The Cork Street Fever Hospital Archive by Fergus Brady

In 2013, the Cork Street Fever Hospital archive was donated to the Royal College of Physicians of Ireland (RCPI). Following a recent funding award, the archivists at the RCPI began the process of cataloguing and preserving these extensive and important medical records. The project is now complete and the final collection list is available to browse through the online RCPI catalogue. In this month's post, Fergus Brady, Archivist, RCPI, reports on the archive and outlines the history of this fascinating Irish medical institution.

Nurses and patients on the 'lower landing', Cork Street Fever Hospital, 1903
(RCPI Archival Collections: CSFH/1/2/1/6)

RCPI win Wellcome Trust funding to catalogue Cork Fever Hospital Archive

A project, funded by the Wellcome Trust, to fully catalogue the archive of Cork Street Fever Hospital has been completed by the staff of the Royal College Physicians of Ireland Heritage Centre. As part of the project, appropriate measures were also taken to ensure the long-term preservation of the archive so that the hospital’s records will be accessible to researchers both in the present and into the future.

The origins of the House of Recovery and Fever Hospital, Cork Street, Dublin

Minutes, Governors of Cork Street Fever Hospital, 1801
(RCPI Archival Collections: CSFH/1/1/1)

The House of Recovery and Fever Hospital on Cork Street, Dublin, grew out of a series of meetings held between a group of wealthy and philanthropic men drawn from Anglican and Quaker congregations during October 1801. In the late eighteenth and early nineteenth centuries in Dublin, as elsewhere in Europe, insanitary conditions ensured that infectious diseases were prevalent among the general population. Those present at the October meetings had a clear idea of the nature and scale of such health issues, stating that ‘...no adequate Hospital accommodation has hitherto been provided for the relief of the Sick poor of Dublin afflicted with fever (especially such as may be of a contagious Nature)’. Influenced by the fever hospital movement in Britain, the provisional Committee believed that the solution lay in the ‘establishment of a House of Recovery to which patients on the first appearance of Fever might be removed’.¹

The fever hospital opens

Original entrance to the hospital, erected 1804
(RCPI Archival Collections: CSFH/7/1/6)

Less than three years later, on 14 May 1804, the newly-erected House of Recovery and Fever Hospital on Cork Street admitted its first batch of patients. As its name suggests, the hospital physically separated the sick from the convalescent by the constructing two buildings 116 feet apart in what was an early attempt at infection control.² The erection of such purpose-built buildings was intentional, as the hospital’s founders were influenced by prevailing theories regarding the control of infectious diseases.

Early years and fever epidemics

Cork Street Fever Hospital and House of Recovery, 1899
(RCPI Archival Collections: CSFH/1/2/1/5)

In the early decades of the hospital’s existence its catchment area expanded from the Dublin Liberties to the whole of the city. Hospital buildings were extended to meet the admissions triggered by the regular epidemics which ravaged the poorest districts in the city. A fever epidemic in 1817—1819 put severe pressure on the hospital, with admissions doubling in 1818. In 1826 an epidemic of typhus necessitated the erection of emergency tents. The 1830s and 1840s were periods of exceptional activity, as the number of patients admitted swelled due to outbreaks of cholera and typhus. In 1847 tents were erected and 400 emergency beds provided to allow for the admission of patients suffering from a typhus outbreak, which had been stimulated in large part by the influx into Dublin of thousands of famine-stricken refugees from the countryside. These regular epidemics took their toll on the health of the medical staff, and in particular the nursing staff, many of whom were struck down with fevers contracted during the course of their work.

The 'Red House'

Nurse and two children on the balcony of the Red House, 1909
(RCPI Archival Collections: CSFH1/2/1/6)

In the 1860s and 1870s epidemics of smallpox placed great pressure on the hospital’s resources, with a record case fatality rate of 21 per cent recorded in 1878. In the last few decades of the century measles, typhoid, scarlet fever and smallpox predominated, prompting the hospital governors to build the ‘Red House’ on the grounds of Cork Street, and to open an auxiliary hospital for convalescents at Beneavin, Finglas. In 1891, hospital reports recorded diphtheria for the first time, a disease which became a significant health problem in the early twentieth century with the arrival in Dublin of the virulent gravis strain.

The move to Cherry Orchard

Patient arriving at hospital in ambulance, 1896
(RCPI Archival Collections: CSFH/1/2/1/5)

In the early twentieth century there were two changes that significantly altered the running of the hospital: in 1904, the hospital was granted a Royal Charter under which Dr. John Marshall Day was designated first Medical Superintendent; and, in 1936, the Dublin Fever Hospital Act changed the hospital from voluntary to municipal control. This alteration sought to “make provision for the establishment of a new fever hospital in or near the city of Dublin and for the closing of the House of Recovery and Fever Hospital, Cork Street, Dublin”.³ Planning for the development of a new hospital was long and protracted, however, with both the Second Word War and a 1944 sworn inquiry into alleged maladministration in the hospital contributing to delays. Led by the efforts of Dr. Day’s successor as Medical Superintendent, Dr. C. J. McSweeney, a 74-acre site was finally secured at Blackditch, Palmerstown, Co. Dublin, and building tenders received in early 1950. The hospital board decided that as the name Blackditch evoked images of plague and death, the address of the new hospital should be changed to Cherry Orchard. In November 1953, patients and staff vacated the premises at Cork Street and moved to the new House of Recovery and Dublin Fever Hospital, Cherry Orchard.

The Cork Street Fever Hospital archive

Staff of Cork Street Fever Hospital, 1938
Dr. C. J. McSweeney, Medical Superintendent, is
pictured sixth from the right in the second row
(RCPI Archival Collections: CSFH/1/3/4/1) 

The archive of Cork Street Fever Hospital is large and varied, and consists of a series of records relating to hospital management, staff, students, patients, finances, buildings, hospital history and events. There are also records of inquiries, routine administration and domestic tasks, and individual Medical Superintendents. The run of minute books is remarkably complete, stretching from the first meetings of the provisional managing committee in 1801 to 1953, a span interrupted only by a gap of twelve years between 1828 and 1842. Similarly annual reports, which usually include medical reports, run from 1801 to 1953 with few omissions. Records relating to individual Medical Superintendents are particularly plentiful for Dr. C. J. McSweeney’s tenure (1934–1953), and consist for the most part in report books, research and teaching notes, drafts of articles and papers, and other ephemera. Patient records are, unfortunately, less comprehensive, with the earliest surviving register of patients dating from 1924 to 1929. Access to patient records and other sensitive files containing personal data are subject to Data Protection legislation and conditions laid out in the RCPI Heritage Centre’s guidelines. There are also some records across the various series which date from the decades following the transfer of the hospital to Cherry Orchard.

If you have any queries about the collection, please contact heritagecentre@rcpi.ie.

---

1. Cork Street Fever Hospital Committee Proceedings, 23 October 1801.↩
2. Patricia Conway, Sheila Fitzgerald and Seamus O’Dea, Cherry Orchard Hospital: The First 50 Years (Dublin, 2003), p.  2.↩
3. Ibid., p. 3.↩

The historical development of Irish Hospitals and the importance of their records by Brian Donnelly

In this month's post, Brian Donnelly, senior archivist at the National Archives of Ireland, outlines the development of Irish hospitals from the eighteenth to the twentieth century.

Rotunda Hospital, Dublin
(RCPI Archival collections: VM/1/4/19)

The establishment of the voluntary hospitals

The early eighteenth century saw the establishment of voluntary hospitals by philanthropists, mainly in Dublin but also in the larger provincial towns. Jervis Street hospital (the Charitable Infirmary) was the first voluntary hospital Ireland and was founded in 1718.  Many of these, like Dr. Steeven’s Hospital (founded in 1733) and Mercer’s (founded 1734) would survive into the twentieth century.  The eighteenth century also saw the establishment of specialist hospitals, most of them voluntary, such as the Rotunda Lying In Hospital, founded in 1745, St. Patrick’s Hospital for mental illness, founded in 1747 and the Westmoreland Lock Hospital, for the treatment of venereal disease, in 1792. 

A modern public health service at county level began in 1765 when a parliamentary enactment provided for the erection and support of an infirmary for each county in Ireland and also permitted support for several existing hospitals, mainly in Dublin and Cork, out of public funds.  The county infirmaries were to be maintained by grand jury presentments, parliamentary grants and local subscriptions. The grand juries were groups of landowners who were called together by the High Sheriff in each county twice a year for legal and local administrative reasons.

The House of Industry hospitals, district lunatic asylums and medical dispensaries

The Dublin house of industry, a precursor of the workhouses of the nineteenth century, was founded in 1772. This institution became in time a vast concern, providing hospitals for the sick, an asylum for children, bridewells, penitentiaries for women and young criminals, a house of industry for vagrants, and cells for lunatics.  From it evolved the House of Industry hospitals – the Richmond, Whitworth and Hardwicke - and it played a major role in establishing the first and largest of the public lunatic asylums – the Richmond Lunatic Asylum – which opened for patients in 1814. Following the report of the Committee on the Lunatic Poor in 1817, the Lord Lieutenant was enabled by statute to build asylums where he considered necessary and, over the next half century, a well-developed mental health infrastructure was in place. By 1871, twenty two asylums were being financially supported by the grand juries. In 1850 a central asylum “for insane persons charged with offences in Ireland” was opened in Dundrum. This institution, the first criminal lunatic asylum in these islands, was under the direct control of the Lord Lieutenant who appointed the staff and made regulations for its management. 

A few dispensaries were supported by voluntary subscriptions in several of the larger towns and cities from the late eighteenth century, but it was not until 1805 that grand juries were authorised to give grants to dispensaries in rural areas. By the early 1830s, there were 450 dispensaries throughout the country, administered by committees of management and supported partly by subscriptions and partly by grand jury grants. There were fewer dispensaries in poorer areas, where voluntary contributions were wanting, and where it was difficult to raise enough money to start them. Inadequate as many of these dispensaries were, they represented the first steps towards domiciliary medical treatment of the rural population.

Robert Graves (1796-1853)
 (RCPI Archival collections: VM/1/2/S/35)

The impact of epidemics on the development of medical infrastructure

Epidemic disease was a major impetus in the development of a medical infrastructure. Typhus was a major scourge in Ireland in the early nineteenth century and, while several fever hospitals had been established in the larger towns in the late eighteenth century, it was not until 1807 that legislation was passed to encourage their construction throughout the country. A fever epidemic of unprecedented proportions raged in Ireland between 1816 and 1819. Under an 1818 Act, local boards of health could be established, supported partly by grand juries, which had extensive powers to combat disease. Grand juries were empowered to make presentments equal to twice the amount raised by private subscription to build fever hospitals. In 1819, legislation enabled officers of health to be appointed in parishes and a parish health tax could be levied. 

The establishment of the Central Board of Health in 1820 marked a major step in the centralisation of medical relief and local boards of health were to play a major role in combating epidemics over the following decades. The Central Board of Health collected statistics about local health conditions, advised where local boards of health should be established and when grant to hospitals should be made. When cholera broke out in Ireland in March 1832, the Central Board of Health, renamed the Cholera Board for the duration of the epidemic, supervised measures to combat the disease which included the establishment of local boards of health. 

Dublin hospitals like the Meath were at the forefront of the fight against infectious disease from the 1820s and introduced new methods of bedside clinical training to the English speaking world.  The census commissioners noted in 1854 that to these metropolitan hospitals “the Irish School of Medicine is largely indebted for the celebrity which it has so long enjoyed”. The Meath hospital received international recognition in the early nineteenth century due to the innovative teaching methods and research carried out by its physicians, Robert Graves and William Stokes. The latter had survived an attack of typhus in 1827 and identified the first case of cholera in Ireland in 1832. This new approach to clinical training had originated on the continent and its introduction into the Meath hospital heralded what has been described as the heroic age of the Irish School of Medicine. The voluntary hospital infrastructure continued to expand during the nineteenth century and following Catholic Emancipation many Catholic religious orders became involved in founding hospitals.

The Irish Poor Law, 1838

The enactment of the Irish Poor Law of 1838 was to have a dramatic effect on the provision of public health services for the rest of the nineteenth century. The country was divided into over one hundred and fifty poor law unions each with a workhouse at its centre and administered by a board of guardians.The structure of the poor law system, being modern and efficient and more easily subject to central control, was adapted on nearly all occasions where a new local function was created or an old one modified .The Medical Charities Act of 1851 led to the modernisation and extension of the old grand jury dispensary network under the boards of guardians and made a domiciliary medical service available to large sections of the population, the destitute poor, for the first time. 

By 1852, every poor law union had been divided into a number of dispensary districts, each with a dispensary and medical officer.  Patients had to apply to a poor law guardian for a ticket every time they wanted to attend a dispensary free of charge. Committees of management were responsible to the boards of guardians for the management of the dispensaries and appointing the dispensary doctors. In 1863, the dispensary doctors were made registrars of births and deaths and of Roman Catholic marriages and the practice of registering births, marriages and deaths was standardised on the 1^st of January 1864. When registering deaths, the dispensary doctors were required to note the cause of death and duration of illness, thus enabling accurate statistics of mortality to be compiled for the first time. The registration of births enabled such measures as the compulsory vaccination of children against smallpox to be carried out effectively and by the end of the nineteenth century this scourge had, to a great extent, been eliminated.

While many boards of guardians had allowed the non-destitute to enter workhouse hospitals for treatment during the 1850s, the 1862 Poor Law (Amendment) Act officially opened the workhouse hospitals to the non-destitute sick. As a result of these developments, Ireland had one of the most advanced health services in Europe in the mid-nineteenth century, if policy and structure are to be taken as criteria. The Local government (Ireland) Act, 1898, replaced the grand juries by democratically elected county and rural district councils. The county councils took over the administration, either directly or through joint committees, of the district lunatic asylums.

Newcastle Sanatorium, Wicklow.
Image courtesy of NLI (L_ROY_05467)

Tuberculosis and the sanatorium

While Ireland had a low death rate from infectious disease in the first decade of the twentieth century, tuberculosis was the marked exception. The last years of the nineteenth century saw the first attacks made against the disease with the establishment of Newcastle Sanatorium in 1893. In 1904, the sanitary authorities of County Cork combined with Cork Corporation to establish Heatherside Sanatorium near Doneraile. In 1907, the Dublin City and County authorities established Crooksling Sanatorium. A Tuberculosis Prevention Act was passed in 1908 which gave the county councils power to provide sanatoria and brought the first veterinary inspectors into the employment of the sanitary authorities.  Peamount Sanatorium was founded in 1912 through the efforts of the Women’s National Health Association, the most formidable health pressure group of the early twentieth century.

Public health provision in post-independent Ireland

The turbulent years of the early 1920s saw some revolutionary changes in the public health system. In general, the boards of guardians outside Dublin were abolished and were replaced by county boards of health and public assistance, essentially sub-committees of the county councils. Most workhouses were closed to save money and central institutions called county homes were established in each county where the poor were to be relieved. While the newly styled county homes were to be reserved in theory for the old and infirm many soon included unmarried mothers, children and the mentally retarded.  Following the establishment of the Irish Free State the Department of Local Government and Public Health formally became, in 1924, the central government authority for local government and health administration. The Minister took over the Lord Lieutenant’s duties in relation to the mental hospitals. In 1930, the establishment of the Irish Hospitals Sweepstakes, a lottery to provide financial assistance to hospitals, provided a financial lifeline to many voluntary hospitals who were struggling to survive following a reduction in the number of endowments and bequests after the Great War.

The post-war period and declining mortality

There were significant developments in health care in the 1940s and 1950s. The Mental Health Treatment Act of 1945 modernised the legal code under which the mental services operated and provided important safeguards against the arbitrary detention of patients although the numbers of persons being treated continued to increase until, by 1959, there were 20,000 patients in Irish mental hospitals.  In the years immediately after 1945 there was a major effort to develop anti-tuberculosis services. The Tuberculosis (Establishment of Sanitoria) Act of 1945 permitted the Minister for Local Government and Public Health to arrange for the building of sanatoria and to transfer these to local authorities when completed. This was a major departure from established practice for the central authority as it stepped outside its normal functions of directing and co-ordinating the local services. Sanatoria were built at Dublin, Cork and Galway and were handed over when completed to the local authorities as was provided under the Act. 

There was also widespread building and conversion of buildings for the treatment of tuberculosis cases by local authorities.  These developments, together with the payment of maintenance allowances for dependents of persons undergoing treatment for infectious disease, mass radiography, BCG vaccination and new drugs such as streptomycin, led to a great decline in mortality for the disease and in the number of new cases appearing.  In 1947 the Department of Local Government and Public Health was divided into two separate departments. The Health Act of 1953 extended eligibility for general hospital services and maternity care to a much wider class. Health authorities were now required to provide child welfare clinic services and the school health service was improved. The dispensary service and dispensary doctors were transferred from the public assistance code to the health authorities. The old dispensary ticket system was done away with and replaced by medical cards. A more liberal code for the governing of county homes was introduced and provision was made for the development of a comprehensive rehabilitation service.

William Stokes (1804-78) and William Wilde (1815-76)
(RCPI Archival Collections: PDH/6/2/12)

1970s regionalisation and the Irish 'love affair' with the hospital bed

By the 1960s, it was felt that as the state had taken over the major financial interest in the health service there should be a new administrative framework combining national and local interests.  For technical and logistical reasons it was believed that better services could be provided on a regional rather than a county basis.  The establishment of the health boards under the Health Act, 1970, marked a major break in the link between the health services and county administration. At this time Ireland had the highest proportion of hospital beds to population in western Europe and the Irish hospital system was described as “one of a large number of small institutions scattered throughout the country”. The following decades would see the closure or amalgamation of many voluntary and state hospitals into larger units and the dismantling of the old mental hospital infrastructure.

The historical value of Irish hospital records

That Irish hospital records are of great historical interest has long been acknowledged. Dr. William Wilde, the internationally renowned nineteenth century physician and statistician, recognised one hundred and seventy years ago that the hospital registers of the Rotunda Hospital represented the ‘most interesting and earliest statistical tables on record’.  Ireland’s medical institutions, both voluntary and public, have a peculiarly rich and varied history and have played a paramount role in medical advances over the last three centuries.  While some collections of hospital archives are now safe in archival custody, many collections remain in peril. These archives have no protection under the law and it is often only through the good offices of interested hospital staff that material has been preserved. 

Brian Donnelly is a Senior Archivist at the National Archives with responsibility for Business and Hospital records. Images courtesy of Fergus Brády, Archivist, RCPI. 

Conference report: Medical training, student experience and the transmission of knowledge by Anne Hanley

In the first blog post of 2015, Dr Anne Hanley reports on 'Medical training, student experience and the transmission of knowledge' - a conference which took place at the Centre for the History of Medicine in Ireland in October and which was funded by the Irish Research Council and the Wellcome Trust. Podcasts of papers from the conference were recorded by Real Smart Media and may be accessed here. 

I recently attended the conference, 'Medical training, student experience and the transmission of knowledge, c.1800-2014' (or #MTSE14 if you want to look over our live tweets), at University College Dublin. Needless to say its focus, and the discussion generated from its wide-ranging collection of papers, was excellent and very much overdue.

Students dissecting

Medical education

Despite an ever-growing interest in the history of medicine, the subject of medical education and student experience continues to be overlooked (the last international symposium dedicated to this subject having taken place in the early 1990s). Yet throughout the nineteenth century medical education was being increasingly formalized, centralized, and consolidated. It became the backbone of one’s medical career. Strangely, however, it has occupied the negative space in histories of clinical practice and patient care. This omission is incredibly problematic (but I digress…).

So, when Laura Kelly emailed to ask if I would give a paper at a conference devoted to the history of medical training and knowledge production, I sent back an immediate and unequivocal ‘YES!!’. (There were so many excellent papers about which I want to talk that my own paper, ‘Venereology at the Polyclinic’, will have to take a back seat for now.)

An important focus of MTSE was the centrality of pedagogy. Traditionally, histories of medical education have been written as administrative histories of major teaching hospitals. They have concentrated on the big names, significant infrastructural changes, and major medical developments that altered practice in these hospitals. Rarely have such histories considered in the implications of the big names and significant changes for the day-to-day learning and experiences of students. Happily, however, historians of medicine are beginning to recognize the importance of pedagogically-focused histories and MTSE really demonstrated this change. It brought a whole host of issues to the fore and, as those of you who follow me on Twitter will have gathered, I was rather excited by the rich collection of papers.

Professor John Harley Warner delivering his keynote.
Image courtesy of Real Smart Media

John Harley Warner keynote address

We began with the keynote address from John Harley Warner, who introduced us to his most resent and gruesomely fascinating work on the photographic history of dissection in American medical schools. As Warner observed, nineteenth-century medicine was often a solitary occupation and so medical schools provided an important opportunity for group learning and for developing a collective professional identity. And this is particularly well-evidenced in the strange collections of photographs in which groups of students posed around tables upon which they were dissecting cadavers. One particularly interesting aspect of Warner’s keynote was the figure of the medical school porter who often appeared in these photographs and who Warner identified as playing a key role in the facilitation of medical education (but I’ll return to this shortly).

Attendees at MTSE.
Image courtesy of Real Smart Media.

Microbes to matron

Many fantastic papers followed, including Claire Jones’s presentation of her most recent research on the ‘Microbes to Matron’s’ project. Her focus on the pedagogy and practice of infection control in British nursing between 1870 and 1900 offers an important counterpoint to what have traditionally been male-focused accounts of medical education. It is very easy to forget that there were (and continue to be) other groups of trained medical professionals beyond doctors who provided care to a wide cross-section of the population. What also interested me about Jones’s paper were the types of sources she and her fellow project investigators are drawing upon. By using surgical nursing examinations, Jones demonstrated the increasingly active role of nurses in their own education, and in surgical practice more broadly.

Dollhouse diorama

Crime scenes and dollhouse dioramas

Similarly, Neil Pemberton’s paper on teaching crime scene investigation through dollhouse dioramas also prompted us to reconsider the role of women in medical and scientific training. By appropriating the traditional female practice of miniature making, women like Frances Glessner Lee created a new way of thinking about crime scene science. Nathalie Sage Pranchère also looked at the important role of women in medicine, speaking about the development of nineteenth-century French midwifery training. Importantly, she also described how obstetric teachers used models to develop the anatomical and obstetric knowledge of their midwifery students. As we saw with Pranchère’s paper, the role of material objects in medical training and practice is becoming an increasingly central focus of historical scholarship and this was reflected throughout MTSE. For example, Jenna Dittmar used the collections from Cambridge’s former Anatomical Museum to demonstrate how human remains allow biological anthropologists to examine the historical tools and techniques of dissection.

Speakers Greta Jones, Anne Hanley,
Nadav Davidovitch and Victoria Bates.
Image courtesy of Real Smart Media.

Spaces of medical education

Another important theme to emerge from MTSE was the different spaces of medical education. Warner described the dissection room as a space for developing collective professional identify. Michael Brown spoke about the dynamic space of the nineteenth century lecture theatre, in which students and their lecturers were appealing to culturally resonant sets of values. Clare Hickman presented eighteenth-century botanic gardens as important spaces for thinking about the material culture of medical teaching. Hickman’s paper, like Warner’s keynote, also demonstrated that the history of medical education is never simply about those who learned the art of medicine but also those in the background. Like the African American medical school porters who procured cadavers for students, gardeners were important (but silent and overlooked figures) in the maintenance of teaching spaces and the facilitation of teaching practices.

Attendees at MTSE.
Image courtesy of Real Smart Media.

MTSE demonstrated how the nature of medical training has changed over time and within distinct national contexts. Through an excellent collection of papers we explored the emergence of centralized and consolidated systems of medical training. We looked at the development of new tools of training and the different spaces in which these tools were employed. And we looked at how medical knowledge and codes of professional identity were being assimilated by medical and dental students, nursing probationers, midwives, and qualified practitioners seeking further education.

I came away from MTSE with a new appreciation for the diversity of student experiences and systems of knowledge dissemination, and will certainly be drawing upon these ideas in future. With any luck, events like MTSE will slowly begin to generate greater interest in the important place of medical training in wider narratives of medical history.

Dr Anne Hanley is an LHRI Research Fellow at the University of Leeds with particular expertise in the history of modern medicine, medical education, health policy and the history of science. She recently completed her PhD at the University of Cambridge on the development and dissemination of venereological knowledge among English medical professionals, 1886-1913. She writes a blog Clinical Curiosities and tweets at @annerhanley.

Childhood illness in twentieth-century Ireland by Ida Milne

In this month's blog post, Dr Ida Milne,  Irish Research Council ELEVATE fellow co-funded by Marie Curie Actions, writes about her postdoctoral project on childhood illness in twentieth-century Ireland.

We live in an era where we expect our children to survive to adulthood without having their lives threatened by common infectious diseases of childhood.  The situation was rather different in the Ireland of the early part of the twentieth century. In 1911, more than 2,000 infants under the age of two died from diarrhoeal illnesses, almost double the number that died the previous year.  The increase was not helped by the hot summer, which exacerbated the hygiene difficulties in an era when many houses, even of the affluent, did not have running water or flush toilets. As a twenty first century mother, I find the idea of nursing a child suffering from diarrhoea in an overcrowded third floor  bathroomless tenement almost unimaginable. 

Child mortality in the early-twentieth century

Having healthy children who would survive to adulthood was not taken as the norm, as we do now. Statistics tabulated by the Registrar-General in 1911 show that one-fifth of the total 72,475 deaths in 1911 were children under 5; of these, 945 were caused by ‘convulsions’ and 1,370 by bronchitis. Scarlet fever claimed the lives of 260 children under fifteen; 460 under-fifteens died from measles, and 819 under tens from whooping cough.  

Slums in Dublin, c.1865-1914 (Image from NLI collection: L_ROY_07881)

Dublin tenements, poverty, and childhood illness

Few families, rich or poor, remained untouched by these deaths, but the over-crowded living conditions of the poor could bring extremes of ill health. Stella Larkin McConnon, trade unionist James Larkin’s granddaughter, told me that the poor health of the nation’s children was one reason he became so interested in improving living conditions for families.  The Larkins had good reason to be aware of the suffering.  Stella’s own mother was brought up in Marlborough Street in the heart of Dublin’s tenements, and was the only one of ten children to survive to adulthood.  Stella still remembers visiting the tenement, one room with only one metal bed, the only toilet downstairs in another part of the tenement, the cooking done on an open fire.

Improving child health

By 1981, the landscape of death in childhood had changed radically. There were no deaths in either Northern Ireland or the Republic from scarlet fever or whooping cough, and only two from measles.  Only 2.78 per cent of the total deaths, 916 of 32,929, were of children under five.

Many factors contributed to the improvements over the course of the twentieth century:  among them vaccination schemes and more effective medicines, public health education and increased state intervention in the health of children, better housing and diet and improved air quality. It didn’t happen by accident – throughout the century, there were individuals who identified areas to change and worked to effect that change.  Their number includes the first chief medical officer for Dublin, Sir Charles Cameron, trade unionists like James Larkin who worked to give families a decent wage, pioneering TB Dr Dorothy Stopford Price,  Department of Local Government and Public Health Chief Medical Officer James Deeny, Noel Browne and many others who played macro and micro roles in the significant reduction in deaths from disease in childhood.

Research project on childhood disease

In October, I began a three year  Irish ResearchElevate Fellowship in the National University of Ireland and Queen’s University, Belfast to research this dramatic changing landscape of childhood disease, which is in general a good news story for Irish society and Irish public health.  While statistical and documentary sources will be important to the project, a key feature will be a series of qualitative interviews with medical professionals, with people who worked in relevant Government and local authority roles, and with parents and sufferers. I intend that these interviews should, at the conclusion of the project, be available in an open access archive to other researchers. 

Mother (to District Visitor): "Lumme, miss! There ain't no danger

of infection. Them children wet's got the measles is at the 'ead of 

the bed, and them wet ain't is at the foot.

London Mail, 23 October 1913

Image courtesy of the Wellcome Library

The project builds on and was partly inspired by the RAMI Living Medical History project; Susan Mullaney, Mary O’Doherty and  Patrick Plunkett of the RAMI section on history of medicine devised this innovative project to interview retired medical doctors about their working lives, collecting memories on the changes in medical practice over the course of their careers. Several of the LMH interviewees had either suffered from diseases like diphtheria and tuberculosis themselves, or had family who did, and this really brought home to me how all-pervasive the effects of childhood disease were on Irish society, that they were not merely confined to the poor and the badly-housed, but could also invade better-off families.

Oral history of medical practitioners

Oral history interviews can add flesh to the dry bones of statistics. When working on my PhD on the effects of the 1918-19 influenza pandemic here,  the people who spoke to me about suffering this influenza as small children, or who told me about how their families coped with the tragic losses of children or parents to the 1918-19 flu, breathed life into its history, recreating the fear caused by the unpredictability of  this most awesome of influenza pandemics.

In the case of this new project, I am hoping to find people who can talk about the changing landscape of childhood illness in the twentieth century, from their own perspective, whether as medical workers, patients, parents or as Department of Health officials and politicians.

I’m curious about issues like knowledge transfer – how and what did parents learn about treating the illnesses their children caught?  As a child growing up in the 1960s, I recall my mother hanging blankets over the windows when we caught measles; the information she had been passed down by her mother was that children with measles could damage their eyesight if they read or were in daylight.

When I had my own children in the 1990s, I was struck by the efficiency and dedication of a district nurse in north Kildare who made sure we parents brought our children for vaccinations, and cajoled and informed those parents who had reservations about allowing their children to be vaccinated. Getting medical workers like her to talk about their work is one of the goals of this project. This district nurse was, it seems to me, a local hero, a micro role player who was a small but significant cog in the expanding machinery which managed and significantly improved the health of our children over the course of the twentieth century. 

Dr Ida Milne is a social historian based at NUI Maynooth and Queen's University Belfast. She holds an ELEVATE Irish Research Council International Career Development Fellowship co-funded by Marie Curie Actions. 

Treating Measles in late Seventeenth-Century London and Dublin by Elizabethanne Boran

This month, Elizabethanne Boran, librarian at the Edward Worth Library, Dublin, writes on treating measles in late seventeenth-century London and Dublin, with particular focus on the works of John Pechey (1654-1718), many of which were collected by the Irish physician Edward Worth (1678-1733). 

A keen collector of medical works

Title page of  John Pechey's Collections of Acute Diseases (1691)

‘These Measles began very early, as they use to do, to wit, at the beginning of January, 1670/1 and increasing daily, came to their height at the Vernal Æquinox, i.e. the Tenth of March: afterwards they gradually decreas’d. and were totally extinguish’d the following July’. Thus begins John Pechey’s account of an outbreak of measles in his Collection of Acute Diseases (London, 1691), a book collected by the early eighteenth-century Dublin physician, Edward Worth (1676-1733). Worth was a keen collector of all kinds of medical and scientific works and was particularly interested in infectious diseases. As the Worth Library’s online exhibition on infectious diseases demonstrates, his main areas of concern were plague, smallpox, syphilis, and tuberculosis, not to mention all kinds of fevers, but he was also avidly interested in books on other infectious (and non-infectious) diseases.

John Pechey

Perhaps it was for this reason that Worth was drawn to the works of John Pechey (1654-1718), for he collected no less than seven books by this popular author: Pechey’s Collection of Acute Diseases (London, 1691) had quickly been followed by his Collections of Chronical Diseases (London, 1692). Three years later Pechey’s Storehouse of physical practice was on the market and in the next two years he produced a book a year: Treatise of Women’s Diseases (London, 1696) and Treatise of Children’s Diseases (London, 1697). All of these books were collected by Edward Worth who joined to them a 1700 edition of Pechey’s Promptuarium praxeos medicae (which had been a Latin translation of the Storehouse), and, finally, in 1707, Pechey’s Compleat Herbal of Physical Plants. Though these books didn’t not represent the entire output of Pechey (which includes a host of pamphlets on the virtues of his famous medical concoctions), it is clear that Worth was drawn to Pechey’s understanding of disease, which was, in turn, heavily dependent on the works of the great English physician, Thomas Sydenham (1624-1689), whose works were translated and published by Pechey.

Portrait of Thomas Sydenham

A fractious relationsip with medical authorities

Pechey was the son of William Pechey, a Sussex ‘Practitioner in Physick and Surgery’, whose influence his son publicly acknowledged in the fifth part of his Collection of Acute Diseases. Judging by this dedication, Pechey had a fractious relationship with medical authorities. Initially his education had been unremarkable: he had taken a BA and MA from the University of Oxford in 1675 and 1678 respectively and in late 1684 he had successfully taken the Royal College of Physicians licentiate examination. Three years later he, and a number of other licentiates, set up practice at the Golden Angel and Crown in King’s Street, London and it was there his trouble started. His and his colleagues’ decision to advertise their medical services with the admirable promise that ‘the sick may have advice for nothing’ was met with less than enthusiasm by the medical authorities, who were appalled at Pechey’s approach. Legal battles ensued and it was in this context that Pechey issued the first edition of his Collections of Acute Diseases, which was published in London in 1686. In effect, Pechey had simply translated Thomas Sydenham’s works on smallpox and measles into English, no doubt in an effort to demonstrate how mainstream his medical teaching was. This was by no means plariarism: Pechey undoubtedly had the support of Sydenham in translating his work and he was himself keen to give credit where credit was due. Indeed he informs the reader that he had ‘chiefly collected from Dr Sydenham, because I have found by Experience, that his Methods in Acute Diseases have been most successful in practice. The Chapter of a Peripneumony was taken from Willis. The Chapter of Women’s Diseases, from Riverius and from Mauriceau, The Chapter of an Apoplexy, Lethardy, Coma and Carus; likewise from Riverius.’ It is revealing that works by all these authors were likewise collected by Worth.

The 'English Hippocrates'

The choice of Sydenham was a shrewd one – as the numerous editions of Pechey’s English translation of Sydenham’s complete works testify. But if Pechey hoped to win approval by translating Sydenham’s works his hopes were dashed for Sydenham’s own relationship with the Royal College of Physicians was problematic. It is at first sight surprising that so eminent a physician, one who was regarded as the ‘English Hippocrates’ due to his emphasis on clinical experience, was never made a Fellow of the College. However, it was precisely Sydenham’s advocacy of experience over theoretical medicine that threatened the status of the members of the College. Sydenham might have avoided publishing his most radical attacks on the medical establishment but there was sufficient criticism of them in his famous Methodus to ensure that they were less than attracted to the likely social implications of his health regime.

Bleeding a patient

'These Men blame me for Englishing their Mysteries'

 So Pechey’s advocacy of Sydenham, though it fitted in perfectly with his own medical philosophy, was unlikely to endear him to the Royal College of Physicians who were already incensed by Pechey’s propensity for advertising his medical wares. Not only this, but, as Pechey explains to the reader in Worth’s 1691 edition of the Collection of Acute Diseases, the very method of his popularizing of Sydenham was criticised: ‘These Men blame me for Englishing their Mysteries, though they know that Hippocrates and Galen and Celsus, and many others wrote in their Mother-Tongue.’ That didn’t stop him for, as his preface to his father makes clear, his publications represented not only an opportunity for financial gain but more importantly were part of a crusade to defend the importance of practice and experience over theory, and, at the same time, to democratize medical knowledge by making the works of eminent doctors available in English to non medical readers. In this Pechey seems to have been following his medical hero, Sydenham, for the latter never joined the ranks of fashionable doctors and was more than happy to treat poor patients.

Bleeding

Therefore, much of Pechey’s description and suggestions for treating measles comes directly from Thomas Sydenham. Certainly both men would have concurred that ‘the Patient be kept in his bed onely two or three days after the eruption, that the bloud may gently breath out, according to its own genius, through the pores of the skin, the inflam’d Particles that are easily separable which offend her; and that he have no more cloaths nor fire, than he is wont to have when he is well’. Though Sydenham in general opposed the treatment of bleeding in cases of fever and smallpox, he admitted that in some cases of measles the standard practice of bleeding should be implemented. Edward Worth’s collection of medical books demonstrate that this early eighteenth-century Dublin physician was a keen follower of the Pechey-Sydenham approach to infectious disease.

Elizabethanne Boran is librarian at the Edward Worth Library, Dublin. She may be contacted at elizabethanne "dot" boran "at" hse "dot" ie.

‘Out of the mouths of babes comes wisdom, and the poor women residing in the slums of Cork’ by Michael Dwyer

During the 1920s, extreme close quarter living conditions took a heavy toll on the health and life expectancy of the residents of Cork city. With a population of 80,000, 18,645 of the city’s inhabitants lived in unsatisfactory conditions with 8,675 inhabitants housed in 719 tenements and small houses. The tenements were generally in a shocking state of repair; crowded together in such a manner as to make it impossible to have fresh air and sunlight around each dwelling. The houses were small and resembled each other merely in their common dilapidation. The alleys, dignified by the name of streets and infused with a conglomerate of odours, said to be ‘almost Neapolitan’, began near the riverbank, in sordidness, and ascended the hills to something like squalor. As bad as the alleys were, the houses were generally worse. As Frank O’Connor succinctly put it, ‘God had abandoned the lanes of Cork city, and so had the Corporation’.

In 1926, a report produced by the Cork Town Planning Association Cork; A civic survey, highlighted the fact that mortality rates were highest in those districts which contained the largest amount of ‘insanitary property’. The survey revealed that the highest mortality rates occurred in dispensary districts three and four, both of which were located west of Shandon Street on the North side of the city. The mortality rates here numbered 2.9 per 1000, per annum and 2.7 per 1000, per annum respectively. Dispensary districts six and seven, located South west of St. Finbarr’s Cathedral, on the South side of the city recorded the second highest mortality rate at 2.4 per 1000 per annum and 2.6 per 1000 per annum respectively. The national mortality rate in 1923 is recorded as been 1.4 per 1000 per annum, making the mortality rate in the Cork Dispensary Districts twice as high as the national average.

The contemporary finger of blame for the high mortality rates, and in particular the high infant mortality rates was directed towards ‘the domestic ignorance of the poor womenfolk in our slum tenements… and to the shocking ignorance of the duties of motherhood’. However, this assertion by Professor Alfred O’Rahilly was roundly challenged by Professor Henry Corby who asserted that;

Out of the mouths of babes comes wisdom, and the poor women residing in the slums of Cork, who through force of circumstances felt compelled to ignore medical advice, have taught me what I consider to be a very valuable lesson.

Ariel view of District Three, on the north-west slopes of Cork city circa 1930. Source: Cork City Council.

'God had abandoned the lanes of Cork city, and so had the Corporation'. View of District Four, taken from the North Cathedral, circa 1930. Source: Cork City Council.

Addressing an article in the British Medical Journal relating to ante-natal care in private practice, Corby lamented that there had been little progress in the field of obstetrics over the previous fifty years to 1924, especially in regard to the preventative treatment of puerperal sepsis; a fatal illness caused by severe infection spread via the bloodstream, and generally contracted after a prolonged hospital confinement. During the 1920s, physicians routinely proscribed between ten and eighteen days post natal bed rest, and as a result, puerperal sepsis had been an all too common cause of death among women, regardless of  social status. Reflecting on his time spent as visiting physician to the Cork Maternity Hospital, Corby noted that he had been ‘forcibly struck’ by two things;

One, was the thorough contempt that the patients of the lanes exhibited for the medical science with regard to the amount of rest that should be taken after a confinement. The other was that puerperal sepsis was unknown among these [Cork] women, though they lived in the midst of squalid poverty and in surroundings which were the reverse of sanitary.

Corby contacted the matron of the Cork Maternity Hospital, and made inquires as to the duration of post natal bed rest taken by women under her care. The matron reported that the majority of women had ‘gotten up and gone about their daily chores on the third day after giving birth’. Furthermore, during her ten year tenure at the Cork Maternity Hospital, the Matron stated that only one case of death caused by sepsis had been recorded. Corby concluded that the adoption and application of the example set by ‘the women of the lanes’ to his own patients ‘resulted in good practical results’.

Similarly, an examination of J.C. Saunders, Typhoid epidemic in Cork city 1920, suggests that high mortality rates in the Cork dispensary districts were not necessarily caused by unsanitary practices among their inhabitants. Saunders account of the typhoid epidemic in Cork, ‘the biggest of its kind in the city and probably of the country also’, found that there had been 243 reported cases ‘but that it was highly probable that this figure represented only a portion of those which actually occurred’. The heaviest incidence was recorded in the northwest ward, that being the congested areas west of Shandon Street, where ‘there were a large number of insanitary and overcrowded dwellings and where the general standard of living is lower than that for the city generally’. The maximum incidence occurred in the eleven to fifteen age group, the youngest victim was three and a half years old and the oldest was seventy two years old.

An investigation focusing on the water supply concluded that it was contaminated with Balantidium Coli (B.coli). B. Coli causes infection when ingested by humans, faecal-oral being the commonest mode of transmission and it usually affects the large-intestine. Symptoms include diarrhoea, nausea, vomiting, fever, and severe fluid loss, a perfect disease to spread rapidly through a community living in extreme close quarters. The source of the contamination was identified as being discharge from Our Lady’s Cork Mental Hospital, which entered the River Lee through a sewage pipe, twenty yards from the pure water basin which supplied the drinking water for the entire city. The focus of the investigation turned to Our Lady’s Hospital, where it was established that typhoid had been endemic for over twenty years previously.  The cause by which the hospital had become ‘a reservoir of infection’ was traced to the institutions milk supply, which was found to be contaminated as a result of unsanitary practices at the production stage.

The overcrowded districts may well have been the ‘breeding ground for disease’ that many contemporary commentators depicted, and lives lived in squalid poverty in unsanitary accommodation presented a daily menace to the health and life of the workers and the poor. However, there is little doubt that the close-quarter habitation, an enforced condition of the physical state of the tenements, intensified the impact of external influences on their captives, who were victims of, rather than creators of their environment.

Michael Dwyer is a PhD candidate at the School of History, University College Cork. His current research relates to the historical significance of diphtheria and the roll-out of childhood immunisation programmes in Ireland. He is the winner of the James and Mary Hogan Prize in History (2011), the Saothar/IHSA Labour History Award (2012), and the Centre for the History of Medicine in Ireland Essay Prize (jointly, 2013). For further information see this link.