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.