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.
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