Tuberculosis in Dublin
Tuberculosis is a disease as old as human history. Research on remains from ancient civilisations confirms its presence in the population. But, until the advent of modern medicine and more effective overall control of the infection, it seems to have had an irregular level of incidence.
There is not much evidence of it being unusually rife in Ireland prior to the time of the Great Famine. It is after that time that it explodes onto the scene. The 1841 Irish census records 135,000 deaths a year as a result of TB infection. TB is a disease caused by a mycobacterium. It is spread, most commonly, by coughing and sneezing, and, of course, spitting; and so its rate of incidence is greatly enhanced by sustained levels of close proximity. After the famine, there was heavy migration into urban areas, resulting in overcrowding and insanitary conditions. It is not really a surprise, in the circumstances, that we find a dramatic rise in the incidence of TB in Ireland, and especially in Dublin, in the latter half of the nineteenth century, and continuing on well into the twentieth.
The symptoms of TB were easy enough to recognise: chronic coughing, bloody sputum, fever and fatigue. But acceptance was not so easy. There was considerable social stigma attached to it. So many, even with obvious symptoms, remained in denial, thereby greatly facilitating the further spread of the contagious disease. It was not uncommon for entire families to be wiped out. Generally referred to as ‘consumption’ – because the disease seemed to consume the whole body – it quickly became the biggest single killer in late nineteenth century Ireland. By 1900, TB was causing 277 deaths per 100,000 of the population each year. Untreated, it would kill over 50% of those infected. The death rate to TB in Dublin was the highest in Europe. Twice as many people died from TB in Dublin as in London. The decline in the disease was slow. The death rate had fallen back by 1930 but it was still accounting for 125 deaths per 100,000 population.
The government only began to address the situation at the beginning of the twentieth century. Laws passed in 1908 and 1911 began to impose responsibilities on local government and health authorities to provide facilities to deal with those diagnosed with the disease. Usually this meant the provision of sanatoria – given that isolation from the rest of the community was recognised as important for preventing further spread. Isolation in itself was certainly not a cure. The government introduced grants to facilitate the construction of sanatoria and the provision of beds. But the take up rate was very low. By the time of the outbreak of World War I only one-third of the available grant money had been taken up. Only 800 dedicated TB beds had been provided, and only one sanatorium had opened in Dublin, in 1912.
So, with no available cure, the continuing social stigma that went with it, limited treatment facilities, and the chronic squalor and overcrowding of the tenements, it is no surprise that the disease continued to spread rampantly through Dublin’s poorest inhabitants in the 1930s.
The regime at the sanatoria was straightforward, even if mostly ineffective. Isolation could last for years. The emphasis was on prolonged exposure to ‘fresh’ air, whatever the weather, and a diet of simple, wholesome food. But the survival rate was pitiful. And certainly the ‘Pigeon House’ was generally referred to as the place to house the ‘terminal’ cases.
Medical science was slow to catch up with the situation. Initially the emphasis was on the search for an effective vaccine. The first of its type was Bacillus of Calmette and Guerin (BCG), which was first deployed in France in 1921 but not more widely across Europe until after the Second World War. The first effective antibiotic did not come in until 1946, with the application of streptomycin.
The Irish government eventually introduced a national TB service towards the end of the 1950s. This comprised a programme of BCG vaccination for all children, and an x-ray screening programme for the adult population. Despite the introduction of effective medications, referral to a sanatorium continued to be part of the approach; although stays were much shorter, and the treatments centred around the application of modern medicine rather than the original, mostly ineffective, regime. The combined approach saw the disease retreat, with the death rate falling back to just 16 per 100,000 population by 1960.
TB is now rare in the developed world, but it persists as a significant killer in under-developed countries. The World Health Organisation reported in 2011 that there are around 9 million incidents of recorded TB infection a year, and that in the world’s poorest countries 10 million children are orphaned each year as a result of parental death due to TB.