REP O R T OP THB COMMISSIONERS OF HEALTH, IRELAND, ox THE EPIDEMICS OF 1846 TO 1850. Presented to both Houses of Parliament by Command of Her Majesty. DUBLIN: PRINTED BY ALEXANDER THOM, 87, ABBEY-STREET, FOR HER MAJESTY'S STATIONERY OFFICE. 1852, Presented to the Statistical Division, Surgeon-General's Library, United States Army Washington, D. C. BT The Prudential Insurance Co. of America Newark, New Jersey REPORT OF THK COMMISSIONERS OF HEALTH, IRELAND. REPORT OP THE COMMISSIONERS OF HEALTH, IRELAND, ON THE EPIDEMICS OP 1846 TO 1850. Presented to both Houses of Parliament by Command of Her Majesty. DUBLIN: PRINTED BY ALEXANDER THOM, 87, ABBEY-STREET, FOB HER MAJESTY'S STATIONERY OFFICE. 1852. Dublin Castle, 29th August, 1850. Gentlemen, The Temporary Fever Acts, under which your duties, as Commissioners of Health, were exercised, having expired, I have been directed by the Lord Lieutenant to tender to you, on the part of Her Majesty's Government, his best thanks for the services which, in that capacity, you have rendered to the community. From the eminent professional position which you occupy in this city, the Lord Lieutenant is fully aware that these onerous duties must have been undertaken at considerable personal inconvenience ; and his Excellency has desired me to assure you that he fully appreciates the motives which induced you to enter upon them, as well as the ability and efficiency with which they have been performed. The unusual duration of the epidemic during which you have acted as Commissioners of Health, connected as that epidemic was with the misery and distress caused by the failure of the potato crop, will no doubt have enabled you to acquire much information which may be hereafter most useful should a similar visitation ever occur again ; and if you would be so kind as to furnish his Excellency with a report embodying your views and opinions upon this important and interesting subject, such a document would, in his opinion, be most valuable, and he would be prepared to lay it before Parliament at the commencement of the next session. I have the honor to be, Gentlemen, Your obedient Servant, Wm. M. Somerville. The Commissioners of Health, &c. &c. &c. CONTENTS. rage Report, Fever, ......••• The result of famine, ...... 1 Hospital Accommodation — Regulations as to granting requisitions for, 3 Rise and Progress of the Epidemic, ..... 4 Extent and Mortality of, . . . • .4-11 Type and Complications, . . . • • .12 Small Pox, ........ 16 Food, 18 Peculiarity of the Potato as Food, . . . . .18 Difficulties attendant on providing a Substitute for the Potato, . 18 Bice Errors connected with its use, . . • .19 Oatmeal and Indian Meal — Comparative Nutrition of, . . 20 Beans and Indian Corn, ...... 20 Potato Flour — Nature of, . . . . .20 Effect of want of variety of Food (without deficiency in quantity), in producing Purpura or Scurvy, . . . . .20 Raw or badly-cooked Food— Observations and Circular on, . . 21 Good Effects from using Cooked Food, . . . .22 Connexion between scarcity of Food and Fever, . . .22 Lowered Price of Oatmeal— Good effects of, . . .24 Fever Hospital Accommodation — Difficulties connected with, . . 25 Observations on, in event of future visitations, . . .26 Do. on attendance on Patients in their own homes, . 26 Ventilation — Simple Plan of, . . . . . .27 Disinfectants — Observations on, . . . . .27 Expenses of Fever Patients, ...... 28 Cholera, ......... 28 Rise, Progress, and Decline of, ..... 28 Large proportion of Children attacked, . . . .30 Diarrhoea, or Premonitory Stage — Comparative infrequency of, . 30 Question of Contagion of Cholera — Observations on, . . 30 Table showing the proportion of Towns in Ireland attacked by Cholera, ........ 34 Cholera Map, ...... to face p. 38 Eeplies of Medical Officers on subject of Contagion, . . .39 Recommendation as to measures in event of future visitations, . 41 Domestic visitation — Observations on, . . . .42 Vlll CONTENTS. APPENDIX A. Forms, Circulars, Orders, and Returns under the Temporary Fever Acts. No. Page 1. Instructions for the erection of Temporary Fever Wards and Bedsteads, ........ 43 2. Plan and Section of Temporary Fever Ward, . to face p. 43 3. Drawing for an Economical Bedstead, . . to face p. 44 4. Scale of Remuneration to Medical Officers, . . . .45 5. Circular recommending Sanitary Measures for adoption by Relief Committees, ........ 45 6. Letters to the Relief Commissioners respecting Rations proposed for the Destitute Poor, ....... 48 7. Form for Weekly Report of Patients in Temporary Fever Hospital, 52 8. Form for Weekly Report of Diets and Stimulants ordered for Patients in Temporary Fever Hospital, . . . .53 9. Form for Inspector's Report, ...... 54 10. Do. to show the Particulars of the Cases in the Temporary Fever Hospital, . . . . .55 11. Do. to show the Particulars of the Cases of Persons 111 at their own Homes, ..... 55 12. Minute of Central Board of Health respecting the amount of Remuneration that they deem fit to be made to Medical Officers appointed under the Temporary Fever Act, . . .55 13. Order for the Regulation and Management of Temporary Fever Hospitals, ........ 57 14. Table showing the order in which Requisitions were issued for the provision of Temporary Fever Hospitals and Dispensaries, . 60 15. Table showing the Number of Patients treated under the Temporary Fever Act, in the principal Towns, . . . .66 16. Table showing the Number of Patients treated in Temporary Fever Hospitals, in monthly periods, . . . . .68 APPENDIX B. Orders, Circulars, Forms, and Returns under the Nuisances Removal and Diseases Prevention Act. 1. Observations of Commissioners of Health respecting Cholera, and Instructions relative to Precautions, . . . .70 2. Directions and Regulations for Preventive Measures, . . 74 3. Qualifications of Medical Officers, ..... 76 4. Form for Hospital Return, . . . . . .77 5. Form for Dispensary Return, ...... 78 6. Table showing the Number of Cases of Cholera reported from the principal Towns, ....... 79 RE PO RT of THE COMMISSIONERS OF HEALTH, lRELAND, ON THE EPIDEMICS of 1846 TO 1850. TO HIS EXCELLENCY GEOBGE WILLIAM FREDEEICK EAEL OF CLAEENDON, K.G., LORD LIEUTENANT GENERAL AND GENERAL GOVERNOR OF IRELAND. May it please Your Excellency. In compliance with the request conveyed to us in Sir William Somerville's letter of the 29th of August, 1850, we beg to laybefore your Excellency the following Report. The failure, to a considerable extent, of the potato crop, in the autumn of 1845, had early awakened the attention of Her Majesty's Government to the suffering and distress that must necessarily result to a population whose means would not enable them to obtain grain food as a substitute for their ordinary diet. Among the consequences to be dreaded from this calamity was a visitation of epidemic Fever, for experience had shown that a scarcity of food in Ireland, if of any considerable duration, had been invariably followed by an epidemic of Fever. "With the view of providing measures to meet this apprehended danger, the Temporary Fever Act, 9 Viet., cap. 6, was enacted on the 24th March, 1846, under the provisions of which it became the duty of the Commissioners of Health to issue such requisitions for the providing of medical relief for the poor of Ireland, suffering under Fever and other epidemic diseases, as might appear to be requisite. The Summer of 1846 passed over without producing much cause of alarm, and the applications for the intervention of the Board having only amounted to seventeen, the sittings of the Board ceased in August of that year. B 2 2 Report of the Commissioners of Health, Ireland, The potato crop having again failed in 1846, the effects of this second failure were severely felt in the succeeding winter, of 1846-7, when potatoes rose to seven shillings per cwt., the price in 1845 having been only two shillings per cwt. Want of employment and of food began to give rise to great suffering. Eeports of the appearance of Fever were received from various parts of the country ; and the returns from the hospitals of Dublin beginning to show an increasing prevalence of Fever in the city, the Earl of Bessborough, then Lord Lieutenant, reappointed the Board of Health in February, 1847 ; and from that date the Board continued its sittings daily, until the termination of the parliamentary session, in August, 1850. The state of the medical institutions of Ireland was unfortunately such as peculiarly unfitted them to afford the required medical aid on the breaking out of the epidemic, The county infirmaries had not provision for the accommodation of fever patients. The county fever hospitals were destitute of sufficient funds, and dispensaries, established for the purpose of affording only ordinary out-door medical relief could, of course, afford no efficient attendance on the numbers of destitute persons suffering from acute contagious diseases in their own miserable abodes — often scattered over districts several miles in extent. In February and March, 1847, the applications for the intervention of the Board became numerous, as will be seen from the following epitome :—: — Number of applications received in each month of the years 1847, 1848, and 1849, for the provision of temporary hospital accommodation. 1847. 1848. 1849. February, - 14 January, - 15 January, - 9 March, - 51 February, - 18 February, - 15 April, - - 53 March, - 10 March, - 13 May, - - 52 April, - - 15 April and) 9R June, - 22 May, - - 21 May, J ZD July, 60 June, 10 June, 10 August, - 48 July, - - 9 July, 8 September, - 10 August, - 4 August, - 3 October, - 8 September. - 3 September, - 1 November, - 13 October, - 10 December, - 12 November, - 19 December, - 14 Total, - - 576 Requisitions for the provision of hospital accommodation were not complied with in all cases, as in some instances it On the Epidemics of 1846 to 1850. 3 appeared, on the necessary inquiries being made, that the relief demanded was not absolutely required. In every instance in which an application was made, the following form of inquiry was forwarded : — APPLICATION FOR CERTIFICATE OF THE BOARD OF HEALTH, Under sec. 2, of 10 Vie, cap. 22. "1. Name of Electoral Division or Divisions respecting which the application is made ; and name of Union in which comprised. "2. Whether there is any, and what Hospital accommodation already available for the district, or any Dispensary. "3. District (stating the Electoral Divisions) from which such Hospital or Dispensary relieves patients. " 4. Name of Medical Officer of such Hospital or Dispensary. " 5. If there is no Hospital available for the District, state the nearest Hospital, and its distance. " 6. Extent to which Fever or other Epidemic Disease prevails in the Electoral Division or Divisions to which the application relates ; stating, as nearly as may be, the number of cases which are not in any Hospital. " 7. If it be desired to provide temporary Hospital accommodation for the District, state the number of Beds for which the Relief Committee consider it necessary to provide. " 8. And the name of the locality which it is proposed to select for the Hospital. " 9- Whether a fitting house is procurable for the purpose, or whether It is proposed to provide temporary sheds, of which Plans can be furnished by the Board of Health. " 10. Has a Relief Committee been constituted under the Temporary Relief Act, 10 Vie, c. 7, for the Electoral Division or Divisions to which the application relates ? "11. Is the application approved by the Inspector of the Union ? "12. Population, and length and breadth in miles of District ; and any additional observations that may be deemed necessary. " The Central Board of Health consider it preferable, on economical and other grounds, that where Hospital accommodation is required for adjoining or neighbouring districts, one Hospital, placed in a central position, should be made to serve for such districts, rather than that small separate establishments should be provided ; and it is recommended that, where practicable, communication should be had with the Relief Committees of adjoining Districts, as to the amount of Hospital accommodation that may be requisite. Signature of Chairman of Relief Committee or Committees. Date and Post-town. Signature of the Inspector of the Union. If still further inquiry or information were deemed necessary by the Board, a Medical Inspector was then directed to inquire into, and report on the extent of disease in the district. The aggregate number of applications from Eelief Committees and Boards of Guardians amounted to . . 576 The requisitions granted by the Board for the provision of hospital accommodation, amounted to .373 The number of applications refused was . . 203 Report of the Commissioners of Healthy Ireland, 4 The dates of the requisitions for hospital or dispensary relief may be considered as indicating, to a certain degree, the rise and progress of the epidemic in the different localities ; and, in accordance with this view, the requisitions issued from February, 1847, are stated in the order of their dates in the table in the appendix (see appendix, A. No. 14). In the principal cities and towns, Dublin, Waterford, Cork, Limerick, Galway, and Belfast, the following was the order of the requisitions issued : — Dublin . . .4th May, 1847. Waterford . . . sth „ „ Cork . . . 17th „ Limerick ? . . 24th „ „ Galway . . . 29th „ „ Belfast . . . 13th Nov., „ In Sligo, proceedings were taken under the 48th George 111., cap. 47 ; the Commissioners are, therefore, unable to give any return of the rise and progress of the epidemic in that town. The table (see appendix, A. No. 15) will show the progress of fever from July, 1847 (when weekly reports first began to be regularly furnished to the Board), until the month of August, 1850, when the Temporary Fever Acts expired. From these returns it appears that the total number of persons treated within the above period of three years and two months in hospitals, provided under requisitions of the Board of Health, wns 332,462, and that of these, 34,622 died, showing a mortality of ten two-fiths per cent, on the number of patients received into hospitals. The proportions of the sexes were as follows :—: — Total Number. Number of Deaths. Mortality per Cent. Males 158,759 17,800 11] Females 173,723 16,823 9-^ An opinion has been entertained by many that the mortality in Fever is less among the poor lying out under temporary sheds, in dry ditches, or in their own wretched cabins, than among those received into hospital. This, however, is a fallacy which has been corrected by the reports of our Inspectors. It arose from the circumstance, that the deaths of all who die in hospital are registered ; but there is no record of those who perish on the road sides, or in their own abodes — the deaths that occurred in such circumstances being very frequently unknown, even among the neighbouring inhabitants, until the bodies of those wllo had died were discovered by the Medical Inspectors. On the Epidemics o/1846 to 1850. 5 The mortality of different periods and places, occasionally differed widely from the general average mortality. On some occasions the rate of mortality increased to 15, and even to as high as 29 per cent. With a view of ascertaining whether such high rates of mortality could be traced to any particular causes, the following Circular was issued to the Medical Officers of hospitals wherein the mortality for the half year exceeded 15 per cent. : — (copy circular.) " Sir — I am directed by the Central Board of Health to draw your attention to the half-yearly return of patients treated in the hospital at under your care, from which it appears, that during the half- ¦ , the mortality has been per cent, (there hay- year, ended ing been admitted patients, died, , remaining). As this rate of mortality from Fever is so much beyond the usual average in Ireland, the Commissioners will feel obliged for any information in your power which may tend to account for the same. " I have the honor to be, Sir, " Your obedient Servant, "W. H. Hoppeb, Secretary. " To Medical Officer." c "Report of the Commissioners of Health, Ireland \ r~ ¦ 00 I—l I I ° I . M 3 -B 4 4 *& i~ CO O> 00 I as' . *i i f J s S° ill 2 j* a' q o_ •s s rill i ii a s i | a | islifn i liriS. till ill. fsiliiS -«j H H J.dUA4L[«4 (^ Ci Ci OO -jojoo s^a °* N °* •QTTTOD/-T 1~1l ~ 1 O 00 O ST l+«°Q >_> r-4 CO jo laqum^ ¦"• o « *> !h CO O O f I § 1 "S I S a fe a >3 3 l^; _ "]¦* -„ i^^ -•toK jo sa^y; co oo i— i »O C? 00 O O> 00 C* 00^ O_ "<* r-? r-T t-T •*; • » - ¦a II ' *S | 1g& £ 1 h o m m •.• • v • • a • • ' . I • " ' j I ' if 1 1 1 I a § a a 10 Report of the Commissioners of Health, Ireland, J o O i— i i I I to R as ••* 00 i-H W hi to o £ rt ¦m"d g «. r -i r-c ,_, ,_, -¦Bjjoj9quin^[ «> «o o o rt o c» r-T I ••-..¦ • • i-H 1 § If til I f J r si On the Epidemics of 1846 to 1850. 11 I -s £ i 4 i i S S- i-i i-H CO r-l «> •.•.• . • • * * | I i | If i gssk w a 5 £££5 £ £ P II- I- if- II- II- S fil 111 if II **| ill i ill sfl II 111 PI iiU I ||| O5 o o 52 "2 rH tN C*_ O CO O 1 S" '• «f I o | 1 i 1 I I II £BoM M O v S » t • L«i • I • » o 1 j 'fill 12 Report of the Commissioners of Health, Ireland, With regard to the type of disease, at different periods of the epidemic, which, with its complications, principally of dysentery, purpura, diarrhoea, and small-pox, has been, perhaps, unparalleled for duration and severity, the following abstracts from reports of Inspectors and Medical Officers, will afford some useful information. It may be stated in general terms, that the malignity of the disease, and of its complications, seemed mainly to have depended on the lowered state of constitutional strength induced by famine o : — PROVINCE OP MUNSTEE County Cork, Bandon Union, 18th March, 1847 (Dr. Stephens). — " The fever is of a low typhoid character, and though not fatal, still convalescence is slow." Waterford Union, Waterford, 23rd 'March, 1847 (Dr. Mackesy) " Fever has been steadily on the increase since November last ; it is not of a malignant character.'' County Cork, Slcibbereen Union, 20th April, 1847 (Dr. Goodison) " Few houses can be said to be altogether free from either fever or dysentery. A new disease appears to have arisen here, under the form of Anasarcous swelling of the lower extremities, without previous fever or dysentery." Waterford Union, Waterford, 13th September, 1847 (Dr. Courtenay) " The type of fever that at present prevails is the mild typhoid, with great prostration of strength, the general duration being 1 4 days, with great tendency to relapse in all cases, and these occur three or four times ; the general determination has been to the abdominal mucous surfaces, gastro enteritis, dysentery, &c, &c, and, in some cases, to the respiratory organs, viz., typhoid pneumonia, pleuritis, and asthmatic bronchitis. The general sequela, and rather an extraordinary one, is erysipelas of the face, which has occurred frequently and severely since the Ist of February. Phlegmonoid has occurred in some cases, but it did not prevail epidemically in the city, nor could it be attributed to want of sufficient ventilation ; the other sequela were enlarged parotidgland, and abcess opening at external meatus — purpura in the young subject. Dysentery at present prevails to a great extent, connected with, and often independent of fever." County Cork, Midleton Union, Midleton, sth October, 1847 (Dr. Courtenay) — " Dysentery prevails here to a great and fatal amount, in fact it is more to be dreaded at the present time than fever." County Cork, Kinsale Union, Nohoval; 16th October, *lB47"(Di\ Courtenay) — " The type of fever here is the simple continued^ and a few cases of exclusive typhus ; the usual duration i 3 from five to eleven days, with a peculiar tendency to repeated relapses — out of 250 cases, 240 relapsed.'' County Kerry, Tralee Union, Dingle, 21st November, 1847 (Dr. Burton). — " The fever which prevailed was short in its duration, but most liable to relapse, no matter what means were taken to arrest it ; it has usually been followed by dysentery and diarrhoea. The was generally from six to eight days ; it was attended with as much debility and emaciation as if the patients had been confined- to bed for weeks. The mortality from dysentery was considerable.'' County Limerick, Kiimallock Union, KUmoMoGk, 30th November, 1847 On the Epidemics of 1846 to 1850. 18 (Dr. Burton). — " The general type of fever is low, but mild, with a few petechial cases ; typhus in about the proportion of one to ten ; there is a great tendency to relapse, followed by gastric irritation and debility, with diarrhoea." County Tipperary, Nenagh Union, NenagJi, 11th December, 1847 (Dr. Burton). — " Fever here appears to be of the short relapsing type in two-thirds of cases, the remainder spotted typhus ; usual duration of attacks four, five, or six days ; head symptoms, pains in the joints, and hands, and top 3 of fingers, were very common ; scarlatina occurred in a few instances ; on an average more females than males have been attacked in this locality ; bad or deficient food in all instances may be considered the causes of fever of short type." County Corky Skibbereen Union, SMbbereen, 7th September, 1 848 (Dr. Hill). — " Variola is very prevalent in this district ; there are at present Dot less than seven cases in hospital. The Medical Officer states, that during the months of May, June, and July last, 1 1 0 cases of variola were treated in the temporary hospital, of whom very few had been vaccinated." PEOVINCE OP CONNAUGHT. County Mayo, Westport Union, Newport, 3rd May, 1847 (Dr. Daly) " Fever, dysentery, and diarrhoea are greatly on the increase. The type of the fever is not typhus, as seen in Dublin and country practice in former years, when famine did not prevail ; but is entirely gastric, begining with vomiting, pains, headache very intense ; and, as I am told, coming to a crisis in about seven days, relapsing again once or twice, from which death occurred through mere debility or diarrhoea, caused and kept up by bad food, principally Indian meal, supplied to them in small quantities, and which they invariably swallow after only a few minutes' boiling, and sometimes cold and raw. The greatest mortality is among the labourers, men and women, on public roads, in cold, wet, boggy hills. The fever begins with racking pains, headache, and shivering, all which symptoms vanish in about two days ; they then appear free from pain, prostrate, dozing, and sink on the fourth or fifth day — no vital power or means of reaction appears in them." Galway Union, Oranmore, 7th May, 1847 (Dr. Daly). — " The type of fever is typhus, much more of it than in Mayo, where gastric fever nearly as fatal ensued. Here the use of bad shellfish is more in vogue than in Mayo, and this horrid diet produces typhus, and bowel complaints, anasarca of face and limbs, &c. I have made a calculation with the aid of the priest and doctor, and from my own observation, am satisfied, three-fourths of the population (1,000) of the town, are now ill of such disorders." Roscommon Union, Roscommon, 11th October, 1847 (Dr. Freke). — " The type of the fever which prevailed in this district was, in far the greater proportion of cases, of low adynamic form, general debility set in early, and, in almost every case, petechial of a measly character occurred. The duration was generally short, the fever usually terminating on the seventh, ninth, or eleventh day by profuse perspiration. Relapses were so common as to appear characteristic of the epidemic — in several instances they have occurred so frequently as three, or even four times in the same individual. In many cases a deep jaundiced hue pervaded the entire surface of the body, and, in several, there was considerable cerebral disturbance.'' Report of the Commissioners of Health, Ireland, 14 County Leitrim, Manorhamilton Union, Manorhamilton, 13 th October, 1847 (Dr. Roughan). — "Character of fever has been synocha and typhus, the latter preponderated in the proportion of four to one ; the synocha was seldom of longer duration than eight days, tendency to relapses about the fifth or sixth day of convalescence. " A great number of patients, when convalescent for a fortnight, were attacked by typhus fever. " The typhoid form was complicated with a red measly rash in almost every case. The head was the particular organ engaged.'' Sligo Union, Collooney, 20th November, 1847 (Dr. Freke) "Two types of fever (I am informed by Dr. Armstrong) have prevailed in this district, one was a mild inflammatory character, the ordinary duration of which was from eight to twelve days, and was usually followed by a relapse ; the abdominal mucous membrane was chiefly engaged, and the most common sequela were anasarca and general debility, with loss of appetite. The second form of fever was of a typhoid character, was much less general than the other, continued its usual course, was not subject to relapses, was frequently complicated with cerebral affections, as also with affections of the chest and abdomen, and demanded stimulating treatment. The other diseases prevalent with fever were dysentery and diarrhoea." PROVINCE OP LEINSTER: County Wicklow, Rathdmm Union, Wiclclow, Ist September, 1847 (Dr. Oourtenay). — " The fever is of a mixed nature, with several cases of maculoe, the determination usually to the respiratory organs, also in several cases gastritis — sequela in some cases, viz., an attack of small-pox, swelling of the glands, particularly the paroted. Out of one hundred cases, eightyfive relapses." County Wexford, Enniscorthy Union, Killegney, 7th September, 1847 (Dr. Courtenay). — " The fever is of a gastric character, going on into gastro iuteritis, duration from five to fourteen days, and, in most cases, a determination to the abdominal mucous surfaces ; in a few cases the chest was the seat of determination. The tendency to repeated relapses is one of the moat peculiar features of thi3 epidemic ; in every case there were relapses. " Purpura has occurred as a sequela in a great number of young patients ; but dysentery has been, as a general rule, the sequela in all cases.'' County Meath, Trim Union, Trim, 24th September, 1847 (Doctor Freke). — "The following is a condensation of what I have been enabled to collect from Dr. Lamprey, with regard to the character of the disease : " He informs me, that he has observed four distinct types of fever to occur in the present epidemic. The first and most numerous are cases of simple continued, and average fifty-five per cent. ; the period of the disease generally lasts nine days, without any marked complication, nor attended with any sequela ; great tendency to relapse, which has occurred in nearly all cases under treatment. " The type of the order of fever observed by Dr. Lamprey to be second in frequency is typhoid, and of 21 days duration, and is liable to relapse; it has occurred in the ratio of twenty-three per cent. " The third kind of this fever, which has received the name of yellow fever, is characterised by the jaundiced appearance of the skin, gastric and On the Epidemics of 1846 to 1850. 15 hepatic symptoms, accompanied by severe head complications, and attended with great perspirations. This type occurs at a ratio of eighteen per cent. " The fourth type observed by Dr. Lamprey is stated to be the rarest, and to be pure typhus, attended with an ecanthematous eruption and dothinuteric symptoms. These cases have occurred only in a ratio of four per cent." King's County, Tullamore Union, Tullamore, 21st December, 1847 (Dr. Burton). — " In this district the ordinary fever is spotted typhus, occurring in proportion of five out of seven, and appearing even in the youngest children ; duration of attack, twenty-two days. " A few cases of a mild ephemeral fever, enduring about seven days ; complications generally of head, abdomen, and chest. Incidental diseases — dysentery, scarlatina, measles, jaundice, purpura." County Kildare, Athy Union, Balhjlinan, 4th January, 1848 (Doctor Burton). — "The type of fever was a kind of typhoid, subject to remissions ; the average duration of attacks about five days. In one- fourth of the cases spotted fever occurred, averaging twenty-one days. " Incidental diseases were chiefly dysentery, purpura, and a great deal of scurvy, with some cases of yellow fever, the symptoms of which were great irritability of stomach, prostration of strength, tar-like stools, blue extremities, and loss of heat — in these cases stimulants had little or no effect. These cases were generally fatal." County Longford, Oranard Union, Granard, 27th May, 1848 (Doctor Courtenay). — " The type of fever prevailing here is of a typhoid character, in fact I have never seen so many cases of a bad maculated character as in this hospital; the duration is from fourteen to twenty-one days, usually complicated with dysentery, the determination being, in most cases, to the alimentary mucous surface ; no marked sequela, but a very great tendency to relapse." PROVINCE OF UtSTEE County Armagh, Lurgan Union, Portadown, 29th September, 1847 (Dr. Roughan). — " The number of patients in hospital is 268, of these there are at present only four cases of maculated typhus fever ; the fever generally ends about the 11th day, and then, in broken constitutions, generally followed either by dysentery or anasarca, or both combined ; most all patients relapsed on the fifth or sixth day of convalescence into a fever of shorter duration than the original one. No cases of purpura occurred in the hospital — several in the dispensary practice ; six cases of small pox were admitted." Counties Antrim and Down, Lishurn Union, Ilittsborough, Ist October, 1847 (Dr Roughan). — "Two forms of fever have been observed in this hospital since its commencement, viz., simple inflammatory fever, and typhus, with a petechial eruption ; the former predominated, and was of a very mild character, its duration being from eight to fourteen days ; vomiting caused much torment to the patients at the beginning — this symptom was always accompanied by tenderness in the epigastric region, much increased by pressure; relapse occurred in almost every case suffering under this form of disease." County Tyrone, Omagli Union, Dromore, 27th October, 1847 (Dr. Roughan). — " Typhus was the character in four-fifths of the fever admitted, all cases accompanied either by petechise or maculae, the latter more IB Report of the Commissioners of Health, Ireland, frequent, in the form of large purple spots scattered over the body, arms, and legs, appearing about the fifth day of the fever, and disappearing about the tenth or twelfth ; in many cases those spots were followed by an eruption, somewhat like purpura." County Cavan, Bailieborough Union, Kingscourt, 30th June, 1848 (Dr. Hill) — " The fever now prevalent is of a mild type, its prominent symptoms being headache, nausea, or vomiting, and acute pains in the limbs, the ordinary duration is from nine to eleven days ; but the tendency to relapse is so strong, that very few escape without one or more secondary attacks, and the convalescence is generally tedious; maculated cases are now seldom seen." "We abstain from entering into any observations on the details of treatment for the following reasons :—: — To render deductions as to treatment satisfactory, it would be necessary to be assured that the cases compared should be of like character and type — a condition which it would be impossible to attain, as the cases in different institutions, in different parts of the kingdom, must be subject to constantly disturbing causes, arising from varieties in locality, constitution, diet, previous habits and employments, &c, and even from hospital arrangements. Satisfactory results as to varied modes of treatment of most diseases, can only be arrived at by practitioners who, deducing their results from instances under their own immediate observation, can thus assure themselves that their observations are made on cases of the same nature. Moreover, details of medical treatment being matters purely professional, would not, perhaps, properly come within the scope of this report. It is, perhaps, scarcely necessary to observe, that this epidemic, like all former similar visitations, assumed a contagious character, and that the mortality was great among the upper classes — Clergymen, members of Relief Committees, Inspectors, and Medical Officers, whose duty, or whose benevolence, exposed them to contagion. Of 473 Medical Officers appointed under the Temporary Fever Acts, 36 died during the prevalence of the epidemic. Emigrants from Ireland carried the disease to Liverpool, and to several ports in North America. Fever thus imported into Canada was, according to reports which have already been published on the subject by the local authorities in that country, exceedingly fatal. We do not deem it necessary to give any meteorological tables for the period of the epidemic, as those already published in the various scientific journals do not show that there was any remarkable deviation from the ordinary climate of the country during its prevalence. SMALL-POX. Small-pox prevailed to a considerable degree during the year 1849. In the month of December in that year, a circular was On the Epidemics of 1846 to 1850. 17 addressed to all the Medical Officers employed under the Temporary Fever Acts, requesting information as to the number and nature of the cases which came under their notice within the year. The returns show a total of 7,319 cases for the year 1849 ; but this scarcely approximates to the real number, for (as observed by some of the Medical Officers) — " relief is not applied for except in very dangerous cases, and the number stated is but a small proportion of the cases that were in the district." Again — " it is only where there is immediate danger of life that a medical man is called in, lest he might be obliged to prosecute the inoculator. The people" (in the provinces) " are generally steadfast in the old practice of inoculation of smallpox." The increased prevalence of small-pox was, no doubt, attributable, in some degree, to the continuance of the practice of inoculation, but more to the want of an efficient system of vaccination ; the Guardians, in many instances, having omitted to make contracts, or having allowed vaccination contracts to expire, thus leaving the poor to the alternative of inoculation as their only protection against small-pox. But as these circumstances did not peculiarly belong to any one year, they do not appear to be in themselves sufficient to account for the increased prevalence of small-pox at this particular time, and still less for its peculiarly malignant character. It was not in the power of the Medical Officers to give accurate returns of the mortality from small-pox ; but their accounts nearty all agree in representing the disease as having generally presented a confluent character and malignant t3 r pe. The following are returns from hospitals in Dublin : — Fever Hospital and House of Recovery, Cork- street. Statement of the number of cases of Small-Pox received into Hospital during the past eleven years, distinguishing the number of Deaths, and whether Vaccinated or not Vaccinated. Years. Admitted. Vaccinated. Not Vaccinated. Died. l«40 28 9 19 3 1841 4 13-1842 33 13 20 5 1813 12 2 10 2 1844 2 111 1845 90 15 75 1!) 184(3 17 2 15 3 1847 10 1 9 2 1848 28 5 23 6 1849 105 19 86 30 1850 47 9 38 10 i 18 Report of the Commissioners of Health, Ireland, Haedwick Fever Hospital. Statement of the number of cases of Small-Pox received into Hospital during the past eleven years. Years. Admitted. Vaccinated. Not Vaccinated. Died. 1840 - 1841 1 1842 23 - - 5 1843 17 - - 4 1844 6 1845 70 - 16 1546 39 - - 9 1847 20 - - 8 1848 47 - - 9 1849 106 46 1850 99 38 61 31 No account of the disease kept prior to 9th September, 1841. The particulars of Vaccination commenced to be taken in the month of February, 1850. FOOD The failure of the potato crop fell with peculiar severity on the laboring class of Ireland — the peasantry generally depending for their food not on money -wages, but on potatoes raised by their own labor — for which there was otherwise little employment at certain seasons of the year. Hence, on the failure of the potato crop, the difficult problem presented itself, of not only furnishing food to the poor at the lowest price, but of providing them with employment, in order to enable them to purchase it. The reports of the Relief and Poor Law Commissioners show the gigantic efforts made to meet those difficulties. We have, however, only to deal with the effects of the failure of the potato crop in a dietetic point of view, and its bearing on the production of fever ; and we are of opinion that even had a full supply of grain food been obtainable instead of the potato, there would still have followed a considerable amount of disease. The following are briefly the grounds on which we advance this opinion :—: — Chemical investigation has shown that the potato has a peculiarity distinguishing it from almost all other vegetables and kinds of grain used as human food. Although affording an inferior nutriment in proportion to the bulk consumed, from its consisting of about three-fourths water, it nevertheless contains in its composition nearly all those elements of nutrition that exist separately in most other vegetables and grain, and are, therefore, only to be obtained from most other articles of food by combining together different kinds. Hence, the potato can be used singly for support and nutrition ; while in using other vegetable products there is required a combination of various On the Epidemics tf/1846 to 1850. 19 kinds to furnish the varied elements that are necessary for the growth and support of the human body. In ignorance of this, rich and poor alike fell into error, in attempting to substitute some one article or other of food, as a sufficient equivalent in itself for the potato. The poor, forced by necessity, attempted to support themselves on whatever grain they could obtain ; the rich, moved, by the best motives, made the greatest exertion to substitute for the potato some other vegetable, such as they were led to believe furnished the staple food of the people of other countries. Rice was one of the main articles which presented itself; and the popular, but erroneous idea, that it furnished the sole article of food for whole nations, led to an attempt to make it a substitute for the potato. Rice alone, however, is not anywhere the sole support of any portion of the human race. Experience or instinct has taught those who use it as a chief article of food that, of itself, it is not adequate to support life, and hence, there is always consumed with it in those countries where it is generally used, oil, dal, or some other vegetable, seed or grain, meat or fish, in order to add to the rice such of the elements of nutrition as it does not in itself contain. Thus, even if a full supply of grain food had been obtainable, the great bulk of the people would have consumed it, ignorant of the need of those combinations that are requisite in its use, and disease, to a considerable extent, would have resulted, until experience and information had corrected the error. A frequent mistake connected with the introduction of rice was the supposition that the bulk acquired by boiling afforded an indication of the quantity of nutriment contained in such bulk. With the view of correcting this error, we issued several communications on the use of rice and other articles of food, and the following extracts from some of those communications will explain our views on those points: — " The Board of Health cannot hesitate to assure the Relief Commissioners, that rice, instead of being superior, is much inferior to Indian corn meal in nutritious qualities. "It is true that rice, by steeping and boiling, may be made to furnish a larger bulk of apparently solid food than will be furnished by an equal quantity of Indian corn, and hence has probably arisen the supposition of its being more nutritious ; but the bulk thus obtained is deceptive as to the quantity of nutriment afforded. Rice contains about eighty-five parts in every 100 of starch ; a given quantity of it will, by steeping and boiling, absorb a very large proportion of water, and will swell into a large and apparently firm mass ; but this mass will contain a very small proportionate quantity of nutriment. A very simple experiment will satisfactorily illustrate this — one ounce of common starch boiled in the ordinary way will form, with a pint of water, a firm mass, which, from its apparent consistency, w 11 seem to be good substantial food ; but the bulk thus formed, it is obvious, contains very little nutriment. In like manner of rice — one pound of it may be made to form, with water, a starchy mass of five or six pounds weight ; but the produce, as in the experiment of the starch, is bulk, without equivalent nutriment. The Board of Health are anxious that their observations 20 Report of the Commissioners of Health, Ireland, on this subject should be clearly understood and widely disseminated, as the error is very generally prevalent of supposing, that in using rice or other similar substances, an amount of nutriment is afforded equal to the bulk gained. The Board of Health do not at all object to the use of rice as food ; on the contrary, they highly approve of it, provided it be furnished in sufficient quantity. " The Board of Health are fully aware how necessary, and how pressing, at the present timej is the exercise of the strictest economy ; but they are also convinced, that if the use of a diet be permitted, containing too large a proportion of fluid, deficient in the due quantity of nutritious elements, and deriving its solidity principally from the presence of starch, the result must necessarily be, in those living on it, debility of constitution with consequent inability to resist disease, and ultimately, increased expenditure in the cost of relief, instead of saving. " For these reasons, the Board of Health deem it important that the principle laid down in their previous communication of 11th May, should be strictly adhered to, viz. : — that rations should be given out cooked, and in as solid form as possible, and that they should be estimated, not by the bulk when cooked, but by the rule that each cooked ration should contain the equivalent of one pound of raw meal, the quantity originally sanctioned by the Relief Commissioners and the Board of Health." It was also frequently proposed by Eelief Committees and Boards of Guardians, to lessen the rations when oatmeal was substituted for Indian meal, the former being erroneously supposed to be more nutritive than Indian meal. The two grains, however, differ so little in nutritive qualities, that the Board decided that rations, whether of oatmeal or Indian meal, should be of the same weight. Similar difficulties to some of those noticed in respect to the use of rice, existed in the attempts to substitute either beans or Indian corn as the sole substitute for the potatoes, viz., that neither of those articles of itself can be used like the potato as the sole article of support. Another error at the time of the failure of the potato, and the most generally diffused, was in the attempt to substitute for the potato itself what was very generally, but erroneously, called "potato flour," which was obtained in large quantities from rotted potatoes. This so called " potato flour" was, however, not flour in the proper sense of the word as applied to wheat flour, for it did not contain the elements of the potato, but consisted wholly of starch or fecula, and was quite unfitted to support health or even life for any considerable length of time. It was as erroneous to consider this starch as equivalent to the potato, as it would be to consider wheaten starch as equivalent to wheaten flour. Even among tradesmen and laborers on railways, who earned sufficient wages to buy good food, the result of the loss of the potato was seen in the production of scurvy or purpura, in consequence of their being unaware that variety of food was necessary to form healthy blood. Their diet was most frequently white bread and coffee, with sometimes animal food On the Epidemics of 1846 to 1850. 21 but yet, these articles not containing sufficient variety of elements, scurvy was the result. The same effect was seen in some public schools from similar causes. The following is an extract from a circular of the Board of Health of the 21st June, 1847, on this subject : — "While on the subject of diet, the Board of Health deem it of importance, through the medium of the Relief Commissioners, to draw the attention of relief committees, and of the people generally, to the fact, that a form of disease, now very prevalent among the people, resembling in many particulars sea scurvy, is connected with or dependent on a defective nutrition, arising not from deficiency of quantity, but from deficiency of quality or variety in the food. The potato, although not containing a large proportion of nutriment, is remarkable as containing within itself all the varied elements necessary for forming healthy blood — no one of the substitutes for it, with the exception of oatmeal, possesses this remarkable property ; and hence, the use of more than one article of food is necessary, in order to secure a sufficient supply of the varied elements of nutrition, and thus to obviate the form of disease referred to. " With this principle in view, the Board of Health, as the season of the jear now gives facilities for it, strongly recommend the admixture of onions, leeks, scallions, or shallots, in cooked meal rations or stirabout, which will both act as condiments, and will also furnish some of the elements of nutrition essential for forming healthy blood. Onions are so rich in nutritive qualities, that, as a mere article of food, one ounce and a half may be considered as equivalent to about one ounce of meal. On. every opportunity, the importance to health of using vegetables, such as carrots, parsnips, turnips, and cabbage, along with meal, should be impressed upon the people. "It may not, perhaps, be out of place in these observations, to make the people generally acquainted with the high nutritive qualities of beans and peas, which, weight for weight, contain from ten to twelve times as much nutriment as potatoes. In those countries where rice is very extensively used as the food of the people, experience has taught them that rice by itself has low nutritive qualities ; but that the deficiency can be supplied by adding about two ounces of beans, peas, or lentils, to each pound of rice. It must, however, be remembered, that with beans or peas, some other vegetable food must be used, as, although possessing in a high degree some of the most important elements of nutrition, they nevertheless do not contain a sufficient variety of other nutritive elements to support the human body in health." Another cause that existed, adding much to the production of diseases among the poor, was the use of raw or badly-cooked food. This engaged the earliest attention of the Commissioners. On the 10th March and 11th May, 1847, we addressed communications to the Belief Commissioners, of which the following are extracts :—: — " The Board of Health, however, suggest, that in all instances where practicable, the food should be given out in a cooked form ; as food, however good in itself, will, if not sufficiently cooked, not afford its fall supply of nutriment, and it will, moreover, predispose to attacks of dysentery and %% Report of the Commissioners of Health, Ireland, diarrhoea, now so prevalent through the country. They likewise suggest that the food given out should be varied occasionally — as for instance, on one day, that bread rations be given ; and on another, soup and bread ; or meal and rice porridge, with bread, &c. " The Board of Health now desire to draw the attention of the Relief Commissioners to the communication from the Board of Health of the 1 Oth March, in which they recommend, that 'in all instances where practicable, the food should be given out in a cooked form.' They are now, from reports which have reached them, anxious to urge on the Commissioners the necessity of taking measures to have this recommendation acted on, without exception, in all instances. The Board of Health feel it only necessary to observe, that they fear, unless the principle be fully carried into effect, of giving out the food only in a cooked form, there will be always both an abuse and a serious evil of another kind to contend with. The abuse is, the sale of raw meal, for which purchasers are always to be found, to whom even the poor requiring the food for themselves or family will dispose of it for money, tea, or tobacco ; and the serious evil is, the consumption of meal or rice, but more particularly Indian meal, in a raw or badly cooked state, which will predispose to, and aggravate dysentery and diarrhoea, already so prevalent through the country.'' The Board received from all parts of the country satisfac* tory communications of the improvement produced in the health of the people by the issue of well-cooked food. The following are extracts from some of the communications :—: — " Those districts in which 'eating houses' arc in full operation, show a great improvement in the sanitary condition of the people — many bad cases of fever and dysentery have recovered from the use of the food given them out of these sources of relief." " Fever and dysentery are of a much milder form than hitherto, and the deaths very few in comparison, especially in those districts where cooked food has been adopted for any length of time." " There has been a marked improvement in the health of the people generally since relief has been administered in food, particularly where it has been cooked. The prejudice which was strong against cooked food at the commencement has gradually yielded ; very many of the people admit they prefer it to meal. There can be no doubt that it has had a marked effect in checking bowel complaints. The districts most free from fever are those where cooked food has been the longest in use." " It is a remarkable fact, that in those divisions where cooked food is not used, fever and dysentery are, or have been, most rife." " Three weeks ago, when fever was rather abounding, the Relief Committee took up the idea of having fever sheds built ; but since cooked food has been given to the people, fever has, under Providence, astonishingly declined." The connexion between the scarcity of food and the prevalence of fever will be seen from the following table, which gives the prices of wheat, oats, oatmeal, and potatoes in the Dublin market, in periods of quarters, for four years, commencing in 1845, and terminating in 1850 :—: — 23 0^ Me Epidemics of 1846 1850. fl 1« -c « IS 3* g § I, I," s s O •- 1 - "^3 O CD O «D •n^v | s 2 * •tonußf "« » ® * * •j 9 qojo o " « « ¦A»r S « ° « •n^T | H « « •Xaanaof -3 o a. n o ri g = 2 c< go § o Report of the Commissioners of Healthy Ireland, v It is impossible not to be struck with the coincidence between the scarcity and consequent high price of potatoes and the prevalence of fever : — t s. d. In 1845, potatoes averaged 2 % per cwt. In 1846, „ „ 4 10 In 1847, „ ?8 4 „ In 1848, „ ?7 0 „ In 1849, „ „ 611 „ In 1850, „ „ 4 4 „ In 1845 there was no epidemic. In 1846 the scarcity was first felt, and fever began to show itself, and as prices still continued to rise in the winter of 1846, and spring of 1847, the effects of want of food were seen in an alarming increase of fever, and during the years 1847 and 1848, and greater part of 1849, the prices continued so high as to deprive the poor of their accustomed food, and notwithstanding all the long continued and benevolent exertions of Government and individuals, an epidemic of unparalleled severity and extent continued its ravages. The number of patients admitted into temporary fever hospitals, in 1847 was 95,890 1848 „ 110,381 1849 „ 87,135 1850 „ 39,056 The price of potatoes, although having fallen considerably in 1850, still averaged, it will be observed, double the price of 1845 ; but the injurious effects that would otherwise have still followed from the continued comparative scarcity and high price of potatoes, were counteracted to a very considerable degree by the cheapness of oatmeal, which fell, in the autumn of 1849, to 10,9. 6d. per cwt., and averaged during 1850, only 10.9. bd. per cwt. This was little more than double the price of potatoes, and as oatmeal in weight for weight contains above four times as much nutriment as potatoes, the peasantry, whenever they were by money- wages enabled to purchase oatmeal, obtained at little more than double the price of potatoes, a food that contained more than quadruple nutriment, which was a benefit equivalent to a reduction of about one-half in the price of potatoes. In the autumn of 1850, a cwt. weight of oatmeal could be purchased for 10*., equivalent in nutrition to more than four cwt. of potatoes, which would cost about 18*. But for this lowered price of oatmeal, it seems certain that the same amount of distress and disease would have continued to prevail in 1850 as in previous years. The people were not slow in discovering, that the advantage in economy and nutriment was on the side of oatmeal. In a communication received from an On the Epidemics of 1846 to 1850. 25 intelligent Inspector under the Drainage Commissioners, he observes — " As to potatoes, they are quite too expensive for ordinary food at present (February, 1851) ; even farmers who have large quantities of them prefer (through, however, motives of economy only) selling them, and living, with their servants, on oaten and Indian meal." It has often been desired, that the people of Ireland could be induced to turn from the potato to grain as their food, as tending to produce improvement in their habits, and as rendering them less liable to suffer from periodic famines. All attempts to effect this have hitherto failed. However, the knowledge that they have now acquired of the very superior nutritious qualities of oatmeal, and its price continuing to bear such a relation to the cost of potatoes, as to render its consumption often more economical than that of the potato, will, it would seem to us, eventually and certainly lead to the desired end. HOSPITAL ARRANGEMENTS — VENTILATION — EXPENSES OF PATIENTS. It has been already observed, that of 576 applications from local bodies for hospital accommodation, 203 were refused, and 373 were granted ; but even this number was far above what would have been requisite if the Board of Health had been able to carry out its views. The Board were most anxious in the outset, to establish hospitals only in suitable central situations, which hospitals might then, from time to time, have been enlarged or contracted as required, and the cost of erecting additional hospitals with all the expenses consequent thereon might have been obviated. Various obstacles, however, prevented this plan from being carried out. The amended Fever Act of April, 1847, clause 2, authorized the Commissioners of Health to issue certificates requiring hospital relief to be afforded in electoral districts ; but only according as the necessity for it arose in each electoral district ; the Board was thus precluded from directing hospitals to be erected in the first instance in central situations. Even where several electoral districts were so circumstanced that they might have been united with great advantage for the purpose of giving combined hospital relief, the several relief committees frequently refused to unite ; in some instances, from a desire to have each a separate hospital ; in other instances, from a reluctance to incur the expense of affording any hospital relief whatever. The consequence was, that notwithstanding the advice and remonstrances of the Board of Health, hospitals were established in much greater numbers than would have been sufficient, and expenses were thus incurred that might have been avoided. In some unions, as many as ten hospitals were erected; in others, eight; and, in very many, from four to seven ; the hospitals, in some cases, not being more than 26 Report of the Commissioners of Health, Ireland, two or three miles asunder. The bad effects of this were felt not only in the outset, by the erecting and maintaining of an unnecessary number of small hospitals with their separate staffs, but were continued when the epidemic had considerably declined ; for it was then often found impracticable to reduce them in proportion to the decline of the epidemic, as they were frequently so inconveniently and unsuitably located, that although there might be several hospitals in one union, no one hospital was sufficiently central in locality to serve for the accommodation of two or more electoral divisions ; and thus, during the decline of the epidemic, several small hospitals, each burthened with a staff sufficient for a large institution, were necessarily continued at an unavoidable expense. The experience of the late and of former epidemics shows that it is hopeless to expect that fever, once having made its appearance as an epidemic, can, by any sanitary precautions, be limited to any particular district. It will, therefore, be found most economical, should a similar visitation again take place, at once to provide hospital accommodation in central situations — such hospital accommodation will be available for large districts, and can be contracted or enlarged according to necessity. The multiplied and unnecessary expenses attendant on the maintaining numerous small hospitals would be thus obviated. Representations were, at different times, made to us from various Relief Committees, requesting our sanction to proposals for providing attendance on fever patients in their own homes, and supplying them there with medicine and nutriment. These we always discountenanced, on the grounds that it would be quite impossible, under any management, to treat cases of fever with advantage to the sick, or with a due regard to economy, in the houses of the poor, often scattered over an extensive district ; while there was, moreover, the very serious objection to the proposal, that the poor, ill of fever, lying with their families in ill-ventilated cabins, would propagate and indefinitely extend the disease. In a few instances, where the plan was introduced by Relief Committees, it was abandoned as being ineffective, and yet more expensive than hospital relief. As in many situations in the country, no buildings could be procured adapted for the purpose of fever hospitals, and as it became necessary to increase the accommodation in previously existing hospitals, Mr. Wilkinson, Architect of the Poor Law Commission, furnished the Board (in accordance with their suggestions) with plans for the construction of fever sheds and wooden bedsteads of a very simple and economical construction, which were found fully to answer the purpose (see appendix A, Nos. 2 and 3). It was a matter of great importance to furnish some simple and effective plan of ventilation for fever hospitals, and after many trials the following has been found to answer the purpose. On the Epidemics of 1846 to 1850. 27 A sheet of zinc or tin plate is punched (not drilled) with holes one-twelfth-inch diameter, and half an inch apart — thus prepared, it is inserted in place of a pane of glass in every window, or every alternate window, as required, care being taken that the side on which the burrs project is turned to the weather so as to throw off the rain. Neither wire-gauze nor perforated zinc of the ordinary kind will be found suitable, as both permit blasts of cold air and rain to pass through them, and the former is liable after some time to become choked with dust. Those who have had practical experience of the importance of ventilation to the sick, and of the difficulty of maintaining it, will appreciate the value of a simple plan that combines utility with cheapness, and which cannot be interfered with by the inmates of the hospital. In the appendix (Ap. A., No. 13) will be found the general order of the Commissioners for the internal regulation, attendance, and dietaries of fever hospitals. Proposals occasionally came before us for the employment of various disinfecting agents, as a means of destroying contagion, and thus destroying the epidemic. We did not feel ourselves authorized to sanction any expense in such trials; experience and experiment have fully shown that chemical agents may deodorise, but fail to disinfect, that the most fatal epidemics are often generated and extended in what (to our senses, and to all chemical examination) would seem to be the purest air, and that the most offensive odours are often habitually inhaled with impunity. It is also to be remembered, that none of the supposed disinfectants have the j)ower of restoring oxygen to the air ; it is evident, therefore, that disinfectant substances which deodorise, must still leave the air, as far as regards its proportion of oxygen, as unfit for the support of animal life as before, while the very destruction of the bad odours by any other means than by a free circulation of fresh air, would rather tend to divert attention from the only effectual purification of the wards of the sick — viz., by the free, and constant circulation of fresh air, in our opinion, the only effectual method of purification. These observations, however, are by no means intended to depreciate the use of charcoal, chlorides of lime and zinc, and of other deodorising substances for the destruction of the bad odours arising, during the emptying of cess-pools, or during the temporary removal of deposits from sewerage. The financial arrangements of the fever hospitals were not under the superintendence or control of the Board of Health, having been managed under the 10th Victoria, cap. 22, by the Relief Committees, and under the 11th and 12th Victoria, cap. LSI, by the Poor Law Guardians. The Board of Health, however, from returns furnished to them, made a report to Parliament in 1850, showing the cost of support of patients in temporary fever hospitals in the year 1849 (Parliamentary Paper, 442). The returns of expenditure were received from Report of the Commissioners of Health, Ireland, 2M the clerks of the unions in which the hospitals were situated, and this return shows that the average weekly cost, including salary of Medical Officer, was 4s. O^d. per patient. CHOLERA. Cholera having made its re-appearance in Europe in 1847, and continuing to advance in 1848 towards this kingdom, your Excellency was pleased, by an order in Council, of the 4th of October, 1848, to direct that we should carry out the provisions of the Nuisances Removal and Diseases Prevention Act, with reference to means for the prevention, as far as possible, of the predisposing causes of the disease, and for the medical care of the poor who might be attacked by it. With the view of promoting the early adoption of precautionary measures, and of having the necessary arrangements perfected in due time, we issued the following circular on the Ist September, 1848 (see appendix B, No. 1), previously to the appearance of the epidemic in this country, and having carefully watched the progress of the disease, and deeming that the time had at length come when it was advisable to issue the requisite legal authority under our hands, in accordance with the provisions of the act referred to, we issued, on the 7th December, 1848, the directions and regulations for carrying out the provisions of the act (see appendix 8., No. 2). The following table is so arranged, from reports forwarded to the Board, as to show the rise, progress, and decline of the epidemic : — 0« the Epidemics o/"1846 1860. 29 feJD I a •B in t3 a> M HH • CD o g 03 c 3 O >— ' pq S <* Q © J| O H 5-1 CC g i I ¦£ & w m O 5h O i 1 -I & 3 s o CD Ph o I 02 •jsnSny _ ¦onnjf " •Xronußp g U9C[UiaDB(I S •jsqrasAon S •joqopo S ¦jaqraajdss •jsnSny g •Xpif | •liiay "i 'XjßtijqSjJ o> •Xjßn üßf o § -Jaqmaoaa 3 5 =f * i i S So IS I l -" ! __i I 2 .s ~~ £ * £- I*! i . * H I o- i "" "" § I 5 ¦§ o * Is ? s § | 1 2 " a I no Report of the Commissioners of Health, Ireland, The rate of mortality on the whole number of cases was forty-two one-fifth per cent. This visitation was remarkable for the large number of children attacked. From the returns, it appears, that of the total number reported (45,698), the number of children attacked under seven years of age was 4,500. It also appears that in this epidemic the first or diarrhoea stage of the disease was not as distinctly marked as in former epidemics. Of the total number, 45,698 cases, 31,162, were preceded by a premonitory stage of diarrhoea, of varying duration ; while in 14,536 cases, or nearly one-third of the whole number, the disease at once showed itself in the stage of collapse, without any premonitory symptoms. The question of the influence which contagion may be supposed to exercise in the propagation of cholera is of the utmost interest, involving as it does the subject of preventive measures. We feel ourselves bound to state that the subject is still enveloped in great obscurity. Differences of opinion still exsit as to the contagious or non-contagious character of the disease ; but the weight of evidence is decidedly in favor of the opinion, that contagion has little, if any, influence in its propagation. Individual cases sometimes occur, which would seem to lead distinctly to the conclusion that personal infection did occur, but it must be always remembered that persons in connexion with the sick are equally with all others liable to be affected by the epidemic, and it becomes a matter of impossibility, under such circumstances, to determine in any given case whether the attack has proceeded from contagious or from epidemic influence ; but this objection does not apply to cases in which the disease has originated without previous exposure to contagion. If it can be established that the disease has appeared where contagion could not originate it, and if it can also be shown that the disease has not appeared or has not spread in circumstances in which there was full exposure to contagion, two points which we believe will be fully established in the following report, the conclusion will then, we think, be satisfactorily established, that contagion is ah element of little, if any, influence in the spreading of the disease. The following instance of the first appearance of the disease in the Convict Depot, Smithfield, Dublin, appears to prove satisfactorily that the disease may originate without the agency of contagion : — Copy of minute of investigation held by Commissioners of Central Board of Health, on Sunday, February %sth, 1849, at Smithfield Depot for Convicts, Dublin, to inquire into the case of John Mohan, convict, reported to have died of Asiatic Cholera. " John Mohan, convict, at 64, committed January 7th, 1848, never in hospital until last illness ; taken ill Saturday, 24th February, 1849, at 3 o'clock, p.m., with purging, cramps in abdomen and legs, rice On the Epidemics of 1846 to 1850, fll water vomiting, and stools, surface blue and cold, pulse almost imperceptible ; seen by Surgeon Rynd at half-past four o'clock ; six o'clock, p.m., again visited — symptoms slightly alleviated. Half-past ten, p.m., (next visit, when Surgeon Rynd remained till twelve o'clock) — Moribund; died at half-past three o'clock, a.m., 25th; duration of illness, twelve hours. " Previously to his illness, Mohan had been under the same circumstances as all the other convicts ; had no intercourse whatever with any person from without, nor with any within the walls except with his fellow-prisoners, and with the turnkey, whose only communication with him was unlocking the door of his cell in the morning, and locking his cell door at night. The turnkey is in perfect health. " No admission of prisoners since 1 lth January until 20th February, when ten prisoners were admitted from King's County, all in good health on admission, and who remained in good health ; these prisoners are in a different part of the building, and have had no communication with the deceased, as they do not belong to the same class of prisoners. " There are two night watchmen on duty, who go round the cells constantly during each night, and who instantly report any case, of illness among the pi'isoners to the hospital attendant, who is provided with medicines and directions for an emergency. " Francis Rynd, " Medical Superintendant of Convicts. " John Lamb, " Governor." A second case occurred on the 27th February, and seven new cases on the following day, the 28th, when the disease suddenly disappeared. It is important to state, that "the depot" which was constituted for the accommodation of 200 prisoners, contained at the breaking out of the disease above 300 inmates (3 being lodged in each cell instead of 2). On the 27th February 100 prisoners were removed to Newgate ; from that day no new case occurred in the depot or in Newgate, where the inmates of the convict depot were received. In the Hibernian School, Phoenix Park, an institution for the reception and education of the children of soldiers, the disease suddenly commenced on Wednesday night, 12th September, 1849, and continued until 3 o'clock on the following Friday, the 14th, when a perfect cessation seemed to take place. Within that period 69 children were attacked, of whom 21 died. The disease then became much milder, there being only one additional death up to the 9th October, when the disease disappeared. There were in the school at the onset of the attack, 303 boys, 43 girls. The total deaths were 21 boys, 1 girl. This school is remarkably well situated, on very high ground over limestone gravel, and with a considerable fall to the river Report of the Commissioners of Health, Ireland, 32 Liffey, which runs with a rapid stream over a gravelly bed, at the distance of 460 yards from the school, and 92 feet below the level of the parade or play-ground. The dormitories are large, airy, well ventilated, and not crowded ; and the children, prior to the attack, were remarkably healthy, the dairy average in hospital having been only 7. The children of the Hibernian School may be considered to have been almost as perfectly protected against contagion as the convicts in Smithfield depot. The attack, progress, and duration of the disease in these two instances present, in our opinion, the characters of an epidemic, not of a contagious disease. There is another very remarkable circumstance to be noted in connexion with the occurrence of cholera at the Hibernian School. The village of Chapelizod is situated on the banks of the Liffey, nearly at the point where the river approaches nearest to the Hibernian School, and is very much below the level of the School, the river being, as before observed, 92 feet below the level of the play-ground of the school. It is the seat of a flax-mill, and is densely inhabited by a poor population of 1,575 persons. This village, from its situation on the great western road, and from its proximity to Dublin, is more than usually exposed to the admixture of strolling mendicants and poor travellers, who might naturally be supposed to carry contagion with them ; yet while the Hibernian School, containing about 400 inmates, placed apparently in the most favorable locality, suffered so much, two cases only occurred during the whole visitation of the epidemic among the ill-circumstanced, poor, and crowded population of the village of Chapelizod. In the small village of Castleknock, about two miles from Dublin, and about one mile from the Hibernian School, also in a healthy, high, and dry locality, containing about 200 inhabitants, the disease suddenly broke out at 2 o'clock, p.m., on Saturday, the 25th of August, 1849, and between that hour and 2 o'clock, a.m., on Monday, 27th, a period of 36 hours, 25 deaths occurred. During the remainder of the 27th no new case ap^ peared ; occasional cases appeared up to 19th September, when the disease totally disappeared. Maynooth and Kilcock are two towns in the County of Kildare, on the great western road, of about equal size, each containing about 2000 inhabitants, and about four miles asunder, both great thoroughfares. In respect of inhabitants, as to mode of living, habitations, and employment, there seems to be a perfect similarity, or if there be any difference Maynooth has the advantage, but the difference in their liability to cholera was remarkable From the 7th June to the 3rd October, 1849, 141 cases occurred in Maynooth — 47 deaths — while not a single case occurred among the inhabitants of Kilcock. One case only occurred in the town, that of an officer of the railway, who travelled down in the train from Dublin. It is also remarkable, that during the previous outbreak of 1832, Kilcock was also free from any On the Epidemics of 1846 to 1850. 33 indigenous case; the only instance of cholera that then occurred was in the person of a visiter from Dublin to the races, while in 1832 there were in Maynooth 231 cases, 33 deaths. In the County Meath similar remarkable circumstances occurred in reference to the towns of Kells, Navan, and Trim. In Kells, containing 4,000 inhabitants, there occurred between the 24th June and 16th August, 1849, 330 cases, 156 deaths. In Navan, containing about 5,000 inhabitants, there occurred during the whole time of the visitation of cholera only 38 cases, 16 deaths. In Trim, containing 2,000 inhabitants, only six cases occurred; of these, one was a gentleman who "was sick on his arrival. The second, a poor labourer, who came sick into town from a distance of four or five miles. The other four were among residents, at different periods in the months of July, August, and September, and in every instance confined to the first attacked, although in some of the cases the exposure to contagion was most perilous." Instances like these might be multiplied from almost every quarter of Ireland ; but those adduced appear to us sufficient to establish the two important points already adverted to, viz., that cholera originates without contagion, and that it is not seen to spread where there is continued exposure to contagion. Fever or other diseases universally admitted to be contagious, do not exhibit the singular feature of visiting the dense population of some one town with such severity, and passing by almost untouched the population of a neighbouring town, in every respect apparently similarly or worse circumstanced. We are gratified to be thus able to confirm by facts the view put forward by us in our Circular of the Ist September, 1848 (see Appendix B, !No. 1), as to the little apprehension to be entertained of the contagiousness of cholera ; views which must so materially tend to procure for the sick, from their relatives, the requisite attention which otherwise might not be afforded through unfounded apprehension of infection. The following table gives a list of all the Towns of Ireland containing 2,000 inhabitants and upwards, distinguishing those from which cases of cholera were reported, those from which there was no report of its appearance, and showing the number of cases, the number of deaths, and the date of the first and last case in each town : — i) 34 Report of the Commissioners of Health, Ireland, 2j — _ J^ O CO' """•"••SJSSR |1 I I",, !-- Lh | 3 |"|«»lf" Mi II l |I"l'lW 11 a ass***- *s 22 | l| I jl $ 1 ....... .. .. .|| = S I i"lfff!rt"Mi..f,fi, I ,,rfi, Ij t? If 2 *l |S33^rs3sis| || | |SS|^iS| |§|^g^| rS-^ I rf ' ' ¦ ' ' ¦'I ¦ ¦ j I 6 -I •«-••• -a ••• ,S SSI r $ -^ - if. 1 - •ii i ii ffiji ril fsiiii Ipfili lllllf i CQ fl ¦ ¦ . _— , bo g !§¦ I a^ || iris in- S fl (SI I s On the Epidemics of 1846 to 1850. 35 H —— Rs s =-oo= == = - === = = = o « „ 111 I I Jlifgl = = =ll|l!|^||^."llUl4=!l S |*J $$$ | I|IJRj | Illf S OS ©NOOOOO d t- -* O3 SiOWKIN i— i -*Ot- fltOtO r-t CJ i-i i-l 03 Oi Ci CiHOt CQ««Ci«i-(«H JCJi-lr-l =- = = = = = = = =- = = = = 11111 #' f ftele ' til ' s "l s '#** = ' = ' tf I II ' 3 -B *S 5 5 5 « •S^ts^'S t~ b-0005 0-^* O?C3>O l>(OKl©t-iOO CO i—l i—l CO i— l O i-i t-03-^t-O^COO O KO«tOOlO I I I I I C I «»«H 3 CO I TfH I HHCN I T* I t-o)i>HO I I I I I I rnlcq^ I lo i-i C* I r-i I i—li — I I . . . CO Ci CO -- — i(OCC C?^>t- .i-HOOO^^HO-^C 1 ? .O ,-#O-*COOO . flSaflfl « S °°- rt rt i=i rt s rtC _ T ~ ISD fi« fl Nr-ictco a OOOCO OCO O Or- 1 OO O Jz; ££ & £ & jzt « !? ,? Jz; O)NIOHCSWOiaCCII>OO-405iOiO0000KIS!>!OCDM«0SOQ0iOO5»3 COOOOiI 00)«K!0!NOOO)c!-i'c>f cf-^i'co'cifco'ci'cf cf ccr®"cf co 1 -^roTcri»"cs~>cr'*"ofi»' r— i CO C$ r— l I—l1 — I ¦¦¦¦¦ t~ I! lit !ll!flrff!!i|il!J!llflfliif|iif H P .••• • g ' i fi g .3 " " g S Report of the Commissioners of Health, Ireland, 30 S8 * g -¦ s| g ass-ss 5 a 8 a a-a : s s mj r 1 53 f_T « ~ - I a - m .- p 1"3 §11 „.-• *i'§,; j -rg 5 ¦3 2 ) « S -= S ?S' - -ftSttg - : a £>'% > - fc- ©"S ooe>i~ So>SiSSTO-seoaoiS io-S^o'S W«r-1 rl«i« OH«K!rtrt«l}i r-| (^ CO — lOSH « - _____ os I It! fill 11l filil'llii! ¦ ¦ ' ' ,—., — . ill B^s i^^^s | | gggggg^g lisss^ i *gi r o ' ~ — r^ cc * H f « 0000 X CSX OfO -f ?T COCOOO li--, r>> 1^ — Hi^(^>»-^!-^_j g || « I fl ~~ ~ ~~~ —~ ¦ o S P;! , I L.. if... ?§... rf . .g g iiililliii Ililllliiillllll I T S y ' -'" g ' II si §q 211 £| PMC? Q O a c I (-} Ofi the Epidemics o/1846 to 1850. 37 00 i ii ' = fi 4ittiiii ' s-fe-ii i# it i tit i r 2 5 ¦S •S'B SIZ "3 ~£ -3 ~3 •£ S~3 £ Mr3 r sq3'B'3:Si*tc'££3 r3 rS •£! q3 •S k co oo cs '^ocScSccti.^.-i — it^J? c~ o o -* o C? i— l o! 0101 Ol n i— l 7-! -i- ¦— I O} Oi CJ i— i OJ TO C-i i— i S^raMH g -< -t; <; s< P4 i hii- c i -i< t- to •»* do -•# cs c 3 oco oono3osoo-*oooo ffl a o o o ¦* cc n o oo co-^oco'ooo II ICi I 1 ¦— l O! I— i Oi I c« CO "* O? C* -^ i~ o cool 000000000000 o o a co * c? n n h o f- i-t-t-^t-oo r ~ l C S SlOS 10 " 1 0-*rH'*-*o<->a®50®Ht»lOOOCS«Oh«lOOOO«COIN>-N«H i-t 00 CO ¦>* b- X- O 00 N C C C fl X O Ci O rt O m ¦* CM- OH- ri c Cf: -f X 00 ¦* O O-H i—i CO vo O CO CO O^O^C^L— _?{_i—^W_i—;^CC_O O?_ O? CS_O O_O '~^CO O C? C: IZ ~^O_ O? CC^^O_C3^CO^ O^O^-^OO^-H^ -f vfasof of csT^H"t-"co"G^"o'~-^"c'>'co"'X"'H ' i-^~ t^~ co *S &£' m ¦rf 01 ci ci c6' ¦?£ c$ a$ o>"o o cd -^"o r-t CD I—lI — 1 t— — I O? i—li — I CO 111 liiiiiiiiiii nil H W O u> ;< r - = 3 = s g - p s s " " $ " ' T s w*a "s* £• g is* o P-i o Repot of the C ' j»tm/.s.s/,j//en- of Health, Ireland, Oo IS 3 -5 3 < -* - - .. - „ - 00 " - • S *> af o i (,- p s a .-6o as ccmoC t-t C* t ! r-l r-l CO •g fi -^ „ „ „ CO " «•»««•* <3 . rf * OJ« Ot- (SOO OCCO . -a ¦* o I k to a o I S ,-i IL- r^ TO CO . C 3 I a rt .2 o cc — o> c: -f co 00 ai-M CDI-iO-<-f KC"o r3 ccociocc c^ cc_ co clj S -<#"cfcN! V- "cc c£ •¦£ -f *-^ Ph i — i o Cv p o H - 5 Centre £&;. HffJfmjm^Arr/?'. Rafters l#fao><2°. On&twereacTis 7^prf^At'S^///y-^&oss tie* te&ej'xjU&dt/e 6 \ /''/< TTfior-JBoard^ 27tjfat/ttrkmjcMfr4*z'(*^- / / 3v t/-//j>s apart Jfe^ mcfoffuck' (Mfi/raa^rs ft? w?sZudes/frs6?zrS&lhiblzni 48 APPENDIX A. No. 1. Dublin, March, 1847. Gentlemen, — I have the honor to submit the accompanying drawings, which have been prepared in accordance with your instructions, for the erection of Temporary Fever Wards of a simple and economical construction. The following are the particulars of their construction, arrangement, and cost: — The buildings are intended to be erected with wood framing, as shown on the Sectional Drawing B, and to be boarded with rough boarding, nailed on the outside of the studs or framing; the boards to have a lap of one inch; the floor to be formed of inch deal, resting on joists 4 inches by 2, and 15 inches from centre to centre, and supported on dwarf walls. The sides of the building to be 7 feet 6 inches high, resting on low dwarf walls of brick or stone, as shown in Section ; the width of the building to be 15 feet 6 inches, which will allow a 3 feet 6 passage down the centre of the ward, and the heads of the beds to be placed along each side. The roof to be also boarded with inch boards, having 1£ inch lap, and if thought advisable hereafter, it can be covered with " asphalte felt, or tar paint."* The windows to be formed on both sides, to be 3 feet by 2 feet 6 inches high, to hang on centres for opening, and glazed like common greenhouse lights, and to have proper lines for opening and closing. On the ridge of the roof small ventilating hoppers to be formed, and about two of them to be placed in a length of 50 feet of roofing. By this arrangement the breath of the patients will be drawn towards the roof, leaving the centre passage of the room the most free from infectious air. Plan A shows an arrangement for a building capable of accommodating 50 beds, spread 1 foot 5 inches apart; it exhibits two wards, one for men, and another for women, with a fire-place between. I purpose the construction of air-flues, 14 inches by 9 inches, in the chimneyshaft, to be carried up from the back of each fire-place to the chimneyshaft above the roof, having an opening from the upper part of the room into the air-flue for the escape of vitiated air, which will be drawninto it by the current of warm air in the air-flue, and be of much service in cold weather when the windows cannot well be opened. At each external gable end of the wards an opening of about 1 foot 6 inches superficial is to be left, and to be covered with a perforated zinc plate fixed against the boarding. The bedsteads to be formed of planed boards, 6 feet long, resting at the foot on a deal tressel, and at the head on a ledge, formed in an * If determined, in the first instance, to be covered with asphalte felt, the boarding might be f inch thick (,4 boards out of a 3 inch plank.) Report of the Commissione?'s of Health, Irelafid, 44 economical manner, by the constructive arrangement of the frame work of the side walls. By this method a deal plank 12 feet long, with two saw cuts down, will make two bedsteads of the cheapest possible construction. The Sectional Drawing C represents the arrangement of the bedsteads, and the framing of the wood-work of the windows, chimneyshafts, &c. For the accommodation of a greater or less number than the 50 bedsteads shown in the accompanying plan, the wards, which are 50 feet in length each, will only require extending or shoi'tening; and for every two feet added to the building space will be obtained equal to one additional bed, 3 feet 11 inches lineal space along each side wall being the allotment for each, with the beds placed 1 foot 5 inches apart. The cost of the building for 50 patients, according to the foregoing particulars, and the plans referred to, including bedsteads, will be £l 10s. per foot; and for every two feet additional length added to the building, being the space, as before stated, for providing each additional bed, a cost of <£3 may be calculated. When it may be necessary to provide additional rooms for convalescents, or for otlier purposes, a similar kind of building can be placed at the rear of this, communicating with it by door-ways, to be formed in the side enclosure. I have the honor to be Gentlemen, your obedient Servant, (Signed) George Wilkinson, Architect Poor-law Commission. To the Commissioners of the Central Board of Health. [Plans, Nos. 2 & 3. DRAWING FOR. AN ECONOMICAL BEDSTEAD PREPARED FOR THE CENTRAL BOARD OF HEALTH, IRELAND. FAMILIAR VIEW OF BEDSTEAD Ferdai lOhj&vwSbDuU'// 6e#. TfEOunsortisJrr/tt MarckfM,7. On the Epidemics of 1846 to 1850. 45 No. 4. REMUNERATION OF MEDICAL OFFICERS. Central Board of Health, 04, Lower Oar diner-street, Dublin. The following is the scale of remuneration acted upon since the formation of the Central Board of Health, in March, 1846, for Medical Officers appointed to Temporary Fever Hospitals and Dispensaries, established under that Board, in pursuance of the provisions of 9 Yic. c. 6, and 10 Vie. c. 22, or acting under the Board :—: — For attendance on a Temporary Fever Hospi-") tal, established within the town or district in which the Medical Officer resides, in addition > to any permanent salary he may receive as j Medical Officer of any existing Institution, .J For attendance on a Temporary Dispensary \ under similar circumstances, . . . . j For attendance on Temporary Fever Hospital i ss. per dnj, or <£91 ss. per annum. ss. per day, or .£9l ss. per annum. ( 10s. per day, or ( £182 10s. per annum. and Dispensary together, under similar circumstances, For attendance on a Temporary Fever Hospital, } where Medical Officer is sent to a distant > district, ) For attendance on a Temporary Dispensary, ) under similar circumstances, . . . . j For attendance on Temporary Fever Hospital ) and Dispensary, under similar circumstances, J 1 guinea per day, or £383 ss. per annum. 1 guinea per day, or £383 ss. per annum. 2(55. per day, or £474 10s. per annum. Separate provision is made for compounding and dispensing medicines, For Medical Inspection, under direction off 2 guineas per day, Board of Health, j Travelling Expenses. No. 5. CIRCULAR. Central Board of Health, Custom House, Dublin, Ylth May, 1847. Applications having been made to the Central Board of Health, to put in force those provisions of the Fever Act, 10 Victoria, cap. 22, which relate to measures for the prevention of fever, such as the cleansing and purifying of the habitations of the poor, and the removal of nuisances, &c, and for the proper and decent interment of the dead, the Board of Health deem it necessary to draw the attention of the various Relief Committees to Sections IX. and XVI. of the said Act, from which it will be seen that the Board of Health are not authorized to issue any order or enforce any measures in relation to the cleansing, ventilating, and purifying of the habitations of the poor, the removal of nuisances, or the interment of the dead. These duties are devolved, by the Act, wholly on the respective Relief Committees throughout the country, who are armed with ample powers for the purpose, without needing any authority from the Board of" Health. The following are the provisions above referred to : — 46 Report of the Commissioners of Health, Ireland, IX. And be it enacted, that it shall be lawful for such Eelief Committee to give all such directions as shall seem to them necessary and expedient for performing all things necessary for preventing the communicating of fever or other epidemic disease within their respective electoral divisions or districts ; and for that purpose to direct that all streets, lanes, and courts, and all houses and all rooms therein, and all yards, gardens, or places belonging to such houses shall be cleansed and purified, and that all nuisances prejudicial to health shall be removed therefrom ; and that all houses in which any sick person shall be, or shall have been, shall be ventilated, fumigated, and whitewashed, the windows and doors thereof opened, and all beds, bedsteads, bedding, and furniture therein be exposed to the air, and be washed and cleansed, and, if absolutely necessary, be burned or destroyed, and all other measures which to such Relief Committee shall seem requisite for the purposes aforesaid. XVI. And whereas it is expedient to provide for the proper and decent interment of the deceased destitute persons, who shall die of fever, or other epidemic disease, in any electoral division or district for which any Relief Committee shall have been constituted as aforesaid ; be it enacted, that it shall be lawful for any Relief Committee to provide for the proper and decent interment of such destitute persons as may die in such electoral division or district as aforesaid, of fever or other epidemic disease, or while receiving relief, and to defray the charge of the same out of the funds which may be at the disposal of such Relief Committee for the purposes and under the provisions of the said recited Act of this Session, or of this Act. The Board of Health can do no more at present than offer some general suggestions. Ist. In reference to the provisions of Clause IX. for cleansing and purifying the habitations of the poor, and for the removal of nuisances. The present time appears to be a favorable opportunity for enabling Relief Committees to effect these objects with little expense, as the services of a sufficient number of able-bodied destitute persons, now receiving gratuitous out-door relief, can probably be obtained for a trifling addition of rations or money, who can be employed, under proper superintendence, in whitewashing the rooms and passages of the habitations of the poor, and in removing nuisances, such as collections of manure, contents of ash-pits, &c. In whitewashing, the regulation should be strictly enforced of having the lime always slacked immediately previously to using it, and of laying on the whitewash while still hot. After whitewashing, the floors and passages should be well sprinkled with a freshly made solution of chloride of lime, in the proportion of about a quarter of a pound to a gallon of water. A short printed notice should also be freely circulated, impressing on the people the necessity of avoiding sick rooms, wakes, and crowded meetings, and the great importance of pure air, free ventilation, and cleanliness of houses, clothes, and persons, as among the best safeguards against contagion. It is advisable not to limit the works of cleansing and whitewashing, and the removal of nuisances, merely to the localities or places where fever may have actually appeared, but to carry out such measures, on a systematic and extensive plan, through the habitations of the poor generally. The details for effecting this can be best arranged by each Local Relief Committee. 2nd. In reference to inducing cleanliness of clothing and person among the poor, — measures so essential to health and the prevention of infection. A rule has been adopted in some instances, of insisting upon all applicants for gratuitous relief coming to the provision depots with On the Epidemics o/1846 to 1850. 47 at least face, hands, and hair clean. This regulation has been attended with good results. The Board of Health, however, think that the principle might be carried farther, with great advantage, and that habits of cleanliness might be rapidly induced, if in every district in convenient localities, washing-houses on a simple and economical plan were established, to be kept open for a certain number of hours per day. It would be only necessary to provide each washing-house with a large boiler for the supply of hot water, and with ranges of wooden troughs divided into compartments, each of which would serve as a separate washing-tub, with a plug at bottom to allow of the dirty water being carried off previously to filling it anew for the next applicant. If a drying-room for clothes could be attached, it would of course be a most desirable addition ; but the Board fear that an attempt to do too much at first might only tend to prevent practicable measures being carried into execution. 3rd. The separation of the sick from the healthy. The early removal of the sick to hospital is a measure of the greatest importance in checking the spread of disease. To effect this with expedition and certainty, arrangements must be made, — Ist. For procuring the earliest intimation of the appearance of illness. 2nd. For the removal of persons affected. To attain the first object, printed papers should be posted up requesting the poor to give immediate notice of the first appearance of illness in their families, at the gate of the hospital, where the porter, or a person appointed for the purpose, should keep a book in which he may enter the names and residences of the applicants for admission — a certain hour, say from 9 to 10 o'clock in the morning, being allotted for this object. There should then be in cities or towns, as in former epidemics, one or more medical inspectors, according to the extent, for each hospital district, whose duty it should be to visit, as soon as possible, the cases reported each morning, and such other cases as they may hear of, and to return to the office by a certain hour a list of those persons who are fit subjects for removal to hospital. On the lists being returned, a light covered vehicle should be in readiness to convey the sick to hospital in the course of the same day. The books kept as above will, besides, be most useful in affording information as to the actual state of disease, its diminution or increase in each district, and the corresponding amount of accommodation required. 4th. Interment of the dead. — On the provisions of Clause XVI. the Board of Health deem it necessary to offer only the following suggestions : — That graves should invariably be sunk to a depth of five feet; that the surface of each grave should be beaten hard ; that where burials have already taken place, leaving the coffins nearer to the surface than five feet, clay should be carted in to cover the graves to a sufficient depth, and that, wherever obtainable, yellow clay should be preferred for this purpose ; and, finally, that when new grave-yards are opened, localities should be selected at least a quarter of a mile from any town, village, or hospital, in a sufficiently exposed situation to prevent the accumulation of malaria. Order of the Board, Arthur Moore, Secretary. 48 Report of the Commissioners of Health, Ireland, No. 6. LETTERS FROM THE CENTRAL BOARD OF HEALTH TO THE RELIEF COMMISSIONERS RESPECTING RATIONS PROPOSED FOR THE DESTITUTE POOR UNDER THE TEMPORARY BELIEF ACT. Central Board of Health, Dublin, 10th March, 1847. Sir, — The Central Board of Health having had under consideration your communications of the 2nd and sth inst. respectively, relative to the rations proposed by the Relief Commissioners to he allowed for adults, I am directed to state for the information of the Relief Commissioners, that the Board of Health are of opinion that the rations therein submitted to them for their opinion are under the circumstances reasonable allowances. The Board of Health, however, suggests that in all instances where practicable, the food should be given out in a cooked form ; as food, however good in itself, will, if not sufficiently cooked, not afford its full supply of nutriment, and it will moreover predispose to attacks of dysentery and diarrhoea now so prevalent through the country. They likewise suggest that the food given out should be varied occasionally ; as for instance, on one day that bread rations be given ; and on another, soup and bread; or meal and rice porridge, with bread, &c. They also recommend as a general principle, that a considerable proportion of the nutriment should be administered in a solid or moderately consistent rather than in a very fluid form ; and they suggest to the Relief Commissioners, the propriety of occasionally consulting the medical officers of dispensaries as to the effects of particular articles of diet, and the substitution of others, according as the preservation of health and 4 the appearance of any sickness may seem to demand such alterations. I have the honor, &c. A. Moore, Secretary. To Win. Stanley, Esq. Secretary, Relief Commission. Scale of Rations proposed by the Relief Commissioners, and referred to in the foregoing Letter. J^lb. of bread; — or, lib. of biscuit; — or, lib. of meal or flour; — or, I quart of soup, thickened with a portion of meul according to the known receipts, and £ ration of bread, biscuit, or meal in addition. Central Board of Health, Dublin. Uth May, 1847. Sir, — I am directed by the Central Board of Health to acknowledge the receipt of your letter of the sth instant, relative to the scale of rations for adult destitute persons, and requesting the views of the Board as to the allowance proposed for children under nine years of age. The Board of Health are of opinion that the scale of rations proposed by the Eelief Commissioners, — viz., half for persons under nine years of age, and full allowance for persons over that age — is, under the circumstances, probably the best that could be devised ; for although a more divided scale is useful and necessary in the dietary of large institutions, containing persons of different ages, the Board of Health fear that any attempt to carry out, in out-door relief under 10 Vie. cap. 7, a scale of On the Epidemics o/1846 to 1850. 49 rations more sub-divided than that recommended by the Relief Commissioners, would be attended with complication in the arrangements, and would be productive of unceasing disputes. Considering these circumstances, and the varying ages of children on the relief lists, the Board of Health concur with the Relief Commissioners in the scale proposed. The Board of Health now desire to draw the attention of the Relief Commissioners to the communication from the Board of Health of the 10th March, in which they recommend that "in all instances where practicable, the food should be given out in a cooked form." They are now, from reports which have reached them, anxious to urge on. the Commissioners the necessity of taking measures to have this recommendation acted on, without exception, in all instances. The Board of Health feel it only necessary to observe, that they fear, unless the principle be fully carried into effect, of giving out the food only in a cooked form, there will be always both an abuse and a serious evil of another kind to contend with, the abuse is, the sale of raw meal, for which purchasers are always to be found, to whom even the poor requiring the food for themselves or family will dispose of it for money, tea, or tobacco ; and the serious evil is, the consumption of meal or rice, but more particularly Indian meal, in a raw or badly cooked state,* which will predispose to and aggravate dysentery and diarrhoea, already so prevalent through the country. The Board of Health also wish to renew their recommendation in their previous communication already referred to, of 10th March, advising as a general principle, that " a considerable proportion of the nutriment should be administered in a solid or moderately consistent rather than in a very fluid form." This principle is the more necessary to be attended to on the approach of warm weather, when soup, containing a large proportion of vegetable matter, is so liable to ferment and become sour. The Board of Health would, therefore, suggest that instead of soup ration, under section 26, there should be henceforth substituted :—: — 1 pint of soup and 16 ozs. of bread, as the daily ration, on soup days. As there are many different forms adopted for making soup, it may be useful to bear in mind, as a general rule, that a pint of meat soup should weigh very nearly l^lb. In serving out stirabout made of oatmeal, or of oatmeal and Indian corn, of oatmeal and rice, &c, in order to prevent all disputes and frauds, and to prevent the error being committed, of mistaking bulk for nutriment, so as to insure that sufficient nutriment is given, the rations should be estimated not by the bulk when cooked, but by the actual weight of raw material: thus, as the allowance per diem of meal for a ration is lib., care should be taken that when cooked, each ration, whatever be its bulk, should contain the equivalent of lib. of raw meal. I have the honor, &c A. Moore, Secretary. To Wm. Stanley, Esq. Secretary, Relief Commission Extract from Regulations for Relief Committees : Section 26, above referred to. "26. One ration may consist either — of l^lb. of bread; — or, lib. of biscuit ; — or, lib. of meal or flour of any grain ; — or, 1 quart of soup, thickened with a portion of meal according to the known receipts, and 1 quarter ration of bread, biscuit, or meal in addition. Persons above 9 years of age to have one ration, under 9 a half ration, in the day. In all cases, where practicable, the food should be given out in a cooked form, and should be varied occasionally, from bread rations to soup and bread, or meal and rice porridge with bread." • Inspectors have reported that they hare seen the people devouring the raw Indian meal. 50 Report of the Commissioners of Health, Ireland, Central Board of Health, 64, Lower Gardiner-street, Dublin, Ist June, 1847. Sir, — In reply to the request of the Relief Commissioners for the opinion of the Central Board of Health, "as to the allowance of rice which may reasonably be made in the rations to destitute persons, in lieu of one pound or other given quantity of Indian corn meal, the rice being considered to have superior nutritious qualities, and an equal weight of it yielding, when cooked, a larger quantity of solid food," — I am directed to state :—: — Ist. — That the allowance of rice which may reasonably be made in lieu of Indian corn meal, should not be less than one pound and a half of rice in lieu of one pound of Indian corn meal, where either grain is given alone, and that the same proportion should be observed in a mixed ration, viz if half a pound of Indian corn meal be given, instead of the standard ration of one pound, that there should be given along with it three quarters of a pound of rice to make the mixed ration equivalent to one pound of Indian corn meal, and in like manner of all other proportions in which rice and Indian corn meal mixed may form a ration. 2ndly.. — That the Board of Health cannot hesitate to assure the Relief Commissioners, that rice, instead of being superior, is much inferior J;o Indian corn meal in nutritious qualities. It is true that rice by steeping and boiling, may be made to furnish a larger bulk of apparently solid food than will be furnished by an equal quantity of Indian corn, and hence has probably arisen th*e supposition of its being more nutritious, but the bulk thus obtained is deceptive as to the quantity of nutriment afforded. Rice contains about 85 parts in every 100 of starch ; a given quantity of it will by steeping and boiling absorb a very large proportion of water, and will swell into a large and apparently firm mass ; but this mass will contain a very small proportionate quantity of nutriment. A very simple experiment will satisfactorily illustrate this : one ounce of common starch boiled in the ordinary way, will form, with a pint of water, a firm mass, which from its apparent consistency will seem to be good substantial food ; but the bulk thus formed, it is obvious, contains very little nutriment. In like manner of rice ; one pound of it may be made to form, with water, a starchy mass of five or six pounds' weight, but the produce, as in the experiment of the starch, is bulk, without equivalent nutriment. The Board of Health are anxious that their observations on this subject should be clearly understood and widely disseminated, as the error is very generally prevalent of supposing, that in using rice or other similar substances, an amount of nutriment is afforded equal to the bulk gained. The Board of Health do not at all object to the use of rice as food ; on th^ contrary, they highly approve of it, provided it be furnished in sufficient quantity. The Board of Health are fully aware how necessary and how pressing, at the present time, is the exercise of the strictest economy, but they are also convinced, that if the use of a diet be permitted, containing too large a proportion of fluid, deficient in the due quantity of nutritious elements, and deriving its solidity principally from the presence of starch, the result must necessarily be, in those living on it, debility of constitution, with consequent inability to resist disease, and ultimately, increased expenditure in the cost of relief, instead of saving. For these reasons the Board of Health deem it important that the principle laid down in their previous communication of 11th May, shouldbe strictly adhered to, viz that rations should be given out cooked, and in as solid form as possible, and that they should be estimated, not by the bulk when cooked, but by the rule that each cooked ration should contain the equivalent of lib. of raw meal, the quantity originally sanctioned by the Relief Commissioners of the Board of Health. I have the honor, &c. To Wm. Stanley, Esq. A. Mookjb, Secretary. Secretary, Belief Commission. On the Epidemics of 1846 to 1850. 51 Central Board of Health, 64, Lower Gardiner-street, Dublin, 2 1st June, 1847. Sib, — The Central Board of Health have had under consideration your letter of the 3rd instant, requesting to be informed — " in how small a proportion rice may be used with Indian meal, (if at all necessary,) without sacrificing its useful properties, as a corrective of the prevailing malady of the population ; or the advantage, if any, of the additional bulk it acquires in cooking ?" — and in reply, the Board desire to observe, that the precise proportion for the object in view could not be fixed, as it would often necessarily vary according to circumstances of seasons, predisposition to disease, and even individual constitutions ; but that as a general rule, rice may be mixed with advantage in almost any proportions, however small, with Indian meal, and in larger proportions according as its cost may permit ; care however, being always taken, as explained in previous letters of the 11th May and Ist June, that each ration when cooked should contain its full equivalent of raw meal and rice, as recommended by the Board of Health in the same communications. The Board of Health, although admitting the advantage of bulk occasionally acquired in some kinds of food by cooking, yet taking into consideration one of the forms of disease now prevalent in Ireland, do not recommend that rice should be used with the object of giving bulk by the absorption of watery particles ; but on the contrary that cooked rations should be given out in as solid a form as possible, leaving it to the natural feelings of thirst to supply the quantity of fluid necessary for healthy digestion. With the object also of obviating the general predisposition to relaxation of the bowels, which will probably increase as the summer advances, the Board of Health, recommend the addition of some of the ordinary condiments to the stirabout, of which perhaps pepper will be found the most acceptable and the cheapest. The Board of Health take this opportunity of acquainting thej Relief Commissioners, that they have learned through the inspectors, and from, other sources, that a diminution in the prevalence of diarrhoea, and a marked improvement in the general health and strength of the people, have followed upon the substitution of cooked food for raw meal ; and they, therefore, again recommend that every exertion should be made for extending the use of cooked food in the distribution of rations. While on the subject of diet, the Board of Health deem it of importance, through the medium of the Relief Commissioners, to draw the attention of Relief Committees, and of the people generally, to the fact, that a form of disease now very prevalent among the people, resembling in many particulars sea scurvy, is connected with or dependent on a defective nutrition, arising, not from deficiency of quantity, but from deficiency of quality or variety in the food. The potato, although not containing a large proportion of nutriment, is remarkable as containing within itself all the varied elements necessary for forming healthy blood ; no one of the substitutes for it, with the exception of oatmeal, possesses this remarkable property ; and hence the use of more than one article of food is necessary in order to secure a sufficient supply of the varied elements of nutrition, and thus to obviate the form of disease referred to. With this principle in view, the Board of Health, as the season of the year now gives facilities for it, strongly recommend the admixture of onions, leeks, scallions, or shallots, in cooked meal rations, or stirabout, which will both act as condiments, and will also furnish some of the elements of nutrition essential for forming healthy blood. Onions are so rich in nutritive qualities, that as a mere article of food, one ounce and a half may be considered as equivalent to about one ounce of meal. On every opportunity, the importance to health of using vegetables, such as carrots, parsnips, and cabbage, along with meal, should be impressed upon the people. It may not perhaps be out of place in these observations to make the £2 52 Report of the Commissioners of Health, Ireland, people generally acquainted with the high nutritive qualities of beans and peas, which, weight lor weight, contain from 10 to 12 times as much nutriment as potatoes. In those countries where rice is very extensively used as the food of the people, experience has taught them that rice by itself has low nutritive qualities, but that the deficiency can be supplied by adding about two ounces of beans, peas, or lentils, to each pound of rice. It must however be remembered, that with beans or peas, some other vegetable food must be used, as, although possessing in a high degree some of the most important elements of nutrition, they nevertheless do not contain a sufficient variety of other nutritive elements, to support the human body in health. I have the honor, &c. A. Moore, Secretary. To Win. Stanley, Esq. Secretary, Relief Commission. Appendix A., No. 7. Union Temporary Fever Hospital at Opened under the Temporary Fever Act, on of 18 Report for Week ending Saturday, of 1850. Number of Beds which the Temporary Hospital 1 is capable of containing, . . . . J Number of Beds provided, Remaining in Hospital on previous Saturday, Admitted this week, Total treated during the week, .... Discharged, Died, Remaining in Hospital on this day, Saturday, of Total (as above), Vacancies, Nos. rejected for want of accommodation, Other Epidemic or Contagious Disease. (Slate name of Disease.) _-1, , I 1 •3 £ -5 > S rt g A &i h ft fi Date, day of 1850. Signature Medical Officer. The numbers in Hospital were— I | Noa. Discharged. Nds. Re- I jected. Nos. Ad-J mitted. J On Sunday, . ? Monday, . „ Tuesday, . ? Wednesday, ? Thursday, ? Friday, ? Saturday, . Total, The whole of the Medical Officers should sign these Reports, in order of appointment, where more than one Medical Officer has been appointed. Ore Epidemics of 1846 to 1850. 53 b" O o »o CO r— l 3 02 °°: w ft g _§ S o Hi a m o C 'S « cv H > H n^ a e3 O2 H P O T2 C-t-l O (4 fc> Oh •snoixvAaasao •1002 HIMJV g < ; •**>¦«>* t h ; —— ¦ •—• 02 v __ I -qooji jiour g \k>lio,i i «tj ~" — ¦ « -XansniAV g 3 — __ "ma •joofi AiOJay g •«,«< : . . £ • J^ JOJ £ to — — . __ W •^n?!HA\. g a . ~ ¦ ¦ W -3UUV g •wa •?oo H MOjjy g S -^isniW. g H — — _^___ ¦wa •»ooji avojjv g o ~ S -;i "!AV g i - »<> o a Aiojjv § >-¦ • j^ i °j tl_ g ••«3Ms!q.«. § b — . en -3U!A\. g ¦esuasid •uoissiiupy jo a^a © 00 I « 1 54 Report of the Commissioners of Health, Ireland, Appendix A., No. 9. Central Boakd of Health. Union. Date Report on Temporary Hospital, under the Temporary Fever Acts, at in the Electoral Division of No. and Names of Electoral Divisions in Hospital District. No. of Beds Certificate has been issued. Date of first admission of Patients in Temporary Hospital. I No. of Patients in Hospital. % O No. of Be* which the Temporary Hospital is capable of containing. Pate of Certificate of Board of Health for thfi provision of the Temporary Hospital. ™ c 5 S t O, 3 » o £ s^s 5 S h H Eh PlmPh Patients — how presented / for admission, . . £ Name of Medical Officer, Medical attendance . > (mode and times of) } Medicines, whence sup- > plied — compounding of \ Situation of Hospital as 1 to healthfulness, and ( whether central for the f District, . . . j Light and Ventilation — No. of cubic feet of air > allowed to each bed, . 3 Supply of Bedding, &c. . „ Water, . Dietary, including ordi- ) nary forms of, and ex- > tras, . . . .j Cleanliness, . Nurses and Wardmaids — ~) Number and arrange- > ment of, . . . ) Hospital Registry \ How "> ? Books 5 kept,) GENERAL OBSERVATIONS, including a short notice of the type of Fever, and ordinary durati on of the attacks, complication, sequelae — tendency to relapse — treatment generally employed; other diseases prevalent with Fever, &c. OBSERVATIONS OF BOARD OF HEALTH. Signature Inspector. On the Epidemics of 1846 to 1850. 55 Appendix A., No. 10. Central Board op Health, Ireland. . . Union. RETURNof Patients in _Temporary Fever Hospital Duration in Hospital. Typo of Disease. Observations. Names. Appendix A., No. 11. Central Board of Health, Ireland, Union. Ivetuen of Patients visited at their own homes in District by Population about c CTowNLANDof ) day of 184 Area 3 £ Disoaso labouring under. No. of House and Namos of Patients in each. Observations. Appendix A., No. 12. Central Board of Health, Dublin, Uth October, 1848. The Board of Health have had under consideration those provisions of the amended Fever Act, 12 Vie, c. 131, which have reference to the salaries of the Medical Officers at the Temporary Fever Hospitals, and are of opinion, that five shillings a day, hitherto allowed to Medical Practitioners for attendance on Temporary Fever Hospitals or Dispensaries within their own districts^ is only a reasonable remuneration for the labour and risk incurred in such attendance, and that it should not be departed from. This amount of remuneration is recommended by precedent, as it appears from Official Eeturns laid before the Board, that such was the remuneration generally allowed to Medical Officers appointed to similar duties during the prevalence of former epidemics of fever, viz., in the years 1816, '17, and '18, and 1826, &c. ; and it has received the approbation of the Lords of the Treasury, having been paid with their sanction from the commencement of the present epidemic fever in 1846, up to the passing of the amended Fever Act, 12th Victoria, chap. 131, on the sth September last. 56 Report of the Commissioners of Health, Ireland, Representations have been laid before the Board of the expediency of constructing a scale which might apportion the rate of remuneration to the relative sizes of the Temporary Fever Hospitals, and the corresponding amount of duty to be performed. The Board, after full consideration, are convinced that it would be hardly practicable to establish any such scale. The numbers under treatment in each Hospital must necessarily vary from week to week, and if the numbers in Hospital were permitted to be the criterion of the amount of Salary, the Medical Officer would be constantly exposed to the imputation of retaining a greater number of patients than necessary, in order to entitle him to a certain amount of Salary. Another mode of lessening the expenditure for Medical Attendance has been proposed for the consideration of the Board, viz., that the attendance of the Temporary Fever Hospital should be given to the Medical Officer already holding the Workhouse Hospital, or some other appointment or appointments under the Board of Guardians, and that thus, by giving such Officer two or more medical appointments, the united salaries would amount to a reasonable sum, although the rate allowed for any one might be very small. The Board of Health consider that such an arrangement would be unjust to the Medical Officer, and injurious to the sick. If attendance on a Temporary Fever Hospital be in itself worth a certain rate of remuneration, that amotmt of remuneration should be given for that particular duty, without reference to any other appointment which the Officer may hold — each duty should be estimated for, and paid for in respect only to itself. The practice of imposing several appointments on the same Medical Officer on the ground of economy, is, however, open to another and more serious objection : — it will be injurious to the sick poor. Every Practitioner requires a considerable portion of each day for private prac Lice, which is generally the main source of his income ; and, if a greater amount of Hospital duty be imposed on a Medical Officer than he can perform within from one to three hours at the very farthest, the sick poor must be neglected ; — no extent of supervision, no inspection, how often soever repeated, can prevent neglect in such cases. It appears, by a return before the Board, that the average number of patients in each Workhouse Hospital in Ireland, in the last week, has been 105. If such cases were like the ordinary cases in a Fever Hospital, similar in kind or type, the time required for mere attendance would not be so great ; but when it is recollected that there is not only this large average number, but that it includes every variety of Medical and Surgical diseases, requiring, occasionally, operations and dressings, it is evident that great care should be taken not to curtail, on the ground of economy, the time required for the due performance of such laborious duties. In no instance in Dublin is the duty of attending 100 patients, in a general Hospital, imposed upon one Officer. In England the practice has grown up of Medical Officers undertaking a greater amount of Medical attendance than they could themselves adequately discharge, and of committing the care of the sick poor to assistants engaged for that purpose. The Board most strongly disapprove of such a system : for it is evident that there can be no sufficient security for the professional knowledge or conduct of assistants so employed. Adequate skill and attention can only be afforded and secured to the poor by not imposing upon any Medical Officer any greater extent of public duty than he can honestly and fairly discharge, without trenching on his private practice, and by requiring that he shall personally fulfil the duties of any Medical appointment he may undertake. This course is not more clearly pointed out by justice and humanity, than it is recommended by true economy ; for neglect or bad management of the poor suffering under sickness or accident, will render them or their families a lengthened charge on the rates. Order of the Board, W. H. Hox'peb, Secretary. On the Epidemics o/1846 to 1850. 57 Appendix A., No. 13. Order for the Regulation and Management of Temporary Fever Hospitals. In pursuance of an Act passed in the 11th and 12th year of the reign of her present Majesty, Queen Victoria, entitled " An Act to amend and continue until the first day of November, 1849, and to the end of the then next Session of Parliament, an Act to make provision for the treatment of poor persons afflicted with Fever in Ireland," by which the Commissioners of Health are empowered to make orders for the regulation and management of Hospitals provided under the s;iid Act. Now we, the undersigned Commissioners, do issue the following directions for the management and regulation of Temporary Fever Hospitals provided under the said Act : — Ist That there shall be kept at every Hospital a Book, in which Members of the Visiting Committee, or Board of Guardians, or Managing Committee are to enter their observations. 2nd That there shall also be kept a Communication Book, in which the Medical Officers are to enter their observations on any matters connected with the management of the Hospital, conduct of attendants, diets, &c. The Commissioners of Health recommend that, in every case, a Committee should be appointed, as provided for by Clause V. of 12 Vie, c. 131, and that one or more of the Committee should undertake the duty of frequently visiting and inspecting the Hospital in turn, particularly at the patients' meal times. Medical Attendance. ]st That the Medical Officer shall visit the Hospital every day before the hour of 12 o'clock, and enter his name and hour of visit in a Signature Book. 2nd. — That the provisions of the following clause be strictly enforced, which prohibits, under a penalty, any Member of Board of Guardians, Committee, or any Paid Officer, from supplying medicine, medical appliances, or any article whatever required for the Hospitals : — " And be it enacted, That no Guardian, Puid Officer, Member of any Committee under the said recited Acts or either of them, or this Act, or other person in whose hands the providing for, ordering, management, control, or direction of any Hospital or Dispensary, or of Medical llelief under the provisions of this Act, shall or may be placed, shall, either in his own name or the name of any other person, provide, furnish, or supply, for his own profit, any materials, goods, or provisions, for the use of any such Hospital or Dispensary, or for affording such Medical Eelicf during the time for which he or they shall retain such appointment, nor shall be concerned, for his own profit, directly or indirectly, in furnishing or supplying the same, or in any contract relating thereto, under pain of forfeiting the sum of fifty pounds, with full costs of suit, to any person who shall sue for the same by action of debt, or on the case in any of her Majesty's Courts of llecord at Dublin." [Sec. 10, 12 Vie, c. 131.] 3rd That, unless in special cases to be determined by the Board of Health, and on application to them, the Medical Officer who prescribes for the patients shall not compound the prescriptions, or perform the usual duties of an Apothecary. 4th That the Prescription Book used at the Hospital be of the form herewith sent, and that the Prescription Book shall be preserved. sth That the medicine required for the use of the Hospital be purchased on the order of the Board of Guardians, or Hospital Committee, according to the list herewith sent, and that the quantities procured for the use of the Hospital, showing each month's consumption, be entered in the Medicine Book, a copy of which is herewith sent. 6th That the Clerk of the Board of Guardians, or of the Hospital Committee 58 Report of the Commissioners of Health, Ireland, transmit, on the first Monday in every month, to the Board of Health, a list of the medicines and medical appliances used, with the prices annexed, and the name and residence of the person or persons from whom such medicine or medical appliances have been procured. 7th — That the Apothecary either reside at the Hospital, or in its immediate neighbourhood, and that the medicines procured as above, be compounded by him, but that he is not to supply the medicine which he compounds. (Vide cl. 10 of 12 Vie, c. 131, as above.) 8th — That a copy of the accompanying Table, (Hospital Weekly Return) properly filled up, be transmitted weekly to the Board of Health, signed by the Medical Officer, or Registrar. 9th — -That a book, corresponding with the accompanying form, showing the names, residences of the patients, nature of the cases, and the results, be kept and preserved for inspection in each Hospital. ; Nurses, Servants, &c. 1st — That every Nurse employed be able to read and write. 2nd That the Nurses and Servants employed in and about the Hospitals receive liberal rations, as part of their wages. This rule should be strictly adhered to, otherwise the attendants will lose time in providing and preparing their own meals ; and they will, moreover, be exposed to the temptation of encroaching on the patients' food. Patients. Ist That there shall be a separate bedstead for every patient. 2nd. — That every patient, on admission, shall be provided with a straw bed in sacking, two sheets, two blankets, a rug, pillow, and night-shirt. 3rd That the night-shirts, and sheets, and the straw, shall be changed on every Thursday in each week, and oftener if soiled. 4th That the straw shall be changed for each new patient. 5th — That the wards be swept every day, and kept clean principally by dry scrubbing. 6th — That the hour for Breakfast be 9 o'clock, Dinner 1 o'clock, and Supper 6 o'clock. 7th. — That the following shall be the dietary of the Hospital, and that it shall not be departed from, unless on special application to the Board of Health, and -with their sanction. Dietary for Temporary Fever Hospitals under the Temporary Fever Acts, 9 Vie, c. 6; 10 Vie, c. 22; and 12 Vie, c. 131. Low Diet. (L.) Middle Diet. (M.) Full Diet. Kice Diet. (B.) Breakfast, Three pints of Whey in Twenty-four Hours. 4 oz. Bread, 1 pint New Milk. C oz. Broad, 1 pint New Milk. 6 oz. Bread, 1 pint New Milk. Dinner, . . i 4 oz. Bread. 1 pint Beef Tea. 4 oz. Bread, 1 pint Rice Milk. 8 oz. Bread, % lb. boiled Beef or Mutton, without bone, 1 pint of Broth. 4 oz. Bread, 1 pint New Milk. Supper, . . I 4 oz. Broad, 1 pint New Milk. 4 oz. Bread, 1 pint New Milk. The Meat and Broth in Full Diets to be given on five days in each week ; on Wednesdays and Fridays 1% pint of Milk Gruel to be substituted for the Meat and Broth at dinner. Children from five to ten years of age to have half the above quantities; above ten years of age to be allowed the full quantities. f Arrow Root, allowed only for Patients on Low Diet. V VTR 4 « J Wine . on Low, Middle, or Rice Diet. { Porter, 6 . . .' '. ~ > on Low or Middle Diet. <$W No Extras to be allowed for Patients on Full Diet. On the Epidemics of 1846 to 1850. 59 FORMS FOR MAKING BEEP TEA, one gallon. Beef cut small, . . . 1 lb. Pepper, ¦ . . . i oz. Salt, ..... A oz. Water, .... 1^ gal. Boil for two hours. EICE MILK, one gallon. Rice, 1 lb. Sweet Milk, ... 1 gal. Sugar, . . . . | lb. Boil slowly for an hour. BROTH, ono gallon. Beef, Hb. Potatoes mashed, . . T 1 lb. Or Barley or Rice, . . "^ lb. Oatmeal, . . . . | lb. Onions or Leeks, ... 2 oz. Pepper, . . . . a oz. Salt, 1 oz. Water, .... 1^ gal. Boil for three hours. MILK GRUEL, one gallon. Oatmeal, . . . . 1 lb. Sugar, . . . . i lb. Ginger, . ¦ . . . |oz. Milk, . . , . 1 qt. Water, .... 3 qts. Steep the Meal from night before. Boil for two hours. Bth That at least one copy of the dietary shall be posted in each Ward for the information of the patients, and as a check on the attendants' giving out the diets. 9th That, in addition to the ordinary diet drinks, there shall be constantly provided at the bed-side of every patient a porringer of water, and that there shall be always kept, on each Ward Table, a supply of fresh water. General Regulations, Copies of which are to be posted through the Hospital. Patients, able to get up, are to rise before breakfast every morning, to fold up their own sheets and blankets, and pack them neatly on the foot of each bed, so as to expose the bed to the air, and to permit a ready inspection. Those patients, who are sufficiently strong, are to obey the directions of the nurses, in sweeping out the wards, supplying drink to other patients, and in affording all other reasonable assistance in their power ; they are not, however, on any account, to be permitted to take any part in the administering of medicines or injections. ~Ho smoking to be permitted in the wards. No food to be brought in by the friends of patients. Patients' friends to be admitted into the Hospital every day, for one hour, from 1 to 2 o'clock, but at no other times, unless by written direction of the Medical Officer. Given under our hands this . day of One Thousand Eight Hundred and Forty-nine. > Commissioners. 60 Report of the Commissioners of Health, Ireland, c Appendix A., No. 14. Table showing the order in which Requisitions were issuer! for the provision of Temporary Fever Hospitals and Dispensaries. Union. Tullamore, Fermoy, Carrick-on-Suir, Athy, . . Koscommon, Baltinglass, Monaghan, Ballina, Carrick-on-Suir, Cavan, . . . Lisnaskea, Mallow, Dundalk, Fermoy, Bandon, Dublin, North, Dublin, South, Mallow, Bantry, Cashel, . Dungarvan, Kilmallock, Macroom, >i • Midleton, >» >> • Scariff, . Tralee, . Waterford, Trim, Dunmanway, . Fermoy, >> • • Kanturk, Electoral Division, or placo named for Hospital, or Dispensary, to bo provided at Tullamore, Mitchelstown, . Porjlaw, Ballylinan, Koscommon, Bait ingl ass, Castleshane, Kilmore, Kilcommon, Binghamstown, Carrick-on-Suir, Belturbet, Derrylin, Doneraile, Monanimy, Carlingford, Castlelyons, Rathcormac, Castletownroche, Kilworth, Ballyhooly, Bandoti, North City, South City, Mallow, Bantry, Castletown Berehaven, Fethard, Dungarvan, Aglish, Bonmahon, Kilmallock, Bruff, . Kilfinan, Ovans, . Agliabullogue, . Magourney, Youghal, Castleraartyr, . Killeigh, Midleton, Lisgood, Dungourney, . Clovne, Scariff, . Killaloe, Tulla. . Tralee, . Waterford, Scariff Ikitlge, . D unman way, . Kildorrery, rerraoy, Freemouiit, Dato of Requisition. 26th February, 1847. 3rd March, ? 17th „ ? 19th ? 24th ',' !' 29th ? „ sth April, ? 14th ',', ',', " >¦> >» >' >> >> 19th ',', " )' 5) )> )> >> ) J 4th May, ,',' j> >» j: sth „ »5 )> )> > J >* )5 )> >» J> )> )> J> )> >) )) ! J ) J >> 7th " '! 10th ? >> 5) )> )1 ) > »> »> J> J) On the Epidemics of 1846 to 1850. 61 Union. Kanturk, Armagh, Ballina, Boyle, . Clogheen, Cork, . Downpatrick, . Enniskillen, Kenmare, Lurgan, Nenagh, Parsonstown, . Eathdrum, Trim, . Carlow, Cashel, Galway, Kilkenny, Armagh, Athlone, Ballitiasloe, Clogheen, Clones, Dundalk, Galway, Kells,' . ! Kenmare, Kilmallock, Kinsale, )> • • Loughrea, New Eoss, Eathdrum, Bandon, Caherciveen, Kenmare, Limerick, Lismore, Londonderry, . Mallow, Naas, Electoral Division, or place named for Hospital, or Dispensary, to be provided at Kanturk, Ready, Ballina, B»yle, . Clogheen, Cahir, . Ballyporeen, Ardfinnan, Cork, . Whitechurch, . Eathcooney, Cove, . . Monkstown, Ballincollig, Killeagh, Enniskillen, Bourdoneen, Moira, . Borrisokane, Uskeane, Wicklow, Trim, . Lei^hlinbridge, Cashel, . Oranmore, Kilkenny, Gowran, Johnstown, Freshtbrd, Castlecomer, Thomastown, . Ballyragget, Lough gall, Athlone, Eyrecourt, Kilbenny, Roslea, . Dundalk, Killanin, Moycullen, Oughterard, Spandaw, Sneem, . Bruree, Ballylanders, . Kinsale, Ballinspittle, Loughrea, New Eoss, Bray, . Clonakilty, Valentia, Kenmare, Limerick, Templemichael, Cappoquin, Londonderry, . Buttevant, Kilcullcn, Duto of Requisition. ]Oth May, 1847. 17th „ >) >> 5> )> J5 J> J» 5> >» )> )> " >> J> 5» ») >> )> >> >> 5> >> )> >> >J >> >' )J >J >» >> >) >> )> J) »> >> 5> " >> >' '» J> >» >» )) J> »' »> >> " 19th ? ? >> j> " >) »» »> »> >) »> >> >> >> )> 5> >' 5> )> »» )» »J " »» »J " 21st „ ? >> >i " 5 J >> " J> )) »> )> 5> 5' • J JJ " )> J5 " . J) H " J> >> " >> »J " »» 9' *> ;> 5» " ») >> " j» »> " 24th ,', ? >¦> >> " »> >> " j> >> " j» '> »» 5» >' " 62 Report of the Commissioners of Health, Ireland, Union. Roscrea, New Eoss, Oldcastle, Bailieborough, . Enniscorthy, Enniskillen, Gorey, . Kilkeel, Kinsale, Lisburn, Rathkeale, Enniscorthy, Gorey, . Kells, . Lisnaskea, Newry, . Eoscommon, Clones, . Fermoy, , . Galway, Kenmare, Lismore, Macroom, Mohill, . Monaghan, Dingle, Lurgan, Scariff, . Sligo, . Thurles, Ballinrobe, Banbridge, Caherciveen, . Clogheen, Eoscrea, Cootehill, Fermoy, Eathdown, Newcastle, Skibbereen, Tipperary, Tralee, Eoscrea, Banbridge, ' Callan, Electoral Division, or place named for Hospital, or Dispensary, to be provided at Shinrone, . Tintern, Virginia, Bailieborough, . Enniscorthy, Swanlinbar, Gorey, . Kilkeel, Carrigaline, Saintiield, Croom, . Newtownbarry, Ford, . . Kells, . Brookborough, Newry, . Strokestown, . Lanesborough, . Clones, . Mogeely, Galway, Tousist, Tallow, Macroom, Mohill, . Monaghan, Dingle, . Portadown, Lurgan, Feakle, Collooney, Thurles, Ballinrobe, Tanderagee, Drumod, . Whitechurch, . Killavenogue, . Corgreagh, Ardnageehy, Rathdown, Newcastle, Abbeyfeale, Ballingarry, Killeedy, Leap, Abbeystrowry, Tullagh, Aghadown, Kilmoe, West Skull, . East Skull, Caherragh, Dromdalleague, Iloscarbery, Tipperary, Castleisland, Dunkerrin, Dromore, Mullinahone, . Date of Kequisition. 24th May, 1847. 25th ? ? >> >> > t 26th „ >) i) > » )> > » >» )> »> > j 5J 5) 5 J ») 5> 5J )> >> >» 28th „ ? J> 5> »5 )> )1 . 5> )9 )J 55 5> >» »> >) >» )> 29th " ',', if 5> J> 3) >> !) )) >> ') 5) >? >> Ist June, ? >» )> >> >> >> >> >» )> >» 2nd ? ? >> >> »> 3rd ,',' 4th ',' ,'' >> 5 J JJ )5 >) J» )> »> »J 5» ) J >» )> J> >» J» 55 5 5 5) J) 5> )5 55 J5 >>5 5 J > >> 5> )> >» J) J> >> »> )> J> >> 5> J> )) 5» 5> 5> J> stll ? ? Bth ? „ On the Epidemics of 1846 to 1850. 63 Union. Carlow, Granard, Macroom, Mallow, New Ross, Eathkeale, Tuam, . Waterford, Carrickmacross, 55 • 55 • • Cootehill, Kanturk, . Kenmare, Naas, . . Bandon, Downpatrick, . Dungannon, 55 • 55 • Mountmellick, . New Eoss, Eathdown, Tipperary, Waterford, Carlow, Shillelagh, Armagh, 55 • • 55 • Omagh, Cashel, Lisburn, Limerick, 5> • 55 • • Glenties, Ballymoney, Enniskillen, 55 • Limerick, 55 • Listowel, Midleton, Rathdrum, Eoscrea, . - . Parsonstown, . Trim, . Ballinasloe, Manorhamilton, Nenagh, Cork' . Electoral Division, or place named for Hospital, or Dispensary, to bo provided at Borris, . Drumlumman, Matehy, Ballinamona, Dunbrody, Eathkeale, Tuam, . Mullinavat, Carrickmacross, Kaferagh, Donaghmoyne, Drum, . Newmarket, Ballybog, Naas, Iniskeen, Innishannon, . Ballynahinch, . Tullyniskin, Moy, Dungannon, Donaglimore, . Mountrath, Fethard, Kingstown, Cullen, . Kilmacthomas, Ballon, . Hacketstown, . . Armagh, Markethill, Middletown, Drumquin, Killenaule, Hillsborough, • Castleconnell, . Cappamore, Caherconlish, . Dungloe, Kilrea, . Clabby, Lisbellaw, Kilbane, Abington, Listowel, Garryvoe, Newcastle, Bourney, Parsonstown, . Athboy, Carnacregg, Manorhamilton, Cloghjordan, . Nenagh, Toomavarra, Silvermines, Newport, Portrue, Inniscarra, Date of Requisition. Bth June, 1847. 55 55 !5 55 55 55 S> 55 55 55 55 55 10th ,',' „ 55 55 )5 55 55 55 55 55 55 11 th ',' ]', 55 55 55 55 55 55 55 55 55 12th r, ',', 55 5 5 55 )5 55 55 5' 55 55 14th ? 55 55 55 15th ? ? 55 55 55 55 55 55 16th ?' „ 18th \\ „ 55 55 55 55 55 55 19th ? „ 21st ? ? 55 55 55 55 55 55 55 55 5J 55 55 5 5 55 55 55 22nd ? ? 23rd ?' „ 55 55 55 55 55 55 55 55 55 55 55 5) 55 55 55 55 >> 55 24th ,',' " 64 Report of the Commissioners of Health, Ireland, Union. "Roscrea, Cavan, )> • • )> Clones, . . Granard, New Ross, Carrick-on-Shannon, . Magherafelt, Omagh, Sligo, . Caherciveen, . Callan, . Kanturk, Kenmare, Kilmallock, Parsonstown, . Bailieborough, . Thurles, Oldcastle, Enniscorthy, Wexford, . Clogher, Cootehill, Killarney, Ballinrobe, Omagh, Cashel, . Omagh, Parsonstown, . Caherciveen, . Downpatrick, . Monaghan, Trim, . Ballina, Drogheda, Abbeyleix, Banbridge, Kinsale, Lowtherstown, Westport, Balrothery, Enniscorthy, Navan, . Tipperary, Carlow, Loughrea, New lioss, Clifden, Kanturk, Roscrea, Tipperary, Ballina, Ballinasloe, Ballyshannon, . Electoral Division, or place named for Hospital, or Dispensary, to be provided at Aghancon, Borris-in-Ossory, Ballyhaise, Crossdoney, Belturbet, Ballymachugh, Stradone, Killashandra, . . Newtownbutler, Granard, Graiguc, Carrick-on-Shannon, . Magherafelt, Omagh, Tobercurry, Caherciveen, Callan, . Kilmeen, Kilgarvan, Glenroe, Kinnety, Kingscourt, Templemore, . Castlepollard, . Killan, . Wexford, Aughnacloy, Cootehill, Killarney, Kilmain, Dromore, KnockgrafFon, . Fintona, Lorha, . Glenbeigh, Ardkeon, Emyvale, Summerhill, Easky, . Droghcda, Bally roan, Loughbrickland, Nohoval, Lowtherstown, Westport, Balbriggan, Clonroche, Navan, . Golden, Doonane, Athenry, Ilosbercon, . Ballindoon, Millstreet, Eathdowney, . Cappawhite, Crossmolina, Mountevans, Ballyshannon, . Dato of Requisition. 24th June, 1847. 25th ? ? > J >5 >> J> 5> >» )) )> J> )) >> >» >> >> J> J5 >> >> J5 >> 5> 26th ,| )| '» »> s> 29 th ',' ',', >> )> >> >) >5 »> >> H 5> )» ) J 5> 30th " H Ist July, ? 2nd ? ? 3rd ',', \\ sth ? 6th ? ? 7th ',', \\ 5» >> >> Bth ,',' " >> >> m » j »> > » >> >> )> 9th „ ? 10th ',', >> >» »» )> >> 5) 12th " " >> >> 13th ? ? >» >» >» 14th " 15th „ „ 5> J >J »» »J 5> 16th ? ? 5> >> J> On the Epidemics of 1846 to 1850. 65 Union. Castlerea, . Gort, . Athy, . Longford, Ardee, . Ballinasloe, Granard, Magherafelt, Dungarvan, Loughrea, Ballinasloe, Ballinrobe, »> • • Longford, Castlerea, >> • • Clogher, Gort, . Ballinrobe, Roscommon, Castlerea, Rathdrum, Clifden, Enniskillen, Granard, Ennistymon, Kilrush, Oldcastle, Cookstown, Navan, . Gahvay, Longford, Rathkeale, Castlebar, Mullingar, New Ross, Tuam, . Ballinrobe, Ballinasloe, Kilmallock, Dingle, . Belfast, Lisburn, Clifden, Naas, Bailieborough, . Carlow, Mohill, . Boyle, . CUfden, Ballina, Callan, . Electoral Division, or place named for Hospital, or Dispensary, to bo provided at Kilkerrin, Kinvarra, Athy, . Eatlicline, . . Ardee, . Ahascragh, Street, . Bellaghy, Moneymore, Clashmore, Portumna, Aughrim, Claremorris, Partry, Tarmonbarry, . Ballyhaunis, Ballinlough, Frenchpark, Fivemiletown, . Gort, . Ross, Churchfield, . Knockroghery, Glannamodda, . Rouixhvood, Roundstone, Killinagh, Coole, . Miltownmalbay, Kilrush, Crossakeel, Ballyj amesduff, Pomeroy, Ardbraccan, Waterdale, Clonaugh, Askeaton, Addergoole, Mullingar, Innistiogue, Monivea, Neal, Kilconnell, Charleville, Castlegregory, . Belfast, Lisburn, Clifden, Robertstown, . Blessinton, Shercock, Tullow, Ballinamore, Carrigallen, Coolavin, Ballinahinch, . Ballinakill, Belmullet, Kilmaganny, Date of Requisition. 16th July, 1847. 17th ¦" " 19 th ',' \\ >)5 > ) > JSJ J 5 > )) 5> ' !» 21st v) ¦ „ >» >» >> 23rd ? ? 24th ? ? 28th ? „ )) 5> ?> 29th ? „ Slst ,', ? >> 5> " 2nd August, ? sth ? - , 7th " ", 9th \\ ? )) JJ '> J J J> " )» J5 5' 10th ? ? l'l'th " ? 12th ", ? 23rd ? ? 26th ',', ? 28th ? 2nd September, ? 4th ? ? 7th „ ? 23rd ? ? 13th November, ? 15th ,\ „ 15 th December, ? 17 th ? ? 3lst ? ? sth January, 1848. 6th „ 18th „ ? F Report of the Commissioners of Health, Ireland, CG Union. Carlow, Manorhamilton, Parsonstown, . Ballina, Carlow, Ballinasloe, Shillelagh, Enniscorthy, Carlow, Ennistymon, Kilrush, Clifden, Galway, Ennistymon, Tuam, . Kilrush, Eathkeale, Westport, Cavan, . Ennis, . Fermoy, Dingle, . Scariff, . Carrick-on-Shannon, . Lisnaskea, Electoral Division, or place named for H< spital, or Dispensary, to bo provided at Bagnalstown, . Drumkeeran, . Frankford, Killala, Carlow, Ballinasloe, Tinnehely, Oulart, . Ballickmoyler, . Moymore, (Dispensaries), Roundstone, Annaghdown, . Ballyvaughan, Dunmore, Kilfiddaan, Shanagolden, . Bonn, '. Miltown, Ennis, . . . Ballynoe, Annascaul, Whitegate, Elphin, . Lisnaskea, Date of Requisition. 18th January, 1848. 19th '? ? ' sth Eebruary, ? 18th '? ? 25th ? ? 13th March, ? 23rd '? „ sth April, ? 15th ? ? 26th '', II 22nd May, ? 25th ? ? 13 th June, ? 20th July, ? 22nd „ ? 24th ? ? 17th August, ? ' 9th October, ? 23rd December, ? 21st April, 1849. 14th May, ? 27th June, ? 28th July, ? 17th October, ? Appendix A., No. 15. Summary Returns, showing the Number of Patients treated under the Temporary Fever Acts in the principal Towns in Ireland. Year. Name of Town. Belfast, Cork, . Dublin, Galway, Limerick, Waterford, Total, Number Treated. 484 3,907 15,357 1,054 . 2,429 2,446 25,677 Number Died. . 44 316 1,089 .46 218 236 1,949 Rate of I Mortality I per cent. I 9-1 8-1 7-1 4-3 8-9 9-6 7-5 1847 ), 5, 5> Belfast, Cork, . Dublin, Gal way, Limerick, Waterford, Total, . j 237 1,792 9,033 1,937 . 5,496 . 1,854 . 20,349 . .19 162 812 136 848 174 2,151 8' 9-9-7; 7; 15-4 9-3 . 10-5 1848 On the Epidemics of 184:6 to 1850. 67 Summary Returns, sliowingthe Numberof Patients treatedundertlie Temporary Fever Acts in the principal Towns in Ireland — continued. Year. 1849 1850 1847] 1848 1 1849 [ 1850J Name of Town. Cork, . Dublin, Galway, Limerick, Waterford, Total, Cork, . Dublin, Waterford, Total, Grand Total, as above, (The number remaining under treatment on the termination of the years 1847, 1848, and 1849 deducted.) Number Treated. 4,149 5,481 1,123 817 2,077 13,647 1,803 3,748 2,184 7,735 64,127 Number Died. 777 499 221 235 127 1,859 148 296 182 626 6,585 Rate of Mortality I per cent. I 18-7 9-1 19-6 28-7 6-1 13-6 8-2 7-9 8-3 8-1 10-2 ["Summary ob 1 Returns. f2 68 Report of the Commissioners of Health, Ireland, Appendix Summary op Returns, showing the Number of Patients treated in Total for all Ireland, with rate of Mortality I PROVINCE OF ULSTEE. PROVINCE OF LEINSTER. PROVINCE OF Number of Patients. Number of Patients. Number of flf I? 1 j i V ill P I liP Iff P 1 1847. July, 675 3,519 4,194 1,704 1512,339 906 5,936 6,842 3,416 1853 ,241 3,121! 10,619 13,740 August, . 2,339 2,761 ; 5,100 2,636 181 2,283 3,241 1 5,541 8,782 4,454 298,4,030 5,833, 7,593 13,426 September, 2,283 2,200 4,483 2,230 i 166,2,087 4,030 5,406 9,436 4,801 401 j 4,234 5,784 5,890 11,674 October, . j 2,087:2,337(4,424, 3,032] 146 1,246 4,234 0,405 10,639 5,960 470 4,203 5,086| 5,460 10,546 November, 11,246;1 1,246; 1,307 j 2,553 1,169: 107 1,277 4,203 4,046] 8,249] 4,0941 348 3,807 3,926j 3,735 7,061 December, 1 1,277 1,35312,030 1,112] 110 1,402 3,807 3,908| 7,715, 4,121 409 3,185 3,295j 4,222 7,517 1848. January,. 1,402] 1,184! 2,586j 1,448 134 1,004 3,185 4,015 7,200 3,652 4G7 ; 3,081 3,530 5,100 8,630 February,. 1,004| 9731,977! 875 101; 1,001 3,0811 2,904 5,985J 2,693 324 2,9G8 3,851 5,416! 9,267 March, . 1,001 ! 1,002 2,063: 854 132 1,077 2,968,3,303 0,271 2,9351 327 3,009 4,354 5,802 10,156 April, . 1,077 1,037! 2,114 1,108 148j 858 3,00.0 i 3,306 6,315 3,188! 413 2,714 4,740! 7,793,12,533 May, . 858, 8691,727; 814 84! 829 2,71412,527 5,241 2,451 272 i 2,518 4,595 C,069| 10,604 June, . 829j 674 i 1,503 728 G7i 708 2,51812,134 4,652,2,325 2031 2,124 4,254 4,4401 8,694 July, . 7081 682] 1,390! 726 G4j GOO 2,1 24 i 2,175 4,299 2,309 2041 ,720 4,114 5,220; 9,340 August, . 600; 301 901; 463 301 408 1,726! 1,476 3,202| 1,683 119; 1,400 3,592 3,167 6,759 September, 408 263 6711 377 19j 275 1,400 1,768 3,1681 ,961 129 1,078 3,039 3,164 6,203 October, . 275 128 403 216 23 164 1.078,1,2091 2,287 i 1,192 85. 1,010 2,395 2,152 4,547 November, 164 00 254 97 17 ' 140 1,010 1,282 2,292)1,044 1 18(1,130 2,259 2,24 C 4,505 December, HO 207 347 140 24 183 1,130 1,495 2,625 1,3G6 147 1,112 2,104 3,150 5,254 1849. January,. 183 321 504 143 63 298 1,112 1,572 2,G84 1,238 18911,307 2,247 3,085 5,332 February, 298 343 641 189 70 382 1,307 1,860 3,1671 1,439 205 1,523 2,591 3,914 6,505 March, . 382 523 905 359 111 435 1,523 2,509 4,032J 1,976 3791 ,677 2,942 4,913 7,855 April, . 435 399 834! 363 111 300 1,677 1,947 3,624! 1.764 316; 1,544 2,965 4,179 7,144 May, . 360 325; 685 1 309 72 1 304 1,54412,170; 3,714 1,756 349 1,609 3,045 4,566 7,611 June, . 304 251 1 555 241 85| 229 1.609J 2,728! 4,337| 2,179 384 1,774 2,984 5,860 8,844 July, . 229 i 213 442: 193 28' 221 1,774 i 1,855] 3,629! 1,829 249 1,551 3,110 3,575 G,t>Bs August, . 221] 207 428! 18G 27| 215 1,551] 1,558 3,109 1,633 189 i 1,287 2,828 3,406 6,234 September, 215J 290 505] . 2GI 18' 226 1,287 1,800 3,147] 1,763 179| 1,205 2,517 3,374 5,891 October, . 226 i IG4 390 150 27 207 1,205 1,352 2,657 1,256 127 1,174 2,201 2,482 4,683 November, 207; 172| 379] 154 18 207 1,174] 1,297 2,4711,161 115 ! 1,195 2,188 2,249] 4,437 December, 207 257 464 227 31 j 206 1,195 1,655 2,850,1,597 127 1,126 2,124 2,671! 4,795 1850. January,. 20G 188 394 153 22 219 1,12611,490 2.61G 1,1311 1441,341 1,940 2,349 4,289 February, 219j 257 476 189J 27 2GO 1,341 1 1,449| 2,790 1.340J 138 1,312 2,032 2,592 4,024 March, . 2GO 304| 564; 207J 57 250 1,312 1,898 3,210 1,737; 205 1,208 2,040 3,416 5,45G April, . 250 230' 480 197 521 231 1,268 1,549 2,817 1,359 i 1G0! 1,298 2,080 2,709 4,789 May, . 231 108 399 192; 35 1 172 1,298 1,611 2,909 1,455' IGO 1,294 1,985 3,001 4,980 June, . 172 362 434 174 38 222 1,294 1,849 3,143 1,753 182 1,208 2,168 3.404 1 5,572 July, . 222 157! 379! 1911 15 173 1,208 1,510 2,718 1,367 139 1,212 1,990 2,426j 4,416 August . 173 i 81 254 112 10 132 1,212 981 2,193 1,014: 791,100 1,913 1,431| 3,344 Totals, .123,373126,059(49,132,23,975 2,627 1 22,8301 73,381 93,536! 166,9171 84.458J 8,884 72,5751 117,762 156,846 274,608 On the Epidemics 0f1546 to 1850. 69 A., No. 16. Temporary Fever Hospitals, per Month, in each Province, and the during the Years 1847, 1848, 1849, and 1850, respectively. MUNSTER, PKOVINCE OF CONNAUGHT. TOTAL OF THE FOEEGOIKG. Patients. Number of Patients. Number of Patients. I !• |ofl a. I f . £ a o i§ o o -> "5 2 ¦ ¦5 ° •§ § 3 "§ (U o «| « c §1 13 Eg 43 o "»O o "o "S "S !« SI g o (X) I— l o 1 s 1 M 1 .3 d 'a I c 4 o p |Z5 OS <] o &: H H W H O H is f-H H *O -I I J J oot~OO||O||[ CT> n* o g h 4^ - a _o _S tO i— l CO T)< rH I-H CO S "e^S ! I CT> >* II 111 -tf a I ° i '«"-' *^ 3 o Snj 000-lOOrHOJ O Oasg | ill CO G^l I I 1 I C E 1 yl | l-sl " i.i iS3 ii i i i.i i | & Q 'g'g 1 I II I §*» 1111 I I I °^ jg O » N-f(Nrt I "'CO B^.g. "* ' 3 -2^-S I n a s h n oi | co Q | Q S. CICOCSCTCMTji^tOCO(MI> CO -°^,S I r-HJI>(MI^COOO«DCT I i-i BoS TjiO>CO»O00(N 00 g 6 o^_ 'g.'&tj K~ 717 1 V 'P 'P ?* 'P oa* I iiOOX)(N00O-*i|| i— ' feg. rt t- (O H h ffl i< Oi 73 'Sv.'S I I I O5 ifl CO t- O I I 1 (N OCOrt MBHMBrI CO ° I Q •2^B | | | COOiONCOtO I I I l~ go» -n ¦SvcCß >O lOffl^HNHtoOffllM O COg IHCOCOINHIMNMH tjg ° I gI i iMiUiUM I Dublin : Printed by Alexander Thorn, 87, Abbey-street, for Her Majesty's Stationery Office. REPORT Of THE COMMISSIONEBS OF HEALTH, IRELAND, ON THE E P I 1) EMI C S 1846 To 18 Presented to both Houses of Parliament by Command of Her Majesty. DUBLIN: PRINTED BY ALEXANDER TIIOM, 87, ABBEY-STREET, FOR HER MAJESTY'S STATIONERY OFFICE. 1852.