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Curiously, social historians of medicine have given relatively little attention to Ireland. The great famine of 1845–47, a health-related event of remarkable magnitude, has been mainly the province of economic, social, and nationalist historians. The fever from which many of its victims died remains known among [End Page 125] Irish historians as one of many “famine” fevers—a term foreign to the nosological systems of most historians of medicine, yet one that is both empirically apt and culturally charged, and that invites inquiry into the interlocking biological, social, economic, and political determinants of health and disease, and alerts us as well to the profound cultural impact an epidemic can have.
The Miasma is a semipopular account of infectious epidemic disease, particularly typhus (with relapsing fever) and cholera in nineteenth-century Ireland. Two of Robins’s twelve chapters deal with the typhus epidemic of 1816–19; two with the first wave of cholera, beginning in 1832, and another with the cholera of 1848-49; and four with the “famine” fever of 1845–47, including its role in emigration to Canada, the United States, and Great Britain. An introductory chapter reviews the pre-nineteenth-century Irish response to epidemic disease, and two concluding chapters treat the changes in ideas of disease causation and in Irish public health policy during the last half of the century.
The most successful part of the book is the middle chapters recounting the impact of, and the response to, each of the epidemics. For each of these Robins recounts the course and causes of the epidemic, the popular response, the reaction of medical professionals and public authorities, and the chronology, geography, and magnitude of its impact on Irish society. His sources include newspapers, diaries, state papers of the Irish administration, as well as numerous parliamentary reports, and the medical literature. With regard to primary sources this is a well-researched book, though the citation style is opaque and many of the archival citations are downright undecodable.
To those familiar with the many recent social histories of nineteenth-century epidemics, particularly of cholera, the story Robins tells will be familiar—of disease preferentially striking those in poor and squalid conditions; of panic and distrust; of confusion of the civil and medical authorities; of occasional noble efforts amidst general social collapse. As with many works on epidemics, one may ask how typical were the events recorded during epidemics and how much we see only the product of sensation-seeking historians quoting sensation-seeking journalists. The problem is acute in this book because of the close juxtaposition of seemingly contradictory responses. Thus on one page we have strangers flocking to Dublin to seek accommodation in a fever hospital; on the next, strangers resisting being taken into the hospital (pp. 44, 45). Or, emigrants feeling fatalistic toward fever on one page, and on the next making every effort to avoid it (pp. 161, 162). It is not a matter of whether both occurred—only of which was the more common, and why.
Because Robins makes no serious attempt to place his story within the context of histories of epidemics, it is hard for the reader to compare the Irish experience with that of England, France, Germany, Canada, Russia, or the United States. Still, it is possible to pluck from his narrative several areas where the Irish experience appears unusual or exemplary, and that merit much further work. One is the high mobility of the Irish poor, a characteristic of normal times as well as of crises, made possible by potato husbandry and necessitated by the demand for cash rents. Associated with this is the significantly rural character of disease, particularly of fever. While there was immense need for sanitary improvement in [End Page 126] Dublin, Belfast, and Cork, my sense is that the arrival of desperate strangers seeking food and medical care is a far larger part of the Irish than of the English, American, or French epidemic experience. Among the most common of the epidemic vignettes that Robins relates...