Irish Doctors in the First World War by David Durnin

April 10, 2013, 9:30 am

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‘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.

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Early Soviet Nursing by Susan Grant

May 9, 2013, 5:04 am

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

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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.

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

June 10, 2013, 1:13 am

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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 andthe 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’sshort 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 andarthritic 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

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

July 3, 2013, 7:24 am

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

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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.

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

July 19, 2013, 4:04 am

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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.

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

August 15, 2013, 8:33 am

≫ Next: Cholera in Belfast in 1832 and 1848/49 by Nigel Farrell

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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 11th1784

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^stMarch 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. 

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

September 12, 2013, 4:52 am

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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.

Charles Lucas (1713-1771) by Harriet Wheelock

September 18, 2013, 3:57 am

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

Charles Lucas was born on 16^thSeptember 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

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‘Out of the mouths of babes comes wisdom, and the poor women residing in the slums of Cork’ by Michael Dwyer

October 22, 2013, 3:49 am

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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.

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

November 19, 2013, 6:21 am

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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

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

January 9, 2014, 4:28 am

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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 includeA 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.

“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

February 12, 2014, 2:48 am

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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).

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

March 13, 2014, 5:13 am

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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.⁴The 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. 4.⁶The caption serves to draw the reader’s attention to the integral message of the leaflet thus preventing any possible misinterpretation.⁷By 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.⁸Campaigns 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^thFebruary 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.↩

Treating Measles in late Seventeenth-Century London and Dublin by Elizabethanne Boran

April 11, 2014, 7:37 am

≫ Next: ‘Poisons or other Noxious Things’: Women’s Illegal Abortion Strategies in Twentieth-Century Ireland by Cara Delay

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This month, Elizabethanne Boran, librarian at the Edward Worth Library, Dublin, writes on treating measles in late seventeenth-century London and Dublin, with particular focus on the works of John Pechey (1654-1718), many of which were collected by the Irish physician Edward Worth (1678-1733). 

A keen collector of medical works

Title page of  John Pechey's Collections of Acute Diseases (1691)

‘These Measles began very early, as they use to do, to wit, at the beginning of January, 1670/1 and increasing daily, came to their height at the Vernal Æquinox, i.e. the Tenth of March: afterwards they gradually decreas’d. and were totally extinguish’d the following July’. Thus begins John Pechey’s account of an outbreak of measles in his Collection of Acute Diseases (London, 1691), a book collected by the early eighteenth-century Dublinphysician, Edward Worth (1676-1733). Worth was a keen collector of all kinds of medical and scientific works and was particularly interested in infectious diseases. As the Worth Library’s online exhibition on infectious diseases demonstrates, his main areas of concern were plague, smallpox, syphilis, and tuberculosis, not to mention all kinds of fevers, but he was also avidly interested in books on other infectious (and non-infectious) diseases.

John Pechey

Perhaps it was for this reason that Worth was drawn to the works of John Pechey (1654-1718), for he collected no less than seven books by this popular author: Pechey’s Collection of Acute Diseases (London, 1691) had quickly been followed by his Collections of Chronical Diseases(London, 1692). Three years later Pechey’s Storehouse of physical practice was on the market and in the next two years he produced a book a year: Treatise of Women’s Diseases (London, 1696) and Treatise of Children’s Diseases (London, 1697). All of these books were collected by Edward Worth who joined to them a 1700 edition of Pechey’s Promptuarium praxeos medicae(which had been a Latin translation of the Storehouse), and, finally, in 1707, Pechey’s Compleat Herbal of Physical Plants. Though these books didn’t not represent the entire output of Pechey (which includes a host of pamphlets on the virtues of his famous medical concoctions), it is clear that Worth was drawn to Pechey’s understanding of disease, which was, in turn, heavily dependent on the works of the great English physician, Thomas Sydenham (1624-1689), whose works were translated and published by Pechey.

Portrait of Thomas Sydenham

A fractious relationsip with medical authorities

Pechey was the son of William Pechey, a Sussex‘Practitioner in Physick and Surgery’, whose influence his son publicly acknowledged in the fifth part of his Collection of Acute Diseases. Judging by this dedication, Pechey had a fractious relationship with medical authorities. Initially his education had been unremarkable: he had taken a BA and MA from the University of Oxford in 1675 and 1678 respectively and in late 1684 he had successfully taken the Royal College of Physicians licentiate examination. Three years later he, and a number of other licentiates, set up practice at the Golden Angel and Crown in King’s Street, Londonand it was there his trouble started. His and his colleagues’ decision to advertise their medical services with the admirable promise that ‘the sick may have advice for nothing’ was met with less than enthusiasm by the medical authorities, who were appalled at Pechey’s approach. Legal battles ensued and it was in this context that Pechey issued the first edition of his Collections of Acute Diseases, which was published in Londonin 1686. In effect, Pechey had simply translated Thomas Sydenham’s works on smallpox and measles into English, no doubt in an effort to demonstrate how mainstream his medical teaching was. This was by no means plariarism: Pechey undoubtedly had the support of Sydenham in translating his work and he was himself keen to give credit where credit was due. Indeed he informs the reader that he had ‘chiefly collected from Dr Sydenham, because I have found by Experience, that his Methods in Acute Diseases have been most successful in practice. The Chapter of a Peripneumony was taken from Willis. The Chapter of Women’s Diseases, from Riverius and from Mauriceau, The Chapter of an Apoplexy, Lethardy, Coma and Carus; likewise from Riverius.’ It is revealing that works by all these authors were likewise collected by Worth.

The 'English Hippocrates'

The choice of Sydenham was a shrewd one – as the numerous editions of Pechey’s English translation of Sydenham’s complete works testify. But if Pechey hoped to win approval by translating Sydenham’s works his hopes were dashed for Sydenham’s own relationship with the Royal College of Physicians was problematic. It is at first sight surprising that so eminent a physician, one who was regarded as the ‘English Hippocrates’ due to his emphasis on clinical experience, was never made a Fellow of the College. However, it was precisely Sydenham’s advocacy of experience over theoretical medicine that threatened the status of the members of the College. Sydenham might have avoided publishing his most radical attacks on the medical establishment but there was sufficient criticism of them in his famous Methodusto ensure that they were less than attracted to the likely social implications of his health regime.

Bleeding a patient

'These Men blame me for Englishing their Mysteries'

 So Pechey’s advocacy of Sydenham, though it fitted in perfectly with his own medical philosophy, was unlikely to endear him to the Royal College of Physicians who were already incensed by Pechey’s propensity for advertising his medical wares. Not only this, but, as Pechey explains to the reader in Worth’s 1691 edition of the Collection of Acute Diseases, the very method of his popularizing of Sydenham was criticised: ‘These Men blame me for Englishing their Mysteries, though they know that Hippocrates and Galen and Celsus, and many others wrote in their Mother-Tongue.’ That didn’t stop him for, as his preface to his father makes clear, his publications represented not only an opportunity for financial gain but more importantly were part of a crusade to defend the importance of practice and experience over theory, and, at the same time, to democratize medical knowledge by making the works of eminent doctors available in English to non medical readers. In this Pechey seems to have been following his medical hero, Sydenham, for the latter never joined the ranks of fashionable doctors and was more than happy to treat poor patients.

Bleeding

Therefore, much of Pechey’s description and suggestions for treating measles comes directly from Thomas Sydenham. Certainly both men would have concurred that ‘the Patientbe kept in his bed onely two or three days after the eruption, that the bloud may gently breath out, according to its own genius, through the pores of the skin, the inflam’d Particles that are easily separable which offend her; and that he have no more cloaths nor fire, than he is wont to have when he is well’. Though Sydenham in general opposed the treatment of bleeding in cases of fever and smallpox, he admitted that in some cases of measles the standard practice of bleeding should be implemented. Edward Worth’s collection of medical books demonstrate that this early eighteenth-century Dublin physician was a keen follower of the Pechey-Sydenham approach to infectious disease.

Elizabethanne Boran is librarian at the Edward Worth Library, Dublin. She may be contacted at elizabethanne "dot" boran "at" hse "dot" ie.

‘Poisons or other Noxious Things’: Women’s Illegal Abortion Strategies in Twentieth-Century Ireland by Cara Delay

May 9, 2014, 3:14 am

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In this month's post, Professor Cara Delay, Associate Professor at the College of Charleston, writes on women's illegal abortion strategies in twentieth-century Ireland. 

Abortion trials in Ireland

From the murder trial of infamous midwife and abortionist Mamie Cadden in 1956 to the tragic death of Savita Halappanavar in 2012, no issue has caused as much scandal, debate, and controversy in Ireland as abortion. Given the difficulty of accessing historical abortion cases, it is not surprising that scholarly analyses of abortion in Irish history remain incomplete. Illegal abortion is still at times perceived by historians as gambles that women took at the spur of the moment.Some researchers have assumed that the very real threat of illness or death would make only the most desperate of women seek to end their pregnancies. Records at the National Archives of Ireland and the PRONI, however, which provide details on over 100 illegal abortion trials that took place in Ireland and Northern Ireland from 1900 to 1970, demonstrate a different reality: for Irish women, abortion was not something that they took lightly but part of a carefully thought out plan. Abortion trial records tell complex and complicated stories, and, when read closely, shed light on women’s reproductive experiences and their decision-making processes.
 

Liquid ergot. Image courtesy of the Wellcome Library.

Attempting to construct a picture of the ‘typical’ Irish woman who hoped to end her pregnancy is nearly impossible: the reality is that women from all different walks of life attempted abortion. Helen O, who died in 1956 after receiving an abortion from Mamie Cadden, was a thirty-four-year old married mother of six. Twenty-year-old Irene A, in contrast, was an unmarried student. Margaret M, a twenty-five-year-old single woman who lived in Dublin but received a surgical abortion in London, was having an affair with her married employer. In 1948, a woman who pled guilty to giving abortions to at least eight women in County Laois had amongst her clients a teenage girl still living with her parents and a married mother of two. The variety that these examples reveal suggests that abortion was widespread and practiced by women of different marital status, age, and region.

It is impossible to know how many Irish women with unwanted pregnancies sought abortion as a solution. Criminal court case transcripts do, however, reveal how some of those women who did choose a termination proceeded. In almost all of the cases that ended up in the criminal courts, a woman with an unwanted pregnancy first attempted a self-induced miscarriage. These women acted to induce abortion through what are often called ‘folk methods’, including physical harm and hot baths. Women, then, attempted to take care of what they referred to as their ‘trouble’ themselves in private, or sometimes with the help of friends and family. As late as 1950, a Dublin woman named Sheila told the court that before she purchased abortion drugs, she tried gin and hot baths, and when that did not work, her lover told her to ‘try high jumps’.

If these physical harm methods didn’t work, women sought help from drugs and poisons, including both readily available items such as Epsom salts, Jeyes’ Fluid, and laxatives and traditional abortifacients, including quinine, pennyroyal, and ergot of rye. Helen O, who died at the hands of Mamie Cadden, tried quinine tablets before she sought a surgical abortion. Similarly, in a 1937 case, a woman unsuccessfully tried miscarriage by quinine pills before visiting abortionist William Coleman. In 1932, a Donegal woman was brought up on charges after she attempted miscarriage by taking ‘six pills, the nature of which is unknown, two Beecham’s pills, and a bottle of castor oil’.

Source: Leitrim Observer, 1 December 1917

The poisoning deaths of women who consumed too many abortifacients remind us that self-induced abortion was hardly a science. Although Irish women were aware of the dangers of consuming too much of a particular drug, they persisted in attempting self-abortions, and they were given hints about drug-induced miscarriages through advertisements. Despite the fact that Ireland’s 1927 Report of the Committee on Evil Literature sought to prohibit any advertisements for drugs that may be used to prevent conception or induce miscarriage, Irish newspapers and medical publications contained dozens of such ads. In the early twentieth centuries, newspapers such as the Irish Times and the Leitrim Observer featured advertisements of Widow Welch’s Pills and Towle’s Pills, which eventually would become evidence in several abortion trials. Dr. Hooper’s Female Pills, created in Britain 1743, were advertised nearly every month in the Irish Chemist and Druggist in the late 1920s and 1930s. Another example is Beecham’s Pills, a British product available in Ireland that featured in several abortion trial cases. Beecham’s Pills were billed as a cure-all for lots of things, including restoring normal menstruation. Female pills contained a variety of substances, some potentially effective and some not. Dr. Hooper’s Pills were made of myrrh, which was rumoured to be an abortifacient. Some emmenagogues, including Towle’s Pills, did contain pennyroyal, which may have effectively induced miscarriage.

 

One of the most striking realities of abortion in twentieth-century Ireland is how many women attempted abortion multiple times. One woman received abortions from Laois’s Kathleen G twice, once for an advanced pregnancy of eight months and once for an early pregnancy of two months. Others admitted in court that they had previously attempted abortion, sometimes successfully and sometimes not. These repeated attempts to cause abortion reveal that determination defined the attitudes of some women. Women for whom abortifacients were unsuccessful or who initially were turned away by doctors or others did not stop looking for someone to help them. In one case, a couple traveled to London for an abortion after an Irish doctor refused to perform one.Other women traveled from the countryside to Dublin, where it was apparently easy to find an abortion practitioner. The Irish Times, reporting on a 1944 abortion case, recorded the remark of the defense lawyer in the case as follows: ‘Dublin was always humming and buzzing with stories about abortion’. Some of the most notorious Dublin abortionists, including not only Mamie Cadden but also William Coleman, faced multiple prosecutions over the years, demonstrating the continued need for and popularity of their services.

Illegal abortion on Irish soil declined rapidly with the 1967 legalization of abortion in the UK (outside of Northern Ireland), combined with relatively easy and inexpensive travel methods that allowed Irish women to seek assistance in Britain. Recently, however, the availability of herbs and pills on the internet has resulted in a return to more traditional abortion practices: more and more women are, once more, turning to abortifacients and home-based, self-induced abortions. In 2009, the Irish Medicines Board confiscated over 1,200 abortion pills that were bought online and imported into Ireland. Abortion rights organization Choice Ireland has argued that there is now an abortion pill black market in Ireland that is thriving during the economic crisis, when it is more feasible for women to purchase pills than travel to Britain for a surgical abortion.

Even a cursory glance at available evidence proves that Ireland is a country with a deep and varied historical record of backstreet abortion. The secret journeys of women who travel abroad for a legal termination every day or who purchase drugs illegally on the internet are legacies of the past in a country that still has a long way to go to recognize the reality of abortion.

Professor Cara Delay is Associate Professor at the College of Charleston. She was a Fulbright Fellow at the Humanities Institute, University College Dublin (2012-2013) where she conducted research on her new project entitled 'Desolate Journeys: Reproduction and Motherhood in Ireland, 1950-2000'. A podcast of her recent paper at the CHOMI Seminar Series on illegal abortion cases in twentieth-century Ireland may be accessed here

Podcast

Podcast of a lecture 'Noxious Things’: Illegal Abortion Cases in Twentieth-Century Ireland by Professor Cara Delay, given as part of the UCD Centre for the History of Medicine in Ireland’s seminar series.

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‘[S]he is in a highly hysterical state. She’s a woman who resists’: the Dangers of Spiritualism in J. S. Le Fanu’s All in the Dark (1866) by Valeria Cavalli

June 12, 2014, 5:25 am

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In this month's post, Dr Valeria Cavalli examines the  theme of spiritualism in Irish writer Joseph Sheridan Le Fanu's novel All in the Dark (1866), and what the author's warnings about the dangers of spiritualism tell us about Victorian attitudes to women and madness. 

The dangerous habit of practising séances

When William Maubray is called to his dear aunt Dinah’s deathbed, he hopes that he will get there in time to say goodbye. He is certainly surprised, then, to find her in quite good shape, if not for her firm conviction that she is going to die before midnight. Dr. Drake explains to the puzzled young man that his aunt suffers from nothing more serious than the ailments of a woman of her age, but that she has recently fallen victim of self-deception. The eccentric old woman has in fact taken up the dangerous habit of practising séances, and the risk is that she will drive herself mad if she insists in taking seriously the ominous revelations of her spirit friend. Written in the peak years of Spiritualism, Joseph Sheridan Le Fanu’s All in the Dark brings forth a way more terrifying reality than being haunted by ghosts, that is, being locked away in a lunatic asylum on the basis of one’s unorthodox creed.

The rise of spiritualism

Emerging in America in the late 1840s, Spiritualism spread almost immediately to Europe, finding fertile terrain in the state of religious uncertainty which was troubling part of the population, regardless of class, age, or gender. When scientific discoveries brought the credibility of the Bible into question, believers began to feel uneasy with the way Christianity explained the supernatural, and began to look for comfort in the occult. In fact, the occult could account for the supernatural according to the laws of nature: whatever forces were inexplicably ruling the Universe or man, they were completely natural, and their present state, if still unknown to science, was open to investigation. However, scientists and members of the Church together raised their voices in opposition to the movement from its very first appearance, and criticism poured from the pages of periodicals and newspapers.

Joseph Sheridan Le Fanu.  Image from: www.swanriverpress.ie/lefanu200,

Spiritualism and female transgression

As Alex Owen has pointed out in her Darkened Room (1989), many medical men regarded the movement with distaste and suspicion in part because of the increasing role it offered to women. In those years, the ideal woman was the submissive wife and mother, “the angel in the house” in charge of the domestic sphere. In giving women the authority and the right to exercise their innate spiritual powers, Spiritualism infringed on the culturally imposed limits of respectable womanhood. In the darkened room, not only did women become the principal actors of the séance, they also transgressed gender norms, by assuming male roles or highly sexualised trance personae. The subversiveness of the movement alarmed and alerted the medical profession, which was in charge of policing any deviations from the social order imposed by Victorian patriarchy. The emerging medical branches of psychiatry and gynaecology effectively teamed up to prove that women’s health depended on female biology. Since women’s role was primarily that of generator, physical and intellectual activities would compromise the balance of nerve force necessary for the functioning of the reproductive organs, thus causing mental instability. Most cases of insanity due to sexual illness tended to result in monomanias, among which Spiritualism was counted, and doctors began to consider any kind of suspension of everyday consciousness suspicious and to associate mediumistic trance, with its uncontrollable convulsions and frequent use of inappropriate language, with the pathological symptoms of hysteria.

'Queer fancies'

In All in the Dark, Dinah Perfect is depicted as a strong-willed, authoritative, and eccentric woman. Her faithful servant explains that Dinah has always been very extravagant, with her odd dispositions concerning her corpse and coffin:

She was very particular, […] and would have her way; […] she had her coffin in the house this seven years – nigh eight a’most – upright in the little press by the left of the bed, in her room – the cupboard like in the wall. Dearie me! ’twas an odd fancy, […] and she’d dust it, and take it out, she would wi’ the door locked, her and me, once a month. She had a deal o’them queer fancies, she had. [II, pp.168-9]

'She is in a highly hysterical state'

It is no surprise, then, that when the novelty of table-rapping reaches the Old World, it appeals mightily to a housebound, bored, middle-class spinster like Dinah, who is looking for excitement and escapism from the monotony of everyday life, and from the increasing fear of ageing and dying. However, Dinah’s credulity is quickly associated with hysteria. Echoing Dr William Carpenter’s theory on unconscious cerebration, the non-believing, sceptical (and alcoholic) Dr Drake describes the dangerous effects that Spiritualism could have on Dinah’s mind, by convincing her of the reality of her delusions to the point that her body comes to provoke the effects that she expects to happen. Dr Drake is afraid that Dinah will ‘frighten herself out of her wits’, and explains to William that Spiritualism can affect the nerves [I, p. 60]:

Why, you know what hysteria is. Well, she is in a highly hysterical state. She’s a woman who resists; it would be safer, you see, if she gave way and cried a bit now and then, when nature prompts, but she won’t, except under awful high pressure, and then it might be serious; those things sometimes run oft’ into fits. [I, pp. 38-9]

 

Wrongful confinement

 

At a time when the advances in the realm of the mind became increasingly associated with scandals related to wrongful confinement, Le Fanu questions the power held by Victorian psychiatry over extravagant and independent women. Dinah Perfect is certainly a bizarre character, with her many fancies and her addiction to table-turning. However, her oddities do not seem sufficient to diagnose her as incipiently insane. Dinah is an elderly woman troubled by the frightening thought of upcoming death. Her anxiety and hysterical crises echo the spiritual uncertainty that afflicted the author’s sister and wife, like many other Victorians. Moreover, her uneasy shifting between her family’s orthodox Christianity and the occult is reminiscent of Le Fanu’s own crisis of faith, which led him to find comfort in the doctrine of the Scandinavian mystic Emanuel Swedenborg.

 Le Fanu's wife Susanna (née Bennett), and his sister Catherine. All three experienced a crisis of faith at some point in their lives. The images of Susanna and Catherine appear in W. J. McCormack’s biography of Le Fanu.

'That foolish spirit-rapping'

Having experienced first hand the anxiety of spiritual doubt, Le Fanu is far from labelling Dinah mad, even though he does not sympathise with Spiritualism. In fact, all throughout the novel, Dinah sounds reasonable and practical, advising her ward on the importance of a good match in marriage, and her nephew on the more advantageous prospect of the Church rather than the Bar as a profession. Even on spiritual matters, the Rector confirms that, ‘I found her views […] all very sound; indeed, if it had not been for that foolish spirit-rapping, which led her away – that is, confused her – I don’t think there was anything in her opinions to which exception could have been taken’ [II, pp. 171-2]. On all subjects but Spiritualism, Dinah is perfectly sound. However, her fancy for table-turning would, for orthodox Victorian psychiatry, be a strong enough proof of her insanity, as the real case of Louisa Nottidge had shown.

Louisa Nottidge

Like Dinah Perfect, Louisa Nottidge was a wealthy middle-aged spinster who had also spent money ‘very wildly’ upon the word of a Spiritualist [I, p. 8]. In 1846, Nottidge decided to leave her mother’s home to follow the influential millenarian prophet Henry Prince. Prince was the founder of a small community in Somerset called the Agapemone (the Abode of Love), where he taught about free love and preached of everlasting life to a group of devotees who had agreed to donate all their wealth to the congregation. Three of the five Nottidge sisters had already joined the prophet (who had thus gained some £18,000), so that when Louisa communicated her decision to her mother, the latter had to act quickly in order not to lose another daughter, and her considerable fortune, to an unscrupulous charlatan. Mrs Nottidge had Louisa abducted and confined to the majestic Moorcroft House private asylum at Hillingdon, in Middlesex, on the grounds of theomania. Louisa spent seventeen months at the Hillingdon, and was released only because the Commissioners in Lunacy were summoned upon concerns about her failing health. After her liberation, Louisa joined the millenarian community, transferred all her possessions to Henry Prince, and took legal action against her wrongful confinement.

A fraudulent committal

Moorcroft House private asylum at Hillington. This picture is taken from Sarah Wise’s Inconvenient People.

The case was heard in court in 1849 before the Lord Chief Baron, the Right Hon. Sir Frederick Pollock, while the attention it received in the press provoked responses from alienists John Conolly and Forbes Benignus Winslow, and Lord Ashley, Chairman of the Commissioners in Lunacy. The Lord Chief Baron accepted Louisa Nottidge’s plea and ordered a compensation for the damages received. The suit made clear that Louisa’s admission to the Hillingdon had not been fraudulently obtained, since two doctors certified her insane on the grounds that she had ‘estranged herself from her mother’s house […] to follow a person of the name of Prince, whom she believed to be Almighty God, and herself immortal’. However, as Joshua John Schwieso has pointed out, although the two doctors had been summoned by the family physician on the basis of their ‘experience in cases of insanity’, their biographies suggest that neither of them was an expert in the field. Despite all this, the final verdict was reached because the Commission in Lunacy, in the person of Mr Mylne, failed to convince the Lord Chief Baron of the necessity of keeping Miss Nottidge confined, as shown in the following report which appeared in The Times in 1849:

The Lord Chief Baron: Mr Mylne, was this lady in such a state of mind as to be dangerous to herself or to others?   

Mr Mylne: Not so as I was aware of; not so far as I knew. 

The Lord Chief Baron: If she were not so, then how was it that you kept her in this asylum for seventeen months?

Mr Mylne: My lord, it was no part of my duty to keep her there. I was only to liberate her if I saw good and sufficient reason for adopting that course. 

The Lord Chief Baron: It is my opinion that you ought to liberate every person who is not dangerous to himself or to others. If the notion has got abroad that any person may be confined in a lunatic asylum or a madhouse who has any absurd or even mad opinion upon any religious subject, and is safe and harmless upon every other topic, I altogether and entirely differ with such an opinion; and I desire to impress that opinion with as much force as I can in the hearing of one of the commissioners. […]You say unsound mind, Mr Mylne. Had she any unsoundness of mind upon any other subject under heaven except as to entertaining these peculiar religious notions?

Mr Mylne: Miss Nottidge did not exhibit any symptoms of insanity of any other subject, my lord, that I observed.

Not only did the Lord Chief Baron support an individual’s freedom to hold religious opinions (as long as they remained harmless to both the person and other parties), he, most importantly, stated that he ‘very much doubted whether, if in this case the plaintiff had been a man, or living under the protection of a husband, the defendants would have dared to have taken the steps they had’.

An unwarranted influence

This case made evident how women, and particularly single women, were in danger of wrongful incarceration, since their unorthodox religious views (Louisa’s own mother affirmed that ‘she worships a false god’) could be easily exploited for financial gain.[ix] In fact, in the case of Louisa Nottidge, what her family were trying to save was the £5,728 7s 7d that she had bequeathed to the prophet. After her death in 1858, which occurred while she was still residing at the Agapemone, the Nottidges brought Henry Prince to court and succeeded in obtaining the return of Louisa’s property on the grounds of the prophet’s unwarranted influence upon the deceased. Thus, in the early 1860s, the case of Louisa Nottidge received new attention in the press, both in England and in Ireland, and was associated with the increasing number of cases of wrongful confinement which were causing much sensation, both in real life and in fiction.

Spiritualism and madness

           

In All in the Dark, Dinah, unlike Nottidge, is surrounded by relatives and friends who love her for who she is rather than for her fortune, and who will miss her dearly after her death. However, in discursively associating Spiritualism with madness, Le Fanu is reminding the reader of the existing danger that even an incompetent doctor like Drake, with no specific knowledge or experience of insanity, could actually provide enough evidence to have a woman like Dinah confined on the grounds of her unorthodox beliefs. Furthermore, he is also presenting a reflection on the double standard with which Victorian psychiatry was dealing with its patients. After Dinah dies, her sceptical nephew William also becomes ‘addicted to the supernatural’ and begins to believe that he is haunted by the spirit of his dead aunt [I, p. 58]. He suffers from nervous strain and hallucinations, and also admits that ‘I think I’m growing as mad as […] poor Aunt Dinah’ [I, p. 216, my italics]. However, no judgement is made about the possibility of his being a case of incipient insanity. William’s temporary condition is attributed to the weight of financial and sentimental concerns which, combined with the strong tea he likes to drink (a recurring theme in Le Fanu’s fiction), the heavy tobacco he likes to smoke, and the supernatural stories he likes to read, provokes nightmares and somnambulistic states. Financial problems, disappointment in love, bereavement, and hereditary disposition were all considered by Victorian psychiatry to be factors in the detection of mental insanity. The fact that such connections are ignored in William’s case seems to validate the words of the Lord Chief Baron, who doubted whether the same precautions would have been taken if the plaintiff had been a man.

      

In All in the Dark, Le Fanu touches on the topical association of alternative spiritualities with insanity. Drawing upon his personal experience as well as his professional familiarity, in his work for the national and international press, with contemporary debates on these topics, Le Fanu investigates the power game played by Victorian psychiatry over difficult citizens, women in particular. Although the novel shows Le Fanu’s contempt of Spiritualism, it nevertheless dismisses the accusations of madness levelled at the believer, thus becoming a warning to women readers.

Dr ValeriaCavalli recently completed a PhD in the School of English, Trinity College Dublin entitled 'They said she was mad: insanity in the fiction of Joseph Sheridan Le Fanu' (2014). She may be contacted at cavalliv "at" tcd "dot" ie. Details of an upcoming conference in Dublin on J.S. Le Fanu (15-16 October 2014) may be found here.

Further reading

• J. S. Le Fanu, All in the Dark, 2 Vols (London: Richard Bentley, 1866), Vol. 2, pp. 168-9.
• For a historical context on Spiritualism and Victorian medicine, see Alex Owen, The Darkened Room: Women, Power,and Spiritualism in Late Victorian England(Chicago, Ill.; London: University of Chicago Press, 2004), Ch. 6.
• On Louisa Nottidge, see Sarah Wise, Inconvenient People; Lunacy, Liberty and the Mad-Doctors in Victorian England (London: The Bodley Head, 2012), Ch. 4; Owen, pp. 151-54; and Joshua John Schwieso, ‘‘Religious Fanaticism’ and Wrongful Confinement in Victorian England: the Affair of Louisa Nottidge’, Social History of Medicine (1996), pp. 159-74. 

A Malady of Migration: theatre production in Coventry and Dublin

June 25, 2014, 5:03 am

≫ Next: Cows, contagion and sanitation and Victorian Dublin by Juliana Adelman

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At a time when the issues of migration and mental health are seldom out of the news, the Centre for the History of Medicine in Ireland (CHOMI) has worked with the Centre for the History of Medicine at the University of Warwick (CHM) and Talking Birds theatre company to develop a new theatre production which explores why the mid-nineteenth century saw a prevalence of mental disorders among Irish migrants.The new piece is called 'A Malady of Migration' and is based on research being carried out by Professor Hilary Marland of Warwick and Dr Catherine Cox of University College Dublin, in a project called Madness, Migration and the Irish in Lancashire, c.1850-1921, funded by the Wellcome Trust. They are supported by postgraduate students and others, who will conduct supplementary research and take supporting roles in the drama.

There will be an expert panel discussion after the Thursday evening performances in each venue and a post performance discussion on Saturday lunchtime, providing opportunities for audience members to discuss the making of the piece with researchers and the theatre company, and to engage in debate on issues raised by the performances. A series of short briefing sheets have been produced to complement the drama and provide background information. These can be accessed here.

Check out the Malady of Migration website here!

Performances

Shop Front Theatre, City Arcade, Coventry CV1 3HW (opposite Argos):
Thurs 26th to Sat 28th June 2014
1pm - £6 (£3) and 7pm - £8 (£4)
Box office 0845 680 1926 talkingbirds.co.uk

The New Theatre, Temple Bar, Dublin:
Thurs 3rd to Sat 5th July 2014
1pm - €8 (€4) and 7.30pm - €10 (€5)
Box office 01 670 3361 thenewtheatre.com

A Malady of Migration

Madness, migration, and the Irish in Lancashire, 1850-1921

Cows, contagion and sanitation and Victorian Dublin by Juliana Adelman

September 29, 2014, 6:53 am

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We are back after the summer break! In this month's post, Dr Juliana Adelman writes about her research on the history of animals and public health in nineteenth-century Dublin.

When I began working on the history of animals I was not sure where I would end up.  I was initially interested from the perspective of a historian of science with a focus on the history of natural history. However, it quickly became clear that I was much more interested in  animal-human interactions outside of the laboratory and museum.  Looking at how animals affected and were affected by changes to ideas about health and disease has allowed me to reconnect with my undergraduate experience in a microbiology lab from a totally different angle. 

Medical progress?

Looking at medicine and disease through animals really highlights how social and contingent that knowledge is.  When we look at the history of disease in humans and how society has sought to address it, we can find it difficult to get away from the idea that things are moving forward.  There is no question that human life expectancy is longer, for example, than it was in the past.  We rarely protest against the idea that states have some obligation to the health of their citizens.  Most of us go to a doctor when we feel really sick and expect that they will help us.  While the social history of medicine has made it clear that the system of medicine we have now was in no way inevitable, most of us have fully absorbed the social attitudes that it represents.  

Disease and animal-human relationships

Cattle Market, Dublin (view from North Circular Road towards Prussia St) Image courtesy of National Library of Ireland: Lawrence Photograph Collection (L_ROY_08909)

When we look at disease from the perspective of animal-human relationships, however, we are forced to face the ways that our feelings and attitudes about animals have affected and been affected by the course of medicine.  For example, in our age of swine flu and avian flu and BSE we can hardly conceive of not believing diseases to pass between humans and other animals.  Yet, as Anne Hardy has pointed out and Abigail Woods's current project seeks to address, there has been no successful attempt to unite human and animal medicine as a single discipline.  There have been few attempts to address animal disease with practices other than containment by slaughter.  We have pushed animals to the margins of developed society, far away from cities and centres of population, but the ways that we depend on them continue to be highlighted in one food contamination story after another.  

The erasure of animals

So I guess what interests me is how did we get here?  To this place where urban residents depend for subsistence on animals, fear infections spread from animals, yet see themselves as completely separate from the animal world.  You need only look around Dublin to see how thoroughly we have erased their former presence: the site of the former cattle market and city abattoir now contain social housing, the North Circular Road never sees cattle blocking traffic, the Great Western railway terminus (where cattle from the country once arrived in droves) is a bus terminus.  I do not advocate the return of cows to urban Dublin, just a bit more consciousness of their role in our history.

Podcast

Podcast of a lecture 'Cows, contagion and sanitation in Victorian Dublin' by Dr. Juliana Adelman, given at the Centre for the History of  Medicine in Ireland (CHOMI, UCD) Seminar Series, 26 September 2013.

Juliana Adelman is lecturer in History at St. Patrick's College, Drumcondra. To listen to a podcast of a recent paper given by Juliana at the CHOMI Seminar Series, click here and for details of the forthcoming 'Science in the City' event she is organising, click here. Juliana may be contacted at juliana "dot" adelman "at" spd "dot" dcu "dot" ie. 

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

November 4, 2014, 3:36 am

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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.

Childhood illness in twentieth-century Ireland by Ida Milne

November 27, 2014, 4:28 pm

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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.