Monday, 10 June 2013

The Irish experience of polio, 1940-70 by Stephen Bance

In this month's blog post, Stephen Bance, MA student at the Centre for the History of Medicine in Ireland, University College Dublin, writes about his research project on the history of polio in Ireland, 1940-1970.

Polio and history

One of the first recorded polio epidemics occurred on the island of Saint Helena, a British colony, in 1836. Outbreaks followed later in the century in Norway, France, Sweden and America. By March 1955, the World Health Organisation recognised that polio was ‘a practically world-wide disease’. In Ireland, polio was scarcely known prior to 1940. The first significant epidemic occurred in 1942 and the incidence of the disease fluctuated during the following years. The worst epidemic wave occurred in 1956, when approximately 500 cases were notified nationwide. Yet, with the exception of Laurence Geary’s short overview of the epidemic in Cork, polio has been largely ignored in Irish history. An exploration of polio in Ireland will provide a new lens through which to critique public health legislation in the mid-twentieth century and uncover Irish lay and medical understandings of disease. It will contribute to the Irish literature on the epidemiology of diseases, eradication programmes and public health policies, which, to date, has focused primarily on tuberculosis. 

Group of polio and arthritic patients on the sundeck, USA, undated photograph.
Courtesy of the National Library of Medicine, Images from the History of Medicine Collection. A015237

Polio project structure

The project is divided into three thematic sections:

1. What was the geographic and demographic distribution of polio?

This section of the project maps the incidence of the polio epidemic at a regional level with a view to revealing the topography of the disease. While the impact of the 1956 epidemic upon Cork has received analysis, little is known of polio consequences nationally or, indeed, whether its effects varied in urban and rural environments. In addition, the study will provide a demographic profile of its victims in terms of age, sex, marital status, class and outcome. It will also interrogate the types and forms of diagnosis and treatment assigned to sufferers. This data will establish whether the gender, class and age of sufferers impacted on susceptibility to the virus and on access to treatment and vaccination.

2. What were the social and cultural meanings assigned to polio and to its victims?

In his study of the American experience of polio, David Oshinsky contextualized the outbreak within the increasingly suburban, family-oriented, and hygiene obsessed 1950s, arguing that the nation’s most affected by polio were considered to be the most hygienic and least at risk to infectious diseases. The impact these domestic hygienic practices had on Ireland in the 1940s and 1950s is unclear, however it would appear that medical research on the epidemiology of the virus in Ireland examined whether the Irish were racially susceptible to the disease; an anti-body survey carried out by the Medical Research Council in 1956 revealed that antibody levels among Irish children were dangerously low. Examining medical research into disease aetiology conducted in Ireland, the study will uncover the social and cultural assumptions underpinning theories of susceptibility to polio.

Polio epidemics were capable of generating widespread fear and apprehension within the communities affected. In a contemporary account of the 1956 Cork epidemic, Patrick Cockburn suggested that public fear of the disease outlasted its virulence within society and the possibility of its return terrified communities. Drawing on newspapers, correspondence and memoirs, the study will look at the social responses to polio, especially the widespread fear of the disease and the consequent stigma attached to sufferers and groups who were identified as likely carriers of the virus. It will consider whether ‘fear’ had a negative impact upon public health initiatives, thereby exploring how social histories of diseases can become intertwined with political and policy narratives. Government press releases and publicity campaigns will give insight into the state’s efforts to assuage public terror. By situating the Irish experience within the international context, the study will consider whether there was universality to social reactions to polio in the twentieth century.

3. What was the public health response to polio in Ireland and how successful was it?

In his pioneering work on the history of public health, George Rosen argued that the protection and promotion of public health and welfare was one of the most important functions of the modern state. For Ireland however, it has been demonstrated that ‘few local authorities approached the problem of eradicating infectious disease with determination’ and only belatedly did public health became a matter of major public concern in the 1950s. James Deeny attested to a political disinterest in public health, concluding that in the case of tuberculosis, the Irish government ‘had been hoping the problem would go away’. Did they harbour similar hopes for polio? Preliminary research has revealed that Irish health authorities were slow to respond to the threat of polio, while specialist centres for treatment were only established fifteen years after the disease had been made notifiable. A Salk vaccination programme was introduced to Ireland in 1957, this was significantly later than in France, America and Britain.

A forgotten epidemic

Polio vaccine dropped onto sugar lump for young patients, c.1980.
Image courtesy of Wellcome Imagse, WFA WF/M/I/PR/P04
This section will examine the public health response to the epidemic at a local and national level, revealing the tensions at play that led to delays in implementing vaccination programmes and other initiatives. It will interrogate whether these failings were a result of underdeveloped public health infrastructure, politico-religious conservatism, an inert bureaucracy, economics or other factors. In addition, correspondence between public health bodies, the Medical Research Council and the Department of Health will reveal the factors informing the delivery of the vaccination programme; who was identified as especially vulnerable to the disease and why? The study will then uncover the impact delays in developing a robust public health response had on infection and mortality rates, especially among children, as Dr Noel Browne later lamented. By uncovering a near forgotten epidemic of 1950s Ireland, this project will add greater depth and sophistication to the literature on Irish health policy and infectious disease eradication.

Stephen Bance may be contacted at stephen "dot" bance "at" ucdconnect "dot" ie