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

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

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.

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 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.