For today’s post, I will analyse the factors that contributed to the introduction of the Irish School Medical Service in 1919.
High rates of childhood mortality plagued early twentieth century Ireland and diseases such as TB, bronchitis, diphtheria, diarrhoeal diseases and heart disease were rampant (Forty-Second Detailed Annual Report of the Registrar General for Ireland containing A General Abstract Of The Numbers of Marriages, Births and Deaths Registered in Ireland During the Year 1905). Treatment was limited for contagious diseases which spread easily amongst children in schools and at home due to unsanitary conditions. According to the Report of the Registrar-General in 1905, 84% of deaths from measles were children under five while about 42% of scarlet fever deaths were of children. Children were vulnerable to diseases due to a lack of proper nourishment. Clarkson and Crawford’s Feast and Famine: A History of Food and Nutrition in Ireland 1500-1920 argues that the national diet in Ireland mainly consisted of food with little nutritional value such as Indian meal and tea. Additionally, independent imitative such as the Ladies School Dinner Committee, founded in 1910, aimed to improve children’s health and nutrition (Earner-Byrne, Mother and Child: Maternity and Child Welfare in Dublin, 1922-60).
In 1906, the Education (Provision of meals) act empowered local education authorities to provide meals for children in national schools that ‘are unable by reason of lack of food to take full advantage of the education provided for them’. However, it was not a compulsory provision. According to Earner-Byrne, in 1914, urban district councils became in charge of the distribution of children’s food in Irish national schools. Under the 1906 Act, the school medical officer or ‘a medical official’ would determine whether the schools meals scheme should be introduced into a national school. However, the scheme only applied to large urban areas. Fionnuala Walsh in Durnin and Miller’s Medicine, Health and Irish Experiences of Conflict, 1914-45 argues that ‘the outbreak…renewed attention to the topic
[of infant welfare]
in both Britain and Ireland’ as a high number of infants died in childbirth although, there was a slow decline in infant mortality rates during the war years.
In 1918, the first Dail established two commissions to inquire into the conditions of primary and secondary schools in Ireland. In 1919, the Killanin report and the Molony report found that the general conditions in Irish schools to be a very poor standard and Killanin recommended that local school committees be responsible for organising school medical services, the maintenance of school building and school equipment in primary schools (Brian Titley, Church, State and the Control of Schooling in Ireland, 1900-1944). Under the 1919 McPherson Bill, local education committees would manage the school medical service and deliver the school meals scheme ‘in each county and county borough’ (John Coolahan, Irish Education: Its History and Structure). However, the school meals scheme was not compulsory as it only applied to state-recognised national schools.
The 1919 the Public Health (Medical Treatment of Children) (Ireland) Act, introduced medical examinations on entry to school or ‘as soon as possible on their admission’. However, like the school meals scheme, it was not compulsory for all children to be examined in national schools. The act made county boroughs and councils responsible for organising school medical inspections. A school medical officer and assistant, dentist and district nurse carried out the service and they could refer children to hospital or dispensary for treatment (First Report of Department of Health 1945-1949). Health authorities relied on district nurses to carry out the school medical inspections in many areas. This service and the school meals scheme was financed by local rates and were only established in urban areas.
Significantly, it was not until the second half of the 1920s that many county boroughs and county councils began to introduce the school medical service. The Annual Report of the Department of Local Government and Public Health 1925-28 complained they were not implemented as ‘the main administrative defects have arisen from apathy on the part of Local Authorities and consequent laxity on the part of their inspecting officers’. It was not compulsory for county councils and county boroughs to establish a school medical service unless they deemed it fit for the area. However, during the 1920s, the concept of preventive healthcare was promoted and the Department of Local Government and Public Heath sought to prevent children from developing health conditions and illnesses through vaccination programmes, education of the mother by the health visitor and Maternity and Child Welfare Centres. Therefore, public health nurses played an essential role in providing health services to the community. Only a small number of counties and county boroughs had established a school medical service in the first half of the 1920s including Cork, Dublin and Clonmel county boroughs. In 1924, Cork and Clonmel County Boroughs established a school medical service (The child health services: report of the study group appointed for the Minister for Health to inquire into the child welfare service and school examination service).
Importantly, the school medical officers and the district nurses found that many children were malnourished and suffered from tonsil and adenoid, eye and nose defects. Schoolchildren had poor dental hygiene as approximately 70% of the children examined had dental defects and 22.5% had defective eyesight (DLGPH 1925—28). Moreover, 11.8% were unclean and 8% were classified as malnourished. This was due to the schools meals scheme inadequate funding by local rates. In Cork County Borough, the school medical officer and the nurse referred children with defective conditions to special treatment facilities (DLGPH 1925—28). As a result of the high number of dental defects, school medical services often included a dental-surgeon. The Annual Report of the DLGPH 1925-28 stated that the Clonmel Corporation provided a school medical service which included a part time nurse and medical officer, dentist and eye specialist.
At the school medical inspections, the nurse educated the parents on nutrition, cleanliness and illnesses and identified children’s medical conditions such as dental defects. The School Medical Service provided preventive health services including vaccination schemes, particularly diphtheria immunisations during the late 1920s and 1930s. Schoolchildren were also referred for specialist services free of charge.
Further reading
Annual Report of the Department of Local Government and Public Health, 1922-25, (Stationary Office, Dublin, 1925).
Coolahan, John, Irish Education: Its History and Structure, Institute of Public Administration, Dublin, 1981.
Clarkson, L. A, and Crawford, Margaret E., Feast and Famine: A History of Food and Nutrition in Ireland 1500-1920, Oxford University Press, Oxford, 2001.
Earner-Byrne, Lindsey, Mother and Child: Maternity and Child Welfare in Dublin, 1922-60, Manchester University Press, Manchester, 2007.
Education (provision of meals). A bill to amend the education act 1902.
Education (Provision of meals) Act 1906.
First Report of the Department of Health 1945-1949 (Stationary Office, 1949).
Forty-Second Detailed Annual Report of the Registrar General for Ireland containing A General Abstract Of The Numbers of Marriages, Births and Deaths Registered in Ireland During the Year 1905.
Public health (medical treatment of children) (Ireland). A bill (as amended by standing committee D) to make provision for the medical treatment of children attending elementary schools in Ireland, and for other matters incidental thereto.
The child health services: report of the study group appointed for the Minister for Health to inquire into the child welfare service and school examination service (Stationary Office, 1967).
Titley, Brian E., Church, State and the Control of Schooling in Ireland, 1900-1944, McGill-Queen’s University Press, London, 1983.
Walsh, Fionnuala, ‘‘every human life is a national importance’: the impact of the First World War on attitudes to maternal and infant health’, in D. Durnin and I. Miller (eds.) Medicine, Health and Irish Experiences of Conflict, 1914-45 (Manchester University Press, Manchester, 2017), pp.15-30. 00000
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