H17 Dermatology in times of famine

Abstract From the years of 1845 to 1852, the Great Famine (An Gorta Mór) ravaged the island of Ireland. A multitude of factors contributed to the eventual extent of its devastation; however, at its core was the widespread failure of the potato crop. The most destitute year came in 1847, and by 1852 Ireland’s population is estimated to have declined from 8.5 million to 6.5 million, with 1 million having emigrated and another million dead. Starvation was the principal cause of death for some of those who succumbed to the Great Famine, but the majority who died did so as a result of illnesses arising from the crisis, both infectious and nutritional, and not only their toll on physical health but the consequent social ramifications. In this manner, infestations and cutaneous manifestations of illness played a vital role in the eventual morbidity and mortality of the Irish famine. General fever was common, mostly originating from lice infestation of the skin, which flourished in deteriorating conditions in settlements. Two variants developed that broadly separated between social classes: recurrent fever in the poor who had previous exposure, known colloquially as ‘getting the cool’, and the more deadly typhus fever that killed many of the middle and upper classes, in particular those who attempted to help the sick such as doctors and priests Geary L. Epidemic diseases of the Great Famine. History Ireland. Available at: https://www.historyireland.com/epidemic-diseases-of-the-great-famine/ (last accessed 29 February 2024). Smallpox arose in frequent epidemics, and the associated widespread pustular rash, crusting lesions and eventual scabbing offered an obvious visual cue of illness. With limited quality food available, nutritional deficiencies contributed too to the deathly appearance of those afflicted. Lack of vitamin B3 resulted in pellagra, with its associated dermatitis, and a dire lack of vitamin C gave rise to scurvy, whose ecchymosis became known in Irish as ‘cos dubh’ or black leg. With such a constellation of symptoms, it can be appreciated why there was misunderstanding and fear of the sick. This led to division in communities about the construction of fever hospitals. Some pleaded for their establishment to quarantine the sick, while others resisted for fear of contagion and, in instances such as in Fethard, County Tipperary and Belturbet, County Cavan, committed arson attacks against the hospitals. Many who did not succumb were left pauperized and ostracized by their communities, in no small part as a result of their cutaneous manifestations of a multitude of diseases.