‘Funding Dublin’s Hospitals c.1847-1880’ by Joseph Curran

In this month's blog post, Joseph Curran, a graduate of the MA in Social and Cultural History of Medicine at UCD, writes about his MA thesis 'Funding Dublin's Hospitals, c.1847-1880'. The blog post examines some of the themes that emerged from the thesis, highlighting the importance of studying hospital finance and why Dublin makes an interesting case study.

Post-Famine Dublin possessed more voluntary hospitals than any other Irish town. Thom’s Directory for 1850 listed nineteen voluntary hospitals operating in the city and many more were established in the next three decades. These institutions varied significantly in scale and function. They included general hospitals such as the Meath and Dr. Steevens’ Hospitals, as well as specialist institutions including the Westmoreland Lock Hospital which treated female venereal disease patients, several maternity hospitals, and a number of ophthalmic institutions. Histories of individual Dublin hospitals have been written which contain valuable information on their day-to-day activities, however they rarely reveal the common challenges faced by the city’s hospitals. Although finance might appear to be a topic far removed from hospitals’ ‘real’ work, recent studies by Keir Waddington and Sally Sheard have shown how examining hospital funding sheds light on these institutions’ interactions with their surrounding communities. From the 1860s hospital managers throughout the United Kingdom were under pressure to improve their institutions’ sanitary arrangements and nursing services. Examining hospital finance allows one to assess the financial impact of such reforms and the role played by the institutions’ ‘paymasters’ in promoting such changes. It makes it possible to examine how receipt of income from different types of sources affected hospital administration.

Dublin presents a particularly interesting case for the study of hospital finance. As David Durnin has pointed out, the city was home to Ireland’s medical elite and its voluntary hospitals were places of medical education. Dublin’s hospitals attracted many students in this period because of their prestigious educational reputation and they gained financially from medical students attending for clinical instruction. Educational activity subsidised hospital services as the institutions’ medical officers performed their duties free of charge while receiving income from student fees. In some hospitals a portion of these fees was also donated to the institution. Receipt of educational income created demands on resources which could interfere with the wishes of the hospitals’ other paymasters. For example, those making charitable donations to the hospitals were often allowed to recommend patients for treatment. Medical officers, however, wanted to prioritise cases they considered interesting from an educational point of view and they sometimes disagreed with lay donors about which patients should be admitted. Studying hospital finance sheds light on how such conflicts affected the administration of Dublin’s hospitals.  

Dr. Steevens’ Hospital, Dublin. This hospital was one of several Dublin hospitals in receipt of annual Parliamentary grants in the post-Famine period. Image courtesy of Wellcome Library.

Mary E. Daly highlighted the importance of religious tensions in shaping social life in post-Famine Dublin. Many of the city’s hospitals, including Dr. Steevens’ and Sir Patrick Dun’s, had historic links with the Church of Ireland. A smaller number of hospitals, such as St. Vincent’s and the Mater, were managed by Catholic religious orders. Examining hospital finance reveals the effects of religious affiliation on the institutions’ interactions with the outside world, and in particular, on their managers’ fundraising efforts. In her study of medical provision in Huddersfield and Wakefield, Hilary Marland pointed out that unlike other types of charities, hospitals and dispensaries gained the support of both Anglicans and Non-conformists in these religiously-divided towns. Studying hospital funding allows one to compare this with the situation in Dublin, did Dublin’s hospital managers emphasise their institutions’ links with one religious group to attract donations, or did they try to appeal to donors of all denominations? 

Studying the finances of Dublin’s hospitals also illuminates the effects of an unusual income source. Nine Dublin hospitals received annual grants from Parliament in this period, a situation almost unique in the United Kingdom. In 1848 a Parliamentary Select Committee recommended the grants be reduced annually until they ended. However this led to protests in Dublin and the decision to withdraw the grants was reversed in the mid-1850s. These events provide an opportunity to examine ideas advanced by those defending what was, at the time, a very unusual form of hospital income. Most British contemporaries would have considered the Parliamentary funding of hospitals to be unacceptable. How did those defending the grants make their case? Did their arguments reflect a greater ideological acceptance of central state involvement in healthcare provision in Ireland compared with the rest of the United Kingdom? Or did the protestors argue that Dublin’s hospitals were special cases entitled to income that would be otherwise objectionable? 

‘Public Engagement’, extract from an advertisement for a bazaar in aid of the Mater Hospital, 

Freeman’s Journal 10 January 1860.

Hospital managers had to appeal to the public in ways consistent with contemporary social expectations, note, for example, the involvement of ‘Ladies of rank and distinction’ in aiding the event. 

Image courtesy of the Irish Newspapers Archive.

As well as shedding light on ideas, analysis of Parliamentary funding reveals how this type of finance affected hospital administration. A supervisory body, the Board of Superintendence of Dublin Hospitals, was established in 1856 to monitor the grant-aided institutions. Gerard M. Fealy highlighted the Board’s role in promoting change in sanitary provision and nursing arrangements at the supervised hospitals. Indeed the Board not only influenced hospitals by inspecting them and offering advice, it published annual reports containing details of hospital income, expenditure, and treatment outcomes, something which brought much information on the supervised hospitals before the public. Hospital managers were aware of the potential importance of this information as many of them also had to appeal to the public for donations. Bad publicity from any source might make such donations less likely. Indeed several Dublin hospitals were also supervised by other funding bodies including Dublin Corporation. Receipt of income from a diverse range of sources created many obligations which directly affected hospital administration in Dublin and shaped how the institutions’ managers interacted with the wider world. The study of hospital finance is not simply the examination of ‘dry’ statistical data far removed from the institutions’ ‘real’ business, rather it reveals key issues in hospital management and provides a convenient way of highlighting the common challenges faced by a city’s hospitals.  Dublin provides an especially interesting case for such a study.    

Joseph Curran is a doctoral student at the University of Edinburgh. His PhD explores philanthropic networks in Dublin and Edinburgh between 1815 and 1845. The aim of the project is to examine what involvement in charitable activity reveals about elite social life in each city. Joseph's PhD research is funded by the Economic and Social Research Council and the Jenny Balston Scholarship. He may be contacted by email at j "dot" s "dot" curran "at" sms.ed.ac.uk

‘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.

Charles Lucas (1713-1771) by Harriet Wheelock

This week marks the 300^th anniversary of the birth of Charles Lucas, a politician, physician and writer.

Charles Lucas was born on 16^th September 1713. Left penniless on the death of his father, Lucas was apprenticed to a Dublin apothecary. Apothecaries, at that time, were the least respectable branch of the rapidly expanding medical profession, but the only one a man in Lucas’ position could hope to access. The apothecaries’ trade was notorious at the time for fraud, malpractice, adulteration of medicines and the use of poison. Lucas actively campaigned for legislation to control the profession, and was partly responsible for the 1735 act which gave this College the power to regulate the Apothecaries trade.

Rising in his profession, in 1741 Lucas was chosen by the barber-surgeons’ guild to represent them on Dublin Corporation. Lucas campaigned against the usurpation of the rights of the common citizens by the Lord Mayor and Alderman, and was instrumental in getting the matter examined by committee. However, his outspoken views created enemies and in 1744 he lost his seat on the Corporation.

Lucas’ appetite for politics had been whetted and in 1749 he decided to contest the vacant parliamentary seat for Dublin. He expanded the arguments he had used on the Corporation, to argue against the deliberate erosion of the citizens’ rights of the entire population of Ireland. His denial of the right of the English parliament to make laws for Ireland raised some eyebrows, but he really overstepped the mark when he stated that there was ‘no general rebellion in Ireland since the first British invasion, that was not raised or fomented by the oppression, instigation, evil influence or connivance of the English’.  Parliament condemned Lucas’ ‘rebellious doctrines’ and ordered his arrest, forcing Lucas to flee to the Isle of Man.

Lucas used his 11 years of exile to great advantage; he studied medicine in Paris and Lieden, before establishing a practice in London and publishing many political and medical works. In 1760, after the accession of George III, Lucas was pardoned and allowed to return to Ireland. On his return he immediately and successfully contested the Dublin parliamentary seat, and was active in pressing for parliamentary and medical reform. For the medical profession his most lasting legacy was Lucas’ Act, passed in 1761. This greatly extended the powers of the College of Physicians, re-establishing their right of inspection over Apothecaries, and giving them the right to compile a Pharmacopoeia, cataloguing and detailing the mixture of all drugs which could be prescribed. Lucas died on 4^th November 1771, at the age of 58.

To mark the tercentenary of Lucas’ birth, the Royal Academy of Medicine in Ireland will be holding an evening symposium of Lucas on 23^rd September in Dublin City Hall, starting at 5pm. The programme is as follows:

Professor James Kelly, St Patrick’s College/DCU; The Life and Significance of Charles Lucas: An Overview

Professor Jacqueline Hill, NUI Maynooth; Dublin and Irish Politics in the Age of Charles Lucas

Dr Eoin Magennis, President of the Eighteenth Century Ireland Society; Charles Lucas and Patriot Politics in mid-18th Century Ireland

Professor Marian Lyons, NUI Maynooth; The Professionalisation of Medical Practice in Dublin during the Early-17th Century: the Case of Thomas Arthur, M.D.

Dr Susan Mullaney, RAMI/UCC; Charles Lucas and Medical Regulation in 18th Century Ireland

Sean J. Murphy, M.A., Genealogy Teacher, UCD Adult Education; The ‘Essay on Waters’ and other Medical Writings of Charles Lucas

Cholera in Belfast in 1832 and 1848/49 by Nigel Farrell

On the 28th of February, 1832 at around midnight, Bernard Murtagh, a 34 year old cooper who resided in a lodging house on Quay Lane Belfast, a narrow street near the River Lagan, became violently ill. Described as a man of irregular habits he had been suffering from diarrhoea for two or three days previously but had not complained of any other symptoms when he went to bed following his usual supper of stirabout and milk. Around midnight his condition worsened and towards morning was accompanied with intense cramps and vomiting, the fluid (from both ends) described as whitish and like milk or meal and water. He was seen by Surgeon McBurney the following morning and was found to be in a state of extreme weakness and collapse, extremely cold and without a perceptible pulse at the wrist. A mustard emetic was administered around midday after which he appeared to revive a little. However, this proved only to be a temporary respite and he died between 7 and 8 p.m. that evening some nineteen hours after becoming ill.

High Street Belfast c.1831. A water cart can be seen to the right of the picture

Source: Ulster Museum IC/High St/831

Murtaugh had become the first recognised victim in Ireland to have died from what was then perceived as a new a frightening disease from the East, Asiatic cholera, though in truth it was new only to the West. Cholera, notable for its severity, rapidity and high mortality had been endemic in India in for some time before spreading throughout Asia after 1817 and Europe after 1829. Its signature symptoms, violent vomiting and diarrhoea resembling rice husks were usually accompanied by agonising cramps, muscular spasms, a weakened pulse, low temperature, and a blue tinge to the nails and skin. They were caused by infection with a microorganism, vibrio cholerae, usually following the ingestion of water contaminated by the excreta of another cholera sufferer, particularly in places where infected sewage was able to seep into the public water supply. In the towns and cities of nineteenth century Ireland where sanitary practices and sewage systems were often rudimentary at best this particular method of dissemination was a common and deadly hazard.

In Ireland alone around 40% of those who contracted cholera between 1832 and 33 would die as a consequence and in some areas mortality rates were as high as 76%. In a second outbreak during 1848/49 mortality rates were even higher, with the disease finding easy prey in the form of a population severely weakened by Famine and its associated illnesses. Belfast’s mortality rate at just 16% was however, much more favourable than anywhere else in the country and was significantly lower than Dublin or Cork who experienced rates in excess of 40%.

A Court For King Cholera. This famous cartoon depicts conditions conducive to the spread of cholera.

Source: Wellcome Images

Nineteenth century Belfast was Irelands only industrialised town and outwardly appeared successful and prosperous. Described by one commentator as looking as if it ‘had money in its pocket and roast beef for dinner’. However, while industrialisation had created opportunity, it also created serious social issues particularly in the provision of housing, water supply and sanitation. Housing for the labouring poor was laid out in a grid pattern of confined and insanitary courts, lanes and alleys, commonly consisting of two story buildings occupied by two or more families. Few houses were provided with piped water and over 7,000 houses were supplied from public fountains, by water carts, or from pumps sunk by landlords. Sewers were often constructed to deposit their effluent directly into the town’s main watercourses and high tides and flooding regularly carried effluvia back onto the streets and into the homes of those who lived in their vicinity, making sanitary conditions and their likelihood of contracting serious illnesses inherently worse.

When cholera came however, Belfast appears to have been as well, if not better prepared to combat the disease than most. The initial response was the remit of the Police Commissioners and of an ad hoc and hastily formed Board of Health. Working closely together, a systematic programme of street cleaning and of whitewashing and fumigating houses was instigated. Temporary hospital accommodation was provided in the grounds of the towns Fever Hospital with Dr Henry McCormac placed in charge. McCormac combined a strict isolation policy with treatments which included bloodletting and the administration of calomel (mercury), opiates and dilute sulphuric acid. Though mortality in the hospital was much higher (22%) than for the rest of the town there does appear to have been less resistance in Belfast to the idea of going to hospital than was the case elsewhere. In Dublin for example, opposition was such that carriages carrying the sick to hospital were occasionally set upon, the patients ‘rescued’ and the carriages thrown in the Liffey.

Cholera Localities Belfast 1832

Source: A.G. Malcolm ‘The Sanitary State of Belfast with Suggestions for its Improvement’

http://www.tara.tcd.ie

By the end of the first epidemic over 400 people had died in Belfast and cholera, as did on-going preventative public health provision, passed quickly from public consciousness. Thus, when cholera returned to Ireland in 1848 practically nothing had changed in the way it was fought. However, during this second epidemic, the efforts of Belfast’s new Board of Guardians, the physician and sanitary reformer Dr Andrew Malcolm and additional sanitary powers granted to the new Town Corporation by town improvement legislation arguably prevented a much higher death toll than was experienced elsewhere. The Guardians, for example acted in defiance of the Poor Law Commissioners when they opened the Belfast Workhouse in 1841 with ten beds for the reception of the sick, rapidly increasing this to 100. The Corporation introduced new housing regulations and were granted additional sanitary powers, giving them more authority to require landlords and property owners to remove nuisances and pave streets. However, by 1848 Dr Malcolm reported that there continued to be a ‘lamentable deficiency’ with regard to the removal of offensive remains. As fears of choleras immanent arrival grew the influential Malcolm rose to the fore to guide the municipal authorities. A Sanitary Committee headed by Malcolm and specifically aimed at dealing with cholera in the first instance was formed in 1848. The Committee published and distributed reports, magistrate’s orders were issued for the removal of nuisances, poor families were provided with straw bedding, houses were whitewashed and new sewers were constructed in some parts of the town.

Despite the preparations however, fatalities were almost treble those of 1832. Though Belfast now had two hospitals capable of receiving cholera patients the willingness of the sick to be admitted had declined decidedly. The Committee of the General Hospital attributed the reluctance to ‘prejudices or perhaps the state of apathy and hopelessness which accompanies this severe malady’ and commented that it was a ‘matter of regret, that that the advantages of the hospital were not more generally or duly appreciated by the poor’. By the end of the epidemic 3,538 cases and 1,163 deaths had been recorded but mortality at 33% was again lower than that of other sizable Irish towns. However, in Belfast’s worst affected areas, poverty and deficiencies in sanitation and hygiene had clearly been instrumental in the spread of the disease. And while the town’s municipal authorities had effected much civic enhancement, major sanitary improvements had not been instigated in the areas of the town where they were most required. Nevertheless, some lasting lessons had been learned and when cholera returned again in 1853 and 1866 mortality rates were almost insignificant by comparison.

Nigel Farrell is a third year PhD student based at the University of Ulster Coleraine and is researching cholera and the development of public health in Belfast between 1832 and 1878. The above post is based on his winning entry to the History of Medicine in Ireland Prize competition.

The Heritage Collections of the Royal College of Surgeons in Ireland by Meadhbh Murphy

In this month's post, Meadhbh Murphy, archivist at the Royal College of Surgeons in Ireland, outlines some of the College's important heritage collections.


The Royal College of Surgeons Heritage Collections contains a unique and amazing collection of material relating to the history of medicine in Ireland and abroad. The collection covers the last 250 years and touches on medical as well as on the social, historical and personal events that took place. The variety and scope of this material is immense ranging from the College Charter granted by George III on February 11^th 1784; ivory handled operating knives to the birth certificate of Emily Winifred Dickson, the first female fellow of the College; from tapestries embroidered by the wife of one of the founders of the college, Sylvester O’Halloran, and finally to a handwritten and signed speech given by William Stoker to the Royal College of Physicians in 1835.

College Charter granted by George III on February 11^th 1784

The most important manuscript in the collection is the Practica Magistri Johannis Ardern (RCSI/MS01) presented by Sir John Lentaigne in 1851. The only complete copy worldwide, it treats of surgical practice. Its author John Arderne was a surgeon who lived near Nottingham from 1307-1390. The historical value of the work lies in the account it provides of surgery in England in the fourteenth century. 

Extract from Practica Magistri Johannis Ardern (RCSI/MS01) 

To make this wealth of material available to researchers and academics the Heritage Collections are undergoing a transformation. Every aspect from the reading room, archival storage, website and online catalogue are being looked at. The reading room has been re-furbished creating a bright and airy research environment. The archival material and manuscripts are being re-housed and catalogued into a user-friendly online system. The Heritage Collections web pages have been updated and can be found here http://www.rcsi.ie/heritagecollections

A blog informing the public and researchers of interesting material, new discoveries, upcoming events and news related to the Heritage Collections can be found here http://rcsiheritage.blogspot.ie/

The Heritage Collections will be closed from 1^st March until further notice to facilitate these changes. But please feel free to contact us at archivist@rcsi.ie or by phone on (01) 402 2511 during this time with any inquiries or possible donations you may have. 

‘Not unlike an evil dream’: a medical student’s account of Spanish flu in the Meath hospital, Dublin by Anne MacLellan

This month's blog post is by Dr Anne MacLellan, Director of Research at the Rotunda Hospital, who discusses the writings of Dorothy Stopford, a Dublin medical student, relating to the Spanish flu in Ireland.

In January 1916, at the age of 26, Dorothy Stopford (1890-1954) entered Trinity College Dublin to study medicine. The 1916 Easter Rising, the Great War, and the Spanish influenza pandemic of 1918-1919, formed the turbulent backdrop to her introduction to medicine. A remarkable series of letters written by Dorothy to Sir Matthew Nathan (Undersecretary for Ireland 1914-1916) during her time as a clinical clerk on the wards in the Meath hospital, Dublin, provide a compelling account of working through the Spanish flu which, hard on the heels of the Great War, claimed the lives of many young Irish people.

The dreaded flu, with its penchant for young lives, brushed against Dorothy in July 1918, following a whirl of exams, when she, herself, had a ‘touch of Spanish flu, cured at night and ignored during the day’. In October 1918, Dorothy, now a third-year medical student, ‘exercised her powers cautiously’ on the wards as she knew she was ‘horribly ignorant and junior’. She could do little other than what the ward sister suggested. ‘I am in her hands and learning a lot. We are packed with influenza cases, mostly DMP [Dublin Metropolitan Police]’. Mortality was high as it was a very violent form of the flu generally ending in pneumonia. However, Dorothy told Sir Matthew that the ‘bug’ had been found and inoculation was being used for curative purposes although it was too late to say with what success.

A monster representing an influenza virus hitting a man over the head as he sits in his armchair. Pen and ink drawing by E. Noble, c. 1918. Courtesy of Wellcome Images. ICV No 16001.

At the end of the month, she suffered from ‘a private tragedy’ when her great friend Cesca Trench died from the flu on 30 October. After a long courtship, Cesca had married Irish volunteer, librarian and biographer Diarmid Coffey on 17 April 1918. Both Diarmid and Cesca were described by Dorothy as ‘very intimate friends’ and she was ‘the most splendid and beautiful creature I had ever known’, wrote Dorothy. Cesca was only ill for three days and ‘went out like a flash, the last person, full of life and vitality, that you could think of dying’.  Cesca’s death was typical in that this flu was more likely to lead to death among young adults than among the usual flu victims – the elderly and the very young.

In November, Dorothy informed Sir Matthew that the ‘general scrimmage of the influenza epidemic which is pretty hot here’ continued. Dorothy worked with two nurses on a landing  in the hospital where there were about 30 ill patients and the sister had been laid low. The ward was full up with policemen and there were a lot of deaths. ‘It was very horrible’, she declared, but things seemed to getting better and most people recovered. Sadly, the sister, who had been ‘particularly nice’ died.

Dorothy was also impressed by her ‘chief’, Professor William Boxwell, who was not only ‘very clever but also very grand and fine, he is up and about night and day and has pulled a lot of people through’. As for her own contribution, she said it was difficult knowing so little and death seemed very terrible. But, she got used to it quickly in the general busyness of ward work and found her feet. The amount of ‘odds and ends’ of doctoring and nursing that she absorbed in two weeks under pressure was ‘rather astonishing and one gains confidence’.

Dorothy Stopford at the Meath Hospital, undated. Photograph courtesy of Dr Ida Milne.

Professor Boxwell was ‘mad on post-mortems’ and Dorothy assisted him with the dead as well as the living. Boxwell tried to get a portion of lung from each flu victim and, at 10 pm, at night Dorothy would bicycle down to the mortuary where, ‘with or without the aid of a night porter’ she carried in about three corpses into the post-mortem room, and ‘stripped them ready and made them tidy again’. She remembered nights when the rain pelted down on the glass roof and she was alone inside trying to get the corpse into its habit and back on the bench. She recalled these details later and did not mention them in her contemporaneous letters – probably in a bid to spare Sir Matthew the horrific details.

On 15 February, 1919, Dorothy Stopford was finding life very exciting, having attained some self-confidence in her powers of healing. ‘I don’t believe at all in women doctors not liking to take responsibility, at least I don’t see why they shouldn’t  but it’s always charged against them.’ It was largely a matter of knowing your work and being careful, she declared, ‘the rest is experience, more than brains, with plenty of self assurance.’ Dorothy Stopford (later Dorothy Price) became a confident, assured doctor with no reluctance to take responsibility. She became a leading international expert on childhood tuberculosis, a public campaigner for the formation of a national anti-tuberculosis league, and the chair of the National BCG Committee.

In March, Dorothy told Sir Matthew that they were having another epidemic, just as bad as the autumn one. ‘Five with pneumonia, the latter proving frequently fatal, and the hospital is once more not unlike an evil dream; still lots recover too.’ She had another public exam looming in a week’s time but was undecided about sitting it as ‘this flu business puts one off book work’.

Author's note: The letters of Dorothy Stopford to Sir Matthew Nathan (MS. Nathan 204, fols.164-291) are held in the Bodliean library in Oxford, England (many are undated so the chronology of the letters is not always clear). The papers of Diarmid Coffey and Cesca Trench are held in the National Library of Ireland, Dublin. The account of post-mortems carried out during the Spanish flu are to be found in the volume Dr Dorothy Price, written by Dorothy’s husband Liam Price, and printed at the University Press, Oxford,  for private circulation, in 1957.

Video

Video of a lecture, 'Victim or Vector? Tubercular Irish Nurses in Britain 1930 to 1960', by Dr. Anne MacLellan, at the workshop, 'Health, Illness and Ethnicity: Migration, Discrimination and Social Dislocation', held at the Centre for the History of Medicine in Ireland, June 2011

Victim or Vector? Tubercular Irish Nurses in Britain 1930 to 1960 from CHOMIreland on Vimeo.

Anne MacLellan is the Director of Research at the Rotunda Hospital, Dublin. She is the winner of the Royal College of Physicians 2012 History of Medicine Research Award and the joint winner of the Ulster University/Centre for the History of Medicine’s History of Medicine in Ireland essay prize, 2011. Anne’s PhD, from the UCD School of History and Archives (2011), was funded by Wellcome Trust. She may be contacted by email at amaclellan1 "at" gmail "dot" com.

How the poor lived: Tenements, public health and medicine in 1913

In April this year, RCPI and the Dublin City Library and Archives held a joint seminar looking at medicine and public health in 1913, as part of the Dublin One City, One Book festival. Webcasts of the two papers give at the seminar are now available on the RCPI Player.

Sir Charles Cameron: Medical Officer of Health for a Strumpet City by Dr Lydia Carroll

Dr Lydia Carroll holds a PhD from the School of History and Humanities at Trinity College Dublin. She recently published In the Fever King's Preserves. Sir Charles Cameron and the Dublin Slums, the first major biography of Sir Charles Cameron. She has also contributed to Leaders of the City. Dublin's First Citizens 1500-1950, edited by Ruth McManus and Lisa-Marie Griffith. She is a seventh-generation Dubliner, whose family have lived and worked in the heart of Dublin for more than two centuries. Her paper looks at the work of Sir Charles Cameron, Medical Officer of Health for Dublin, and his work in improving the sanitary and living conditions in the city at the end of the 19^th and beginning of the 20^th centuries.

A grave crisis?: The impact of the National Insurance Act on health care and the medical profession in Dublin by David Durnin

David Durnin is an Irish Research Council for the Humanities and Social Sciences Doctoral Scholar at the Centre for the History of Medicine in Ireland, University College Dublin. He holds an MA in the Social and Cultural History of Medicine from the Centre. His current research project, entitled 'The War away from Home': Irish Medical Migration during the Great War Era, 1912-1922 explores the role and experiences of Irish medical personnel during the First World War. His paper looks at the conditions facing the medical profession in 1913, and especially the impact of the newly introduced National Insurance Act.

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

Early Soviet Nursing by Susan Grant

In this month's post, Dr Susan Grant, Irish Research Council CARA Mobility Postdoctoral Fellow, University College Dublin and University of Toronto, outlines her research project which examines nursing in Russia and the Soviet Union, 1914-1941.

In 2005 the Nurses Association of Russia joined the International Council of Nurses; this was the first time that any Russian or Soviet nursing association or organisation had cemented official links with an international nursing organisation. Until this point, Soviet nursing and nurses had remained isolated behind an iron curtain. In an effort to explain the deeper, underlying reasons for the lack of a strong professional organisation of Russian and Soviet nurses, it is necessary to examine the origins of Russian nursing. Consequently, this project explores the early development of Russian and Soviet nursing, beginning with its original philanthropic roots in the late Imperial era to the impact of the First World War and Bolshevik Revolution in 1917. This was a critical period for Russian nursing with events and decisions arising from war and revolution largely determining the future course of Russian nursing.

2nd sister detachment of workers from the textile factory in Kostroma. 

Departure to the front in 1919.

Source: Rabotnitsa 4 (1933): 7.

Source: Za sanitarnuiu oboronu, 10 (1939): 13.

With the Bolsheviks securely in power, the project then moves on to assess Soviet attitudes to nursing and examines the type of system that was established for the training and education of nurses under the new regime in the 1920s and 1930s, and the various changes that occurred in this system over a twenty year period. In the immediate wake of the October 1917 revolution and ensuing civil war (1918-1921) there were efforts to establish an international school of nursing, pursued largely by English and American Quakers, who hoped to establish a nurse training centre in Russia based on a western system of nursing education. However, in spite of official Soviet government approval, this never came to pass. In this project I examine the various reasons for this and outline the reasons behind why the kind of training system that emerged in Soviet Russia during this period was established. 


The type of system that eventually did emerge after years of war and revolution sought to separate nurses from their Tsarist era image of a religious Sister of Mercy and instead turn her into a proletarian type of “red sister”, and later a “medical sister”. However, in attempting to transform the social and political perception of the nurse, the nurse’s social status was not improved. Inhabiting almost the lowest rung on the medical professional ladder, the nurse struggled to gain respect and professional recognition. With largely inadequate training facilities, mixed attitudes to their competency by both colleagues and the authorities, and frequently poor living and working conditions, I aim to assess the doctor/nurse/patient dynamic within the hospital, clinic, or sanatorium and how this impacted on treatment and care. Using a variety of archival and printed sources in Russia, Britain and the United States, I aim to bring into focus the role and status of the Soviet nurse during this formative period of Russian history and draw on various Soviet, gender, and medical discourses to shed light on the position of the nurse within Soviet society.

Podcast

Podcast of a lecture 'Caring Communists? The Development of Early Soviet Nursing, 1917-1941' by Dr. Susan Grant, given as part of the Centre for the History of Medicine in Ireland (CHOMI, UCD) Seminar Series, 31 January 2013.

Susan Grant is an Irish Research Council CARA Mobility Postdoctoral Fellow, University College Dublin and University of Toronto.  She recently published her book, Sport and Physical Culture in Soviet Society: Propaganda, Acculturation, and Transformation in the 1920s and 1930s (New York and London: Routledge, 2012) which is based on her PhD dissertation. Susan also held the 2012 Alice Fisher Fellowship at the Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania. For more information on Susan's research, click here.

Irish Doctors in the First World War by David Durnin

‘The absence of conscription in Ireland leaves it open to young Irish practitioners to profit by the military service of English, Scottish and Welsh doctors and set up practice in the homes of the absentees to their obvious hurt. How does the British Medical Association hope to deal with that? Nay, to put it more fairly, how can we hope that the British Medical Association can right this wrong?’ 

 On 20 January 1917, the British Medical Journal published the above letter sent by an unidentified Captain in the Royal Army Medical Corps – the British Army’s medical division. The letter highlighted underlying feeling among some British doctors that Irish medical personnel, rather than participating in the First World War, travelled to Britain to occupy jobs left vacant by medical men serving with the British Army. In response, Dr Maurice Hayes, a graduate of the Catholic University of Ireland, argued that the Irish medical profession, without compulsion, had ‘provided a steady flow of volunteers to the British Army’. From 1915 to 1919, Hayes acted as Honorary Secretary of the Irish Medical War Committee – a group of leading medical professionals, responsible for encouraging Ireland’s doctors to enlist in the British Army. Prominent members of the committee included Ephraim Cosgrave, President of the Royal College of Physicians of Ireland; D.J. Coffey, President, University College Dublin; A.F. Dixon, Dean of Faculty of Physic, Trinity College, Dublin and F. Conway Dwyer, President, Royal College of Surgeons Ireland. The group, through letters and newspaper advertisements, appealed to Irish medical professionals to volunteer for war service. Their appeals were successful. From the outbreak of war in 1914 to the end of hostilities in 1918, Irish doctors enlisted in the British Army medical services.

Portion of a battle line, outlining casualty clearing stations 

Source: Wellcome Images, L0027194, Wellcome Library 

 On 18 August 1914, the first contingents of Irish medical personnel travelled to France; No.1 Stationary Hospital, No.1 General Hospital and No.13, 14, and 15 Field Ambulance Divisions departed Dublin for Le Havre. On the same date, No. 16 and 17 Field Ambulances departed Cork for Saint-Nazaire. Initial reactions to the wartime setup varied among the contingent depending on their assignment. In 1914, RAMC Command implemented an intricate casualty clearing process on the Western Front. Significant numbers of medical personnel occupied the roles at each stage of this process and Irish physicians and surgeons were among them. Stretcher-bearers collected injured soldiers from the combat zone and carried them to the nearest Regimental Aid Post – a zone occupied by RAMC MOs, normally located in shell craters or building ruins – before transporting the wounded to Advanced Dressing Stations. Here, injured soldiers had their wounds dressed and were then transported via Field Ambulance – horse-drawn carriages or motor vehicles – to a Casualty Clearing Station (CCS). RAMC medical personnel in the CCS dealt with injuries requiring immediate treatment and conducted numerous surgical procedures. Ambulance cars and trains then transported the wounded, fit for transportation, to nearby hospitals established by the RAMC or voluntary groups, like the Red Cross. Hospitals were located close to battlefields. MOs also identified wounded men better suited to treatment in hospitals on the home-front and recommended these men be moved, via hospital ship, back to domestic hospitals in Britain and Ireland. 

Photograph showing a ward, with patients either in bed or on chairs, c.1915 

Source: Wellcome Images, L0060826, Wellcome Library 

The majority of hospital ships arriving in Ireland docked in Dublin and contained an average of 400 soldiers. From 1914 to 1918, approximately 70 institutions located throughout Ireland provided facilities for the treatment of 16,000 returning sick and wounded. These included auxiliary wards and hospitals and a number of specialist institutions established by RAMC Command (Ireland) for the treatment of specific diseases. In 1915, for example, the War Office appointed Lieutenant-Colonel William Dawson, Inspector of Lunatic Asylums in Ireland, as RAMC (Ireland) specialist in nerve diseases. On 16 June 1916, Dawson took charge of the Richmond War Hospital, located in Dublin’s Grangegorman Asylum. The Richmond War Hospital catered for 32 soldiers suffering from mental disorders. From the date of opening till its closing on 23 December 1919, the Richmond War Hospital treated 362 cases, of which two-thirds were discharged to friends or ordinary military hospitals, two returned to duty and 31 sent directly to civil asylums. While the institution was helpful in the RAMC’s attempts to provide treatment for mental cases, it was undeniably small. Therefore, in October 1916, the War Office requested Dawson to facilitate them by placing an asylum with 500 beds at the disposal of the RAMC. Similar arrangements had been managed successfully in Britain. In Ireland the vastly overcrowded asylums made this an unlikely prospect. Yet, in April 1917, the War Office acquired Belfast’s Civil Lunatic Asylum and incorporated it as part of the Belfast War Hospital. The hospital received Irish men suffering from mental illness during active service and also treated men, not of Irish birth, who belonged to Irish regiments. The first military cases arrived on 15 May 1917. Staff consisted of men who had enlisted in the RAMC for the duration of the war and who had previous experience working in asylums. Between the opening of the hospital and its closing on 15 December 1919, 1,193 cases were admitted; 772 were discharged into the care of their family or friends and 103 transferred to other hospitals more suited to their treatment needs. 

This post has given a brief overview of Irish medical involvement in the First World War and using the small example of Irish asylums, has highlighted the impact of the conflict on Irish medical infrastructure. In future pieces, I will profile some of the Irish doctors who participated in the First World War and, using details gathered from diaries and letters, detail their roles and experiences on various fronts. As a PhD student researching Irish medical personnel in the First World War, I am always pleased to be contacted with details of new source material. If you are in possession of diaries, letters or postcards of Irish medical personnel who participated in the First World War, please get in touch – David “dot” Durnin “at” ucd.ie 

David Durnin is an Irish Research Council Doctoral Scholar, at the Centre for the History of Medicine in Ireland, University College Dublin. For more information on his research, click here.