Five Useful Online Databases for Health History Research

For today’s post, I will identify some of the most useful online databases for historical research on the history of healthcare and more general academic websites.

Throughout the course of my undergraduate and MA dissertations, I was introduced (by fellow students and academic staff) to online repositories that have provided useful to my own research. However, some of these resources can only be accessed my university students while others are also open to the public.

Lenus the Irish Health Repository

I first encountered Lenus as a third year history student undertaking my research seminar on Health and Politics in Independent Ireland at UCC. While Lenus holds newly published medical research, it contains various nineteenth and twentieth century Irish health archives. For example, the Hospital Commissions’ Reports, Reports of the Department of Health (1945-), and reports from Fever Hospitals. The full documents are be downloaded and accessed by researchers and the public.

U.K Parliamentary Papers

This database boasts a wide range of Bills, Acts and meetings of committees relating to Scotland, Wales, England and Ireland. I found the Parliamentary Papers useful to determine when certain medical provisions were first recommended and to trace amendments to significant acts on maternity and child welfare. Of course, the Irish Statute Book website records legislation passed in Ireland following 1922.

Irish Newspaper Archive

As far as I am aware to view the Irish Newspaper Archive you must set up an account, however, it Irish university students can usually access the archive through their library database section. Notably, the Irish Times have a separate online arrchive with a substantial collection of newspapers.

CSO.ie

The Central Statistics Office contain the annual registers for births, marriage and deaths in Ireland from the nineteenth century. In terms of my own research, they provided a detailed summary of the number and causes of infant and maternal deaths in Ireland between 1919 and 1979.

Cora, Cork Open Research Arachive

Lastly, most University’s such as University College Cork have an Open Research Archive which stores past PhD theses. Before I start my research, I need to ensure that the topic has not been already been carried out by another researcher because you want your findings to make a new and significant contribution to historiography. Websites like CORA, and TARA, Trinity’s Access to Research Archive, allow free access previous PhD research undertaken in your main research area.

Links:

Central Statistics Office https://cso.ie/en/index.html

CORA https://cora.ucc.ie/handle/10468/1

Irish Statute Book http://www.irishstatutebook.ie/

Lenus the Irish Health Repository https://www.lenus.ie/

TARA http://www.tara.tcd.ie/handle/2262/76240 2 Acc

Childhood Immunization Schemes in Ireland, 1922-50

For today’s post, I will examine the expansion of immunization schemes in Ireland which aimed to reduce incidences of childhood deaths from infectious diseases, 1922-1950.

Vaccination programmes for diseases such as smallpox had been in operation in Ireland since the nineteenth century. Deborah Brunton (‘The Problems of Implementation: the Failure and Success of Public Vaccination Against Smallpox in Ireland, 1840-1873’, in Jones and Malcolm (eds.) Medicine, Disease and the State in Ireland, 1650-1940 (Cork University Press, Cork, 1999), p.139) states that smallpox declined in Ireland in the nineteenth century due to ‘the introduction of compulsory vaccination in 1863’. Medical Officers of Health were responsible for the undertaking of immunisation schemes and local authorities managed health services within their district.

However, infant mortality rates remained rife until the 1950s in Ireland. Their deaths were facilitated by poor sanitation, lack of nutrition and overcrowded housing. They died from a wide range of infectious diseases such as whooping cough, diphtheria, measles and tuberculosis. In 1900, 10.9% of registered births of infants under one died (Annual Report of the Registrar-General 1900, p.20). The establishment of district nursing association and voluntary nursing association such as Lady Dudley’s Nursing Scheme, assisted the reduction of infant and childhood mortality rates from smallpox. The district nurses were trusted by the community as they had the power to convince patients to receive vaccinations (Sheila Armstrong ‘Public Health Nursing’, in Robins (ed.) Nursing and Midwifery in Ireland in the twentieth century: fifty years of an Bord Altranais (the Nursing Board) 1950-2000 (An Bord Altranais, Dublin, 2000), p127).

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, children could opt out of the inspections undertaken by the School Medical Officer. Following the creation of the Irish Free State, county health schemes were established and the new Irish government under Arthur Griffith attempted to co-ordinate health services. By 1923, the County Medical Officer of Health was appointed in every county to oversee the administration of county health services including maternity and child welfare services and TB schemes. Various infectious diseases legislation was implemented during this period, making the notification of dangerous diseases, such as poliomyelitis, compulsory.

Successful diphtheria vaccination schemes were introduced in the county boroughs with the highest rates by the late 1920s, including Louth, Cork and Dundalk (See Michael Dwyer, Strangling Angel: Diphtheria and Childhood Immunization in Ireland, Liverpool University Press, Liverpool, 2018). Diphtheria was spread easily in classrooms due to a lack of ventilation. There were three injections for the immunisation against diphtheria but the Report of the Department of Local Government and Public Health, 1928-30 (p.40) were concerned that the scheme would be ineffective if people refused vaccination due to suspicion. The 1930 Public Health (Infectious Diseases) Regulations 1930 enabled a board of health or urban district council to carry out diphtheria immunisations. Isolation was heralded as the best method to prevent the spread of childhood disease and the DLGPH recommenced that children with infectious diseases such as measles should not attend school. Dr Dorothy Stopford Price introduced the BCG vaccine into Ireland in 1937 and also established a clinic to vaccinate children against the disease at St Ultan’s Infant hospital in Dublin, It was not until 1952 that a national BCG centre immunization scheme was founded

The significant peak in infant mortality rates during the ‘Emergency’ in Ireland prompted the further expansion of immunisation schemes throughout the country. In 1941, the Public Health (Infectious Diseases) Regulations made the notification of infectious diseases including polio, measles, enteric fever, whooping cough, scarlet fever compulsory (DLGPH 1941-42, p.36). The war made it difficult to import the food including flour and BCG vaccine (O hOgartaigh, Margaret, ‘Dr Dorothy Price and the elimination of childhood tuberculosis’ in J. Augustin (ed.) Ireland in the 1930s (Four Courts Press, Dublin, 1999), p.80) Despite the foundation of the Department of health in 1947, the Catholic Church had rejected the inclusion of compulsory school medical inspections in the 1945 Health Bill. They felt that it was an encroachment of the State on the role of the parents and that the parents should choose whether the child was inspected (Irish Nurses’ Magazine, Vol. 19, No. 8 (August/September), p.4.). However, the 1947 Health Act proposed free medical and specialist services for children discovered to have defects at the School Medical Service and the Child Welfare Clinics.

Cases of poliomyelitis increases during the 1940s (First Report of the DOH 1945-49, p.50). Children found to have polio were isolated at home or hospital and the Department of Health recommended that schoolchildren should not attend the school or other areas ‘in which the disease has occurred’ (Ibid). A routine diphtheria vaccination scheme was carried out, ‘local dispensaries, schools and other centres selected by the Chief Medical Officer’ (Ibid, p.46) Gamma Globulin serum was used to vaccinate schoolchildren against the measles. In 1948, the Consultative Child Council was set up to reduce incidences of disease in children. Less infants were infected with gastro-enteritis due to the availability of clean, uncontaminated milk and the scarletinal anti-toxin also contributed to reduced death rates from scarlet fever. However, because some parents feared the side effects of inoculations there were less vaccinations undertaken in years without epidemics.

During the 1950s, there were advances in treatment for TB such as therapeutic drugs, radiography, and chemotherapy. Anti-biotics including penicillin were also sued to treat diseases such as tonsillitis and meningitis. By the 1960s, diphtheria immunisations were carried out at the county clinics and schools. However, some of the specialist services attached to the School Medical Service including TB services were inadequate and children had to wait long period of time until they receive treatment until the mid-1970s. Parents also became more educated on the symptoms of disease and domestic cleanliness.

Bibliography

Primary Sources

Annual Report of the Department of Local Government and Public Health, 1928-29, (Stationary Office, Dublin, 1929).

Annual Report of the Department of Local Government and Public Health, 1941-42, (Stationary Office, Dublin, 1942).

First Report of the Department of Health 1945-1949 (Stationary Office, 1949).

Thirty-seventh detailed Annual Report of the Register-General (Ireland) containing a General Abstract of the Numbers of Marriages, Births and Deaths Registered in Ireland During the Year 1900.

Irish Nurses’ Magazine, Vol. 19, No. 8 (August/September).

Secondary Sources

Armstrong, Sheila, ‘Public Health Nursing’ in J. Robins (ed.) Nursing and Midwifery in Ireland in the twentieth century: fifty years of an Bord Altranais (the Nursing Board) 1950-2000 (An Bord Altranais, Dublin, 2000), pp.125-139.

Barrington, Ruth, Health, Medicine & Politics in Ireland, 1900-1970, Institute of Public Administration, Dublin, 1987.

Brunton, Deborah, ‘The Problems of Implementation: the Failure and Success of Public Vaccination Against Smallpox in Ireland, 1840-1873’, in Jones and Malcolm (eds.) Medicine, Disease and the State in Ireland, 1650-1940 (Cork University Press, Cork, 1999), pp. pp.138-157.

O hOgartaigh, Margaret, ‘Dr Dorothy Price and the elimination of childhood tuberculosis’ in J. Augustin (ed.) Ireland in the 1930s (Four Courts Press, Dublin, 1999), pp.67-82.

Robins, Joe, Nursing and Midwifery in Ireland in the twentieth century: fifty years of an Bord Altranais (the Nursing Board) 1950-2000, An Bord Altranais, Dublin, 2000.

Mother and Baby Homes: How the Catholic Church, the State, and Irish Society Influenced their Establishment

For today’s post, I will examine the Catholic Church, the State and, Irish society’s role in the emergence of Ireland’s mother and baby homes, with particular reference to Bessborough Mother and Baby Home in Blackrock, Co. Cork.

According to O’ Donnell and O’ Sullivan’s Coercive Confinement in post- Independence Ireland: Patients, Prisoners and Penitents (p. 4), the respective roles of the Church, State, and family “varied considerably by institution” and these penal institutions including mother and baby homes and Magdalan Asylums were organised for the protection rather than punishment of the unmarried expectant mother. Importantly during the nineteenth century, female religious orders were invited over from France to establish Magdalan asylums with an incentive rehabilitate ‘fallen’ women or prostitutes.

Ferriter (Occasions of Sin: Sex and Society in Modern Ireland, p.87) argues that the prevalence of sexual crimes and the determination to prosecute them remained constant in Ireland. This was due to the high rates of illegitimate births in the Irish Free State. The solution to the problem of illegitimate births was believed to be the establishment of antenatal homes in which the unmarried mother and child “might be maintained together for at least five years” (Ibid, p.127). The mother and baby homes were designed for those who transgressed social norms during the twentieth century and after the establishment of an independent Ireland in 1922, workhouses were reclassified as County Homes. They would be managed by female religious orders such as the Sisters of Mercy and Our Lady of Charity. Significantly, Milotte (Banished Babies, p.17) notes that the Church’s authority was “unquestioned” in Irish public life and due to the stigma attached to pregnancy outside of marriage, the family was involved in a process of denial and concealment.

Ferriter (p.128)states that the state classified two types of unmarried mothers and advised that the ”first-offenders” would remain in the newly funded institutions for a year, fulfil “domestic duties” and care for their child and the “sinful” women were sent to Magdalan Asylums. Separate homes for unmarried expectant mothers were set up by an English female religious congregation, the Sister of the Scared Heart of Jesus and Mary. Additionally, Milotte (Banished Babies, p.21) maintains that the nuns were sole arbiters of the Church’s moral values and “rejected unmarried mothers and banished their hapless offspring”. In 1927, The Report of the Commission on the Relief of the Destitute Poor Including the Insane Poor recognised further highlighted the stigma associated with illegitimacy. It was described as a danger to the child’s welfare and stated that the “illegitimate child was “proof of the mother’s shame”(Ibid, p.73). The State accepted these proposals and laid the foundations for the infrastructure of religious-controlled mother and baby homes.

O’ Sullivan and O’ Donnell (Coercive Confinement) maintains that there was no legal basis for confinement but the mother and baby’s freedom to leave the home was restricted as “many matrons rely” on these inmates to perform the “large” institution’s domestic duties. The Department of Health noted that an unmarried mother must remain in the mother and baby home for a two year period before her release without the baby which was reduced to six months (Ibid). Maguire (Precarious Childhood in Post-Independence Ireland, p.87) adds that most mother and baby homes operated privately, including Roscrea in County Tipperary and they received capitation grants under the Public Assistance Acts.

In 1922, Bessborough mother and baby home was established by The Sisters of the Sacred Heart of Jesus and Mary in Cork for “young mothers who have fallen for the first time and who are likely to be influenced towards” a “respectable life” (O’ Sullivan and O’ Donnell, Coercive Confinement, p.19,). The matron of Bessborough, Sister Sarto Harney, posits that “these lapses from virtue” are “evident to all who trouble to observe life around them: no parental control, cheap romantic fiction” (Ibid). Dr James Deeny, Chief Medical Advisor in 1951, investigated the high mortality rate in Bessborough and the mother and baby home was closed for a short period of time. Importantly, infant mortality rates were very high in Ireland. By the late 1940s, the main causes of infant deaths included ‘congenital debility’ and other related diseases, diarrhoea and enteritis and pneumonia (Report of the Department Health 1949-1950, p.10).

Illegal adoptions also took place in the Mother and Baby Homes until the introduction of the 1950 Adoptions Act. O’ Sullivan and O’ Donnell (Coercive confinement, p.99) state that between the three Sacred Heart homes in Tipperary, Westmeath, and Cork and in the “largest of them”, there were 150 babies born in 1965 of which 115 were adopted. After the two years spent at a mother and baby home, the unmarried mother’s children would be boarded out by the local authorities and the women were sent to “find work elsewhere” (Ferriter, Occasions of Sin, p.252). Almost 100,000 children were born outside of marriage between the 1920s and the mid-1970s (Milotte, Banished Babies, p.18). O’ Sullivan and O’ Donnell (Coercive Confinement, p.264) note that Ireland’s “containment culture” emerged during the 1920s and the Church, the state and the family were concerned with sexual morality. Milotte (Banished Babies, p.22) states that the adopted children were sent to “good Catholic homes” but there was no “established criteria for the suitability of applicants”.

The Catholic Church and the state managed the mother and baby homes until their closures in the 1990s. By the 1970s, the Church and State’s coercive confinement was transformed as there was profound economic and social change. The Irish state was unable to establish welfare services to provide for the unmarried mother and child which left the Church to regulate mother and baby homes. Moreover, the government introduced a financial allowance for unmarried mothers in 1973. While the “expressed aim” was to reform the inmates, most of these institutions were “austere” and the experience was stigmatising (O’ Sullivan and O’ Donnell, Coercive Confinement).

Bibliography

Commission on the Relief of the Sick and Destitute Poor Including the Insane Poor appointed on the 19^th March 1925 (Stationary Office, 1927).

Ferriter, Diarmaid, Occasions of Sin: Sex and Society in Modern Ireland, Profile Books, London, 2009.

Maguire, Moira, Precarious Childhood in Post-Independence Ireland, Manchester University Press, Manchester, 2008.

Milotte, Mike, Banished Babies, New Island Books, Dublin, 1997.

O’ Sullivan, Eoin and, O’ Donnell, Ian, Coercive Confinement in post- Independence Ireland: Patients, Prisoners and Penitents, Manchester University Press, Manchester, 2012.

Report of the Department of Health 1949-1950 (Stationary Office, 1950).

An Bord Altranais, the Catholic Church and Nurse Training, 1950-60

For today’s post, I will analyse developments in nurse training in Ireland between 1950-1960. I will examine the influence of the Catholic Church over nurse training.

From the 1890s, nursing training was confined to voluntary hospitals established by female religious institutions. Robins (Nursing and Midwifery in Ireland in the twentieth century: fifty years of an Bord Altranais (the Nursing Board) 1950-2000, p.20) states that nurses were required to pay a fee in order to train at one of these hospitals which led to the development of nursing as a middle class profession. However, the moral character of nurses was emphasised due to the influence of Florence Nightingale and the Sister of Mercy during the Crimean War. By 1900, nurses were ‘obedient, hardworking, gentle and vigilant’ and most importantly they were ‘moral’ figures (Preston, Charitable Words: Women, Philanthropy and the Language of Charity in Nineteenth Century Dublin, p.139). However, free medical services were distributed in poor parts of Western Ireland by Lady Dudley’s Nursing Scheme, founded in 1903, and nurses trained by Queen Victoria’s Institute of Jubilee Institute. These organisations were outwardly non-denominational as they trained both catholic and protestant nurses. However, they were trained in separate centres confined to Dublin (Pendergast, ‘Jubilee Nurses’ p.63).

In 1919, the General Nursing Council was established to supervise nurse training, examinations and to conduct inspections of training hospitals and centres. The Nurses Registration (Ireland) Act created a register for nurses and set up separate divisions of nursing such as psychiatric nursing and district nursing. Nurses had to be enrolled in a training hospital in order to join the register (Nurses Registration (Ireland), section 3.2 b). District nurses were also provided with refresher courses organised by the Irish Nurses Organisation. They usually ran for a week and were held in Dublin. Postgraduate included topics such as midwifery and child welfare (Moore, ‘Ireland and the Queen’s Institute’, p.508). As early as 1928, the Department of Local Government advocated for the establishment of a training scheme for public health nurses (See Report of the DLGPH 1925-28, p.66).

In 1950, An Bord Altranais was formed when the General Nursing Council and the Central Midwives Board were amalgamated and the Midwives Committee was set up. The redefinition of district nursing, public health nursing and domiciliary midwives duties coincided with an interest in the creation of a district nursing course. District nurses carried out a range of duties to communities including preventative health services and child welfare services and therefore, they needed a training course. Under the 1953, Health Act, An Bord Altranais had the authority to approve nurse training hospitals and to appoint lecturers. However, the Catholic Church were against State interference in areas traditionally operated by Catholic religious orders such as hospitals. Robins (Nursing and Midwifery, p.33) argues that ‘nurses were seen as being on the front line of the defence of traditional family values and sexual relationships’. The Catholic Church sought to control subjects studied by student nurses in order to ensure that Catholic values were present in the nursing profession. They had objected to the free choice of doctor in Noel Browne’s Mother and Child Scheme due to fears that Protestant doctors would attend Catholic mothers and educate them on matters related to sexuality such as contraception. Under the 1953 Health Act poor women given a free choice of doctor and although the Maternity hospitals were divided in different zones in Dublin, however, patients could also apply to another hospital outside of her zone (Earner-Byrne, Mother and Child: Maternity and Child Welfare in Dublin, 1922-60 p.159). The same arguments were also emphasised when first Minister for Health, James Ryan proposed that sex education would be provided through the school medical service in the 1945 Health Bill.

From 1954, Archbishop McQuaid met with members of An Bord Altranais to address how ethics and psychology were taught in University College Dublin (Robins, Nursing and Midwifery, p.33). It was decided the syllabi would be reviewed by McQuaid (Ibid). The Catholic Church gained further control in nursing as they also ensured ‘that the lecturers chosen were to be appointed by each training hospital but only after the approval of the local bishop’ (Ibid, p.34). The Catholic Church also influenced the nursing syllabus. They proposed that there would be no official examinations for ethics and psychology for nursing students and these reforms also applied to Protestant students (Ibid).

In1956, the division pf public health nursing was founded and designated community health services such as undertaking vaccination schemes, operating maternity and child welfare centres and the school medical service. By 1959, the first short public health nursing course was established in UCD (Ibid, p.37). The nursing board were in charge of the refresher courses and existing public health nurses could qualify to practise and enter the register (Irish Nurses’ Magazine, Vol. 27, No. 8 (August 1960), p.9).

However, local authorities were reluctant to employ nurses who attended the new course. The Irish Nurses’ Magazine (Vol. 28, No. 9, p.10) argued that .Public health nurses who had undertaken the new public health nursing course found it difficult to acquire permanent jobs because ‘their additional training and experience [was] rated so low’. Subsequently, the creation of the public health nursing division contributed to the gradual decline of the voluntary nursing organisation (Robins, Nursing and Midwifery, p.39). Moreover, community nurses services were disorganised and inadequate in some areas outside of main cities and public health nurses duties required to work during off duty hours.

Bibliography

Primary Sources

Health Act, 1953.

Nurses Registration (Ireland). A bill to provide for the registration of nurses in Ireland.

Irish Nurses’ Magazine (August 1960-September 1962).

Irish Nurses’ Magazine, Vol. 28, No. 9, p.10.

Secondary Sources

Earner-Byrne, Lindsey, Mother and Child: Maternity and Child Welfare in Dublin, 1922-60, Manchester University Press, Manchester, 2007.

Moore, John W., ‘Ireland and the Queen’s Institute of District Nursing’, British Medical Journal, Vol. 2 No. 3532 (September 1928), pp.508-509.

Elizabeth Pendergast, ‘Jubilee Nurses’, Old Dublin Society, Vol. 66, No.1/2 (Spring/Autumn 2013), p.63.

Preston, Margaret H., Charitable Words: Women, Philanthropy and the Language of Charity in Nineteenth Century Dublin, Prager, Westport, 2004.

Robins, Joe (ed.) Nursing and Midwifery in Ireland in the twentieth century: fifty years of an Bord Altranais (the Nursing Board) 1950-2000, An Bord Altranais, Dublin, 2000. fffff

The Expansion of TB Sanatoria in Ireland, 1900-1922.

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.

Review: CIT Investigates Public Talk on ‘Mother & Baby Homes and Adoption Practices in Ireland’.

For today’s post I will review a public talk organised by CIT School of Humanities and CIT Arts Office on ‘Mother & Baby Homes and Adoption Practices in Ireland’.

I was drawn to this event as I have a personal interest in the history of children’s and women’s institution in Ireland. I was greatly impressed and familiar with some of the guest speakers that were on the panel discussion, namely, Professor Eoin O’Sullivan, author of Suffer the Little Children: The inside Story of Ireland’s Industrial Schools and Coercive Confinement in Ireland: Patients, prisoners and penitents and Mike Milotte, author of Banished Babies: the secret history of Ireland’s baby export business which highlighted the illegal adoption system during the twentieth century in Ireland. Other members of the discussion panel consisted of Conail O’ Fatharta, a Senior News Reporter from the Irish Examiner and Liam O’ Mahony, a Psychotherapist and Addiction Counsellor whom was born in Bessborough Mother And Baby Home, Mary Slattery whom ‘lost her first born to a forces, secretive and closed adoption system through St Anne’s Adoption Society Cork’ in 1973 and Terri Harrison whom was abducted by the Catholic Aid and Rescue Society from Britain and brought to Bessborough Mother and Baby Home and later St Patrick’s Mother and Baby Home on the Navan Road, Dublin as she was a single expectant mother.

Prof. O’Sullivan, Professor of Social Policy at Trinity College Dublin, argued that by the 1950s, 1% of the Irish population were institutionalised such as psychiatric hospitals and county homes and although these institutions existed across Europe, they lasted longer in Ireland due to a tendency to care for the ‘dispossessed’ and ‘unwanted’ by society. Moreover, he maintained that some of these institutions were inherited from the pre-independence period while others such as the Mother and Baby Homes emerged during the 1920s to suit the needs of Irish society. Mother and Baby Homes and the Magdalan laundries were designed to separate first-time unmarried expectant mothers and women who had ‘fallen’ more than once and O’Sullivan argues that the cost of caring for ‘recidivist’ women and their children led to the development of adoption in Ireland. However, children from county homes or industrial schools were fostered while babies born in the Mother and Baby Homes were illegally adopted as they were perceive to possess a lesser ‘recidivist gene’ than those born with mothers with a number of ‘illegitimate ‘children in these other institutions. O’Sullivan states that the State paid a capitation fee for each child attending industrial schools which encouraged these intuitions to extend the stay of children for a long period of time.

Mike Milotte states that about 2,000 children were officially adopted from Ireland in 1950 and that it was organised by a religious infrastructure including nuns, the Archbishop of Dublin, Charles McQuaid, and the Department of External Affairs (whom were responsible for allocating passports). He argues that an illegal adoption system existed in Ireland and it is possible that thousands of children were exported to America during the twentieth century. According to Milotte. American business travelled to Ireland to adopt and left Ireland two weeks later with the children. He noted that this practise emerged during the Second World War as American airmen brought children back from Europe to their wives however, in 1948, the illegal exportation of children was prohibited in Europe except in Ireland. Milotte highlighted that there was no inspection of the family before the child was placed in their care as the Catholic Charities. The Catholic Charities, an adoption organisation based in America would investigate the family however, these inspections often did not take place. The only prerequisite required for the family’s approval by the religious order was that they were a Catholic family. The media collaborated with the Catholic Church’s hierarchy to conceal the scandal and therefore, stories of illegal adoptions went unreported. Therefore, unregulated adoption system in Ireland and children possibly sent to unsuitable homes. The children were referred to as ‘orphans’ but many had one parent alive in Ireland.

O’Fatharta spoke about Mother and Baby Homes in relation to the media and he stated that when the Tuam Mother and Baby Home Scandal emerged in 2014, the Minister for Children, was aware of the story since 2012. Moreover, he noted that the death rates in the Mother and Baby homes were underreported by the nuns and the homes were not inspected by the government. O’Fatharta maintained that the public need to view Mother and Baby Homes and other related institutions as a network operated by the Catholic Church in Ireland. Mary Slattery ‘lost’ her daughter to St. Anne’s Adoption Society in 1979 and explained how the Catholic ethos from her social environment influenced her decision to have her daughter adopted. Importantly, her family were supportive of her pregnancy but the Catholic Church and government acts such as the 1931 Illegitimacy Act stigmatised unmarried pregnant women and their vulnerable children. St’ Anne’s Adoption society organised through an organisation known as Ally for Mary to travel to Dublin to give birth. However, she later discovered that some of the information provided to her before the adoption was deliberately misleading in an attempt to encourage her to choose adoption. Mary Slattery states that she was told that her daughter was going to family in their thirties however, she later discovered they were in their forties.

Terri Harrison explained that she was accepted as a single expect mother in England.. However, the Catholic Aid and Rescue Society ‘abducted’ her and forced her onto an airplane back to Ireland. When she arrived at Bessborough Mother and Baby Home in 1973 she was assigned a house name and a house number. She escaped from Bessborough but was found in Dublin and sent to St. Patrick’s Home on the Navan Road. She highlighted the sexual double standard that existed for men and women in Ireland as she maintained there were no special homes for unmarried fathers. Terri described how she felt ‘de-humanised’ by the lack of medical attention and counselling after she gave birth to her son, Niall. She states that ‘[her] first encounter with motherhood was destroyed’. Due to a genetic medical condition she and her son urgently needed to go to hospital following the birth however, the nuns’ ambulance passed ‘seven hospitals’ on their way to St. Kevin’s Hospital. Liam O’Mahony, member of the Irish Association for Counselling and Psychotherapy and Addiction Counsellors of Ireland described how early development trauma impacted his life after he was born on Bessborough Mother and Baby Home. He cited his inability to form meaningful relationships with other people, his negative self-image as he felt ‘unwanted’ and his perception of others as potentially ‘threatening’.

Significantly, the majority of the guest speakers cited the economic benefit for the religious orders as the reason for the long-term retention of women and children in mother and baby homes and industrial schools in Ireland. The Mother and Baby Homes Commission of Investigation report was granted an extension of one year in February 2019. The adoption system was illegal and unregulated in Ireland until the introduction of the Adoption Act in 1952. The Catholic Church’s hierarchy and the Department of External Affairs facilitated a large number of adoptions in Ireland, many which are unaccounted for. Single and expectant mothers and their babies were stigmatised by Irish society, the State and the Catholic Church and institutionalised in a Mother and Baby Home exempt from State inspections.

Bibliography

Mother & Baby Homes and Adoption Practices in Ireland: A Panel Discussion and Q & A with Conail O’ Fatharta, Prof. Eoin O’ Sullivan, Mike Milotte, Liam O’ Mahony, Mary Slattery, and Terri Harrison, Cork Institute of Technology, 13 February 2019.

Developments in District Nurse Training, 1890-1919

For today’s post, I will briefly analyse the developments in nurse training from the late nineteenth century to the introduction of the 1919 Nurses Registration (Ireland) Act.

Under the 1851 Medical Charities Act dispensary midwives were appointed to work in a local dispensary district. Ciara Breathnach ‘Handywomen and Birthing in Rural Ireland, 1851-1955’ (41) argues that although, the dispensary midwife was employed in the local dispensary, ‘distances from dispensaries and union hospitals coupled with a reticence to engage with medical care under the poor law served as deterrents for pregnant women’. Many women continued to avail of the handywomen’s service rather than the district voluntary nurses due to a difficulty in the community to raise funds to support a nursing association (Ibid, 40). ‘Handywomen’ were untrained midwives and facilitated the spread of disease amongst new mothers. However, most women did not give birth in hospitals and there was no ante-natal provision available during late nineteenth century in Ireland. Joe Robins’ Nursing and Midwifery in Ireland in the twentieth century: fifty years of an Bord Altranais (the Nursing Board) 1950-2000 (14) highlights that ‘the family home was accepted as the proper place for birth’. Many women died from puerperal sepsis and other conditions related to birth.

Most nurses were untrained during the nineteenth century, with a bad reputation for drunkenness and their lack of education (Gerard Fealy, A History of Apprenticeship Nursing in Ireland, 18). However, Florence Nightingale influenced the new value of morality becoming a requirement for nursing during the second half of the nineteenth century (Ibid, 11). Apprenticeship nurse training then developed during the 1890s and nurse training schools were attached to ‘voluntary hospitals and in the large hospitals operated by religious orders’ (Robins, Nursing and Midwifery, 11). Nurse training was denominational and there were separate training schools for Protestant and Catholic nurses. Maria Luddy’s ‘‘Angels of Mercy’: Nuns as Workhouse Nurses, 1861-1998’ (106) states that religious orders, drawing recruits from educated middle classes, played a significant role in the establishment of nurse training and thereby helped to raise nursing standards including the Sisters of Mercy. To train as a nurse, women were required to have a good moral character, ‘a positive reference and an ability to pay a general fee to the training school’ (Ann-Marie Ryan, ‘General Nursing’, 79).Various nursing trainings schools were set up including The Dublin Metropolitan Technical School for Nursing during the 1890s (Robins, Nursing and Midwifery, 14).

By 1900 attempts were made to provide official training for district nurses and various organisations such as Lady Dudley’s Nursing scheme (1903) and Queen Victoria’s Jubilee Institute (1897) organised voluntary nursing services throughout rural and poor parts of Ireland. The nurses treated a range of illnesses including tuberculosis and they often arrived to treat patients following a ‘referrals from general practitioners, the Jubilee Committee and pharmacists’ (Armstrong, ‘Public Health Nursing, 127). According to Armstrong (Public Health Nursing’, 127), the district nurses were trusted by the community as they had the power to convince patients to receive vaccinations. However, they worked long hours as they held a dual role of midwife in many districts (Ibid). The voluntary nursing services were limited in Ireland as Breathnach ‘Lady Dudley’s District Nursing Scheme and the Congested Districts Board, 1903-1923’ (151) states that there were only a small number of Lady Dudley nurses: only 21 for 24 congested districts. It was a free service and the nurses travelled from areas on bicycle (Robins, Nursing and Midwifery, 12).

In 1919, the Nurses Registration (Ireland) Act was introduced, establishing the General Nursing Council, and a register for separate nursing divisions including general nurses and mental nurses and the Council would supervise nurse training, inspections and examinations. Nurses had to be enrolled in a training hospital in order to join the register. Moreover, a Central Midwives Board was founded and midwifery training would take place in maternity hospital for six months (Robins, Nursing and Midwifery, 17). Armstrong ‘Public Health Nursing’ (127) maintains that ‘the district nurses was also the appointed midwife for the area’ and they worked all day as they may be called to treat an injury or an illness. After the Irish Free State was established in 1922, the new Department of Local Government and Public Health funded Maternity and Child Welfare schemes and half the costs of local authority and voluntary nursing association nurses (Annual Report of the Department of Local Government and Public Health, -1925, 34). However, nurses were given insufficient wages by by the government and local rates (Commission on the Relief of the Sick and Destitute Poor Including the Insane Poor appointed on the 19^th March 1925, 65-66). However, by 1927, general nurses in many counties only had midwifery skills (Ibid, 66).

Voluntary scheme provided an essential service to the sick poor by travelling to patients in rural parts of Ireland. By the twentieth century, most nurses were moral and middle class women trained in a voluntary hospital or training school based in Dublin. District nurses employed by local authorities or voluntary nursing associations carried out a wide range of duties such as the maternity and child welfare schemes and preventive health services. However, district nurses continued to be over-worked and underpaid by the DLGPH and local rates in the Free State.

Bibliography

Primary sources

Annual Report of the Department of Local Government and Public Health, 1925-28, (Stationary Office, Dublin, 1928).

Commission on the Relief of the Sick and Destitute Poor Including the Insane Poor appointed on the 19^th March 1925 (Stationary Office, 1927).

Nurses Registration (Ireland). A bill to provide for the registration of nurses in Ireland.

Secondary Sources

Breathnach, Ciara, ‘Lady Dudley’s District Nursing Scheme and the Congested Districts Board, 1903-1923’ in in M. H. Preston and M. O’ hOgartaigh (eds.) Gender and Medicine in Ireland, 1700-1950 (Syracuse University Press, New York, 2012), pp. 138-153.

Breathnach, Ciara, ‘Handywomen and Birthing in Rural Ireland, 1851-1955’, Gender and History, Vol. 28, No. 1 (April 2016), pp.34-56.

Fealy, Gerard M, A History of Apprenticeship Nurse Training in Ireland, Routledge, London, 2006.

Luddy, Maria, ‘‘Angels of Mercy’: Nuns as Workhouse Nurses, 1861-1998’ in G. Jones and E. Malcolm (eds.) Medicine, Disease and the State in Ireland, 1650-1940, (Cork University Press, Cork, 1999), pp.102-117.

Robins, Joe, Nursing and Midwifery in Ireland in the twentieth century: fifty years of an Bord Altranais (the Nursing Board) 1950-2000, An Bord Altranais, Dublin, 2000.

Ryan, Anne-Marie, ‘General Nursing’ in in J. Robins (ed.) Nursing and Midwifery in Ireland in the twentieth century: fifty years of an Bord Altranais (the Nursing Board) 1950-2000 (An Bord Altranais, Dublin, 2000), pp.77-99.

The Evolution of Magdalan Asylums in Ireland and Common Routes of Entry, 1829-1960

For today’s post, I will examine the evolution of Magdalan asylums in Ireland and the most common routes of entry into Magdalan asylums including self-committals, committals by clergymen and through the judicial system.

According to Maria Luddy’s Women and Philanthropy in Nineteenth Century Ireland (p.99), Irish cities had high rates of prostitution which created a need for Magdalan refuges. The Moral Rescue Movement in Britain aimed to prevent unmarried mothers from turning to prostitution (Maria Luddy, Prostitution and Irish Society, 1800-1940, p.115). Protestant asylums were founded during the eighteenth century. In 1767, Lady Arabella Deeny established the first protestant refuge (Ibid, p.77). By the end of the eighteenth century, there was a significant number of lay refuges established. However, they were reluctant to accept women who had been involved in prostitution for a long period of time (Ibid, p.84).

Magdalan asylums were founded during the nineteenth century and they offered refuge and redemption for ‘fallen women’. In 1832, the first Magdalan refuge was founded by the Irish Sisters of Charity in Townsend Street, Dublin (James M. Smith, Ireland’s Magdalan Laundries and the Nation’s Architecture of Containment, p.28). The asylums were denominational. They were based on the religious icon of Mary Magdalene, a prostitute who repented for her sins and was forgiven by Jesus Christ. Magdalen asylums were often referred to as Magdalen laundries as they had a commercial business attached. They were not financially supported by the State and therefore, they were dependent on donations and bequests (Jacinta Prunty, Monasteries, Magdalan laundries and reformatory schools of Our Lady of Charity in Ireland, 1853-1973, p.147).

There were 10 Catholic Magdalen asylums manged by four religious congregations in Ireland including the Sisters of Mercy, the Religious Sisters of Charity, the Sisters of Our Lady of Charity and the Sisters of the Good Shephard. Most of these asylums were established by laywomen and/or a member of the Catholic clergy in the early nineteenth century such as the refuge Drumcondra, Dublin in 1829 (Ibid, p.93). The laywomen or a bishop often invited a religious order from France to assume the responsibility of the refuge. Frances Finnegan’s Perish or Penance: a study of Magdalen laundries in Ireland (p.35) argues that some of the refuges were reluctant to allow the women to re-enter society however, they were not required to stay for the rest of their lives. They hoped to inculcate religious values.

Most women who entered the refuge were in their twenties during the nineteenth century. In the Good Shepherd’s asylum in Cork, 51 percent were in their twenties on entry between 1872 and 1890 (Ibid, p.235). However, the McAleese Report (p.173) states that most girls entered the refuges at 17 or 18 years of age in the twentieth century. In 1922, the Irish Free State was established and the Catholic Church exerted a powerful influence over the Nation State, especially on issues related to morality and thus stigmatised those in society that did not adhere to social norms and values, especially unmarried mothers and their illegitimate children. Diarmaid Ferriter (Occasions of Sin: Sex and Society in Modern Ireland, p.17) maintains that there was a sexual double standard in Ireland as ‘little attention focused on the men who impregnated the unmarried women: there were no ‘fallen men’ in Ireland’. The majority of women left after less than one year in the asylum in the twentieth century (Inter-Departmental Committee to establish the facts of State involvement with the Magdalen laundries, p.168). However, during the nineteenth century, 62.7 percent of known cases remained in the refuges for more than ten years while others never left (Ibid, p.195).

In the nineteenth century, self-committal accounted for 10 percent of committals (Smith, Ireland’s Magdalan laundries, p.30). Women entered for a number of reasons including ‘alcohol addiction, misfortune, expulsion from home, seduction, violent abuse by a partner of relative, illness, mental or physical disability and entrapment into prostitution’ (Prunty, Our Lady of Charity, p.304). Importantly, many women re-entered asylums during the nineteenth century which indicates that Magdalan asylums may not have been regarded as a punitive institution but rather a sanctuary from danger and immorality. According to Luddy’s Prostitution and Society (p.97), 29 percent of women re-entered the Good Shepherd’s asylum in Belfast between 1851 and 1899. However, self-committals only accounted for 16.4 percent of entries in the twentieth century (Inter-Departmental Committee to establish the facts of State involvement with the Magdalen laundries, p.888).

Many women were referred to Magdalan asylums through a priest during the nineteenth century as 37.49 per cent of entries into the Sisters of Charity’s asylum in Donnybrook was through the priest (Luddy, Philanthropy, p.128). It was the third most common route of entry during the twentieth century at 8.8 per cent (Inter-Departmental Committee to establish the facts of State involvement with the Magdalen laundries, p.854). Moreover, nuns also had the authority to transfer women from Magdalan asylums from another which accounted for a significantly higher percentage of admissions after 1922 at 14.8 percent (Ibid, p.162).

During the nineteenth century, prostitutes entered the Magdalan asylums from Lock Hospitals. During the 1860s, the Contagious Diseases Acts permitted police officers to arrest women suspected of being a prostitute at army and naval bases in Britain. However, many were committed to Magdalan asylums after they were medically treated, for example, 18 prostitutes entered the Good Shepherd’s asylum in Waterford between 1842 and 1900 (Finnegan, Perish or Penance, p.107). The Legion of Mary also committed prostitutes into the asylums after 1919 (Inter-Departmental Committee to establish the facts of State involvement with the Magdalen laundries, p.232).

After 1922, Mother and Baby Homes were established in Ireland for first time unmarried mothers as Magdalan asylums did not accept pregnant women. After 1922, 3.9 percent of entries were from mother and baby homes (Ibid, p.437). Illegitimate birth rates were extremely high during the 1920s in Ireland and the church strongly disapproved of unmarried mothers and their illegitimate children. Moreover, there were 107 from ‘psychiatric hospitals and institutions for the intellectually disabled’ after 1922. The NSPCC and County Councils also referred women to Magdalan asylums in Ireland (Ibid, p.163, 479).

Significantly, society was complicit in the incarceration of ‘fallen women’ as more than 10 percent of admissions were through a family member or relative during the nineteenth and twentieth centuries (Ibid, p.194, 858). These women were placed in a Magdalan asylum due to promiscuity, poor health or a disability (Ibid, p.860). Importantly, the McAleese Report (xiv) highlights that after 1922, an increased percentage of girls (7.8 percent of admissions) were committed to the Magdalan refuges from reformatory and industrial schools. Reformatory schools were established during the second half of the nineteenth century and detained children convicted of minor offences while industrial schools were set up to organise provision for abandoned and neglected children. Some girls were refused entry into industrial and reformatory schools and they were placed in a Magdalen asylum including victims of sexual abuse as the nuns feared that they would exert a bad influence over the other children (Smith, Ireland’s Magdalan laundries, p.20).

Another route of entry into the Magdalen asylum was upon release prison or the criminal court. Prunty (Our Lady of Charity, p.146) argues that 46 women were transferred from Grangegorman Jail to High Park between 1859 and 1895. Women continued to be committed through the courts into the asylums after 1922 as 24.8 percent of state admissions into Magdalen asylums were from the court system (Inter-Departmental Committee to establish the facts of State involvement with the Magdalen laundries, p.165). Some received a suspended sentence and in other cases it was used as an alternative to jail (women convicted of infanticide were sent to Magdalan asylums) (Ibid, p.229). During the twentieth century, women were committed to Magdalan asylums on probation by their probation officer for a period between 6 months and 3 years and these committals accounted for 31.4 percent of state admissions (Ibid, p.165, 228). Additionally, girls on remand were sent to Magdalan refuges as the State did not want to place them with hardened adult criminals in jail (Smith, Ireland’s Magdalan Laundries, p.67). Under the 1960 Criminal Justice Act, the Lower Sean McDermott Street asylum accommodated girls on remand (Inter-Departmental Committee to establish the facts of State involvement with the Magdalen laundries, p.221). However, some Magdalen refuges accepted girls on remand before the 1960s including the Good Shepherd’s in Limerick (Ibid, p.226). Prunty (Our Lady of Charity, p.491) maintains that girls awaiting sentencing in the Magdalen refuge were there ‘from an overnight stay to seven days’.

Magdalan asylums were originally established to rehabilitate ‘fallen women’ including the unmarried mother and prostitute. However, after the establishment of the Irish Free State, The Church used these institutions to punish women that did not obey the Catholic Church’s moral doctrine such as promiscuous women and women deemed vulnerable to seduction. The number of self-committals remained high from the nineteenth to the twentieth century and the incarcerations by clergymen, nuns from reformatory and industrial schools and mother and baby homes reflected low levels of social tolerance towards those that society considered deviant. Moreover, the State increasingly relied upon these asylums to place young women on remand and women convicted of infanticide.

Bibliography

Report of the Inter-Departmental Committee to establish the facts of State involvement with the Magdalen laundries. Available at http://www.justice.ie/en/JELR/Pages/MagdalenRpt2013 (accessed 10May 2018).

Ferriter, Dairmaid, Occasions of Sin: Sex and Society in Modern Ireland, Profile Books, London, 2009.

Finnegan, Frances, Do Penance or Perish: a study of Magdalen Asylums in Ireland, Cosgrave Press, Kilkenny, 2001.

Luddy, Maria, Women ad Philanthropy in Nineteenth-Century Ireland, Cambridge University Press, Cambridge, 1995.

Luddy, Maria, Prostitution and Irish Society, 1800-1940, Cambridge University Press, Cambridge 2007.

Prunty, Jacinta, The monasteries, magdalen asylums and reformatory schools of Our Lady of Charity in Ireland, 1853-1973, The Columba Press, Dublin, 2017.

Smith, James M., Ireland’s Magdalen Laundries and the Nation’s Architecture of Containment, University of Notre Dame Press, Indiana, 2007.

The Growth of Maternal and Infant Welfare Services during the ‘Emergency’ in Ireland, 1932-1945

For today’s post, I will examine the expansion of maternity and child welfare services during the 1930s and how the ‘Emergency’ impacted maternity and infant welfare servcies in Ireland.

During the 1930s, maternal and infant health services and preventative health services significantly expanded in Ireland. Diphtheria immunisation schemes were introduced into county Boroughs with high death rates and in 1933, the Free Milk Scheme was introduced and powder milk became available to poor children under five years of age from the maternity and child welfare centres. In Dublin, milk supply was also available from the Infant Aid Association in Dublin (Lindsey Earner-Byrne, Mother and Child: Maternity and Child Welfare Services in Dublin, 1922-60). According to Earner-Byrne, milk supply became one of the key campaigns to improve maternal health and to enable mothers to breastfeed their children making them less vulnerable to disease. Low breastfeeding rates were viewed as one of the main factors in the high infant mortality rates. By 1936, 17,656 children in county boroughs, 10,353 children in urban districts except one and 29,771 children in other areas participated in the free milk scheme (Annual Report of the Department of Local Government and Public Health, 1930-31). Campaigns were also set up to improve the mother’s nutrition, for example, The Dublin Maternity and Child Welfare Clinics and St John Ambulance Brigade provided free meals to poor mothers and ran dental clinics for ‘expectant and nursing mothers’ (Annual Report of the Department of Local Government and Public Health, 1932-33).

During the 1930s, there were increased visits to the Maternity and Child Welfare Clinics, in Cork, Limerick and Waterford. Moreover, health visits in Waterford from 4,926 in 1933 to 6,656 in 1934 (Annual Report of the Department of Local Government and Public Health, 1934-35). Ante-natal services were available in the maternity hospitals in urban areas including Limerick, Dublin and Cork but not in rural areas. Moreover, the out-patient attendances were almost doubled from 1933 to 1938 with 60,375 mothers attending these clinics (Hospitals Commission Fourth General Report 1938). However, the new housing schemes introduced in 1936 meant that in Dublin the health visitor travel longer distance and had less time with expectant and nursing mother (Ibid).

Although the maternal mortality rate remained high in Ireland during the 1930s, sulphonamide drugs aimed to reduce the maternal mortality rates from 1937 (Earner-Byrne, Mother and Child). By 1939, 148 maternity and child welfare schemes were in operation throughout the country (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). 44,566 mothers and 86,308 children were visited by the health visitor employed by local authorities and 15,464 mothers and 32,285 children by district nursing organisations including Lady Dudley nurses (Ibid). Moreover, 56,129 mothers and 70,112 children attended the local authority clinics and 3,955 mothers and 4,893 children attended the district nurse clinics (Ibid).

The outbreak of the ‘Emergency’ in September 1939 interrupted maternal and infant health services in Ireland. Laws were passed to control the spread of infectious diseases and ensure that the maternal mortality rates continued to decline. In 1941, the notification of puerperal sepsis cases became compulsory under the Public Health (Infectious Diseases) regulations. The infant mortality rate also rose, increasing from 3,759 in 1940 to 4,175 in 1941(Annual Report of the Department of Local Government and Public Health, 1943-44). Dublin County Borough, Waterford County Borough and Cork County Borough had some of the highest infant mortality rates (Ibid). In 1941, the Public Health (Infectious Diseases) Regulations made the notification of infectious diseases including polio, measles, enteric fever, whooping cough, scarlet fever compulsory. TB and gastro-enteritis were rampant during the Emergency and in 1943, Public Health (Diseases) Regulations made cases of gastro-enteritis in children under two notifiable in certain areas including County Boroughs (DLGPH 1943-44). Significantly, the neonatal death rate was extremely high and in 1943, the neonatal mortality rate was 322 per 1,000 infant deaths and the causes included congenital debility and gastro-enteritis (Ibid).

During the Emergency, food shortages contributed to the lack of nourishment of infants and children (Ruth Barrington Health, Medicine & Politics in Ireland 1900-1970). According to Bryce Evans’s ‘Food, the Emergency, and the lower-class Irish body, c.1939-45’ in D. Durnin and I. Miller (eds.) Medicine, Health and Irish Experiences of Conflict, 1914-45, p.49, ‘the transport of….medicines was seriously compromised by Britain cutting off coal and petrol supplies’. Therefore, maternal and infant mortality rates increased during the ‘Emergency’ due to the spread of disease and lack of nutrition and medicine and vaccinations. The war made it difficult to import the BCG vaccine which led to a peak in TB deaths during this period (Margaret O’hOgartaigh, ‘Dr Dorothy Price and the elimination of childhood tuberculosis’ in J. Augustin (ed.) Ireland in the 1930s). According to Dr James Deeny, the Chief Medical Advisor to the government, memoir To Cure & to Care: Memoirs of a Chief Medical Officer, ‘between 1942 and 1945, 16,186 people died of the disease’.

Maternal and infant health services were under additional strain. In 1940, the Archbishop of Dublin, Charles McQuaid established the Catholic Social Service Conference which offered food, milk and clothing to mothers at the ante-natal clinics (Earner-Byrne, Mother and Child). However during the 1940s, breastfeeding was regarded as the best method to prevent infant deaths. Dr Collis, the head of sick infant department in the Rotunda, recommended that infants should be breastfed until they were three or four months old (Irish Nurse’s Magazine November 1940). However, many mothers did not breastfeed their children as they were malnourished and many suffered from anaemia (Earner-Byrne, Mother and Child). Due to the food shortages, mothers and children receiving milk under the Free Milk Scheme from the clinics increased. Importantly, the government provided a grant of £90,000 towards the scheme (DLGPH 1943-44). In 1943, 839, 291 gallons of milk was distributed (First Report of the Department of Health 1945-1949).

The Emergency interrupted the health visitation service and the school medical service. Barrington’s Health, Medicine & Politics maintains that fuel shortages ensured that public health nurses could not travel in a motor car to visit mothers and infants and carry out medical inspections in schools. Importantly, there was a significant increase in health visits undertaken by the district nurses. In 1941, 1,354,095 health visits were carried out to mothers and children (Annual Report of the Department of Local Government and Public Health, 1941-42). In 1943, a higher number of mothers and children were visited by nurses employed by local authorities and attended their Maternity and Child Welfare clinics (DLGPH 1943-1944,). Dublin county borough had highest number of attendance to clinics by 467,840 mothers and 51,375 children while in Limerick 3,072 mothers and 3,552 children visited the health clinics (Ibid). New clinics and specialist services also emerged, for example, children received orthopaedic treatment in various institutions such as the Sunshine Home and in general hospitals (Ibid).

The Free Milk Scheme, the expansion of maternity and child welfare centres and the introduction of TB and diphtheria immunisation schemes helped to improve infant health and aimed to reduce the infant mortality rate in Ireland. Moreover, the introduction of sulphonamide drugs and ante-natal services in maternity hospitals heralded a decrease in maternal mortality rates in Ireland. The ‘Emergency’ disrupted the importation of drugs, fuel and food into Ireland which contributed to an increase in maternal and infant death rates. However, the government made cases of infectious diseases notifiable and public health nurses carried out more health visits and there were increased attendances to their centres.

Bibliography

Annual Report of the Department of Local Government and Public Health, 1930-31, (Stationary Office, Dublin, 1931).

Annual Report of the Department of Local Government and Public Health, 1932-33, (Stationary Office, Dublin, 1933).

Annual Report of the Department of Local Government and Public Health, 1934-35, (Stationary Office, Dublin, 1935).

Annual Report of the Department of Local Government and Public Health, 1941-42, (Stationary Office, Dublin, 1942).

Annual Report of the Department of Local Government and Public Health, 1943-44, (Stationary Office, Dublin, 1944).

Barrington, Ruth, Health, Medicine & Politics in Ireland, 1900-1970, Institute of Public Administration, Dublin, 1987.

Deeny, James, To Cure & to Care: Memoirs of a Chief Medical Officer, The Glendale Press, Dublin, 1989.

Earner-Byrne, Lindsey, Mother and Child: Maternity and Child Welfare in Dublin, 1922-60, Manchester University Press, Manchester, 2007.

Evans, Bryce, ‘Food, the Emergency, and the lower-class Irish body, c.1939-45’ in D. Durnin and I. Miller (eds.) Medicine, Health and Irish Experiences of Conflict, 1914-45 (Manchester University Press, Manchester, 2017), pp.45-60.

First Report of the Department of Health 1945-1949 (Stationary Office, 1949).

Hospitals Commission Fourth General Report 1938 (Stationary Office, 1940).

Margaret O’hOgartaigh, ‘Dr Dorothy Price and the elimination of childhood tuberculosis’ in J. Augustin (ed.) Ireland in the 1930s (Four Courts Press, Dublin, 1999), p.76-7.

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).

The Irish Nurse’s Magazine, Vol. 11, No. 7 (November 1940). i

The School Medical Service in Ireland, 1904-1925

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.