Since its establishment in Canada, the RHSJ has set up a number of hospitals, schools and other facilities during the period of increased immigration and growth beginning in the mid-nineteenth century. In September 1845, the RHSJ order established the Hotel Dieu Hospital (Kingston, Ontario). That facility was in operation when Kingston suffered an epidemic of typhus in 1847. In addition to ill and dying patients, Hotel Dieu cared for 100 orphaned children who had lost their parents. The disease had accompanied poor Irish immigrants fleeing famine in their homeland. No one yet understood how the disease spread, and poor sanitation practices compounded the epidemic.