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 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