The Tuberculosis Epidemic in Ireland:II

3 The Tuberculosis Epidemic in Ireland:II What then accounted for the rising mortality from tuberculosis in Ireland in the late-nineteenth century and what light does her experience throw upon the current controversies surrounding tuberculosis epidemics? Ireland’s epidemic followed a roughly similar trajectory to that experienced elsewhere in the British Isles. It rose over several decades, peaked and then entered a period of decline. John Brownlee, in his study of tuberculosis for the Medical Research Council, published in 1917, noted that ‘the mortality curve for the whole of Ireland in recent years resembles closely the mortality curve for Scotland as a whole during the period 1860-80. It would thus appear that the epidemic in Ireland may be compared with the epidemic in Scotland in its progress except that the maximum point in the former is twenty years later than the latter.’1 The rise in mortality from tuberculosis in Ireland occurred first in the industrialising regions of the north east. In the 1860s, 1870s and 1880s, Belfast and its hinterland had a higher tuberculosis death rate than any other region of Ireland. 2 Some of the highest rates of mortality in the north east in the 1880s were recorded in the smaller linen towns of Ulster. 3 The incidence of tuberculosis was rising everywhere in Ireland in the late-nineteenth century but the industrial north east suffered first. In Ireland as a whole, tuberculosis peaked at the point when other urban areas, particularly Dublin, caught up with and surpassed the tuberculosis death rate in Belfast. This took place in the 1890s when the rates of mortality from tuberculosis in Dublin finally exceeded those of Belfast. By then mortality rates had also risen in other Irish towns such as Limerick, Cork and Galway. Phthisis was most severe in urban areas, a position which remained unchanged into the twentieth century. Grimshaw’s calculations were that the rate of phthisis in civic unions in 1881 was 280 and in rural 160. 4 From 1891-1900, it was 290 and 175 respectively. 5 By the 1920s and 30s figures calculated for rural areas of the twenty-six counties of Saorstat Eireann by Counihan and Dillon demonstrated that the rural mortality rate from tuberculosis rate was still lower than the urban and had fallen largely in line with the urban rate. 6 63 Greta Jones - 9789004333413 Downloaded from Brill.com09/28/2021 11:46:11PM via free access Greta Jones Though Ireland remained predominantly an agricultural country, her urban population was growing in the late-nineteenth century. 7 Of the two major cities in Ireland, Dublin and Belfast, Belfast grew most dramatically from the mid-nineteenth century and Dublin’s population started to rise at the end of the century. 8 Between 1901-10 these two cities accounted for twenty-eight percent of deaths from all forms of tuberculosis in Ireland. 9 The population of other towns in Ireland, with the exception of the smaller industrial towns of the north east, remained static or even fell. By the 1900s, however, there was a rise in tuberculosis there too.10 In addition, although there was emigration and a net fall in population in many rural areas, rural rates of mortality from tuberculosis also increased, although they remained lower than those of the towns and cities. Therefore mortality from tuberculosis exploded, as it were, in the areas of industrial and/or urban growth in Ireland but the effects were felt everywhere. Urbanisation increased the incidence of cases, sustained high levels of infection and raised the overall rates of mortality. Grimshaw in the 1880s noted that rural areas near larger towns had higher rates of tuberculosis mortality than those which were more remote. He believed that tuberculosis spread out from the urban to the rural areas. This certainly happened, but it is important to note other channels of infection in the countryside. Tuberculosis was endemic in Ireland even before the rise in mortality from the disease in the second half of the nineteenth century, and it is possible that rural rates of tuberculosis increased because of changes in social and economic structure or in patterns of migration exclusive to agricultural regions and regardless of urban growth. For example, Irish emigrants from predominantly agricultural areas sometimes passed straight into British and American cities, developed full blown tuberculosis and returned to their home in Ireland aggravating the problem of tuberculosis there. The incidence of rural tuberculosis was, therefore, not just a consequence of a rise in infection in the towns which was then exported to the countryside. Within rural communities there were differences in the rates of tuberculosis mortality arising from conditions specific to these areas. Cronje has pointed to certain exceptional concentrations of tuberculosis mortality in rural parts of England and Wales in the nineteenth century. 11 William Johnston notes that in Japan, although rural rates were lower than urban, ‘Yet a number of rural prefectures had a higher consumption mortality than the national average, higher even than some urban 64 Greta Jones - 9789004333413 Downloaded from Brill.com09/28/2021 11:46:11PM via free access The Tuberculosis Epidemic in Ireland: II prefectures.’ 12 In 1930 a study by R. C. Geary also drew attention to variations in deaths from tuberculosis between rural counties in Ireland and argued that TB mortality was higher in agricultural regions where there was a predominance of small farmers and wage labourers.13 Thus rural tuberculosis rates, whilst undoubtedly affected by the rise in urban rates, were not a simple reflection of them. Other factors from patterns of migration to the character of local industry and farming played a part independent of the urban epidemic. 14 Nonetheless the epidemic in late-nineteenth century Ireland was sustained by high urban rates. The relationship between tuberculosis and urbanisation is however, complex. All the public and private spaces of cities – the factory, the tram, the barber’s shop, the public house, the music hall, the prison, the student dormitory, the boarding house, the police barracks, the shop, the theatre, the school and the home – are rendered places of possible infection. However three things affect this: infection generally depends upon close proximity with a sufferer for an appreciable length of time: some environments are rendered more than averagely dangerous by the conditions in them, and susceptibility to infection differs between individuals as does the chances of that individual developing the full blown disease after the initial infection. Each victim presents an incidence of infection unique to them, not always comparable with others or illustrative of a general rule. Therefore, whilst the tuberculosis epidemic was linked to the growth of the urban environment, this in itself raises questions because urban environments are varied and present a wide range of possible precipitating causes of tuberculosis infection. It is possible, nonetheless, by comparing Belfast and Dublin, to see patterns emerging in the character of the epidemic in Ireland particular to the economic and social structure of the two cities. A variety of individual causes are always at work in the spread of tuberculosis but there may be some particular, underlying environments which give rise to high tuberculosis mortality. Belfast grew because of industrial development in the nineteenth century. It was the fastest growing urban area in Ireland. In 1821 around 2 percent of the population of the province of Ulster lived in Belfast compared to around 25 percent in 1911. 15 From being a cotton town, though to a more modest extent than the towns of north west England, Belfast changed to linen manufacture in the 1840s. Some cotton manufacturing continued but by the last third 65 Greta Jones - 9789004333413 Downloaded from Brill.com09/28/2021 11:46:11PM via free access Greta Jones of the nineteenth century it was a small sector of the economy compared to linen textiles. 16 In 1850 there were 69 linen mills in the north east of Ireland, in 1874 149 and in 1890 162. There was particularly rapid growth from 1854-74, the numbers in linen manufacture rising from 1,121 to 60,316. The growth slowed after 1874 but the linen industry peaked in the years before the First World War. In 1910 there were 75,000 linen operatives in Belfast alone of which five sixths were women. 17 Outside Belfast smaller towns like Armagh. Lurgan and Lisburn were also centres of linen manufacture. Linen was predominantly an industry of young women and girls. The age at which females were allowed to enter the mill full time was initially twelve and later rose to fourteen. In 1871 ten percent of linen operatives were under 15 and fifty percent aged 15-25. 18 In the 1860s, the shipbuilding and engineering industries began to take off in Belfast providing largely male employment. These industries grew particularly fast in the years immediately leading up to the First World War. By 1914 Belfast and its environs was the most important centre of linen manufacture in the world and Belfast a leading centre in the British Isles of shipbuilding and engineering. In contrast Dublin’s nineteenth century urban development resembled London’s. Dublin experienced a decline in some industrial sectors in the nineteenth century and her importance came from being a centre of government, fashion and the professions. With some important exceptions, the industries she had tended to be those servicing the population or connected to transport and import/export. The structure of her industrial and working-class population was, therefore, different in many respects from that of Belfast, with a higher proportion of casual and unskilled labour and of small scale and artisanate manufacturing.

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