% of all patients. A group referred to as itinerants made up a further 9% of the total. These may have been patients who lived outside the hospital’s catchment area. This was an attempt to isolate the source of fever. The hospital physicians were of the opinion that fever might be originating in particular areas or streets. The St. Catherine’s referred to here is the Church of Ireland parish based in Thomas Street. Later in the century St Catherine’s Roman Catholic Church opened in Meath Street. The annual report of 1813 contains a lengthy review of the practice of blood letting which was being practiced by a Dr. Mills in the hospital. The hospital physicians reviewed the survival rate of his patients by analysing 2,240 of his cases. They came to the conclusion that blood letting exerted no influence in rendering the disease less fatal or less protracted. They concluded their review by stating that they owed it to the public and the profession not to be silent on the claims ‘so boldly put forward and so pertinaciously maintained.’(Annual Report, 1813, pp1-13) The 1813 report also reported that there had been a great influx of people into the city many of whom were the wives and children of soldiers and sailors serving abroad who when seized with fever are quite destitute. This is presumably a reference to Irish men fighting for the British army in the Napoleonic wars. The hospital was too busy to publish an annual report in 1814 but they resumed the practice the following year. The 1815 report returns once again to the issue of blood letting with one of the physicians, Dr. O’Brien, believing that it had a role to play in the treatment of fever. The other physicians were apprehensive that even the loss of a small quantity of blood was likely to lead to exhaustion. O’Brien went on to question the preferred treatment which was to support the patients strength with ‘enormous’ quantities of wine whose only effect was to increase the ‘determination of blood to the head’ and aggravate the problem it was intended to cure. (Annual Report, 1815, p 2) Blood letting, involved shaving the head of the patient and washing the head frequently with vinegar and water. Leeches were then applied to the temples and if this produced no relief, the temporal artery was opened and four to six ounces of blood removed. Alcohol was still widely used in 1827 when the board enquired into the quantities purchased. In the first four months of that year there had been a daily average of 355 patients and thirty gallons of spirits and 41 dozen of wine of wine had been consumed. (Minutes, 5th June, 1828 p464))
The belief that weather conditions influenced the spread of fever is highlighted in their 1816 report when the weather conditions of every single day in the first three months of the year are recorded. The barometer and thermometer readings at specified times of the day, direction of the wind and a brief description of the overall weather conditions are all noted. The 1818 annual report reports the completion of a further extension to the hospital, capable of holding an additional eighty patients. This had been made possible by a special government grant. In some months of that year the influx of patients exceeded one thousand. A lengthy discourse on the weather conditions prevailing was included in the report. They concluded that the average rainfall was higher, the average temperature lower, ‘the influence of the Sun’s rays upon the soil must have been much less than usual.’ The consequence was that the grain ripened imperfectly, bread made from the grain matured imperfectly, potatoes were small and watery, provisions were scarce, the price of potatoes tripled. (Annual Report, 1818,p6). Stoker in his 1835 review stated that in 1818 that fever and famine combined with the pestilence of fever from previous years resulted in 7866 admissions but the majority of these were affected by famine rather than fever and judicial administration of food rather than medicine was called for. The annual report details the extent of the problem in Dublin. ‘Mendicants in unusual numbers were to be seen in every quarter, and many wretched country labourers, sometimes followed by wives and children, their pallid and emaciated countenances, testifying the reality of their wants, resorted to the streets of the capital in expectation of obtaining employment and escaping the horrors of want. ’(Annual Report, 1818, p7) In one house at the rear of No.8 New Street containing four ’miserable’ rooms twenty three people lived and all of them had been affected by fever. This was a lodging house, whose beds, the report referred to as fever beds. Subsequent lodgers had become similarly affected. The report went on to detail eighty seven cases of patients as an example of the overall position. The details presented in tabular form recorded only the name of the patient, the date admitted, number in family previously ill and some general remarks on those previously ill. One of these was a patient called Burn, admitted 20th May 1818, one person ill in family previous to admission who had died three weeks ago.
This type of reporting did little to improve medical knowledge and the hospital was to be criticised later in the century for their poor record keeping, particularly the dearth of patients information No record of the patient’s type of illness was kept until the late 1830’s. The hospital staffs were not immune from fever either. The chief medical officer, James Clarke, Register and Purveyor died in February 1819 from malignant fever and left a pregnant widow and three small children with no support. In the hospital itself thirteen nurse tenderers had been affected and at least three had died. A total of forty seven nurse tenderers and servants were employed at that time. In 1819 the hospital minutes mention that the hospital is providing soup and bread to members of the public and in the first seven months 9,295 persons availed of the services, this consisted of two quarts of soup and ½ lb of bread, total cost 3 ¼ d. This appears to be a service requested by the government which the hospital was specifically reimbursed for providing. The period 1814 to 1819 was clearly a very difficult one. As the fever raged in Dublin, in 1818, the government wrote to the hospital requesting their views on the likely cause and solution. The managing committee and the physicians both replied separately to the request. The committee referred to the poor harvests of 1816 and 1817 which they said caused a degree of distress scarcely to be believed. The lack of employment, scarcity and price of food all induced a more than usual neglect of cleanliness in the homes of the poor and in their persons. They suggested that anything that would promote cleanliness and sobriety among the poor would lead to abatement of the present epidemic and of fever generally. A copious supply of water would promote this objective.(Francis Barker and John Cheyne,An account of the rise, progress and decline of the fever lately epidemical in Ireland together with communications from physicians in the provinces, (Dublin, 1821),pp 243-246)
The physicians emphasised the need for additional facilities for the hospital noting that patients had to wait days for admission and some had died during the waiting period. They also noted a reduction in the number of beggars on the street. Beggars contributed to the spread of contagion and they hoped the evil of permitting them to be at large will not recur.( Francis Barker and John Cheyne, An account of the rise, progress and decline of the fever lately epidemical in Ireland together with communications from physicians in the provinces, (Dublin, 1821),pp 247-250)
This particular period was the subject of review and analysis. In 1821, Francis Barker, M.D., and John Cheyne, M.D. published a two volume review of the period and the incidence of fever in the entire country. Barker was a physician in the hospital. Their work was based on reports from doctors and hospitals in every part of the country. In the eighteen month period between January 1817 and the middle of 1818 they estimated that a million and a half people had suffered from the effects of fever. In the Dublin area they state that 42.000 people had been affected. In the city at large a degree of panic was evident. People entering shops would inquire if there was illness present in the shopkeeper’s family. Physicians attending the families of trades people and shopkeepers were often requested to drive up to their door ‘lest the suspicion of fever should be raised’. In 1846 Dominic Corrigan, M.D. published his On Fever and Famine where he discussed the incidence of fever and famine in Ireland and advanced his theory that famine and fever are as cause and effect. He was also warning of the impending failure of the potato crop and the likely consequence. Corrigan traced the incidence of fever in Ireland beginning in the eighteenth century. He draws heavily on Barker and Cheyne’s work in his review of 1817/1818. He claims that one sixth of the population of Dublin, 42,000 people, were hospitalised in that period suffering from fever. In the entire country one and a half million suffered from fever and over 60,000 died. Corrigan traced the incidence of famine caused by the bad crops of 1816/1817 to its alleviation by the better harvest of 1819.