The Crusade to ‘Conquer Cancer’ in Ireland, 1950s-70s - Smoking and Lung Cancer: The Rise of the Visual by Jane Hand

In this month's blog post, Jane Hand, a PhD student at the Centre for the History of Medicine, University of Warwick, writes about public health initiatives in the campaign against lung cancer in Ireland, c.1958-78. This was the subject of her MA dissertation undertaken at CHOMI, UCD (2011).

Since the late 1950s the relationship between smoking and lung cancer gained increased national prominence in Ireland, becoming the focus for a variety of both public and voluntary health education campaigns. The visual component of these health campaigns was central to the formulation of health education strategies reflecting changing perceptions of disease. In addition, as health advertising became increasingly central to public health, aspects of medicine and media consumption became more closely allied. This facilitated the emergence of a lifestyle-orientated public health centred on behavioural modification in relation to chronic disease diminution.

Fig. 1 Anti-Smoking Leaflet aimed at children, 

Department of Health and Children (NAI S16659A)

The causal connection between smoking and lung cancer was the first major chronic disease model to be explicitly linked to lifestyle factors. Consequently, health education material attempted to incorporate models of behavioural change. The initial release of anti-smoking publicity material in 1958 consisted of two leaflets highlighting the connection between smoking and lung cancer. As shown in Fig. 1 and Fig. 2, the first leaflet targeted adults, whilst the second aimed at reducing the smoking uptake amongst the young. Both publications employed visual techniques centred upon simplistic imagery, eye-catching colour usage and the juxtaposition of upper and lower case text to emphasise particular aspects of its composition to the reader. By adopting a question/answer format these leaflets provided concise and precise health information whilst removing medical jargon from their explanatory texts. Their basic function was to establish a specific mode of behaviour and correct health conduct in relation to cigarette smoking. Minister for Health, Séan MacEntee made the rationale behind the publication of these leaflets by the Department of Health exceedingly clear: ‘The reports of investigations into the death rates from lung cancer have ensured that the results must be brought to the notice of the public’.¹

                                                 

Fig. 2 Anti-Smoking Leaflet aimed at adults,
Department of Health and Children (NAI S16659A)

Efforts to reduce tobacco consumption amongst younger age groups remained a central objective of state-led health promotion initiatives. Consequently the “Smoking Kills Your Taste for Life” campaign centred upon the mantra ‘If You Don’t Smoke - Don’t Start, If You Do Smoke – Stop Now!’ which represented the principal component of the Department’s health education strategy for much of the 1970s. A series of health educational films, including the “Smoking Kills Your Taste for Life” filmlets, were shown in primary schools throughout the country, with Irish-language voiceovers for those schools situated in Gaeltacht areas and some others that requested the Irish version.²

The dangers of smoking were compiled in a booklet The Facts about Smoking and Health, anti-smoking posters were widely circulated and a series of shorts were aired on RTÉ television.³ The establishment of a poster competition on a non-smoking theme proved particularly popular.⁴ The competition itself was widely advertised using press, radio and television. Entry forms had themselves acted as advertisements, comprising a strong anti-smoking message. As displayed in Fig. 3, these provided educative information concerning the dangers of smoking whilst appealing to the public-consciousness to elicit a positive response: ‘Deep down you must know that smoking is bad for your health – but let’s face it, at your age lung cancer seems a remote possibility’.⁵  The use of a direct-address style in the accompanying text to this pamphlet only served to further foster a perception that confidence in curative measures was maintained within the visual expression of disease and illness.

       

Fig. 3 ‘Smoking Kills Your Taste for Life’ poster competition entry form
Department of Health Files (INACT 428227)

During the 1970s an emphasis on the harmful effects of tobacco smoking on the lungs became more overt. The utilisation of various shock tactics, specific medical knowledge and biological explanations became increasingly standard practice. Science was becoming as much a part of the various promotion techniques employed, as were those pleas to health consciousness. Increased biological knowledge facilitated the emergence of a series of intellectually founded anti-tobacco smoking campaigns, particularly those instigated by the Irish Cancer Society, such as “How Smoking Affects Us” reproduced as Fig. 4.⁶ The caption serves to draw the reader’s attention to the integral message of the leaflet thus preventing any possible misinterpretation.⁷ By combining text and illustration the pamphlet successfully attempts to heighten its educative purpose. Ultimately the use of a diagram coupled with numbered explanations serves to convey an otherwise complicated medical message in a concise and understandable format.

           

Fig. 4 Anti-Smoking Leaflet produced by the Irish Cancer Society,
Department of Health Files (INACT 428227)

The 1970s represented the era when persuasion media as a method of health education became central to public health campaigns. Analogous to Britain, state expenditure on health promotion increased dramatically reaching £110,000 for the year 1970-1971, thereby facilitating the application of new-style advertising campaigns highlighting the tobacco and lung cancer risk.⁸ Campaigns developed a more scientific and biological character. The use of a series of precise anatomical diagrams designed to outline the effects of smoking on the body became evermore commonplace Whereas almost all anti-smoking propaganda produced during the late 1950s and 1960s had focused exclusively on the relationship between smoking and lung cancer, the 1970s was notable for widening the scope of the anti-smoking crusade. No longer was the lung perceived as the only body organ to be affected by the adverse effects of prolonged cigarette smoking, but rather its additional detrimental effects, as displayed in Fig. 5, Fig. 6 and Fig. 7, on the heart, brain, and nose and throat in particular were increasingly expounded.

Fig. 5, Fig. 6 and Fig. 7 The Better Health Pack Leaflets
on the bodily effects of smoking (NLI Ir614 h4)

Moreover, the focus altered somewhat with increased state interest in the effects of smoking on the pregnant woman. The dangers of smoking in pregnancy were highlighted in a special article entitled ‘You and Your Baby’ which was distributed nationally by the medical profession to expectant mothers.⁹ With the formation of the Health Education Bureau in 1975 and its greatly increased budget following the appointment of Charles Haughey as Minister for Health in 1977, state sponsored health campaigns adopted a more sophisticated composition.¹⁰ The tar and nicotine content of cigarettes was increasingly emphasised to create an anti-aesthetic surrounding the habit of smoking.¹¹ The promotion of anti-smoking material centred on the endorsement of behavioural change rather than on compulsion, with the media providing the key factor within a new style of health activism. 

The modification of individual behaviour through the initiation of highly stylised visual health campaigns became central to public and voluntary information programmes. As encapsulated by MacEntee, lifestyle choice and behavioural change became pivotal to the success of anti-smoking education campaigns centred upon the concept that ‘If you have never smoked, don’t take it up; if you are already a smoker, give it up, or at least do not smoke immoderately’.¹² By accepting the epidemiological argument for a connection between smoking and lung cancer both the state and voluntary organisations alike firmly aligned themselves to the implementation of a programme of preventative measures. This was achieved through the adoption of visual illustration as the main feature of health advertisement material. The promotion of anti-smoking material within Irish public health campaigns relied upon the efficacy of visual advertising in producing health responses on the part of the public. Ultimately this ‘visuality’ in promotion methods was key to the rise of a new health ideology based on individual responsibility for healthy lifestyles and behaviours.

Jane Hand is a doctoral student at the Centre for the History of Medicine, University of Warwick. Her PhD is entitled 'You Are What You Eat: Chronic Disease, Consumerism and Health Education in Britain since the Second World War' and she may be contacted at j "dot" hand "at" warwick "dot" ac "dot" uk

Author’s note:

The images reproduced in this post were sourced directly from the Department of Health with the permission of Fergal Flynn, Department of Health.

All other primary source material is held at the National Archives of Ireland.

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1. Department of An Taoiseach, ‘Cancer: Publicity Leaflets etc.,’ 11^th February 1958, National Archives of Ireland, TAOIS S16659A. [Italics added by author].↩
2. Anon, ‘Radio programme on cigarette smoking’, 1973, Department of Health and Children, INACT 461262.↩
3. Minister for Health (Erskine Hamilton Childers), ‘Radio Programme on Cigarette Smoking 19/06/1973 – Written Answers’, Department of Health and Children, INACT 461262.↩
4. Minister for Health (Erskine Hamilton Childers), ‘Radio Programme on Cigarette Smoking 19/06/1973 – Written Answers’, Department of Health and Children, INACT 461262.↩
5. Minister for Health (Erskine Hamilton Childers), 'Address by Mr Erskine Childers, T.D., Táinaiste and Minister for Health at the Prize-giving ceremony in the anti-smoking poster competition in the Metropole Ballroom, Dublin, 6 January, 1971’, Anti Smoking Poster Campaign for School Children and Television Campaign, Department of Health and Children, INACT 422036.↩
6. The Information Services of the Irish Cancer Society, Smoking Burns You Up: How Smoking Affects Us, Leaflet Department of Health and Children, INACT 428227.↩
7. Cooter and Stein, ‘Coming into focus’, p. 186.↩
8. Coiste no gConnartha Rialtas, ‘A meeting of the Government Contracts Committee’, 6 August 1970, Department of Health and Children, INACT 422036; Minster for Health (Erskine Hamilton Childers), ‘Ceisteanna – Questions. Oral Answers – Health Educational Programmes’, Dáil Debates, vol. 254, col. 2249-2250, 23 June 1971; Berridge and Loughlin, ‘Smoking and the New Health Education in Britain 1950s-1970s’, pp 960-961.↩
9. Anon, ‘Radio programme on cigarette smoking’, 1973, Department of Health and Children, INACT 461262; ‘ “You and Your Baby”: A Family Doctor Publication by the Irish Medical Association in conjunction with the British Medical Association’, Department of Health and Children, INACT 461262.↩
10. Dwyer, Short Fellow, p. 152. ↩
11. Berridge and Loughlin, ‘Smoking and the New Health Education in Britain 1950s-1970s’, p. 961.↩
12. Irish Times, 5 Dec. 1959.↩

“Is it in a crazy-house for females that I'm landed now?” Psychiatric institutions and the theatricality of madness in John Millington Synge’s drama by Claire Poinsot

In this month's blog post, Claire Poinsot, a visiting doctoral student from Université Sorbonne Nouvelle, Paris 3, at CHOMI last year, writes about her research on psychiatric institutions and the theatricality of madness in the work of the Irish playwright John Millington Synge.

Raging madmen, true idiots born, and raving maniacs

When Old Mahon sees his son Christy being acclaimed by the villagers in The Playboy of the Western World (1907), he does not recognise the cowardly young man who tried to kill him a few days earlier. “Is it in a crazy-house for females that I’m landed now?” the old man exclaims, incredulous. The comical reference to the asylum here serves a pragmatic purpose – to emphasize the situational turnaround that made poor Christy a playboy. But one cannot help but notice the recurrence of such references to psychiatric institutions and symptoms in Irish drama during the Celtic Revival. John Millington Synge (1871-1909), one of the most famous playwrights of the period, peopled his plays with “raging mad[men]”, “true idiot[s] born” and “raving maniac[s]” “foaming”, for whom “madhouse[s]”, “crazy-house[s]” or more properly called “asylums” were the only possible end.

Could madness be a defining theme of Irish writing?

Did these representations of madness echo the actual structures and strategies of the care of the insane in Ireland? This would evidence the fact that the playwright knew about psychiatry; how could artists be acquainted with medical discourse? From a literary point of view, what did the recurrent reference to madness entail in terms of stylistic effects? Were these mentions of the various psychiatric symptoms, nosologies and institutions a mere stylistic effect, a hyperbolic vulgarization of the medical lexicon meant to emphasise the linguistic vivacity of the characters and the destabilisation of society during the nationalist struggle? In that case could madness, and more precisely identity and memory disorders be a defining theme of Irish writing? These are some of the questions I aim to bring into focus in my thesis.

Psychiatric discourse and Irish drama

The celebrated Irish scholar Declan Kiberd wrote that “the first [way to interpret a classic] is to interpret it historically, in terms of the ideas and events of its own age. One of the most useful services a scholar can perform is to create the conditions and materials out of which a work of art first came.”[1] With this quote in mind I came to the Centre for the History of Medicine in Ireland in April 2013 to try and recreate the medical context in which J. M. Synge’s but also W. B. Yeats’ plays were written. I meant to determine the extent to which psychiatric discourses pervaded Irish drama through newspapers articles, advertisements, and vulgarized representations of madness in paintings and other literary texts; this theory would help qualify the traditional representation of the Celtic Revival as a merely backward-looking movement.  In this post I would like to outline some of the key stakes of my research by focusing on the example of asylums in John Millington Synge’s drama.

John Millington Synge (1871-1909)
Image from: http://www.stanford.edu/group/fam/cgi-bin/family/individual.php?pid=I12183&ged=auden-bicknell.ged

A potent, dramatic setting

Though Synge deplored the effects of modernity on Irish traditions and literature in his preface to The Playboy of the Western World, he was concerned with contemporary medical debates. This can be linked to his declining health – he was to die of Hodgkin’s disease in 1909 - but also to an intellectual interest in the question of mental health in particular. The playwright repeatedly mentions asylums in his works, and also includes popular representations of madness, thus informing us of the way mental disease was perceived at the beginning of the twentieth century in rural Ireland. The system of care for the insane in Ireland had steadily developed since the end of the eighteenth century. In 1900 indeed, there were 22 district asylums, 12 private asylums, 4 charitable hospitals for the insane and a Central Criminal Asylum in the country. All in all 21,169 patients were accommodated in psychiatric institutions in Ireland according to medicine historian T. Percy Kirpatrick.[2] Asylums had therefore become a prominent part of the Irish landscape but still inspired awe and defiance, and playwrights were keen on exploiting this potent, dramatic setting.

Conflicting representations of the asylum

Synge used the asylum in his plays either as a fantasized place where patients were deprived of their freedom and individuality, or on the contrary as a place of quietness and beneficial isolation, far from the vicissitudes of society. Such conflicting representations of the asylum mirror those that could be found in newspapers as scandalous testimonies on the supposedly awful conditions of living alternated with laudatory praise of the board of governors’ and medical superintendants attempts to promote activities and humane care for the “lunatics”. The asylum is never the actual setting of the plays, but it features in several of them, most prominently so in his first play When the Moon Has Set Yeats and Lady Gregory rejected in 1901. The protagonist, Colm, hears a “nearly crazy”[3] woman moan and scream as he walks across the bogs. Bridget tells him about the tragic story of Mary Costello and her stay at the Asylum in those terms:

it’s ten years she was below in the Asylum, and it was a great wonder the way you’d see her in there, not lonesome at all with the great lot were coming in from all the houses in the country, and herself as well off as any lady in England, France, or Germany, walking around in the gardens with fine shoes on her feet. Ah, it was well for her in there, God help her, for she was always a nice quiet woman, and a fine woman to look at, and I’ve heard tell it was ‘Your Ladyship’ they would call her, the time they’d be making fun among themselves.[4]

The idyllic depiction of the institution is contradicted a few years later in The Shadow of the Glen (1903). In the following excerpt, a Tramp tries to convince a woman living in an isolated glen that living on the road is the ultimate form of freedom, though the life of a tramp is not devoid of fear. He admits it implicitly when he declares:

TRAMP (Speaking mournfully) […] If myself was easily afeard, I'm telling you, it's long ago I'd have been locked into the Richmond Asylum, or maybe have run up into the back hills with nothing on me but an old shirt, and been eaten with crows the like of Patch Darcy—the Lord have mercy on him—in the year that's gone. 

The Richmond Lunatic Asylum

The Richmond Lunatic Asylum, opened in 1815, was probably the most famous asylum in Ireland; it is here depicted as society’s attempt to regulate the outcasts’ alternative way of life, but also as an avowal of failure for those who are unable to cope with harsh conditions of living and a dreaded sanction for this lack of courage. As for the spectacular and apparently unrealistic case of Patch Darcy, he was probably inspired by the real case of farmer John Winterbottom Synge heard about when he was staying in County Wicklow. Winterbottom apparently did take off his clothes and ran away, only to be found dead weeks later.[5] Synge notes the importance of the structures of care for the insane in the Wicklow peasants’ imagination: “when they meet a wanderer on foot, these old people are glad to stop and talk to him for hours, telling him stories of the Rebellion, or of the fallen angels that ride across the hills, or alluding to the three shadowy countries that are never forgotten in Wicklow – America (their El Dorado), the Union and the Madhouse”.[6] Therefore the comparatively numerous references to asylums and workhouses in his drama correspond to his own almost anthropologist observations of Irish rural life. Real psychiatric institutions and cases were a source of inspiration for the Irish writer and give a somewhat realistic background to his depiction of madness whereas in other excerpts madness is staged in its popular conception. This shows how the beginning of the twentieth century was a transition from traditional views of madness to an increasingly scientific stance that began to pervade Irish society as a whole, with artists as the advance guard in the process.

The Lower House of the Richmond Lunatic Asylum (later Grangegorman)
Image from: http://pix.ie/limerickstudent/757250

A peculiar climate

As a layman, Synge had a limited knowledge of the aetiology of mental illness; he therefore resorted to traditional interpretations and attributed the seemingly high proportion of mental diseases in Ireland (a question that was a matter of debate and speculations at the time) to the peculiar climate of the island:  

[in Wicklow] when the sun rises there is a morning of almost supernatural radiance, and even the oldest men and women come out into the air with the joy of children who have recovered from a fever. In the evening it is raining again. This peculiar climate, acting on a population that is already lonely and dwindling, has caused or increased a tendency to nervous depression among the people, and every degree of sadness, from that of the man who is merely mournful, to that of the man who has spent half his life in the madhouse, is common among the hills.[7]

Was insanity on the increase?

“Is insanity on the increase?”, Dr William Corbet wondered in 1874, or was it simply a matter of increased structures of care and a better knowledge of madness ?[8] Whether it corresponded to an actual observation or not, there was indeed an inflation of the number of insane at least in Irish drama…or to be fair of people labelled “mad”. Unsurprisingly, the words from the lexical field of madness that are the most commonly used in the Playboy are those that have “contaminated” everyday language as terms of abuse, such as “fool”, “mad” and its derivatives (“madman”, “madness”). This general hyperbole entails an exaggerated and deformed representation of Irish rural society and takes part in a process of rhetorical undermining of the characters by one another. One should keep in mind the comic potential of the medical terms of abuse and interjections for the audience, since almost all of the characters have their mental health questioned in the play, from Old Mahon whose “cracked skull” could cause delirious hallucinations to the Widow Quin who murdered her husband and Christy himself, “the loony of Mahon”. By repeatedly using the lexicon of mental illness, the playwright stages an unstable world, a society on the brink of collective madness where no truth or character is permanent but transitory and fluctuating.

Dottyville

The clinical symptoms of madness in the play are fascinating to analyse in that some of them actually resemble real clinical cases recorded at the time. To give but one brief example, Old Mahon tells the Widow Quin that he was once committed to a lunatic asylum where he had hallucinations probably caused by delirium tremens. He proudly presents himself as a “a terrible and fearful case”, and goes on : “there I was one time screeching in a straitened waistcoat with seven doctors writing out my sayings in a printed book.”  As often in an Irish context,[9] Mahon’s madness is attributed to an excessive drinking – a feature satirists were keen on using in pamphlets and caricatures. “I have never heard the men [in Kerry] talk for half an hour of anything without some allusion to drink”[10], Synge himself remarked in his notes. Mahon’s violence is such that he has to wear a straitened waistcoat, at a time when it was most often only used in potentially dangerous cases after the reports of the commissions denounced abuses. The description he makes of his hallucinations strongly resembles the clinical cases described by famous Irish psychiatrist Conolly Norman  in the “Note on Hallucinations, II”  he read in front of the Medical Section of the Academy of Medicine in Ireland on March 13th, 1903.[11]  Incidentally Norman is well-known to us literature students because he is mentioned by James Joyce in Ulysses as head of “dottyville”....the Richond Asylum! The sensation of having rodents crawl around or on him Mahon describes (“one time I seen rats as big as badgers sucking the life blood from the butt of my lug”) was frequently recorded by Norman in his case studies.

Madness and the limits of identity

“O, isn't madness a fright?”, the Widow Quin wonders in The Playboy. It is indeed since madness in literature is often evidenced by spectacular symptoms – hallucinations, fainting or raging fits etc. The example of spectacular manifestations of madness in drama are numerous - one can think of raving, half-naked Edgar in Shakespeare’s King Lear (even if his madness is feigned!), or of apathetic, hallucinated Martin who thinks he is a prophet in Yeats’ play The Unicorn from the Stars (1908). Interestingly enough “rage” and “raging” (and to a least extent “raving”) are often used by Synge. The dramatic dimension of mental illness corresponds to the popular representation of madness as can be found in numerous artistic productions and obliterate less “spectacular” symptoms (these adjectives are not chosen lightly in a theatrical context of course). My research will examine how madness allows the characters to experience the limits of their identity and memory and favours creativity and dynamism in language that may result in modern experimentations, which is one of the main ideas I would like to explore further in my thesis.

Literature and medicine

In this post I meant to give a brief overview of the way literature could echo contemporary debates of psychiatry, from the prominence of alcohol as a cause of mental disease to the use of straitjackets and the conflicting representations of asylums in society. Literature and medicine are by no means impermeable discourses but impact one another notably through a circulation of medical vocabulary in everyday speech. Researchers are increasingly interested in medical humanities and Irish literature has a lot to offer; let’s hope that this will lead to fruitful collaborations between historians and arts researchers such as the one I was lucky to experience at CHOMI.

Claire Poinsot is a doctoral student at the Université Sorbonne Nouvelle, Paris 3. She may be contacted by email at claire "dot" poinsot "at" hotmail "dot" fr. 

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[1] Declan Kiberd, Irish classics (Harvard University Press: Cambridge, 2001), p.x.

[2] T. Percy C. Kirkpatrick, A Note on the History of the Care of the Insane in Ireland up to the end of the Nineteenth Century (Dublin: University Press, Ponsonby and Gibbs, 1931), p.34.

[3] J.M. Synge, When The Moon Has Set, in Ann Saddlemeyer, J.M. Synge, Collected Works, Volume III, Plays, Book I (Gerrards Cross: Colin Smythe, 1982), p.159.

[4] Synge, When The Moon Has Set, in Saddlemeyer, op.cit., p.161.

[5] TCD MS 6218, 23/7/1902, 30/7/1902 and 4/9/1902.

[6] J. M. Synge, “The Peoples of the Glens”,  In Wicklow, West Kerry and Connemara (Dublin and London: Maunsel & Company, Ltd., 1919), p.27.

[7] J. M. Synge, “The Oppression of the Hill”, In Wicklow, West Kerry and Connemara, p.14.

[8] William J. Corbet, On the Statistics of Insanity, A Paper read before the Statistical and Social Inquiry Society of Ireland, On Tuesday, 21st April, 1874 (Dublin: R. D. Webb & Son, 1874), p.4.

[9] See W. R. Dawson, Alcohol and Mental Disease, reprinted for the Author from the Dublin Journal of Medical Science, June 1908 (Dublin: John Falconer, 1908).

[10] J. M. Synge, “In West Kerry”, In Wicklow, West Kerry and Connemara, p.100.

[11] Conolly Norman, “Note on Hallucinations, II”, read before the Medical Section of the Academy of Medicine in Ireland on March, 13^th, 1903, reprinted from the Journal of Mental Science, April1903 (Hanover Square and Dorking: Adlard and Son, 1903).

Domestic instruction and cookery classes in early twentieth-century Ireland by Ian Miller

In this month's blog post, Dr Ian Miller, Wellcome Research Fellow at the Centre for the History of Medicine in Ireland, University of Ulster, writes about domestic instruction and cookery classes in Irish schools in the early twentieth century.

Deep concern about declining nutritional health in Ireland emerged after the Famine. The potato diet, despite the sustained criticism which it had been subjected to, had at least granted the less affluent in Ireland access to a nutritious diet. Although initially welcomed, its gradual replacement with a varied diet created new food-related concerns. Criticism of the seemingly dismal culinary skills of the Irish poor was rife. Working-class women across Ireland found themselves subject to sustained criticism due to their apparent obsession with tea. Over-reliance upon the substance was undoubtedly a symptom of post-Famine poverty and a lack of access to a nutritious diet. Nonetheless, in the late nineteenth century individuals rather than poverty tended to be blamed for poor personal and familial health. It is against this backdrop that the idea that Irish schools could provide regular domestic instruction gained currency.

Sisters of Charity Cookery Class, late 19th century.
Image courtesy of National Library of Ireland. REF:P_WP_4616

Educational reform

At the turn of the twentieth century, National School provision was limited. Cookery was offered as an extra, optional subject from 1855. In 1884, it was offered by just fourteen schools. This figure had risen dramatically by 1894 to fifty-five. Nonetheless, the availability of cooking facilities failed to match this rising demand. National schools tended not to have the luxuries of space or spare classrooms in which to teach cookery. As Miss Coulter of Carrickfergus Model School lamented in 1899:

While the cookery classes are in operation the smell pervades the whole department… there is only one small gallery, I cannot dispense with it so, as soon as, the cookery lessons are over, it must be used for the ordinary English classes. This is unhealthy for the pupils and myself.

Cookery instruction remained predominantly theoretical due to a lack of equipment and space. In 1895, one school inspector wrote that ‘in many parts of Connaught the people are exceedingly poor, and it seemed strange to see grown girls fairly advanced in grammar, geography, and arithmetic but left wholly unacquainted with plain cookery, management of poultry, dairy management, &c’.

Arguments for improved provision contained important gendered dimensions. The format of cookery instruction proposed was essentially intended to train girls as housewives. For instance, the Bishop of Limerick, Edward Thomas, asserted in 1900 that if Irish women knew how to keep their homes bright and clean, and provided their husbands with comfortable, savoury meals, then domestic happiness would ensue. Similarly, the Irish Homestead argued in 1898 that:

When a young artisan, when the time for mating comes, chooses her or her comely face and bright spirits, none of this knowledge [of cookery] or capacity does he find in his wife. The consequences are disastrous to them both. How often does the working man in an Irish city, when he gets up in the early morning, find that there is no appetising breakfast in a cheery and tidy room prepared for him to start him on his day’s work. The ever hospitable ‘pub’ is open, however, and, as the man must have some nourishment, he turns in and takes ‘eating and drinking’ in the form of a pint of stout. A day so begun is not calculated to develop and close propitiously.

Restructuring education

Domestic education reform was formally initiated in 1900. By July 1901, fifty-six teaching centres had been formed across Ireland. During 1904, sixty-three domestic instructresses delivered a total of 360 courses, with an average attendance of forty-two pupils, complemented by 300 house visits. Courses of instruction lasted for seven weeks, five of which were devoted to cookery and two to laundry.

Nonetheless, upon returning from training most teachers faced a dearth of funding which would have allowed them to purchase utensils and materials. Many of them relied upon using the facilities of convent schools. This restrictive scenario was condemned throughout the echelons of educational administration. One senior inspector insisted that ‘the want of funds will, I fear, prevent the introduction of cookery and laundry work into the great majority of schools, unless the Commissioners can see their way to make an equipment grant to each school’. To clarify his point, he observed that only one school had been able to commence cookery instruction in his city despite the training of fifteen teachers in the previous year.

Miss Crowe and Mr Gildea with their pupils at Kilglass National School, Ahascragh,
Co.Galway, c.1902.
Image courtesy of National Library of Ireland. REF: CLON836 

If space was unavailable in schools, then it had to be sought elsewhere. In Kilkenny, cookery classes were delivered in abandoned houses, rented rooms and cramped, poorly ventilated converted dwelling houses. Throughout Co. Wexford, teaching was undertaken in an array of unsuitable sites including unoccupied dwelling homes, courthouses, a security room attached to a church, a stockroom, a spare room in a disused mill, a joiner’s workshop, and even in barns and coach-houses. In 1903, the Irish Technical Journal asserted that ‘the pupils who attend regularly under these conditions are heroes without knowing it. Neither the teachers nor the pupils, however, can do the best work when their work is done in a vitiated atmosphere’. The article was concluded by declaring: ‘it is absurd to give courses of lectures on Hygiene in a ‘Black Hole’’.

It was only in 1907 that the Chief Secretary of Ireland agreed to receive a deputation on the matter. Reverend Father Dowling vociferously asserted at this:

If you preach technical instruction as the cause of the economic salvation of the country and then point to an old jail or some such building as the centre from whence this panacea of the wants of Ireland were to come, it creates a bad impression.

And what of the teaching itself? In 1903, one District School Inspector reported positively that ‘the children are very fond of cookery, which, through the habits of cleanliness and attention to details which it induces, is likely to have a permanent beneficial effect on the social condition of the country’. In the same year, Miss Fitzgerald confidently announced that parents were pleased with the instruction of their children in cookery, adding that they considered it to be ‘the most useful thing that has ever been taught, and will bring comfort to our homes’.

Despite these sanguine assertions, cookery instruction for younger pupils was not as encompassing as originally hoped. Infants in the first class learnt only matters of personal cleanliness and hygiene. Similarly, the second class was marked by an emphasis on cleanliness, although students were taught how to prepare potatoes and cabbage for cooking, the purposes of salt and how to toast bread. It was only in the third class when pupils were actually allowed to cook their potatoes and cabbage and to make colcannon, tea, coffee and cocoa, boiled eggs and fried potatoes. Remaining years were devoted to more advanced, but useful, forms of cookery involving bacon, sausages, mutton and beef.

The implementation of cookery instruction ultimately failed to live up to its aspirations. The principle that cookery instruction held high social value failed to be met in Ireland with a corresponding allocation of material resources that might have cemented that idyllic vision.

Podcast

Podcast of a lecture 'Reforming Diet in Post-Famine Ireland' by Dr. Ian Miller, given as part of the Centre for the History of Medicine in Ireland (CHOMI, UCD) Seminar Series, 2 February 2012

Ian Miller is a Wellcome Trust Research Fellow in Medical Humanities at the Centre for the History of Medicine in Ireland, University of Ulster. His publications include A Modern History of the Stomach: Gastric Illness, Medicine and British Society, 1800-1950 (London: Pickering and Chatto, 2011) and Reforming Food in Post-Famine Ireland: Medicine, Science and Improvement c.1845-1922 (Manchester University Press, 2014). He is currently co-editing a volume on medicine and war in twentieth-century Ireland with David Durnin.

‘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