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.

Welcome!

Welcome to our new blog! This blog is a collaboration between the Centre for the History of Medicine in Ireland at University College Dublin and the Royal College of Physicians in Ireland Heritage Centre. It aims to highlight exciting research and events in the medical humanities in Ireland. If you are interested in contributing to the blog, please get in touch by emailing historyofmedicineinireland@gmail.com