The Miasma:epidemic and panic in nineteenth-century Ireland Joseph Robins (Dublin: Institute of Public Administration, £7.95)

Published in 18th-19th Century Social Perspectives, 18th–19th - Century History, Issue 3 (Autumn 1996), Reviews, Volume 4

The Oxford English Dictionary defines the term ‘miasma’ as ‘infectious or noxious exhalations from putrescent organic matter; poisonous particles or germs floating in and polluting the atmosphere’. Before the later nineteenth-century scientific discoveries of Pasteur, Lister and Koch established the germ origin of infection, many medical practitioners believed that the environment was responsible for the causation and transmission of epidemic disease. They believed that the air was tainted and poisoned by miasmas rising from a number of sources, including human and animal corpses, sick persons, excreta, rotting vegetable matter, stagnant marshes and pools. These miasmas or effluvia generated and transmitted disease and this was the reason why numbers of people were affected by a specific disease at the same time. The theory evolved primarily to explain epidemics naturalistically rather than providentially.

The miasmatic concept of disease was an extremely elusive one: disease was caused and spread by unknown atmospheric phenomena, by some mysterious, intangible influence in the air, which was both potent and poisonous. The main alternative theory, that of contagion, or the belief that disease was transmitted by direct contact with an infected person or object, was much easier to grasp. Both views were widely held in Ireland and elsewhere until well into the nineteenth century.

Fever and other infectious diseases terrified the general population, especially the poorer classes, and with good reason. People feared what they did not know and could not control. The absence of any scientific understanding of the origins or mode of transmission of such diseases caused consternation and panic. The highly visible and olfactory symptoms—offensive body odour, skin discoloration and distinctive sounds—greatly disturbed the popular mind. The skin of typhus victims took on a dark or dusky hue, while those suffering from relapsing fever and cholera became yellow and blue respectively. Cholera symptoms were graphically described in April 1832 by the government-appointed Cholera Board. They included great laxity of the bowels, often with vomiting, sunken eyes, a leaden, blue or purple body colour, while the tongue became flabby and chilled, like a piece of dead fish. The mortality rate was often very high, especially in the case of cholera, which killed very quickly. Epidemic diseases pauperised, when they did not kill, and reduced the most vulnerable and oppressed to squalid misery and despair. Fever and cholera had a devastating impact on the already precarious existence of the poor and often reduced them to absolute penury.

Joseph Robins deals comfortably and engagingly with the miasmatic and contagionist theories of disease, and with more unorthodox, eccentric and bizarre ones, as they applied to nineteenth-century Ireland. He is primarily concerned with the appearance and re-appearance of fever and cholera in the first half of the century. Two chapters are devoted to the fever epidemic of 1816-19, which may have affected as many as 1,500,000 people, and another two to the cholera pandemic of the early 1830s. These early sections address and adhere to the book’s subtitle, epidemic and panic in nineteenth-century Ireland. The remainder of the work is less focused and less satisfactory. The two chapters relating to fever and cholera during the Great Famine are underdeveloped, say virtually nothing about popular panic, and add little to existing knowledge. Another three are more concerned with Famine emigration, to Canada, the United States and Great Britain, than with either sickness or fear in Ireland. Two concluding chapters deal with post-Famine scientific developments and improvements in public health, but without any specific or distinctive Irish focus.

Despite its somewhat uneven nature, Robin’s latest work is a welcome and worthwhile addition to the underdeveloped area of the social history of medicine in Ireland. The book is attractively produced and reasonably priced, while the author possesses an easy and fluent writing style. Depending on your perspective, the work is further enhanced, marred, or merely distended by the inclusion of twenty-six pages of illustrations, many of which have only the most tangential relationship with the subject matter. There are few typographical errors but many authorial generalisations. There is no bibliography and the chapter notes are often unintelligible, as a result of truncated citations and unexplained acronyms. In sum, Dr Robin’s book is like the curate’s egg, good in parts.
Laurence Geary

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