She Died Of The Fever

Dublin as depicted in the song “Molly Malone,” and the fever that took her.

Molly Malone “died of the fever” on June 13, 1699, according to the Dublin Millennium Commission, and there’s a statue on Suffolk Street to prove it.

“In Dublin’s fair city”

The city wasn’t so fair in the 18th, 19th and first half of the 20th century. In common with other capital cities of Europe, Dublin suffered poverty, overcrowding, the absence of sewers, ignorance of the germ theory of infections, illiteracy and political incompetence, all of which encouraged the spread of disease.

Port cities are crossroads in the movement of peoples for trade and transport. London, Marseilles, Venice, Dublin and later New York were scourged repeatedly by imported plagues such as the bubonic, smallpox, tuberculosis, influenza, syphilis and malaria. 

The threat has not gone. The latest pandemic mostly flown in on commercial airlines is SARS CoV2, the virus that causes Covid-19.

“. . .she was a fishmonger”

Molly “wheels her wheelbarrow through streets broad and narrow….” she would have loaded up her barrow at Fishamble Street in the Temple Bar area of Dublin. She would then have pushed it all around the city center, “crying cockles and mussels, alive, alive, oh!”

This line in the song expresses an intense irony. Not only are Molly’s wares alive but they may also carry with them the cause of her own premature death.

“She died of the fever”

What, then, did Molly die of? Typhoid fever caused by the bacteria Salmonella typhi, lives in seafood, particularly mussels, so this is certainly a leading contender.

As likely as this may be, I propose another cause  as I believe the song is a folk acknowledgment of the darkest eras of Ireland’s past.

The Great Hunger from 1845 to 1849 and its apocalyptic sidekick, infectious disease led to a million deaths. The worst was “the fever.”  The definite article implies the country knew only too well of this particular scourge; Typhus.

Typhus was the leading cause of death from infection; there was also dysentery, smallpox, tuberculosis and relapsing fever. This was the worst pandemic to hit any European country since the Black Death and sadly, many of those Irish refugees fleeing starvation at home crowded together on ships to the New World and died from Typhus, “ship’s fever,” before they ever reached their destination. 

The word Typhus is from the Greek and means “clouding” (of the mental state) or in contemporary parlance “delirium” a dominant feature of the illness. It is accompanied by high fevers, shaking chills and a typical rash.  It is not to be confused with Typhoid. There is fever to be sure in Typhoid but that’s about all they have in common. It is a different disease caused by a different microbe.

How long has “the fever”, Typhus, been in Ireland? Manuscripts dating back to the seventh century refer to Fiabhrus Morgaighthe the “putrid” fever with rash. Recurrent epidemics over the next 1300 years were so frequent that the disease became known in the rest of the British Isles and in parts of Europe as the “Irish Ague.” Dr Gerard Boate, physician to Cromwell’s army wrote: “What is vulgarly called the Irish Ague occurs with great violence, that notwithstanding all good helps, some are thereby carried to their graves; and others who come off with their lives are forced to keep to their beds a long time from extreme weakness.” This last is prolonged convalescence; call it Long Typhus.

Recurrent epidemics continued to plague the land through the centuries. They were particularly likely in cold winters, or when crops had failed and food was short and in times of war.

It was not until 1902 that Howard Ricketts, an American pathologist in Ohio showed  that a particular type of microscopic bacteria caused “the fever” and Stanley Prowazek, a Czech, showed during the Great War precisely which one. Both men died from the infection they were studying. In their honor the bacteria is called Rickettsia prowazekii.

The last major epidemic of Typhus in Ireland was in 1880, but spasmodic outbreaks and individual cases continued through WWII.

“No one could save her.”

No one could save poor Molly as Rickettsia prowazekii was not discovered until 1916; nor was its means of transmission known. (It was from insects, particularly lice); nor was the negative effect of large gatherings such as wakes understood; nor was the significance of poverty, cold, malnutrition known; nor was there any curative treatment (tetracycline antibiotics were not discovered until the 1960s): nor was there any supportive care such as excellent nursing, intensive care units, technological support and the rest of modern medicine. 

The songs that we sing heal us from History.    

We are largely unaware of the devastating pestilences of the past, because they are gone. Yet we remember them in song.

We celebrate “life” with Molly Malone’s ghost, symbolizing the victory of Science over plagues as we walk with her through our streets, some broad, some narrow singing as loud as we can:

“Alive Alive O.” ♦

Infectious Disease Specialist Dr. John Froude is the author of Plagued: Pandemics from the Black Death to Covid-19 and Beyond, available on Amazon.