Alive, Alive Oh …
Molly Malone’s plight exposes the unequal burdens of infectious disease
Dublin’s ‘sweet Molly Malone’ is a well-known sight on the city’s tourist map, and her ballad ‘Cockles and Mussels’ has been recorded by musicians from The Dubliners to Joni Mitchell. However, the story of the Irish capital city’s unofficial daughter is darker than its catchy tune implies. Shellfish hawker Molly dies “of a fever”, which may well have been typhoid. Exploring this tragic side of Molly’s anthem not only highlights the death and terror caused by the disease around 1900, but also the role of precarity and neglect in driving it.
Typhoid fever is caused by the bacterium Salmonella enterica serovar Typhi (S. Typhi) and spreads from person to person through food and water contaminated with human faeces. Although the disease is no longer common in Europe and America, typhoid remains a major public health threat in low- and middle-income countries where it sickens an estimated 9 million people and 110,000 people die from it every year. What is more, flooding and draughts caused by the climate emergency and rising antimicrobial resistance threaten a future resurgence.
In this situation, the history of earlier control efforts offers valuable insights and warnings on how to design or not to design public health interventions. During the 19th century, Dublin, which was still part of the British Empire, had gained international notoriety for its high typhoid levels. An 1888 investigation found that British troops garrisoned in the city had a 40 percent higher case rate for enteric infections than the UK average. Between 1890 and 1891, Dublin made further headlines when five members of Nationalist politician James O’Connor’s family died after eating contaminated shellfish — a tragedy captured in James Joyce’s Ullysses (1920) — and Prince George of Wales (the future George V) fell ill with typhoid shortly after an autumn visit to Dublin.
The Dublin official responsible for public health, Sir Charles Cameron, was well aware of the threat posed by typhoid — and, after typhoid epidemics in the city in 1891 and 1893, commented on the fact that disease incidence was far more common among the urban poor than selective press attention for outbreaks amongst the wealthier implied. Although Dublin had invested considerable resources in new water and sewage systems, typhoid had remained stubbornly prevalent. To his credit, Cameron recognised that some of this prevalence was driven by the city’s broader social problems — namely, that over a third of its population lived in precarious circumstances. The damp, drafty rooms of Dublin’s notoriously overcrowded tenement houses were perhaps the most visceral symbol of the city’s nineteenth-century economic decline. Many tenement inhabitants could not afford the basic necessities of life — food, fuel, and adequate clothing — and had to share insufficient sanitary facilities, generally limited to a single water pump and toilet in a communal yard. Such unsanitary living conditions were a hotbed for direct typhoid transmission.
Unfortunately, urban infrastructure development exacerbated problems by taking little account of working-class needs. Historically, many poor Dubliners had consumed locally sourced shellfish to supplement their bread-based diet. The late 19th century saw many of the shellfish beds supplying this inexpensive protein become contaminated due to Dublin’s growing population and the increasing discharge of raw sewage. Although Dublin authorities such as Charles Cameron had warned about the link between shellfish contamination and typhoid outbreaks as early as 1880, the city’s new sewage system (completed 1906) discharging partially treated sewage just off the entrance to Dublin Port failed to resolve the issue. Unsurprisingly, typhoid prevalence was particularly pronounced amongst those depending on the shellfish trade for their living. Although ‘sweet Molly’ may well have been fictional, our reconstruction of historical case rates shows that many hawkers like her would have been exposed to both infectious shellfish and the polluted environment in which they were produced. Meanwhile, authorities’ attempts to stop typhoid transmission by putting up signs warning of local shellfish did little to provide alternative protein sources or incomes for those affected.
Dublin eventually gained control over its typhoid rates with a mix of improved public health surveillance, health care, welfare, and sanitation. However, this was not a straightforward development but a drawn-out process with public health officials warning about local shellfish until the 1980s and sewage pollution of Dublin Bay continuing to cause problems.
Far from being a simple story of providing drinking water and sewage solutions, Dublin’s history shows how controlling a disease like typhoid depends on understanding the interrelation of local environments and livelihoods. To this day, contracting typhoid through exposure to polluted food or water remains an acute risk in countries without safe sewage disposal– or where humans are asked to service sewage systems without adequate protection. Dublin’s unofficial anthem of ‘Sweet Molly’ and her ‘Cockles and Mussels’ serves as a stark reminder that tackling the social inequality that drives disease exposure is a prerequisite for public health.
Our new exhibition ‘Typhoid, Cockles & Terrorism: How a Disease shaped Modern Dublin’ launched on 16th June 2024.
The Typhoidland team are: Dr Claas Kirchhelle (Inserm), Dr Carly Collier (UCD), Dr Samantha Vanderslott (Oxford), and Dr Emily Webster (Durham). To find out more visit: www.typhoidland.org.
