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).

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.

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.