disease – HealthHistoryIreland

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.

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.

Tag: disease

Childhood Immunization Schemes in Ireland, 1922-50

The School Medical Service in Ireland, 1904-1925