Perhaps one of the lesser-known Irish heroines is Dr Dorothy Stopford Price. Born in Ireland in 1890, Dorothy became of pioneer of the BCG vaccine and the tuberculin test in Ireland. Although this blog post series is entitled ‘Irish Women and Death’, this is about an Irish woman who prevented death and dying amongst the Irish people. She was credited by her peers with playing a huge part in helping bring an end to the tuberculosis epidemic in Ireland. Often referred to as ‘Ireland’s rebel doctor’, this is the story of Dr Dorothy Stopford Price and her battle against death in Ireland.
Dorothy went to study medicine in Trinity College Dublin in 1916, a very tumultuous year in Ireland in which the Easter Rising took place. The execution of the rebels caused her to swing her sympathies towards the nationalists, even though she was very friendly with a key figure in the British administration. After the Rising, Dorothy joined Cumann na mBan (League of Women/ Irish Women’s Council), a nationalist group for Irish women as she began to question to British regime in Ireland. She even trained some Cumann na mBan members in first aid at the West Cork IRA stronghold – risking her career in the process. She treated the wounded during the Irish War of Independence and the Irish Civil War, working as a medical officer for the RIC barracks.
Whilst in her third year of medical school, the Spanish Flu epidemic hit Ireland after the First World War. Dorothy was exposed to huge amounts of death and dying, tending to the inflicted living as well as conducting post-mortems on the dead. The rate of death and infection no doubt had a huge impact on Dorothy’s later championing of vaccination. As part of her MD thesis, she investigated the diagnosis of tuberculosis in early childhood.
After witnessing a huge amount of child mortality in the 1920’s in Dublin whilst working as physician in a children’s hospital, it was in 1931 that came was a defining moment in Dorothy’s career. In Vienna, she saw Dr Franz Hamburger use tuberculin to diagnose tuberculosis by observing a skin reaction. Dorothy brought a tube of tuberculin back to Ireland, and by 1934, she had managed to carry out over 500 tests. Her findings concluded that vaccination needed to be implemented in Ireland (as many had not been exposed to tb so immunity could not develop), and in Sweden in 1936 Dorothy saw the use of the BCG vaccine. She was the first person to use the vaccine in Ireland in 1937, around the same time of the Ring Disaster – this brought the effectiveness of vaccination into question as a group of children who had been vaccinated against diphtheria had developed tuberculosis.
Dorothy attempted to set up an Antituberculosis League in Ireland in the 1940’s, but unfortunately the Archbishop of Dublin at the time protested against the number of protestants who were present in the league. The league was never established, but Dorothy still campaigned for vaccination against tuberculosis in Ireland and across Europe. In 1949, the Irish health minister asked Dorothy to lead a new committee to implement vaccination in Ireland. Dorothy was also nominated for a WHO prize for her contribution to social medicine. She suffered a stroke in 1950 and died in 1954 from a second stroke. Many attributed her stroke and death to stress and overworking. Dr Dorothy Stopford Price is one of the unknown heroines of the Irish healthcare system who worked herself to death in an attempt to prevent death on a mass scale in Ireland.
‘Coffin Ships’ were the name given to the emigration ships that carried members of the Irish population across the Atlantic to North America and Canada during the Irish famine. Emigrants were trying to flee from the devastating potato famine which began in 1845, when the potato crop began to fail from blight (P. infestans). Ireland’s population has never gotten back to the numbers it was before the ‘Great Hunger’ (An Gorta Mor as Gaeilge). Between the years of 1846- 51 one million people died in Ireland due to starvation and disease, with a further two million people emigrating to places such as North America and Canada between 1845-55. Growing up in Ireland, we were always taught about the devastating effects of the famine, even as far back as primary school. I remember reading the fiction book ‘Under the Hawthorne tree’ by Marita Conlon-Mckenna. This was a children’s book, but it was set during the Irish Famine and dealt with death and dying during this period. The famine is often a politically charged topic, as it is often questioned how effective the British government were in assisting the Irish. Debates surrounding the inaction of Queen Victoria, and around that fact that exports to Britain during the famine may have actually increased during the years of starvation, are often discussed by historians. Tony Blair issued a formal apology to Ireland for the British governments mishandling of the crisis in 1997 when he was prime minister.
There is an extremely rich narrative surrounding the Irish Potato Famine, but for this blog post I will be focusing on ‘Coffin Ships’. I grew up outside the town of New Ross in Wexford which has a replica of the Dunbrody famine ship, so my interest in these floating ‘coffins’ has a long history. JFK visited New Ross five months before his assassination, as his great grandfather sailed from New Ross to Boston during the famine in 1848.
Due to the large number of evictions of poor Irish tenants during the famine, many ended up on the streets. This resulted in many having no choice but to flee the country on a ship, or it was often more economical for a landlord to pay for a poor family’s crossings- making false promises of a better life. The ships immigrants boarded in the hope of a new life during the famine were often not seaworthy, as well as being overcrowded, and unsanitary. There was a severe lack of food and clean water on board, and it was clear the people who set sail on these ships were in a desperate situation. The ships during the famine also set sail during the winter months to accommodate the demand (and to make more money) of those wishing to flee, meaning they were sailing during icy, bad weather – before this, transatlantic crossings were mainly done during the Spring and Summer months. Death was all around the Irish population at home, and now it was all around them as they hoped to sail to a better life. On board the ship there was no escape from disease, dehydration, and starvation either- the very things they were trying to flee. Steerage passengers were only allowed outside on deck for a very limited amount of time each day.
Thousands of ships left the country full of passengers, mostly setting sail from the west coast. Disease such as typhoid, typhus, dysentery, and cholera would spread rapidly throughout steerage- the average death rate on board was 20% but could be as high as 50%. Bodies were usually buried at sea. The British built ships were not required to have doctors on board, and even those who were ill upon inspection by doctors before boarding were still allowed to travel. Passenger shipping laws were neglectful of the passengers, with many taking double the number of passengers the ship was meant for.
If passengers managed to survive the six-week journey, the were often infected with disease and extremely weak upon arrival – they were not exactly opened with open arms when they reached their destination either. Families had been surrounded by death and dying, and now found themselves in a new country where they were poor and illiterate. Many were thought to spread disease amongst the Canadian and American populations, thus resulting in shunning of these immigrants – there was also a lot of anti-Catholic sentiments at the time.
These ‘Coffin Ships’ are an important aspect in Irish history that touches upon the themes of death, dying and bereavement – all over the world we see memorials to those who died during the potato famine. Many were trying escape death, but instead died upon these ships. Many died when they reached the shores, and many were accused of causing death in the populations they newly inhabited. Bereavement was everywhere, with families even holding an ‘American Wake’ for those who purchased a one-way ticket to America – as it was highly likely they never see their family again (and that is if they survived the journey). Many mourned their dead, for the life they once had, and for those who left Ireland.
With the recent development of Covid-19 vaccines by Moderna, Oxford University and Pfizer, there seems to be little else on everyone’s mind. Vaccination against deadly diseases has a history that can been illustrated in archaeological examples left behind. Death rates from crude attempts at ‘variolation’ (the practice of grounding up smallpox scabs for inhalation or scratching onto the skin) had a death rate as high as 30% in China during the 16th century. Refining of such techniques using inoculation and vaccination has led to a revolution in global health, with some diseases such as smallpox eradicated completely. This blog post will examine the history of vaccines in the last 300 years, associated with four deadly diseases, by examining archaeological examples in museums. There are many more vaccinations for an array of diseases, but I have narrowed it down to four for this blog post. Although proven to be safe and effective, vaccines are becoming more and more controversial in today’s society- something that can be traced back to past societies as well.
Disease: Smallpox Symptoms: Fever, aches, vomiting, rash, sores, and pustules that eventually scab and fall off. Objects: Civil War Era Vaccine (Mutter Museum) and Lancets of Edward Jenner 19th century (Science Museum)
When one thinks of vaccination, Edward Jenner and smallpox usually springs to mind. Inoculation was being practiced in China as far back as 1000 years ago. This inoculation was being carried out using pus or scabs from smallpox to boost immunity against the disease. It was around the 18th century this concept began to develop in Europe. Lady Wortley Montagu seen the ‘scratch method’ of inoculation in 1721 in Turkey and used this method to inoculate her own children against smallpox. She is credited with introducing this method to London high society. Edward Jenner (1749-1823) noticed a similar practice on English farms and in the surrounding communities. Milkmaids in the countryside were renowned for having a clear complexion. This was because they were often infected with cowpox, meaning they were often left immune to smallpox (thus not having any facial scarring). Locals began to inoculate themselves with cowpox to immunize against the deadlier smallpox. Jenner adapted this method in his own practice, applying pus from a milkmaid’s cowpox pustule (these were usually on the hand) to that of a young boy in 1796. You can still see the lancets Jenner used to apply the pus to the boy’s arm, he would have used the scratching technique. He later exposed the boy to smallpox, after which no disease developed. In 1798, Jenner published his findings in a book entitled ‘An Inquiry into the Causes and Effects of the Variolae Vaccinae; a Disease Discovered in some of the Western Counties of England, Particularly Gloucestershire, and Known by the Name of The Cow Pox’ (Vacca is the Latin word for cow).
George Washington insisted on quarantining regulations within the Continental army in the 1770’s when smallpox outbreaks occurred, eventually crudely inoculating the army in 1777. A higher percentage of British troops had already suffered from smallpox, unlike the Americans who were more susceptible to catching the disease. Unlike Jenner, Washington was inoculating the army with the live smallpox virus- a very risky procedure instead of using a milder related orthopoxvirus. Vaccination was also being carried out in the army during the American Civil war (c.1860’s), an example of a lancet vaccination kit can be seen at the Mutter Museum in Philadelphia. Like Jenner’s kit, it consisted of lancets for scratching. DNA testing of the blades revealed a virus used for vaccination was present, there were no signs of the smallpox virus itself.
Disease: Cholera Symptoms: Diarrhoea, vomiting, thirst, cramps. Objects: Glass Amboules of Cholera Vaccine 1924 and 1892 (Wellcome Collection)
Cholera is most associated with the physician John Snow, who mapped the cases of cholera in Soho, London in the 1850’s – Asiatic cholera reached Britain in 1831. This allowed him to conclude that the water supply was the source of the disease, debunking claims concerning miasma theory. Prior to this there had been numerous outbreaks of cholera in Britain, with 1854 becoming the worst year of the disease to take hold. Snow realised sewerage contamination was the cause of the disease, suggesting the removal of the pump handle in the affected area. However, it was not until 1885 that the vaccine was developed by Spanish physician Jaime Ferrán (1852-1929). The cholera vaccine was the first vaccine to protect humans against a bacterial disease. The vaccine was developed when Ferrán cultivated bacteria from an ill person and then administered injections into the arm (not the scratch technique). He went on to develop vaccines for plague, rabies, and tetanus. Louis Pasteur is also credited with developing a cholera vaccine using chickens. He used a weakened culture to inoculate the chickens, after survival they were immune to the disease. The Wellcome collection houses a 1892 example of the vaccine that had been developed from inoculating guinea-pigs. In the Wellcome Collection, there is an example of the cholera vaccine dating to 1924. The amboules are French (from Paris), and have the name of a laboratory that developed vaccines for the army. Because of the water-borne nature of the disease, cholera, as well as typhoid, were considered serious threats to soldiers. Vaccination was a part of an initiative to keep the army healthy. This strongly echoes the times of the smallpox outbreaks amongst American soldiers in the previous centuries – however we see the move away from the previously crude ‘scratch’ technique with a lancet.
Since the outbreak of Covid-19 in 2020, there has been many comparisons drawn between today’s pandemic and the Spanish Flu H1N1 pandemic of 1918. The spread of the disease was exacerbated by movement of troops at the end of World War 1. Half a billion people all over the world were infected, eventually killing somewhere between 50-100 million people- the most severe pandemic in recent history. Mortality rates were high in children under 5, the elderly and those aged between 20-40 years old (the healthy being susceptible was unique in this pandemic). Prior to the vaccine, interventions such as quarantine, hand hygiene, social distancing, and disinfecting were used to control the illness.
Vaccines had been developed for other diseases at the time of the outbreak, so it was hopeful a vaccine could be developed for influenza. A few vaccines developed around this time are now thought to have been ineffective. As the disease was viral influenza, it would not have been treated by these newly developed bacterial vaccines, but many may have prevented pneumonia from developing. It wasn’t until the 1930’s that researchers realised that influenza was caused by a virus (in the 1918 case it was influenza A strain) – it was successfully isolated in 1933. It can be said then that the 1919 vaccine example from the Pharmaceutical Society Museum was likely ineffective during the outbreak. This had been developed by the Royal Army Medical College using lung scrapings from infected patients. The influenza A vaccine was developed in the 1930’s, followed shortly by the influenza B vaccine in 1942. In 1945 the vaccine (for both A and B) was approved for military use in the US and for public use in 1946. Both Dr Thomas Francis and Dr Jonas Salk were involved in flu vaccine research and development after Ernest William Goodpasture was able to grow viruses using chicken embryos in 1931.
The BCG vaccine is made from a weakened strain of Mycobacterium bovis, close in nature to M. tuberculosis which causes TB. Bacteriologists Albert Calmette and Camille Guerin are credited with developing the vaccine between 1908 and 1921 at the Pasteur Institute, Lille, France – the oral dose was endorsed by the League of Nations in 1928. Calmette was a pupil of Louis Pasteur and had acquired Mycobacterium bovis from the milk of an infected cow. The vaccine was adopted in France and Scandinavia initially, with widespread distribution stalled due to a contamination that killed 75 babies vaccinated within 10 days of birth- known as the 1930 Lubeck Disaster. The vaccine eventually became widespread after the Second world war and is administered via needle into the arm today. The Science Museum houses a set of freeze-dried intradermal BCG vaccine dating to 1980-85. Made by Evans Medical Ltd, freeze drying allowing for transportation over long distances. This would have been particularly significant at the time as in the 1980’s there was a rise in TB cases in developed countries due to healthcare complacency, movement of people from countries with a lot of TB cases, and the spread of the HIV (there is evidence of co-infection). According to the World Health Organisation, TB kills 1.8 million people every year, with one third of the global population infected but asymptomatic. Despite initial reluctance in uptake, over 4 billion people have now been vaccinated against TB, making it the most widely used vaccine in the world. Unlike the UK, the US has never introduced mass use of the vaccine as it is thought there are not many cases of TB in America- vaccines can be purchased privately for around $100-200.
Mary Mallon was born in Cookstown, Ireland, in 1869. At around the age of 15, Mary migrated to New York City to live with her Aunt and Uncle and took up work as a cook. It was in the Summer of 1906 when Mary was working for a wealthy banker called Charles Warren that she earned her nickname ‘Typhoid Mary’, she has become infamous as a healthier carrier of Salmonella typhi. However, it should be noted that Mary was likely not the most lethal of typhoid carriers in New York, with banker Tony Labella reportedly causing over 100 cases in 1922. Nevertheless, Mary has become synonymous with the disease. Typhoid fever was linked with the poorer population as poor sanitation and overcrowding were thought to trigger outbreaks. It was a shock to the population when the wealthy family of Charles Warren contracted the disease in Oyster Bay in the Summer of 1906. The family hired a sanitation engineer called George Soper to investigate why the family had been infected, and after testing of the water supply and shellfish came up negative, Soper linked the disease to an individual- Mary. Mary would make peach ice cream for the family in the Summer heat, thus allowing the bacteria to survive in the cold dessert after it transferred from her hands due to inadequate washing. It was then discovered that seven families who Mary had worked for in the six years previously had also had outbreaks of the disease. She was linked to infecting over 20 people with the disease, resulting in the death of a least one person. Soper labelled her as ‘patient zero’ and Mary was thought to be the likely cause of the New York outbreak that year that infected over 3,000 New Yorkers, rising to 4,500 the following year. The seriousness of her carrier status was elevated by the fact a vaccine was not developed at the time – this was only created in 1911. Mary was forcefully quarantined by the police at a cottage at Riverside hospital and her stool samples tested positive for Salmonella typhi.
Mary was confined until 1910 by the health department, even attempting to sue them in 1909 (unsuccessfully). A range of treatments did not help her condition, with officials even offering to remove her gallbladder- which she refused. After her release, Mary changed her name and began to work as a cook again, despite promising officials she would not. She further contaminated at least 25 people whilst working in Sloane Maternity Hospital, Manhattan. She was confined at Riverside once again, where she remained until her death of pneumonia in 1938 (She had suffered a stroke in 1932 and never walked again). It is likely her poor, immigrant status was linked to her long confinement- many others who may have caused more serious outbreaks were only quarantined for a few weeks before being released. Mary was not fully educated by medical staff on her condition and carrier status – this is likely why she did not stay out of the kitchen when first released.
‘Typhoid Mary’ became the butt of jokes in the city and her name often appeared in medical books and newspapers. Mary is an example of how public health can have societal prejudices; many doctors did not work with her to help her understand her status. She was just used as a ‘lab rat’, spreading the disease out of ‘ignorance, not malice’. She is now known as ‘the famous typhoid carrier who ever lived’ (she was not even the deadliest carrier of the time), with at least 51 people becoming infected from her spread and 3 dying from the infection. Her body was cremated, and her ashes were scattered in the Bronx. There are conflicting rumours that she had been autopsied upon her death. Some suggest a post-mortem revealed her gallbladder to contain Salmonella typhi. Others state this was a rumour created by health officials as to rationalise her forced confinement and calm public opinion on the matter. Ethical concerns were raised concerning her treatment and long-term isolation.
Amid the current Covid-19 pandemic, it is more important than ever to talk about death and disease in a manner that is sensitive yet pragmatic. A way to understand the development of public health is to look to the past through archaeological material. However, dismissing the current pandemic as being ‘not as bad as the past’, can be a problematic approach. Yes, the 14th century Black Death killed 200 million people, but that doesn’t lessen the severity of our current health climate. On the other hand, we cannot directly compare the two, as to do so only creates an atmosphere of mass panic and hysteria. Comparing Covid-19 to a pandemic in a time of poor sanitation with little known effective medicines is dangerous and irresponsible. Both approaches have their dangers- so what should we do?
We should approach historical and archaeological material with both approaches in mind as to make sensible observations. For example, the British Society for the History of Medicine (BSHM) recently posted an article entitled ‘Can history help us in the Covid-19 epidemic?’ asking whether global health management of today can learn anything by examining the handling of the 1918 Spanish Flu pandemic. Whilst comparisons are made between both pandemics (i.e. lack of vaccine, slow implementation of social distancing), it is clear that the research of mortality rates of Spanish Flu were done to encourage quick intervention, not as a way to create panic amongst the general public. Epidemiologists are approached more and more on contributing to global health management, a responsibility with a lot of strings attached.
This post will look at four examples of archaeological material from four different pandemics/ epidemics (most were originally epidemics that became pandemics) with the hope of encouraging discussion on disease mortality without directly comparing them with Covid-19. Discussion of current public health concerns through observing archaeological material is important but should be done with an objective mind in assessing how relevant they are today.
Bubonic Plague- ‘The Black Death’ (1346-53) Death toll: 50 million worldwide Mass burial ‘Plague Pit’, East Smithfield, London (1348). Everyone has heard of the ‘Black Death’, the catastrophic tragedy that killed 60% of Europe’s population. The bubonic plague outbreak was linked to the bacterium Yersinia pestis (though recently this has been challenged) that spread through wild rodents. With rat infestation such a problem in the past its no wonder the disease spread with such ferocity. Once fleas killed off the rat colonies they would turn to humans as new hosts. Bubo sites would often form in groin, thigh, armpit or neck (Lymph node sites) and the bacteria could spread through the blood stream to the lungs causing cases of pneumonic plague. This was only in a small number of plague cases, but the bubonic infection would kill 80% of victims. Often symptoms would only develop 5 days after infection, and another 3-5 days after the victim would die. In 1986 archaeologists discovered a large cemetery near the Tower of London in East Smithfield. The burial ground was confirmed to be an emergency cemetery to cope with the rising death toll, and over 24,000 people are thought to be buried at the site. Plague pits were all over Europe to dispose of victims of bubonic plague. These mass, anonymous graves can be viewed as pragmatic response to death- but what were the effects on the bereaved? Although the outbreak occurred at a time when mortality rate was high anyway, one cannot help but ponder how the population felt about their loved one buried or ‘stacked’ without the pomp associated with religious rites. The use of mass graves has been linked to infectious disease as a way to stop the spread of an epidemic- in this case however it was likely to confine the ‘smell’ which was more associated with sickness then the disease itself (i.e. Miasma Theory). Some probably went into the pits without identification, another worry for families in a time of desperation.
Bubonic Plague (last wave in Britain)- ‘The Great Plague’ of London (1665-1666) Death Toll: 100,000 in London 17th Century plague doctor mask The plague outbreak of 1665, was the worst outbreak of the disease since it’s 14th century outbreak. It was the summer months that caused the outbreak to swell, with many of the wealthier classes fleeing the city. Much of the poor had to stay in London to prevent the spread of infection to other parts of England – all trade was halted from the city and Scotland even closed its border with England. Infected houses were watched over and the dead were searched for at night and buried in plague pits in the same manner as the 14th century outbreak. This era of the epidemic resulted in the further rise of plague doctors. Perhaps the most iconic image of this era is the plague doctor mask. This beak-like mask was used to protect the wearer against bad smells and prevent contagion, with a wooden cane used to probe victims to stop themselves touching the infected buboes. The nose of the masks was filled with substances such as cloves, rose petals and other pleasant-smelling herbs. Charles de L’Orne is credited with creating the iconic costume in 1619, it was usually made from goat leather. Although we still see the association with disease and miasma theory, it is clear the population were becoming more conscious of the isolation of the infected. Plague doctors also carried out autopsies on the dead and listed deaths on the public register. Treatment often included blood letting and the use of leeches.
Broad Street Cholera Outbreak, London (1854) Death Toll: 500 in 10 days on Broad Street, London The Broad Street (now Broadwick Street) Pump There were numerous outbreaks of cholera in London in the 19th century. The worst outbreak killed almost 15,000 people in 1849. Whilst cholera was a worldwide pandemic, the Broad Street outbreak is significant as we look at the investigatory work of Dr John Snow. Cholera effects the intestines and can cause death at quite a rapid pace, the first symptoms are vomiting and diarrhoea. According to the World Health Organisation, cholera still kills 100,000 people annually. Miasma theory (Illness from bad air/smells) was still a prevalent theory surrounding disease outbreaks, until Snow was able to prove that this epidemic was a result of contaminated water. Snow studied the patterns of death and plotted their locations on a map, allowing him to conclude that water was the source of the outbreak. The Broad Street pump was very close to a cesspool and Snow removed the handle from the pump himself after community officials ignored his pleas to intervene. Although the original pump is no longer at the site, a replica one was placed there in the summer of 2018.
Influenza Pandemic (‘Spanish Flu’), H1N1 (1918) Death Toll: 50 million worldwide Spanish flu face masks Perhaps one of the deadliest pandemics of recent history, Spanish flu spread between 1918 and 1920. It is estimated that half a billion people were infected with the virus – this was about one third of the world’s population at the time. The mix of urbanisation without any known vaccine or antibiotics to prevent secondary infection, meant the virus was particularly lethal. There was quite a high mortality rate amongst the younger population, with those between the ages of 20 and 40 considered one of the most vulnerable groups, as well as those under the age of 5 and over the age of 65. Health initiatives of the time became strict and limiting, with quarantining and social isolation becoming the norm. Images of the time are striking in their similarities to modern populations, as face masks become more of a fashion statement than sanitary necessity. Face masks worn by women of the time could stretch down like a veil – echoing the ‘trendy’ masks we see now. Hand washing and personal hygiene also became the prime advice given by health professionals. Perhaps it is the similarities in societal anxieties and healthcare advice that allows us to make links with outbreaks of the past, not similarities in the nature of the disease itself.