Friday, 28 November 2014

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. 

Tuesday, 4 November 2014

Workshop report: Soviet healthcare in the comparative perspective by Susan Grant

In this month's blog post, Susan Grant reports on the recent 'Soviet healthcare in the comparative perspective' workshop which took place at UCD in May 2014.

Historians of Soviet and medical history met in the UCD Humanities Institute May 29-30 to discuss Soviet healthcare in comparative perspective. Generously supported by the Wellcome Trust, UCD Seed Funding, and the Irish Research Council, this workshop represented an important international gathering of scholars from Ireland, the UK, Canada, and the United States.  The inter-disciplinary nature of the workshop meant that there was much debate and discussion among participants (the programme is available on the CHOMI website here).

Nursing in the Soviet Union

The overall aim of the workshop was to analyse the history of Soviet nursing and healthcare in comparative perspective, and to critically examine issues such as professionalization, gender, and care. The workshop mandate was to evaluate Soviet nursing relative to international nursing and healthcare, and to explore how nursing in the Soviet Union developed in relation to other medical professions. Participants were asked to consider the development of Russian healthcare and to compare the Soviet healthcare system to that of other countries.

Comparative aspects of Soviet healthcare

The workshop was a great success, particularly in facilitating cross-disciplinary discussion about the comparative aspects of Soviet healthcare. Panels focused on three key aspects of Soviet healthcare: professionalization, gender and care. The issue of care and the idea of the ‘virtue script’ (as conceptualised and explained in the work of Prof. Sioban Nelson, University of Toronto) fostered a particularly engaging dialogue about how nursing care is conceived and understood. This fed into discussions of what constitutes a ‘good’ and ‘bad’ nurse, as well as patient perceptions of ‘good’ and ‘bad’ nurses.  Nursing care, whether in the Soviet Union or elsewhere, depends on a variety of factors and an individual’s experience of nursing care. Studies of Soviet nursing are limited and probing expectations of care from an international perspective proved very productive in thinking about approaches to Soviet nursing and healthcare practices.

Panel on gender

Papers that focused on gender were particularly helpful in illuminating the difficulties and challenges of dealing with source material such as memoirs, interviews, etc. Prof. Dan Healey, Dr Laura Kelly, and Prof. Christopher Burton shared their experiences of working with memoir literature and the problems this can raise in terms of medical history. This was very informative for everyone, and especially instructive in highlighting the similar experiences of scholars who focus on different periods and countries. Indeed, scholars of medical and nursing history, and also the history of Russia, Ireland, Great Britain, etc., found that they had much in common. Participants specialising in Soviet history were surprised to learn of the liberal aspects of medicine in Ireland at the turn of the century. Cross-disciplinary dialogue here proved fruitful and underlined points of intersection and diversion between Russia and the West.

Transnational healthcare

The comparative dimensions of international healthcare were underscored in the panel featuring Prof. Susan Solomon, Prof. Paul Weindling, and Prof. Anne Marie Rafferty. Papers here focused on the transnational aspects of healthcare, dealing with Soviet cultural diplomacy in the 1920s, continental nurses in the UK  1933-1945, and nursing and decolonization during the second colonial occupation of Malaya, 1946-1955.

Round table on professionalization

The issue of professionalization was discussed in the opening and round table discussions. Scholars of Russian history, including Prof. Donald Filtzer, Prof. Benjamin Zajicek, and Dr Susan Grant presented their papers on professionalisation and practice in Soviet healthcare history.  Discussions about professionalization were elaborated on in the roundtable session, with participants Prof. Susan Solomon, Prof. Sioban Nelson, Prof. Dan Healey, and Prof. Anne Marie Rafferty contributing to a lively debate. It was questioned whether or not theories of professionalisation and histories of the professions are helpful as methods in analyzing both healthcare history and the Soviet case. Findings here were inconclusive, with some scholars acknowledging the merits of professionalisation literature in their work on the Soviet Union or healthcare, and others noting that they found this literature less useful.

The workshop proved that healthcare history continues to be a vibrant field and one that has much value when considering comparative international experiences. We look forward to more discussion of these debates in the future.