Friday, 7 April 2017

Alcohol, Medicine and Irish Society, c.1890-1970 by Alice Mauger

Wellcome Trust Medical Humanities Fellowship


A Wellcome Trust Postdoctoral Fellowship has been awarded to Dr. Alice Mauger. Her three-year project on ‘Alcohol, Medicine and Irish Society, c.1890-1970’ is being hosted by the UCD Centre for the History of Medicine in Ireland (CHOMI). It is mentored by Dr. Lindsey Earner-Byrne, Deputy Head of the School of History, UCD and sponsored by Associate Professor Catherine Cox, Director of UCD CHOMI.


The project explores the evolution of medicine’s role in framing and treating alcoholism in Ireland. It assesses the period from the 1890s, when acceptance of inebriety as a disease led to the creation of the short-lived inebriate reformatories, to the 1970s, when dedicated rehabilitation facilities were formed in response to the rising number of psychiatric patients diagnosed with alcohol-related illnesses.

Until now, the history of medicine has offered little reflection on the relationship between medicine and alcoholism in Ireland. While the ubiquitous “drunken Irish” stereotype, still prevalent today, has been evaluated from several viewpoints, we have yet to discover how international and Irish medical communities interpreted, informed and absorbed this label. By investigating care in asylums and inebriate reformatories, along with medical debates and shifting government policies, the project questions how the exchange of medical, government and lay ideas came to shape understandings and experiences of alcoholism in Irish society.

Still image from the television show, 'Home Truths', featuring a segment
on alcoholism,  RTÉ, 7 December 1966. Image courtesy of the RTÉ Stills Department.

Context


Despite the popularity of temperance and pioneer movements in Ireland since the mid-nineteenth century and high levels of abstinence reported into the 1950s, the Irish have traditionally been viewed as being especially prone to alcoholism. Irish emigrants were persistently portrayed as heavy drinkers, while the emergent Irish nationalist movement sought to associate abstinence with patriotism – some prominent members even claiming that the British encouraged Irish drinking to demoralise the population. In these ways, alcoholism was inextricably linked to theories or fears of Irish degeneration.

This project questions the extent to which enduring stereotypes of the Irish as violent and drunken permeated contemporary medical conceptions of alcoholism, and whether this in turn influenced political and lay interpretations.


Internationally, several works have focussed on shifting medical concepts of addiction. This project situates Irish therapeutic and diagnostic trends alongside those in other western countries, including Britain, America and Australia. It also seeks to inform the extensive literature on the history of psychiatry, particularly degeneracy and ethnicity, and related discourses in Irish social history covering themes such as poverty, violence and the family.



Aims


The project aims to make a significant contribution to the medical humanities, exploring historical sources to better understand and contextualise Irish society’s relationship with alcohol. In doing so, it hopes to inform present-day social and cultural concerns.

Keys findings from the project will be presented in a monograph, journal article and a series of posts on the CHOMI blog, as well as papers given at relevant forums.

In 2019, Alice will organise an interdisciplinary workshop on ‘Alcohol, Medicine and Society’ at CHOMI, inviting policy makers and academics from Ireland and overseas. A call for papers for this event will feature on this blog.

Alice has also planned a one-month knowledge exchange to the Centre for History in Public Health in the London School of Hygiene and Tropical Medicine to engage with prominent experts on addiction history including Professor Virginia Berridge and Dr. Alex Mold.



Biography

Dr Alice Mauger

Dr Alice Mauger is a postdoctoral fellow at the UCD Centre for the History of Medicine in Ireland, University College Dublin. She was awarded a PhD by UCD in 2014 for her thesis which examined public, voluntary and private asylum care in nineteenth-century Ireland. Prior to this she completed the MA programme on the Social and Cultural History of Medicine at the UCD Centre for the History of Medicine in Ireland, UCD. Both her MA and PhD were funded by the Wellcome Trust. Dr Mauger has published on the history of psychiatry in Ireland and is currently finalising her first monograph: The Cost of Insanity in Nineteenth-Century Ireland: Public, Voluntary and Private Asylum Care.

Monday, 13 March 2017

A Forgotten Episode of International Health by Dora Vargha

In this month's blog post, Dr Dora Vargha, University of Exeter, uncovers the neglected role of the Socialist Bloc and Eastern Europe in the history international public health. Dora argues that rectifying this omission is essential to capture a complete picture of international and global public health in the crucial era following the postwar settlement. 

The Establishment of the World Health Organization


The establishment of the World Health Organization is no doubt a crucial and fundamental moment in the history of international (and global) public health. The leadership, ideas and early decades in the unfolding Cold War can be assembled through biographies of Director-Generals, the Organizations own chronicle of its first decades and through histories of malaria eradication. However, certain equally important aspects of the early years of the WHO, like the sudden exit of the Soviet Union and Eastern Europe shortly after the establishment of the organization merit little more than a mention in these histories.

The Socialist Bloc and the Missing History of the WHO


Andrija Stampar (1888-1958), born in Drenovac, Croatia,
was a key figure in the history of twentieth-century public
health and  a leading figure in the League of Nations Health
Organisation. Commemorative Stamp of Anrija Stampar,
 issued 1970, Yugoslavia (Public Domain).
This omission from the historiography is not entirely surprising. The Socialist Bloc, and Eastern Europe in general has been, until recently, missing from international health narratives on the whole, despite foundational Eastern European figures in its history such as Andrija Stampar, key member of the League of Nations Health Organization (LNHO) and president of the First World Health Assembly, and Ludwik Rajchman, director of the LNHO and founder of UNICEF. Often seen as a politically homogeneous area under complete Soviet control in the postwar era, Eastern European countries have not been considered to have agency in international health during the Cold War.

But the history of international and global health has a lot to gain by including the Socialist Bloc in the picture. This unexplored history points to questions whether international health always happens within organizational structures of international agencies and through philanthropic entities such as the Rockefeller Foundation; what the stakes were in this Cold War divide in the formative years of the WHO; and the extent to which we can talk about a unified response within the Socialist Bloc to diplomatic and public health challenges in their time outside of the organization.

Socialist Networks and International Public Health


Considering alternative international public health, in this case socialist networks, is crucial in getting a complete picture of postwar international public health and its effect on modern global health. The historiography of internationalism has been going under a rapid change by including alternative internationalisms and focusing on socialist exchange in ideas, practices and knowledge. Much of this new research has addressed issues of development, culture and education. Many have called attention to Eastern Europe’s role in transcontinental collaboration and have placed contributions to postcolonial projects in focus. With some notable exceptions, such as Young-Sun Hong’s work on East German development projects, or Ana Antic’s research on transcultural psychiatry in Yugoslavia, health has mostly escaped the attention of these new histories.

Through the lens of Hungary, the last country to re-join the WHO in 1963, my research aims to put Eastern Europe in the focus of international health inside and out of the World Health Organization. I seek to explore what happened to international health in Eastern Europe, outside of the purview of the usual suspects: international agencies and non-governmental organizations, like the Rockefeller Foundation, how complete was the break with liberal internationalism and what, if anything, took its place.

It was not long after Eastern European states successfully joined that the Soviet Union decided to leave the WHO. The Russians were not very eloquent in their reasoning, they cited the mammoth bureaucracy, high member fees and the political influence of the United States in the WHO. The exit of the Soviet Union, followed by the whole Socialist Bloc challenged the proclaimed universality of the newly formed WHO and the centrality of technical expertise in opposition to political allegiance. The quick deterioration of the East’s relationship with the organization seems to fit neatly into a narrative of the escalating Cold War and increase of the Soviet Union’s hold on Eastern Europe. However, when inspected in detail, the reasons for the exit of these countries was more complex and had to do as much with expectations of what an international health agency should do, as with foreign policy.

Grievances towards the WHO


Dr Josepf Plojhar, (right), Minister for Health, Czechoslovakia.
Also pictured, Tadeusz Michejda (left), Minister for Health, Poland;
Luitpold Steidle (right), Minister for Health, GDR.
Berlin, 14 September 1950. Bundesarchiv. Bild 183-T00826
   
The grievances towards the WHO had been many and from an Eastern European perspective, were mostly justified. The overpowering American influence undoubtedly played a large role in this. Certain issues, such as Americans barring access to vital drugs, such as penicillin in Poland and Czechoslovakia, became especially sore points for Eastern European politicians and physicians. In his memoir from 1978, Tibor Bakács, Hungarian virologist and representative to the second World Health Assembly in 1949 gave a dramatic account of the appeal of Josef Plojhar, Czechoslovak health minister and roman catholic priest.

Socialist countries did not have their own penicillin plants back then, they had to import the needed amount for hard currency from the West. The Czechs, in order to become independent, purchased a whole penicillin plant from the Americans before the political turn of February 1948, which according to the contract the US had to deliver in two installments. The first one arrived, but the second one, which was to be delivered after the political turn, was held back by the Americans. Father Plojhar, wearing priest’s attire, asked the delegation of the United States in front of the Assembly, why they had not honored the contract. The American delegate, putting aside all civility (and with the knowledge of the subservient voting machines behind its back) just briefly said: "Contract, no contract, you turned socialist, you get nothing!" The president of the assembly then put the Czechoslovak question to vote, and apart from the 5 yes votes of the socialist countries present, the issue was overruled by the majority. The vassals "voted well" - it was a real American decision. I wouldn’t have thought that professional issues, what’s more, questions of health can be distorted so under political duress.1  

While Plojhar’s speech does not appear in the minutes, the American delegate, Leonard A. Scheele Surgeon General referred to it and dismissed the claim by stating that the equipment in question is not necessary for the production.

Attributing Eastern European countries’ decision to leave solely to Cold War political alignments would be a mistake, however. Recent research on the years of communist takeover has shown that the relationship of the Soviet Union and Eastern European countries was a complex one and certain aspects of that relationship were very much open ended. We cannot readily assume a master plan from the Soviet side, with which Eastern European states quickly fell in line with. Moreover, while the overwhelming influence of the United States in the WHO and pressure from the Soviet Union no doubt playing an important part, countries like Hungary had other, substantial reasons for discontentment.

Second World Health Assembly


Second World Health Assembly, Rome,
13 June to 2 July 1949: Decisions and
resolutions: plenary meetings verbatim records:
committees minutes and reports: annexes.
Courtesy of WHO: IRIS
The Socialist Bloc did not immediately follow the Soviet Union in stepping out of the WHO. The minutes of the second World Health Assembly in 1949 give a glimpse of the short time when Eastern European countries took part in the WHO’s work without the presence of the Soviet Union in the organization. In their speeches, Eastern European delegates acknowledged the merits of the WHO and the overall significance of the organization.

However, there were problems: several Eastern European delegates criticised the WHO for its one size fits all approach. Apart from issues with access to penicillin, the Czechoslovak delegate called on the WHA to rethink the universality of certain public health issues and instead, consider health priorities on a national level. The Hungarian Health Minister, István Simonovits pointed to the fact that while Hungary considers fellowships to be crucial as a form of pursuing international public health, many of its fellows are regularly denied entry visas to WHO member states and are therefore unable to attend conferences they are invited to. Simonovits also considered visiting lecturers to be less useful for Hungarian public health: “Even the best lecturer was hardly more useful than a good article, because in many cases the lecturer had no knowledge of our special local problems.”

The criticism of several of the Eastern European delegates point to a different expectation of the tasks and responsibilities of international health organizations. In the late 1940s the countries in question were still in a horrid state, their hospitals bombed, medical equipment seized or destroyed, with extreme housing problems and crumbling infrastructure. In countries with extreme shortages of medication, physicians and buildings fit to house patients, and with no access to the Marshall Plan or other forms of aid, the policy of the WHO to give technical assistance instead of material aid seemed pointless, offensive even. As Plojhar, the Czechoslovak delegate put it: "It is more urgent for us to dispose of some public-health problems than to receive good advice."

The buildings of the Foreign Ministry and War Office in Budapest, 1949.
Photograph by Carl Lutz. Foto:Fortepan/Archiv Für
Zeitgeschichte Eth Zürich / Agnes Hirschi. Photo ID: 105808

Withdrawal from the WHO


The second World Health Assembly was the last one that Eastern European countries attended for almost a decade. Romania, Albania, Poland, Czechoslovakia and Hungary left the organization in 1950. Some of the delegates, like Plojhar warned of this possibility at the Second WHA in 1949. But perhaps the withdrawal was not a clear choice. Instead of issuing a warning, the Hungarian delegate used his speech to plead for the inclusion of socialist approaches to public health, and to remedy the situation that caused the Soviet Union to leave the organization.

The withdrawal of such a substantial number of countries from the WHO placed the question of membership into focus and pointed to broader questions of supranationality and state sovereignty. The WHO navigated its practice among two legal school of thoughts: one of which considers such an international organization to be supranational, making a unilateral withdrawal impossible once a member voluntarily joined, and another considering membership in the international organization to be dependent on its alignment with foreign policy. The United States favoured the latter interpretation, its Congress upholding the right to withdraw within a year of joining the WHO. The organization itself adopted a position of compromise between the two schools, introducing “inactive membership” for withdrawing states. This latter solution also helped save the international organization some embarrassment, when the Soviet Bloc exited the WHO.

Not only did the practice of international public health in Eastern Europe continue with the budding socialist internationalism within the Bloc, but countries like Hungary continued to participate through interaction and collaboration with the West. Being out of the WHO, divided by the Iron Curtain also did not mean that the region was isolated in terms of international health. If we shift our focus from viewing internationalism in public health from the perspective of international organizations and governments, and turn to the agents of internationalism themselves, we find that the sites of international collaboration in public health were as varied as the people acting as internationalists. Families and virologists, hospital directors and religious scholars were actively involved in shaping international collaboration in research, treatment and access to technology.

Decentering Narratives of Internationalism and Global Public Health


Geographically and conceptually de-centring narratives of internationalism and global public health, especially ones tied to the Cold War, is crucial for a nuanced understanding of this formative era. By bringing Eastern Europe into the focus and considering alternative internationalisms, new faces, practices and relationships become visible, which, in the end, can help us piece together a very messy and often confusing picture of international and global health in the 20th century.

Dora Vargha
Dr Dora Vargha


Dr Dora Vargha is a lecturer in the Medical Humanities at the University of Exeter. Previously, she has held research fellowship positions at the Max Planck Institute for the History of Science, Berlin and at Birkbeck, University of London. She is an acclaimed authority on the history of global health and biomedical research in the Cold War era with a particular focus on Eastern Europe. 

Dora's work has been widely published in leading peer-reviewed journals including Contemporary European History, and Bulletin of the History of Medicine. She has recently completed the manuscript for her forthcoming monograph Iron Curtain, Iron Lungs: Governing Polio in the Cold War which explores a series of polio epidemics in Hungary in the context of international Cold War politics. She has recently embarked upon a new research project, for which she received a Wellcome Trust Seed Award, titled, 'Socialist Medicine: An Alternative Global Health History'.

Dora is the recipient of many scholarly awards including the J Worth Estes Prize from the American Association for the History of Medicine and the Young Scholar Book Prize from the International Committee for the History of Technology. She is the founding editor of and a contributor to the Central and Eastern European History of Medicine Network Blog. Dora is also a collaborating member of the Reluctant Internationalist research group, a Wellcome-Trust funded project that is researching the history of public health and international organisations. 




1 Tibor Bakács, Egy Életrajz Ürügyén (Budapest: Kossuth Könyvkiadó, 1978).

Wednesday, 15 February 2017

Event: Mind-Reading 2017

MIND-READING 2017: MENTAL HEALTH AND THE WRITTEN WORD


Venue: Studio Theatre, dlr LexIcon
Date: 10 March 2017

Conference Organisers:
Dr. Elizabeth Barrett (UCD) and Dr. Melissa Dickson (Oxford).

Keynote Speakers:
Prof. James V. Lucey (TCD),
Prof. Fergus Shanahan (UCC) and
Prof. Sally Shuttleworth (Oxford).

Introduction

This one-day programme of talks and workshops seeks to explore productive interactions between literature and mental health both historically and in the present day. It aims to identify the roles that writing and narrative can play in medical education, patient and self-care, and/or professional development schemes.

Bringing together psychologists, psychiatrists, interdisciplinary professionals, GPs, service users, and historians of literature and medicine, we will be asking questions about literature as a point of therapeutic engagement. We will explore methods that can be used to increase the well-being and communication skills of healthcare providers, patients and family members.

Conference Coordinator:
Victoria Sewell (UCD)
child.psychiatry@ucd.ie

Book HERE with UCD 


Friday, 25 November 2016

Public Engagement Officer Posts

Two new Public Engagement Officer positions have been announced on the Wellcome Trust Senior Investigator Award Project, 'Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850–2000', led by Principal Investigators Dr Catherine Cox (UCD CHOMI) and Professor Hilary Marland (CHM, University of Warwick).

Role


The successful applicants will act as key intermediaries between the project and relevant partners in the arts and policy, play a lead role in promoting the project through various media outlets and in the planning, organisation and promotion events. They are seeking applicants with previous experience of working in public or policy engagement.


Public Engagement Officer, CHOMI, University College Dublin


This Public Engagement post will be based at the UCD Centre for the History of Medicine in Ireland, School of History, University College Dublin. This part-time position will last for 24 months commencing from shortly after 9 January 2017. 

Salary: €33,900 per annum pro-rata (40% pro-rata, i.e. €13,560 per annum part-time)

Those interested should contact Dr Catherine Cox prior to making an application.

Closing Date: 4 December 2016

Reference Number: 008854

For further details and to apply, please see: Public Engagement Officer, UCD

Public Engagement Officer, CHM, University of Warwick


This Public Engagement post will be based at the Centre for the History of Medicine, Department of History, University of Warwick. This part-time position will last for 24 months commencing from shortly after 9 January 2017.

Salary: £29,301 – £38,183 per annum pro-rata (0.4 FTE).

Closing Date: 1 December 2016

For further details and to apply, please see: Public Engagement Officer (78714-106)


Tuesday, 6 September 2016

Sharing of Medical Ideas and Information among Early Modern Practitioners by Benjamin Hazard

In this month's blog, Dr Benjamin Hazard (School of History, UCD), writes about a recent scholarly meeting which he co-convened at the Edward Worth Library (1733) in association with UCD Centre for the History of Medicine (CHOMI). The meeting was entitled: 'The Sharing of Medical Ideas and Information among Early Modern Practitioners'.

Early Modern Medicine


To raise awareness of early modern medicine and to develop networks for future research, the UCD Centre for the History of Medicine in Ireland (CHOMI) and the Edward Worth Library presented a conference on Tuesday 2 August entitled 'The Sharing of Medical Ideas and Information among Early Modern Practitioners'. Open to the public with free admission, the event was held at Dr Steevens’ Hospital, founded in 1733. As one of the organisers of the event, I had the pleasure of introducing the meeting and welcoming the large audience in attendance. I'd also like to take this opportunity to thank once again to the Trustees of the Worth Library, to Dr Elizabethanne Boran, the Librarian, and to Dr Catherine Cox, the Director of UCD CHOMI, for their support. Nicole Fleming of Brown University, Visiting Intern at the Edward Worth Library, assisted with proceedings on the day.

With the sharing of medical knowledge as the principal theme, the topics for discussion concentrated on the sixteenth, seventeenth and eighteenth centuries. Professor James Kelly MRIA of Dublin City University chaired the first sessions.

Viringus and Military Medicine

Dr Hazard explained that early modern physicians held themselves in high regard but Johannes Walterius Viringus, a professor of medicine in Leuven in the late sixteenth century, did not limit the propagation of medical knowledge to his fellow physicians. Dr Hazard described how Viringus wrote a manuscript of medical recipes for military chaplains in Spanish Flanders. This offered them the means for self-medication and illustrates the varied definition of the term practitioner. 

Dr Benjamin Hazard (speaker) with Professor James Kelly (chair)
at the meeting, 'The Sharing of Medical Ideas and Information
among Early Modern Practitioners'
(Dr Steevens' Hospital, 2 August 2016).

Medical Doctors and Classical Learning

Drawing attention to the composition of medical writings, Dr Jason Harris of the Centre for Neo-Latin Studies, University College Cork, explained that communicating in Latin was integral to the sense of identity among physicians. In his paper, Dr Harris examined the use of Latin in a book published by Johannes Walterius Viringus in 1597. Medical doctors were expected to demonstrate their grasp of Classical learning. Familiarity with Latin and Greek helped students recognise medical terms and also distinguished physicians from surgeons.

Book Merchants, Auctions, and the Medical Mind


Dr Elizabethanne Boran presented detailed findings from her investigation of book merchants' catalogues according to criteria such as medical specialities and languages. This shows how the purchase of books containing scientific information helped to shape the medical mind. Auctions reflected book sellers' efforts to anticipate changing tastes while catering for as broad a readership as possible.

Professor Ole Grell


Chaired by Dr Catherine Cox, the keynote lecture was given by the renowned historian of early-modern medicine, Professor Ole Peter Grell of the Open University and the Royal Historical Society. Professor Grell considered the part that Olaus Wormius (1588-1654) played in the Republic of Letters by corresponding with key thinkers in distant places. Wormius, a Danish physician, antiquarian and natural philosopher, is recognised as one of the last great polymaths. Widely-travelled, he completed his medical studies in Basel, Padua, Montpellier and Paris before being called to Copenhagen. An avid collector, he kept his own museum and applied the information gathered in his correspondence to improve medical methods.


Dr Benjamin Hazard,
School of History,
University College Dublin
Dr Benjamin Hazard


Dr Benjamin Hazard (School of History, UCD) was born in London in 1971. He specialises in early-modern history. Among other matters, his research and publications deal with medical humanities with a particular focus on military medicine, its interaction with civilian life, and methods of education. In 2009, Benjamin published his monograph Faith and Patronage: The Political Career of Flaithrí Ó Maolchonaire c.1560–1629.

Wednesday, 4 May 2016

Local Health Authority Day Nurseries by Angela Davis

Local health authority day nurseries in post-1945 England 


In this month's blog Dr Angela Davis (University of Warwick) considers the fate of local health authority day nurseries in England from 1945 to the 1970s. While the national trajectory during this period may have been one of decline, this trend masks considerable local variation with some authorities regarding the day nursery as an intrinsic part of the health service and others considering them, at best, marginal.


War Nurseries


Handing over the Women's Voluntary Service War Nursery,
Manor House, Wendover, Buckinghamshire, England, UK,
1941, © IWM (D 2424).
In a Ministry of Health Circular in 1945 the Minister of Health for England and Wales declared that the right policy to pursue would be to positively discourage mothers of young children under two from going out to work and to make provision for children between two and five by way of Nursery Schools and Nursery classes.

From the numerous and widely used local authority administered day nurseries, commonly known as ‘war nurseries’, which were open to all working mothers during World War Two (in 1944 there were around 1,450 full-time nurseries and 109 part-time nurseries), in the late 1970s the day nursery service had become a much more limited form of provision intended to prevent children being harmed by inadequate homes or parents and to avoid the last resort of resort of residential care, including children from difficult family backgrounds, one-parent households, and some handicapped children.

Local Variation


However these national trends figures mask the very real variation at the local level that took place. State-provided day nurseries remained the responsibility of Ministry of Health in the years after the war (responsibility was finally transferred to the Social Services Departments in 1971), and administered through the local health authorities. The local health authority day nurseries were under the ultimate control of the medical officer of health for the area and these medical Officers of Health had very different attitudes about the importance of the provision of day nurseries. While some thought the service was an intrinsic part of the health and welfare provision in their area others were keen to cease providing the service altogether. Throughout the period the provision offered by London Local Authorities was higher than anywhere else in the country. In contrast, the provision offered in rural areas was the most limited. In order to consider these local differences more fully, will look at three case studies – Coventry, Camden (London) and Oxfordshire.

London Borough of Camden


The London Borough of Camden was created in 1965 from the former area of the metropolitan boroughs of Hampstead, Holborn, and St Pancras, which had formed part of the County of London. In 1948 there were 23 day nurseries in the health division area 2, which most closely resembled the later borough of Camden. These nurseries had places for 1,398 children. The divisional health officer explained that many of the wartime nurseries that had been requisitioned for the duration of the war had since been returned to their original uses. As a result, the number of children on the waiting list, which numbered 3,121, far exceeded the number of places available and therefore a scheme of priorities for admissions to day nurseries has been drawn up to take into account of economic and health factors. The cost to parents at this time was negligible. A standard charge of 1s. a day was made for each child placed which covered the cost of the midday meal. However, even the following year, the tone of the reports was changing with the London County Council Medical Officer now stressing that the high cost of maintaining a child in a day nursery caused concern, and attempts were being made to effect economies. Instructions were issued as to economical ordering of supplies and preparation of meals. By 1951 it had become policy that the total day nursery provision should be kept at its existing level, although notably no expansion was planned. Moreover attendances at the nurseries were to be continually under review and closures and amalgamations were to take place when possible. The ratio of staff to children reduced. Nurseries were now to be closed on Saturdays and the priorities for admission were tightened.

Policy Reversal


Annual Report of the Medical Officer of Health
and Principal School Medical Officer for the
year 1965 by Wilfrid G. Harding (1966). Wellcome
Library, London's Pulse: Medical Officer of Health
Reports 1848-1972.
Interestingly, in 1953 there seemed to be a reversal in policy. The priorities for admission were softened. A third group was introduced, namely the children of working mothers whereby the parents income exceeded 9 pounds a week. Why did this occur? It seems clear that the council were concerned about falling attendances that had resulted from a central government order increase the charges for day nurseries with the charges for children at the nurseries was raised to a minimum of 4s. a day. As demand grew in the years that followed, however, the number of children admitted from priority group 3 was again reduced. Other groups were also seen as more needy, particularly those from ethnic minority backgrounds, but also children with disabilities. However there was no growth in the number of day nurseries to match the increased demand. In 1965, the report of the new Camden health authority, reported that the council had ten nurseries providing 541 places for children under five. This compared to the 23 nurseries with places for 1,398 that had existed in 1948.



Cutting Costs


So what do these reports from Camden reveal? Firstly, they indicate that provision declined rapidly after World War Two, but mainly from a desire to cut costs. Nowhere is it mentioned that the policy of the council was that the place of young children was to be with their mothers. The priorities for admission reflected this overriding economic concern. Priorities were tightened when the nurseries were over-subscribed and reduced when attendances fell. The authority seemed to be guided above all by a desire for the day nurseries to be cost effective and seemed to view them a worrying expense rather than an essential part of their service.

Coventry


Portrait of Sir A. Massey.
Wellcome Library, London.
But not all authorities viewed day nurseries in the same way. In his Annual Report from 1944 Arthur Massey, the Coventry Medical Officer of Health stated that, ‘There is no doubt that there is a useful place in the peace-time maternity and child welfare scheme for day nurseries, for they offer valuable medical, nursing and educational care to the children in attendance. Moreover they could provide for the occasional care of children of mothers needing respite from the continual round of domestic work’ (p. 7).

It is clear from the outset that Coventry envisaged a wider for their day nurseries than the belief of central government that they should only be for children in ‘special need’. In consequence every effort was made to keep the nine day nurseries that had existed during the war in operation in the years that followed.

Reducing Charges


Coventry health authority also reacted in a very different way to London in response to Ministry of Health Circular No. 23/52 which increased the daily charges of the nurseries. Like London, Coventry quickly saw a fall in numbers, but unlike London, who responded by opening up the nurseries to non-priority groups, Coventry responded by reducing the charges. Moreover, rather than aiming to simply maintain provision at the level of the early 1950s as London did, Coventry wanted to increase day nursery provision. They were certainly not seeking to reduce their number of nurseries. Indeed the poor state of the current nurseries, the need to build new nurseries, and the increasing demand upon places was a constant refrain in the annual reports. By the mid-1960s, the medical officer reported that they could no longer offer places even to those deemed of high priority. Moreover in his report from 1969 the then Medical Officer of Health Thomas Clayton clearly indicated that he would like to reduce the stringency of the priorities imposed, stating: ‘The slowly declining birth rate has as yet had little effect on the under 5 population and the static day nursery provision is gradually becoming more inadequate. (p. 38). Moreover, unlike in Camden, the Medical Officer could report in 1970 that the number of day nurseries in Coventry had remained at the same level as at the end of the war. In 1948 there were 9 nurseries with 88,650 attendances. In 1970 there were still nine nurseries with 89,437 attendances.

An Essential Part of Health Authority Provision


So from the Coventry experience we can see that some local health authorities took a far more active approach to the provision of day nursery provision than my other case studies. The Coventry Medical Officer of Health saw day nurseries as an essential part of health authority provision in the area. Rather than seeking to reduce the service or being concerned about the cost of providing day nurseries, he was constantly wanting to expand the number of nurseries and places he could offer, and indeed make them available to children without ‘special needs’. Moreover, he was clearly frustrated with the lack of encouragement he received in this ambition from central government.

Oxfordshire


A Nursery School: Watlington Park Children
in Wartime - Five Lithographs by Ethel Gabain.
© IWM (Art.IWM ART LD 263).
The provision of day nurseries in Oxfordshire was considerably lower than in either Camden or Coventry. From the seven war nurseries that had been open throughout the county in 1945, only 2 remained in 1948, accommodating about 80 children.

The Medical Officer noted that they were ‘primarily intended for mothers who are forced by economic circumstances to go out to work. By 1951, there was only one day nursery provided by the county, in Banbury, accommodating 40 children. In 1960 the Medical Officer of Health was questioning the nursery’s continued existence. While the nursery did stay open, it was clearly not viewed as an essential service.

Better off at Home with Mother


The reason for this ambivalence may be in the Oxfordshire local health authority’s attitude towards the institutional care of children. They clearly felt that young children were better off with their mothers and in his 1966 report stated: ‘attendances under the age of two and a half are discouraged’ (pp. 18-19). However, the annual reports also documented the growing demand for day nursery care in Oxfordshire, which the Medical Officer of Health attributed to the increasing urbanisation of Oxfordshire. However, even in 1970, there remained only one nursery in the County. So it is clear that day nursery provision was considered as being rather marginal to the Oxfordshire local health authority. They were unsure about whether they should provide such a service and indeed whether young children should be in day nurseries at all.

Variable Provision


The provision local health authority day nurseries in postwar England was highly variable. It depended on the different material conditions and make-up of the populations in different areas, but also upon on local policies and personalities. For example the Medical Officer in Coventry championed day nurseries in a way that was not seen in Camden and which may account for the continued level of nursery places throughout the decades after the wars.

Angela Davis

Dr Angela Davis, Centre for the
History of Medicine, School of
History, University of Warwick.

Angela Davis is a Senior Research Fellow (Wellcome University Award) in the Department of History at the University of Warwick. Her research interests concern parenthood and childcare in Britain and Israel and the use oral history. Her book Pre-school Childcare, 1939-2010: Theory Practice and Experience was published with Manchester University Press in 2015.

You can listen to a podcast below of a talk by Angela, 'Developing Bodies and Minds: Children's Experiences of Preschool Childcare, Britain c.1939-1979',  given as part of the CHOMI Seminar Series, 29 January 2015.



Monday, 11 April 2016

The Cost of Insanity by Alice Mauger

The Cost of Insanity: Public, Voluntary and Private Asylum Care in Nineteenth-Century Ireland

How did Irish medical practitioners and lay people interpret and define mental illness? What behaviours were considered so out of the ordinary that they warranted locking up, in some cases never to return to society? Did exhibiting behaviour that threatened land and property interests, the financial success of the family or even just that which caused embarrassment eclipse familial devotion and render some individuals 'unmanageable'? These questions are addressed in this month's post by Dr Alice Mauger. In 2014, Alice successfully completed her doctoral thesis at the UCD Centre for the History of Medicine in Ireland on domestic and institutional provision for the non-pauper insane in Ireland during the nineteenth century.

The Evolution of Asylum Care


Paying patients in the Richmond District Asylum (1885-1900).
Pictures courtesy of the Grangegorman Community Museum
The nineteenth century saw the evolution of asylum care in Ireland. While Jonathan Swift famously left most of his fortune to found Ireland's first lunatic asylum in 1746, it would be 70 years before the government followed his lead. In 1817 it enacted legislation permitting districts throughout Ireland to form asylums and by 1900, twenty-two such hospitals accommodated almost 16,000 patients. Growing demand for care for other social groups prompted the decision, in 1870, to admit some fee-paying patients, charged between £6 and £24 per annum, depending on their means. Out of this 16,000 only around 3% actually paid for their care. Private asylums, meanwhile, charged extremely high fees that were out of reach for the majority of society (usually several hundred pounds per year) and by 1900, thirteen private asylums housed 300 patients. Occupying a sort of middle ground, voluntary asylums, established by philanthropists, offered less expensive accommodation to those who could not afford high private asylum fees (from around £24 to a few hundred pounds). By 1900, these four voluntary asylum had outstripped the thirteen private ones, providing for 400 patients.

The Road to Committal


Advertisement for Farnham House, Private Asylum and
Hospital for the Insane, Finglas Dublin.
Source: Medical Directory (London, 1899), p. 1616.
Families were usually responsible for determining when it was time to commit a patient, where to send them and how much they should pay for their care. Factors such as cost, spending power, standard of accommodation, a hospital's religious ethos and the sort of people confined there all coloured these decisions. Broadly speaking, certain social groups (of the same religion) chose certain asylums.

Once admitted, patients were assessed by the medical authorities who determined a cause for their illness along with a diagnosis. This process was based on the medical certificate obtained prior to committal; evidence supplied by the patient and family; and the medical practitioner's own views. The two primary nineteenth-century diagnoses – mania and melancholia – reveal relatively little about reasons for committal. The causes named, however, were far more colourful and wide-ranging and expose much about contemporary perceptions of the life events or circumstances that led to mental illness and therefore committal. Given causes encompassed a range of 'psychological' factors such as grief, bereavement, business or money anxieties and religion, and physical influences including accidents and injuries, physical illnesses, hereditary and alcohol. These later two were the most frequently employed, demonstrating widespread medical understandings of the physical nature of insanity. However, many patients, families and increasingly asylum doctors, reported that fears about financial stability, land interests and the state of the economy had caused the illness.1 In reality, it was often these anxieties that resulted in committal, especially among those with a degree of resources, such as white-collar workers, shopkeepers and farmers.

The Case of John D


Entries in Casebook 2, c.1898.
Source: St John of God's Hospital,
Patient Records.
Land and property interests certainly featured in the case of John D. In 1891, at the age of 77, John was committed to the Enniscorthy lunatic asylum by this two sons. John's sons provided details of his personal history to the asylum authorities; details which were later transcribed by the asylum's Resident Medical Superintendent, Dr Thomas Drapes, into his case notes. Reportedly a 'healthy old man', the first symptom noticed by John's sons was that he wanted to marry his servant, a girl of twenty:

Says if he doesn't marry her his soul is lost and that he'll burn in hell ... he is very supple and has often tried to take away across the country to get to this girl ... Son says he won't allow bedclothes to be changed or bed made since the girl left, as he says no one can make it but her.2
While John was a patient in the asylum, this girl visited him disguised as his niece. Following this, John's sons told Drapes to prevent any further communication between the pair. They were very much against the proposed marriage, insisting that 'she and her family are a designing lot' and 'all encourage her to get him to marry her'. One son informed Drapes that in his opinion his father would have married '"anything in petticoats" for past two years or so'. Allegedly, the girls he proposed to were 'not at all suitable, and "strealish" in appearance and habits'.

Underlying this narrative were anxieties about John's property. A farmer and a shopkeeper, John was certainly not a pauper. His maintenance in the asylum was £18 per annum and while he was in the asylum, John presented Drapes with a further £16 'to keep for him'. The sons made clear their anxieties about the family business. On one visit they stated that lately, their father 'was not capable of properly doing business in his shop'.

The real motivation for committing John, however, became clear when the patient later informed Drapes that 'he gave his sons up his land, but wished to retain his shop for himself and get a wife to mind it for him'. John also gave what Drapes termed a 'rational explanation' for his romance with the servant girl, explaining that:

the girl had been so spoken of in connection with him that her character had suffered, and that if he did not make her the only reparation he could by marrying her, he would suffer in the next world.3

Just two months after his committal Drapes discharged John. In his notes he wrote that this was 'greatly against the wishes of his sons, but I have not been able to find any distinct evidence of his insanity'.4 By 1901, John, now aged 87, had married a woman of 27, possibly the servant girl. However, ten years later, it was his son who resided at this address with his own wife and six children suggesting that he had ultimately inherited the property.5 The most plausible explanation for this outcome was that John's young wife had not borne him any children, which would have prevented her from being entitled to property rights following his death.

Conclusions


The case of John D adheres comfortably both to contemporary public hysteria over the perceived vulnerability of private patients to wrongful confinement and commonly held representations of the rural Irish.6 Although some historians have emphasised the detrimental impact of issues such as the consolidation of landholdings, emigration, land hunger and Famine memories on emotional familial bonds, historians of psychiatry have identified the 'range of familial emotional contexts' which asylum patients came from.7 Families often sent letters querying treatment, offering advice and enclosing food and money for patients.8

Yet, in cases where property or business interests were at stake, these factors tended to eclipse those of familial devotion. In fact, the high numbers of fee-paying patients who were unable to control their business or function in their profession suggests this was a major reason for committal. While the extent to which John D actually struggled in his shop is difficult to ascertain, it is conceivable that a number of other relatives' claims regarding patients' incapacity to work were genuine.

The association between working life and mental illness speaks volumes about contemporary society's interpretation of insanity and what drove families to commit relatives to asylums. In relation to social status, those unable to maintain their position within their given occupation were defined in terms of this failure. Land disputes and an inability to manage one's affairs threatened to shatter emotional familial bonds. In these cases, families may have viewed committal as a last resort in order to protect their resources or livelihood. After all, in smaller rural towns, relatives would have little control over the actions or interactions of a mentally-ill person positioned behind the shop-counter or at a farmers' market.

Dr Alice Mauger


Dr Alice Mauger was awarded a PhD by University College Dublin in 2014 for her thesis which examined institutions for the non-pauper insane in nineteenth-century Ireland. Prior to this she completed the MA programme on the Social and Cultural History of Medicine at the UCD Centre for the History of Medicine in Ireland, UCD. Both her MA and PhD were funded by the Wellcome Trust. Dr Mauger has published on the history of psychiatry in Ireland and is currently writing a monograph stemming from her doctoral research.
Below you can listen to Alice's talk, entitled 'The Cost of Insanity', given on 4 February 2016 as part of the UCD Centre for the History of Medicine in Ireland Seminar Series.



1 Fears of poverty and unemployment among pauper asylum patients are discussed by: Akihito Suzuki, 'Lunacy and labouring men: narratives of male vulnerability in mid-Victorian London' in Roberta Bivins and John V. Pickstone (eds), Medicine, Madness and Social History: Essays in Honour of Roy Porter (Basingstoke, 2007), p. 118; and, Catherine Cox, Negotiating Insanity in the Southeast of Ireland, 1820-1900 (Manchester, 2012), pp 59, 121.
2 Clinical Record Volume No. 3 (Wexford County Council, St Senan's Hospital, Enniscorthy, p. 264)
3 Ibid.
4 Ibid.
5 Census of Ireland 1901.
6 David Fitzpatrick, 'Marriage in post-Famine Ireland', in Art Cosgrave (ed.), Marriage in Ireland (Dublin, 1985), pp 116-31; Timothy Guinnane, The Vanishing Irish: Households, Migration, and the Rural Economy in Ireland, 1850-1914 (Princeton, 1997).
7 Cox, Negotiating Insanity, pp 108-9; Guinnane, The Vanishing Irish, pp 142-43, 230-35.
8 Oonagh Walsh, 'Lunatic and criminal alliances in nineteenth-century Ireland' in Peter Bartlett and David Wright (eds), Outside the Walls of the Asylum: The History of Care in the Community 1750-2000 (London and New Brunswick, 2001), p. 145.