My First Experience of Presenting at a Conference: The Irish History Student’s Association 69th Annual Conference

For today’s post, I will discuss my experience of presenting a paper at a conference for the first time at the Irish History Student’s Association Annual Conference at Mary Immaculate College, Limerick.

During the 1950s, the IHSA conference was established in the 1950s by representatives from Irish universities. I was delighted when my abstract on ‘Public health nurses and the expansion of maternal and infant provision, 1922-1960’ was accepted by the organisers of the IHSA. They consistently sent out emails regarding the programme, direction to the campus and other important information leading up to the conference. The conference was held on the 1^st – 3^rd March 2019 at Mary Immaculate College, Limerick. I was chosen to present on the 14^th panel on ‘20^th Century health and body histories’ at 3:30pm on 2^nd March alongside two other speakers.

I felt enthusiastic and a tad nervous to present a paper for the first time at a history conference. My only experience with public speaking had included classroom presentations in front of fellow students and friends as well as a year’s experience of debating during my time at secondary school. However, I constantly reminded myself that I was overly familiar with my research and that I had rehearsed my presentation at least five times at home. I was also looking forward to meeting other researchers with similar interests in maternal and child welfare in Ireland. I was especially excited to meet the chair of my panel, Dr Sarah-Anne Buckley, whom had undertaken research on the NSPCC and child welfare in the Irish Free State during the twentieth century.

However, due to the fact that I was travelling from Cork to Limerick I was unable to attend the Keynote address by Professor Jane Ohlmeyer (UCD) on Friday, 1^st March. The organisers of the conference were very welcoming and kind as were all the other speakers I met on the day. They offered me advice on public speaking and gave me directions to the room I was presenting in. I felt relaxed and at ease while I presented my paper and was asked numerous questions at the end of my panel. I also had the opportunity to meet Dr Sarah-Anne Buckley whom was very friendly and interested in all the speakers’ papers.

Overall, it was an incredibly positive experience as I made new friends and researchers with similar interests to myself. The IHSA’s conference offers a great opportunity in a supportive and friendly environment for anyone interested in presenting for the first time. ffffff

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

Health Visitation and Maternity and Child Welfare Centres: the Expansion of Maternal and Infant Provision, 1915-1930

In 1900, maternal mortality rates were high in Ireland due to numerous factors. The only provision available to mothers was through the dispensary midwife from the local dispensary and voluntary nursing associations such as Lady Dudley’s nurses. Moreover, most women did not give birth in hospital and relied on a handywoman, an untrained midwife, to assist with childbirth. This practise often resulted in the spread of infection to the new mother. According to the 37th Annual Report of the Registrar General, 6.4 per 1,000 women died in birth from puerperal fever or other diseases linked to parturition in 1900.

At the start of the twentieth century infant mortality rates were extremely high due to the spread of infectious diseases such as diphtheria, pneumonia, gastro-enteritis and tuberculosis. In 1900, the Registrar General’s report stated that 38 per 1,000 children under five years of age died. According to Joe Robin’s Nursing and Midwifery in Ireland in the twentieth century: fifty years of an Bord Altranais (the Nursing Board) 1950-2000, the high infant mortality rate was influenced by various socio-economic factors including a lack of nutrition and an unclean living environment. Poor mothers were not educated on sanitation, nutrition, breastfeeding and infant illnesses. However, independent initiatives were established by middle class women such as the Women’s National Health Association in 1907 to reduce the high infant and maternal mortality rates in Ireland and to educate mothers on breastfeeding and cleanliness.

In 1907, the Notification of Births Act was passed, however, it did not make the notification of births compulsory. Under the 1915 Notification of Births (Extension) Act, health visitation was introduced for new and nursing mothers and children under the age of five. The Local Government Board was made responsible for the establishment of Maternity and child welfare centres and for the distribution of food to mothers and young children. However, the act only applied to urban areas.

In 1918, the Maternity and Child Welfare Act was passed, requiring local authorities to ensure provision for nursing and expectant mothers and children under five including health visitation, maternity and child welfare centres and free food and milk to poor mothers and young children. Nurses from voluntary nursing associations were mainly employed by local health authorities to undertake the health visitation service. It sought to educate mothers on nutrition and breastfeeding, thus helping to eradicate the ignorance of mothers about childbirth and babies. Significantly, in 1918, the Central Midwives Board was set up and a register of trained midwives was introduced to ensure that the practise of handywoman was discontinued. A register for general nurses was also introduced under the 1919 Nurses Registration Act.

During the 1920s, health services such as hospitals were co-ordinated. In 1923, a County Medical Officer was appointed to manage county health schemes including maternal and infant health services. Health visitors were appointed to work in the maternity and child welfare centres in county boroughs with high infant mortality rates including Dublin and Cork. They educated the expectant or nursing mother on childbirth and dangers of handywomen. The DLGPH’s Report 1922-1925 stated that ‘the ultimately the remedy lies in the gradual enlightenment of expectant mothers with regard to risks involved’. The Irish Nurse’s Union Gazette advised that the public health nurse to teach mothers through physical instruction rather than an explanation, for example, ‘by boiling the water we are going to use we can demonstrate the principle of sterilisation’. However, health visitation continued to be the only provision available to women in rural areas.

The high infant mortality rates encouraged the growth of the schemes in other counties and county boroughs. According to Report of the Commission on the Relief of the Sick and Destitute Poor Including the Insane Poor appointed 19^th March 1925, by 1925, there were 93 Maternity and Child Welfare schemes in operation throughout the country. The maternity and child welfare centres were funded by the Irish government. They funded half the costs of the voluntary nurses working under the Maternity and Child welfare schemes while the remainder was paid by local rates. It was mainly voluntary nurses that operated the maternity and child welfare schemes. Ruth Barrington’s Health, Medicine & Politics in Ireland, 1900-1970 maintained that in 1927, the first child welfare centre was set up in Lord Edward Street, Dublin, providing health education to mothers and public health nurses could refer patients for specialist treatment. Specialist treatment included treatment for medical conditions including rickets.

By 1930, the notification of births began in urban districts in countiessuch as Donegal. The voluntary nurses managed more maternity and child welfarecentres than district nurses employed by local authorities. According to the DLGPH’s Report 1930-31, health visits were carried out to 18,379 mothers and 33,930 children and 37,914 mothers in their homes. The Maternity and Child Welfare Schemes also provided free milk to poor mothers and infants. The DLGPH’s report 1930-1931stated that a Maternity and Child Welfare Centre opened at Tukey Street, Cork in 1931. Lindsey Earner-Byrne’s Mother and Child: Maternity and Child Welfare in Dublin, 1922-60 argues that Maternity and Child Welfare Schemes in urban areas including Dublin, Limerick and Cork were co-ordinated with the maternity hospitals, facilitating the development of ante-natal services.

Significantly, the 1915 Notification of Births (Extension) Act was the first attempt by the British government to establish provision for mothers and infants in Ireland. Importantly, the Nurses Registration Act 1919 and the Midwives (Ireland) Act 1918 marked the beginning of the decline of untrained handywomen and nurses. Maternal and infant provision was reinforced by the County Medical Officer whom oversaw their gradual introduction into county boroughs. By 1930,numerous maternity and child welfare centres were established and the number of health visits undertaken by nurses increased. They offered an ante-natal service to expectant mothers and the provision of food and milk for poor mothers and children under 5 helped to reduce medical conditions linked to malnourishment.