Stones & Bones: Containing Typhoid in 'Dear Dirty Dublin' (Part Two)

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.

Like many public health officials of his time, Charles Cameron used mortality statistics and contact tracing to understand typhoid outbreaks.

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.

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.

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.

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.”

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.

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.

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.

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.

Meanwhile the suburbs of Rathmines and Pembroke, which weren’t connected to the Main Drainage system, continued to dump raw sewage into the Bay.

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.

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.

Contemporary research on structural links between poverty and ill health also prompted Cameron to try to tackle Dublin’s bad housing.

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.

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.