A Dublin street scene (2023) by Clare FoleyOriginal Source: Typhoidland
Chapter 3. Understanding Typhoid
For most people around 1900, the idea that disease was transmitted by germs was a radical one. Many instead focused on things that were easier to see, touch, and smell: foul odours, lack of sanitation, and overcrowded, run down housing.
When a major typhoid epidemic broke out in the 1890s, attacking 1 in 200 people, Dublin’s experts initially leaned on classic filth- and climate-based arguments to explain it. By 1900, bacterial explanations for typhoid became more common.
Sir Charles Cameron (1882) by Smith & SeeOriginal Source: Royal College of Surgeons in Ireland
From Filth to Germs: A Paradigm Shift
Dublin’s slow-rolling typhoid epidemic was a big concern for Medical Superintendent Officer of Health, Charles Cameron, who as head of the Public Health Department between 1879-1919 was responsible for disease surveillance (see the RCSI’s exhibition on Cameron here).
Like many public health officials of his time, Charles Cameron used mortality statistics and contact tracing to understand typhoid outbreaks.
Return showing the deaths from Typhoid Fever amongst six classes of the population ... (1894) by Charles CameronDublin City Library & Archive
When these methods couldn't identify a chain of infection, Cameron turned to social and environmental factors to explain the disease.
Grey Day (Vartry Reservoir) (2015) by Denis MoynihanDublin City Library & Archive
The Vartry Reservoir, County Wicklow
Based on mid-19th century epidemiological investigations, the most popular theory of how typhoid spread was through contaminated water supplies. Medical Officers of Health would check whether reservoirs had been polluted.
But this method didn’t seem to work in Dublin, where the municipal corporation had followed London’s lead by investing in a major upgrade of its water system.
"One of the purest in the world"
The Vartry Reservoir, completed in 1863, was frequently described as “pristine”, and often hastily absolved from connection to typhoid.
The Dublin Metropolitan Cattle Market (c.1926) by Dublin CorporationDublin City Library & Archive
The Milk Connection
Milk-borne theories of typhoid transmission were popular amongst health officials. Milk could be adulterated with unsafe water by dairies looking to save a penny, and milkers didn't always wash their hands.
Map of typhoid cases in Dublin (1893) by Charles CameronDublin City Library & Archive
To explain the explosive nature of the 1890s outbreak, Cameron initially employed the popular ‘soil and seed’ theory of disease transmission, which held that certain climatic conditions could cause a sudden ‘bloom’ and airborne spread of 'noxious' germs such as typhoid.
Unearthing Dublin's Typhoid Patterns
In this 1893 map showing Dublin soil types and the distribution of typhoid cases since 1882, Cameron argued that the parts of the city built on gravel instead of clay had become dangerously polluted by faeces leaking from sewers, buried cesspits, and poorly maintained cesspools.
Professor Edmund McWeeney (1890) by LafayetteOriginal Source: UCD Special Collections
Dublin's Bacteriological Pioneer
In Dublin, the new science of bacteriology was represented by Edmund Joseph McWeeney (1864-1925). Based at Mater Misericordiae Hospital, McWeeney consulted on typhoid outbreaks and introduced new laboratory techniques to identify S. Typhi in water, food, and soil.
While McWeeney and Cameron initially disagreed on whether lab-based science was helpful in identifying and tracing typhoid, by 1900, Cameron started sending milk, water, and food samples for bacteriological analysis to look for S. Typhi.
Typhoid Agglutometre, No. 2 (c.1920s) by Parke, Davis & Co.Dublin City Library & Archive
In addition to isolating and growing S. Typhi from human and environmental samples, McWeeney was an early adopter of diagnostics such as the Widal Test for typhoid, which used antigen-antibody reactions to identify S. Typhi in patients.
City Celebrities No.3. - Sir Charles Alexander Cameron, M.D., F.R.C.P.I., D.P.H. (Camb.)., &c. (1906) by Thomas FitzpatrickDublin City Library & Archive
Cameron's Shellfish Theory
One typhoid transmission theory was very special to Dublin's Charles Cameron - his own, which was that typhoid could be contracted from consuming sewage-polluted shellfish. This theory didn’t prove popular with others, though.
In 1880, Cameron presented his theory about shellfish and typhoid transmission to The British Medical Association, where it was met with some skepticism. The Association's President dismissed it as “one of [Cameron's] usual Irish jokes.”
A bird's eye view of turn of the century Dublin (2023) by Clare FoleyOriginal Source: Typhoidland
Chapter 4. 'Preventing' Typhoid
By 1890, it was clear that stopping faecal contamination would lower typhoid rates. Dublin’s public health authorities tried to prevent exposure to S. Typhi through infrastructure investment and regulation.
From the mid-19th century onwards, cities across Europe, the UK and North America started upgrading their sewage infrastructure. Engineers often copied templates from other cities, even if these were ill-suited to local environments.
Section of the Thames Embankment (1867) by Unknown printmakerOriginal Source: Wellcome Collection
A Landmark in Sewage Systems
The London Municipal Sewer System, designed by Joseph Bazalgette (1819-91), was a hallmark development in modern water-carriage sewage systems. It opened in 1865. As part of the British Empire, Dublin turned to London for guidance for its new sewerage scheme.
In London, sewage outfalls had been rerouted downstream of the city, leading to significant land reclamation in the form of the Thames Embankment.
Bazalgette visited and advised many cities on adopting similar solutions, including Dublin. However, what worked in London wasn’t a “one-size-fits-all” solution across the rest of the Empire – as the citizens of Dublin, Bangalore, and Belfast would soon find out.
Dublin Main Drainage Plan of intercepting sewers ... (1868) by Parke NevilleDublin City Library & Archive
London's Influence on Dublin
In 1868, Dublin City Engineer Parke Neville (1812-86) and Bazalgette developed a London-style plan that included intercepting sewers running along the Liffey and collecting feeds from smaller brick conduit sewers before discharging into the Bay at the North Bull Wall.
The Dublin Main Drainage Scheme, as it was called, was accepted by Dublin Corporation in 1870 and finished in 1906.
Despite its popularity with city administrators, engineers warned that the slower-moving Liffey river posed a significant risk of sewage flowing back into the city and potentially contaminating its shoreline.
Surviving documentation of the Dublin Main Drainage Scheme relating to the construction of the Pumping Station on the Pigeonhouse Road, Ringsend.
A Modern Filtration System (Film: Wellcome Collection)
It was suggested that settlement tanks (like those shown in this film clip) should be built to filter out solid waste, which could then be sold for use as fertilizer or dumped into the sea. The remaining ‘clarified’ waste water (effluent) would then be released at high tide.
The Outfall Works, Main Drainage Scheme (1906) by Dublin CorporationOriginal Source: Wellcome Collection
Dublin Corporation duly had settlement (also called precipitation) tanks constructed as part of the Main Drainage outfall works on the Pigeonhouse Road, and commissioned the building of a 'sludge ship' - the SS Shamrock - for transporting the solid waste out to sea.
The ‘clarified’ waste water (effluent) released at high tide should have been swept straight out to sea. But the tidal patterns had other ideas. Have a look at this hydrological model of the newly-completed sewage system. Where does all the effluent seem to be going?
Map of Clontarf Foreshore (Map No 31) (1903) by Local Government Board for IrelandOriginal Source: Wellcome Collection
Far from flushing it away, the Bazalgette-inspired design left sewage swirling in the Bay, leading to pollution at places like Clontarf (on the north side) and impeding navigation. What’s more, the settlement tanks frequently overflowed during storms.
Meanwhile the suburbs of Rathmines and Pembroke, which weren’t connected to the Main Drainage system, continued to dump raw sewage into the Bay.
James Joyce (1935) by Jacques-Emile BlancheOriginal Source: National Portrait Gallery, London
Dublin's Unpleasant Reality
Dubliners commented on the ongoing pollution:
The grainy sand had gone from under his feet ... Unwholesome sandflats waited to suck his treading soles, breathing upward sewage breath. He coasted them, walking warily.
James Joyce, Ulysses, 1922
Dublin's failure to adequately address its sewage problem, despite investment in a modern drainage system, became clear in 1903. A typhoid epidemic led to the formation of a commission to investigate the pollution of Dublin Bay.
Map of Clontarf Foreshore (Map No 31) (1903) by Local Government Board for IrelandOriginal Source: Wellcome Collection
Proof of Contamination
What the subsequent report revealed is what Cameron had argued all along: Dublin’s shellfish beds were heavily contaminated with sewage and a risk to public health.
Main Drainage Inauguration Ceremony (1906-09-24) by Dublin CorporationOriginal Source: Wellcome Collection
Dubliners were caught in a bind. On the one hand, the city was proud of its "modern" British sewage system. On the other hand, citizens were keenly aware of the increasing pollution of their local ecosystems.
Sir Charles Cameron (1882) by Smith & SeeOriginal Source: Royal College of Surgeons in Ireland
Behavioural Corrections
Unable to correct the city’s infrastructural lock-in and emboldened by the validation of his shellfish-borne typhoid hypothesis, Charles Cameron intensified his focus on improving food hygiene.
A Warning (1908-06-01) by Charles A. CameronOriginal Source: Wellcome Collection
In the early 1900s, Cameron printed signs discouraging the consumption of shellfish from Dublin Bay, as well as contaminated milk.
Flies - Carriers of Disease (1914-07-01) by Corporation of Dublin: Public Health CommitteeDublin City Library & Archive
The Fly Factor
Cameron also circulated warnings to cover food and milk to prevent flies, which often rested on faecal matter, from spreading disease.
Sir Charles and the Flies (1911) by Thomas FitzpatrickDublin City Library & Archive
Cameron’s campaigning wasn’t always appreciated. In 1911 he was mocked for the introduction of an anti-fly initiative, where the Corporation offered 3 pence for the collection of a paper bag full of dead flies. However, it took around 6,000 flies to fill the bag,
Table showing Daily Diet of the Poorest Classes (1904) by Charles CameronOriginal Source: Royal College of Surgeons in Ireland
Milk: A Double-Edged Sword
Milk-borne typhoid transmission seemed a more straightforward target for public health interventions. As this 1904 survey shows, milk was an important protein source for the urban poor in an otherwise bread-heavy diet. Improving its quality became a major public health priority.
More power to your elbow, recorder! (1908) by Thomas FitzpatrickDublin City Library & Archive
To ensure milk safety, dairy practices needed reform. Dilution of milk, a common practice, was illegal and could spread typhoid through contaminated water. Also, milkers often contaminated milk with unwashed hands, furthering the risk of infection.
However, under-resourcing meant that enforcing hygiene regulations was difficult. To deter offenders, some thought that milk adulteration should be punished with prison sentences.
Public health authorities also tried to detect asymptomatic (healthy) typhoid carriers amongst milkers, street vendors, and cooks [learn more here]. In 1908, they suspected that a carrier working at a dairy had caused a major typhoid outbreak in Clontarf.
Clontarf outbreak press headlines (all autumn 1909) by Irish Times; Freeman's Journal; Sunday Independent; Irish IndependentDublin City Library & Archive
The Clontarf investigation
On September 21, 1908, Charles Cameron received a cluster of typhoid fever notifications from Clontarf. The outbreak, which started with 126 cases, grew dramatically over the next few weeks, causing widespread alarm.
Typhoid bacteria proved elusive, even when contact tracing pinpointed a shared milk source. This difficulty highlights how challenging it was to isolate the source of a typhoid outbreak.
Sir Charles Cameron (1882) by Smith & SeeOriginal Source: Royal College of Surgeons in Ireland
The Clontarf outbreak triggered an investigation into Irish milk, which led to a new regulatory act. The Dairies Order of 1908 imposed stricter regulations on milk production and sales and required vendors to register with the local authority.
At the door of the W.N.H.A. Dublin Pasteurised Milk Depot (1907) by Women's National Health AssociationDublin City Library & Archive
Consumer concerns also made some dairies invest in equipment to pasteurise – heat treat – milk to kill bacteria. However, it was only in 1958 that pasteurisation became compulsory in Ireland, and safe milk became widely accessible.
Church Street Housing Scheme (1915) by Dublin CorporationDublin City Library & Archive
The Housing Reform
Contemporary research on structural links between poverty and ill health also prompted Cameron to try to tackle Dublin’s bad housing.
Cameron proposed a radical policy of subsidized housing for Dublin's poorest. He argued that each new Corporation-built housing unit should have its own individual water supply and toilet.
He achieved some success in getting municipal housing schemes off the ground. However, lack of political will and resource constraints meant that relatively few tenements were ultimately upgraded.
The Sanitary Sub-Officers of the Corporation of Dublin (c.1909) by J.M. GloverDublin City Library & Archive
Hygiene Campaigns: When in Doubt, Alter Behaviour
In the absence of effective solutions, Cameron's department resorted to cheap behavioral interventions.
'Lady Sanitary Sub-Officers', tasked with 'educating' women who lived in the tenements, faced an uphill battle suggesting scrupulous cleanliness to people with limited access to sanitation resources.
To find out how Dublin authorities gradually managed to control typhoid threats as the 20th century progressed, see the conclusion of the exhibition 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.