For today’s post, I will examine the expansion of TB sanatoria between 1900 until 1922. In 1882, Robert Koch discovered that tuberculosis was spread by air droplets when the infected person coughed. It was a highly contagious disease and there were two main types of tuberculosis in Ireland. Pulmonary tuberculosis was caused by bacteria in the lungs and its symptoms included a cough and sputum with blood. Moreover, non-pulmonary TB could affect any part of the body including bones and joints and lymph nodes. According to the Thirty-Sixth Detailed Annual Report of the Registrar-General for Ireland in 1899 (p.8), 12,813 people died from TB and it accounted for the second highest cause of death in Ireland.
The lack of TB health services contributed to the development of anti-TB campaigns by The National Association for the Prevention of Tuberculosis and Consumption and The Women’s National Health Association. The NAPT was founded in 1899 and the WHNA was set up by Lady Aberdeen, the viceroy’s wife in 1907. They advocated for improved sanitary conditions in the home and workplace as well as a healthy diet as the best form of prevention against TB (Forty-Seventh Detailed Annual Report of the Registrar-General for Ireland 1910, p.xxvii).
There was limited provision available in Ireland for TB patients. The government had to find suitable accommodation to treat and isolate TB cases. Greta Jones (‘Captain of all these men of death’: The History of Tuberculosis in Nineteenth and Twentieth Century Ireland, p.105) maintains that the ‘general hospitals were reluctant to admit tuberculosis cases and hostile to the possibility that they might be used for segregation of the consumptive’ and the workhouses could not effectively implement the isolation of TB cases. Moreover, the TB sanatoria also refused to treat advanced cases (Ruth Barrington, Health, Medicine & Politics in Ireland, 1900-1970, p.72). Many TB cases were treated by the dispensary doctor in their homes.
The 1909 Tuberculosis (Ireland) Act made county councils responsible for providing of TB sanatoria and dispensaries. TB sanatoria would be financed by local rates. It made the notification of TB cases compulsory but only in the case where the infected person was in close contact with another person. In 1909, the Allan Ryan House was founded by Aberdeen and Heatherside was set up in Cork in 1911 (Jones, ‘Captain of all these men of death’, p.110). In most sanatoria, treatment included ‘fresh air, bed rest and nutritious food’ and early detection of the disease gave the tuberculous a greater chance of recovery (Ibid, p.160).
Under the 1911 National Insurance Act, a sick allowance would be given to TB patients in sanatoria. The government gave a grant of £145,623 for the construction of sanatoria. In 1913, the Tuberculosis Prevention (Ireland) Act made county councils responsible for the construction of sanatoria from board of guardians and the hospital boards. Sanatoria and dispensaries were financed by local rates and the county councils. However, the acts were weakened from the beginning. The county councils ‘found purchasing beds in voluntary sanatoria such as Newcastle and Peamont, a cheaper alternative to the costs of constructing their own TB hospitals’ (Greta Jones, ‘The Campaign against Tuberculosis in Ireland, 1899-1914’, p. 167). Therefore, patients were not effectively isolated.
TB mortality rates significantly rose during the First World War in Ireland, 1914 and 1918. It peaked in 1917 with 9,680 deaths (Fifty-Fifth Detailed Annual Report of the Registrar-General for Ireland 1918, p.xiv). Jones argues that there was no specific reason for the increase in TB deaths as ‘Ireland’s agricultural economy benefitted from the increase in food prices and the shipbuilding, engineering and textile industries’ (Jones, ‘Captain of all these men of death’, p.129). However, it postponed the building of sanatoria (Ibid, p.72). Moreover, Alan Carthy’s The Treatment of Tuberculosis in Ireland from the 1890s to the 1970s: a case study of medical care in Leinster (p.231) argues that the Irish War of Independence affected the operation of sanatoria as a number of sanatoria run by the Dublin Corporation were temporality closed including the Crooksling sanatoria.
County health services remained unco-ordinated during the 1920s and 1930s in Ireland. There were a number of weaknesses in the TB health services including a strong reliance on the TB dispensary, a low rate of reporting of TB cases and when most cases were diagnosed they were in the advanced stages of TB (Jones, ‘Captain of all these men of death’, p.138-9). During the 1930s, Dr Dorothy Stopford Price introduced tuberculin testing and the BCG vaccine to Ireland. However, TB mortality rates remained high until the 1950s. The Minister for Health, Noel Browne, constructed regional TB sanatoria and introduced a national immunisation scheme and a free X-Ray service during this period.
Bibliography
Thirty-Sixth 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 1899.
Forty-Seventh 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 1910.
Fifty-Fifth 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 1918
Barrington, Ruth, Health, Medicine and Politics in Ireland 1900-1970, Institute of Public Administration, Dublin, 1987.
Carthy, Alan Francis, ‘The Treatment of Tuberculosis in Ireland from the 1890s to the 1970s: a case study of medical care in Leinster’. PhD thesis, National university of Ireland Maynooth, 2015.
Jones, Greta, ‘The Campaign against Tuberculosis in Ireland, 1899-1914’ in E. Malcolm and G. Jones (eds.) Medicine, Disease and the State in Ireland, 1650-1940 (Cork University Press, Cork, 1999), pp.158-176.
Jones, Greta, “Captain of all these men of death”: the history of tuberculosis in nineteenth and twentieth century Ireland, Rodophi, New York, 2001.
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