Stones & Bones: Containing Typhoid in 'Dear Dirty Dublin' (Part One)
A Typhoidland exhibition for Dublin City Library and Archive.
Molly Malone Statue, Dublin (2024) by Carly CollierDublin City Library & Archive
Alive, Alive Oh...
If you live in Dublin (or have spent any time there), the tune of “Molly Malone” will be familiar. You may even have seen the city’s statue of Molly on Suffolk Street. But Dublin’s unofficial anthem is far more than a catchy ballad...
Molly’s song reminds us of a not-so-distant past when life was tough and “dying of a fever” was a common occurrence. A major killer was typhoid fever, a deadly disease spread by faeces contaminated with typhoid bacteria (Salmonella enterica serovar Typhi – S. Typhi).
Typhoid fever lurked around every corner, with many aspects of daily life exposing Dubliners to the disease. Step inside Edwardian Dublin, where S. Typhi thrived in sewers, waterways, and food supplies – and where public health officials struggled to contain its spread.
The typhoid bacterium (2023) by Clare FoleyOriginal Source: Typhoidland
Chapter 1. Meet Typhoid
Typhoid is a serious infectious disease caused by the bacterium Salmonella enterica serovar Typhi (S. Typhi). S. Typhi is transmitted when the faecal matter of an infected person is ingested by an uninfected person, either directly (touch) or indirectly (by food and water).
Typhi's Journey
Artwork by Eliza Wolfson;
Curated by Claas Kirchhelle and Carly Collier;
Animated by Ben Leighton.
The typhoid bacterium (2023) by Clare FoleyOriginal Source: Typhoidland
Typhoid Fever Pathology
Typhoid was (and in many parts of the world, still is) a very common infectious disease. Without effective antibiotic treatment, it kills up to 1 in 5 people.
Typhoid presents with a cluster of non-specific symptoms, which can include a high fever, nausea, diarrhoea, a rash and constipation. In around 1 in 5 cases, it can lead to fatal sepsis. This makes typhoid hard to diagnose without a test.
These 19th-century watercolours show necrosed (dead) Peyer's patches (dead lymphatic tissue) in the large intestine, a key postmortem indicator of typhoid [left], and a patient with a rose-coloured rash, one of the clinical symptoms associated with the disease [right].
Feeding cup from Cork Street Fever Hospital (1900/1950) by Unknown makerOriginal Source: Royal College of Physicians of Ireland
Typhoid's Toll
For those who survive, it takes about three weeks to recover. Survival is more common with access to supportive care, nutrition, and better overall health. Today, antibiotics are used to treat acute infections and have reduced mortality to around 1 in 100.
Importantly, up to 5 in 100 people infected with typhoid will seem to recover from the infection but continue to shed bacteria in their stool. These people have been called typhoid carriers (you can find out more about one of the most (in)famous carriers, "Typhoid Mary", here)
Tranmission of Typhoid Fever and Means of Protection (1908) by George Whipple and William Thompson SedgwickOriginal Source: Wellcome Collection
An Ecology of Typhoid Fever
There are different routes and speeds of typhoid transmission.
A bird's eye view of turn of the century Dublin (2023) by Clare FoleyOriginal Source: Typhoidland
Three Different Categories for Typhoid Transmission
One: “Short cycle factors” are transmission routes that can be traced from one person to another, like infected milk or food, faecal contamination of shared facilities like toilets or baths, or direct contact between sick and healthy people.
Two: “Long cycle factors” are features that facilitate typhoid transmission on a bigger scale – like a leaky sewage system that contaminates shared water sources.
Three: “Extra-long cycle factors", which relate to how long typhoid bacteria can survive for very long periods in the environment, such as hospitable wet soils, sediment-filled rivers, or wide, shallow bays.
Custom House, Dublin (c.1890-1920) by UnknownDublin City Library & Archive
Typhoid's Coastal Threat
Typhoid spreads easily in coastal settings. So which factors were particularly important in Dublin? And why was typhoid so hard for public health officials to contain?
A funeral for a typhoid victim, Dublin (2023) by Clare FoleyOriginal Source: Typhoidland
Chapter 2. A “Contagious” City: Nineteenth-Century Dublin
Dublin was rapidly expanding in the second half of the 19th century. The Irish Potato Famine (1845-1852) and economic investment in Dublin Port brought people flooding into the “Empire’s Second City”.
Between 1800 and 1901, the population of the municipal district expanded from 180,000 to 291,000. Rapid population growth overwhelmed the city’s infrastructure and housing.
Kavanagh's Court, off Bow Street, off North King Street (1913) by Local Government Board for IrelandDublin City Library & Archive
Disease in the Streets
Walking through 19th century Dublin, it would have been hard to avoid contact with somebody who was sick or with contaminated water and foodstuffs.
Rampant inequality exacerbated Dublin’s health problems. For much of the 19th century, housing was mixed, with very wealthy administrators and government officials living just a few streets over from extreme poverty.
Dublin Street Directory Map (1833) by Society of the Diffusion of Useful KnowledgeDublin City Library & Archive
A City Divided
Over time, wealthier people moved to new suburbs, such as Rathmines, Rathgar, and Pembroke, where they could avoid poor neighbours - and paying taxes to Dublin city.
Map of the City of Dublin and its Environs (c.1910) by ThomsDublin City Library & Archive
Look at these maps of Dublin. Can you see the suburbs expanding to the North, South, and West of the city? Can you identify any infrastructure (tramways, train lines) that grew with the city?
While the wealthy moved to the suburbs, old parts of the city like Inchicore, Dublin North, and Dublin South (including the Liberties and the Docklands) continued to house thousands of people in overcrowded tenement houses.
Dilapidated Houses, 30 and 31 Grenville Street (1913) by Local Government Board for IrelandDublin City Library & Archive
Dublin's Tenements
Many tenements had been converted from old Georgian houses, which had originally been built for single households.
A Tenement House, Kilmainham (1914) by Dublin CorporationDublin City Library & Archive
In 1903, nearly two-fifths of Dublin’s families lived in just one room. Of the over 21,000 one-room tenements in Dublin, nearly half had more than four people occupying them - and nearly 200 housed more than nine people.
Tenement sanitary facilities were basic, with many buildings sharing a single privy or ashpit to defecate in. Toilets were rare [left]. Water for drinking and washing was often provided by a single pump in the yard of the tenement house [right]. Conditions in these "fever dens" were ideal for short-cycle typhoid transmission.
Our milk supply (1908) by Thomas FitzpatrickDublin City Library & Archive
Food and Milk
Contaminated milk and food were another route of typhoid transmission. Milk was contaminated either by infected milkers or by the use of polluted water or ice to dilute or cool it.
“The question of milk supply is one which has had the very closest attention from the Medical Officer, who has distinctly traced Typhoid Fever cases to polluted milk supplies.”
Charles Cameron, Report upon the State of Public Health and the Sanitary Work performed in Dublin, during the year 1891 (Dublin, 1892)
Our milk supply (1908) by Thomas FitzpatrickDublin City Library & Archive
Milking Dairy Scandals
In 1908, after a typhoid outbreak was traced to a local dairy, Dublin’s The Lepracaun Cartoon Monthly highlighted how insanitary and poorly regulated dairies could spread disease.
Some foods were considered particularly risky. Ice cream and leafy vegetables could easily be contaminated with faeces in dirty water or by poor hand hygiene.
Anxiety around typhoid, and the disease’s unclear connection to food, opened the door to discriminatory policies and practices. Italian immigrants commonly operated “hokeypokey cars” and ice cream stalls in Dublin.
The River Liffey (2023) by Clare FoleyOriginal Source: Typhoidland
Water and Waste
The slow current and tidal patterns of the Liffey meant that sewage often backed up into the city. The nutrient-rich waters would have been ideal for the survival of S. Typhi.
Irish Essay (1946-07) by Hans WildLIFE Photo Collection
...it stank like hell (Bagatelle, 1980)
For centuries, the Liffey and Dublin’s smaller rivers had served as sources of drinking water and as a main route of sewage and waste disposal. However, rapid population growth and a corresponding increase of human and animal waste turned the river into an open sewer.
Faeces entered the Liffey through surface drains, leaky cesspools, and a piecemeal network of crumbling sewers. New water closets increased the amount of polluted water in the system.
Sir Charles Cameron (1882) by Smith & SeeOriginal Source: Royal College of Surgeons in Ireland
A Call to Action
Charles Cameron, ‘Presidential Address to the Congress of Public Health’, The Dublin Journal of Medical Science, 1 September 1898.
A cockle (2024) by Clare FoleyOriginal Source: Typhoidland
Where the Liffey emptied into Dublin Bay, S. Typhi bacteria came with it – contaminating the many oysters, mussels, and cockles that called this shallow coastal estuary home.
Three cockle pickers, at the coast [probably Co. Donegal] (1890) by J.J. ClarkeOriginal Source: National Library of Ireland
A Coastal Feast, A Hidden Threat
Many Dubliners harvested shellfish either as a leisure activity, or as a low-cost protein supplement to a heavily carbohydrate-based working-class diet. Hawkers went to the shores of the Bay to collect cockles and mussels to sell in the city.
Many typhoid cases were traced to shellfish collected from Dublin’s shores.
"Dear, Dirty Dublin." Wanted a Public Health Department. (1908) by Thomas FitzpatrickDublin City Library & Archive
Typhoid's Grip on Dublin
Driven and sustained by contaminated food and water, overcrowding, and poverty, infectious diseases tarnished Dublin’s reputation. By 1900, the city was regularly referred to as the unhealthiest in the United Kingdom.
Dublin's death rate was “considerably in excess of that in any of the thirty-three large towns of England and Wales” in 1900, according to a Government Commission, highlighting the city's urgent need to address public health issues.
But when city public health officials noticed that typhoid rates were higher in Dublin than in any other Irish city (except Belfast), resolving typhoid's grip on Dublin became a priority.
To find out more about Dublin's struggle with typhoid and the attempts to control it, see Part Two of Stones & Bones here.
Research by Dr Emily Webster. Co-curation by Drs Emily Webster and Carly Collier, with contributions from Dr Claas Kirchhelle. With thanks to Dr Alice Maugher, Dr Diarmuid O’Shea, Jessica McCarry, Lorraine McLoughlin and Mairéad Walsh. Research based on Webster, 2024. Maps and epidemiological charts available here. Full references available here.
You are all set!
Your first Culture Weekly will arrive this week.