By Anne Mac Lellan
In 1922, the year the independent Irish state was founded, a total of 4,614 deaths from tuberculosis were recorded in the country. Of these deaths, 611 were among children under the age of 15 years. This is probably an underestimate of the real death toll as there was a stigma associated with the disease and people tried not to have tuberculosis recorded as the cause of death for family members.
For every death, it is estimated that there were five to seven people ill with tuberculosis. The Irish epidemic began to decline gradually from its peak in 1904 (quite late by European standards) but for the first half of the twentieth century tuberculosis was the third leading cause of death among Irish children eclipsed only by gastroenteritis and pneumonia.
Dorothy Price was a paediatrician. When she practiced medicine in Dublin from 1923 until 1950, there were no antibiotics available that were effective against the bacterium that caused tuberculosis (streptomycin became available in Ireland in the late 1940s but resistance quickly developed). Nonetheless, she believed that early accurate diagnosis, followed by isolation from the source of the disease along with bed rest were essential for recovery. She also believed that the use of a preventive vaccine would help protect much of the population and reduce the levels of disease in Ireland. These beliefs were controversial.
Tuberculosis could be difficult to diagnose however a skin test using a substance called tuberculin was in wide use on the continent from 1907. In TCD, when she was a medical student (1916-1921), Dorothy was taught that this test was ‘faddy’. In 1931, on a visit to the Kinderklinik in the Allegemeines Krankenhaus in Vienna, she saw Professor Franz Hamburger using the test and became convinced of its value. Dorothy ascribed the Irish lack of engagement with the test to Irish doctors’ inability or disinclination to read German medical literature and the fact that they did not visit German-speaking centres; instead, in her opinion, they ‘took everything via England’. She began to learn German to read relevant textbooks and later did a short post-graduate course in Sheidegg in Germany.
In 1934, a small study carried out by Dorothy and a colleague showed the value of tuberculin testing. They tuberculin tested 53 children in the children’s pavilion in Peaumont Sanitorium. To their astonishment, 14 of these children tested negative. These children were duly sent home with a letter to their County Medical officer of Health explaining that they were not tubercular. In addition to its role in diagnosing or out-ruling childhood tuberculosis, Dorothy demonstrated the usefulness of tuberculin testing in mapping tuberculosis infection in Irish children. The common belief that all Irish children had been exposed to tuberculosis by the time they reached adolescence was shown to be untrue. Adolescents from rural areas were more likely to be tuberculin negative and migration to cities (tuberculosis was largely an urban problem) to study or find work could result in infection with the disease. This made these adolescents suitable candidates for preventive vaccination.
In the mid-1930s, Dorothy’s interest in tuberculin testing came to be equalled, if not surpassed, by her interest in a vaccine that could prevent tuberculosis. This vaccine was named Bacillus Calmette-Guérin (BCG) after the two French scientists Albert Calmette and Camille Guérin who developed it. It first became available for clinical use in the early 1920s but, at this time, it had not been tried in Ireland. BCG was controversial: Albert Calmette’s statistics about the vaccine’s efficacy were unreliable while, in a disastrous incident in Lübeck in Germany, in late 1929 and early 1930, seventy-seven infants died of tuberculosis following oral vaccination with a substance that purported to be BCG.
In August 1936, Dorothy and her husband Liam visited Scandinavia: Dorothy combined a holiday with the opportunity to visit various hospitals, clinics and laboratories. She saw BCG being manufactured and used. Deeply impressed, she immediately applied for a research license to use the vaccine in Ireland. This was granted and she gave BCG to a handful of children in Dublin. However, conditions were difficult: St Ultan’s Hospital where she did much of this work, was overcrowded. An Irish vaccine disaster, known as the Ring disaster, unfolded in 1937. Then, with the advent of the Second World War, BCG vaccine which was flown into Ireland from Sweden, in perishable liquid form, became unavailable. As the war raged, Dorothy became a more and more vocal advocate of BCG. When the war ended, she began once again to import BCG, this time on a larger scale.
In 1948, Dr Noël Browne became Minister for Health. He appointed Dorothy as the chairman of a National Consultative Council on Tuberculosis. She used this position to lobby for a national BCG scheme which would be located in St Ultan’s and controlled by herself. At this time, Dr Maired Dunlevy of Dublin Corporation was also using BCG vaccine although she favoured the Danish rather than the Swedish vaccine espoused by Dorothy. Dublin Corporation and Department of Health officials were not in favour of an independent BCG scheme that would funded by the Department but not controlled by it. In the end, Dorothy got her way and, in 1949, she was appointed as the first chairperson of the National BCG Committee which was tasked with offering mass vaccination to the Irish population on a voluntary basis. Dorothy soon became ill and although she remained associated with the committee until her death in 1954, she did not play the active role that she had hoped in rolling out BCG in Ireland.
Dorothy’s work on tuberculosis including her research and publications, her participation on voluntary national committees and her continuous highlighting of the problem of tuberculosis in Ireland as well as her struggles to introduce tuberculin testing and BCG vaccination, place her among the most active of the Irish medical profession in the first half of the twentieth century, with respect to the disease. The Irish tuberculosis epidemic ended in the late 1950s with the advent of effective antibiotics, improved public health structures and socio-economic conditions as well as the use of BCG vaccine and tuberculin testing. Much of the credit for the ending of Ireland’s tuberculosis epidemic has been claimed by two of Dorothy’s contemporaries, Dr Noël Browne and Dr James Deeny (chief medical adviser to the Department of Local Government and Health and its successor the Department of Health (1944–50). In fact, the ending of the tuberculosis epidemic owes much to the work of many hardworking health professionals including Drs Pat Alston, Robert Collis, Theo Dillon, John Duffy, Mairead Dunlevy, E.J.T. McWeeney, Dorothy Price, Noël Browne, James Deeny and others.
Some useful sources:
Jones, G., ‘“Captain of all these Men of Death”. The History of Tuberculosis in Nineteenth and Twentieth Century Ireland (Amsterdam and New York: Rodopi, 2001).
Mac Lellan, A., ‘The Penny Test: Tuberculin Testing and Paediatric Practice in Ireland, 1900–1960’, in A. Mac Lellan and A. Mauger (eds), Growing Pains: Childhood Illness in Ireland 1750–1950 (Dublin: Irish Academic Press, 2013), pp.123–41.
Mac Lellan, A., ‘Victim or Vector: Tubercular Irish Nurses in England 1930–1960’, in C. Cox and H. Marland (eds), Migration, Health and Ethnicity in the Modern World (Houndmills: Palgrave Macmillan, 2013), pp.104-25.
Ó Broin, L., Protestant Nationalists in Revolutionary Ireland: The Stopford Connection (Dublin: Gill & Macmillan, 1985).
Ó hÓgartaigh, M., ‘Dorothy Stopford-Price and the Elimination of Childhood Tuberculosis’, in M. Ó hÓgartaigh (ed.), Quiet Revolutionaries. Irish Women in Education, Medicine and Sport, 1861–1964 (Dublin: The History Press Ireland, 2011), pp.106-20.
Price, D., Tuberculosis in Childhood (Bristol: Wrights, 1942, 1948).
Price, L., Dorothy Price. An Account of Twenty Years’ Fight against Tuberculosis in Ireland (Oxford: Oxford University Press, 1957). For private circulation only.
Dorothy Stopford Price’s medical papers are held in manuscripts collection of Trinity College Dublin. Collections of her papers and correspondence are also to be found in the National Library of Ireland and the Bodleian Library, Oxford. The annual reports of the National BCG Committee are among the collections of the Royal College of Physicians of Ireland.
Dr Anne Mac Lellan is a scientist (Fellow of the Academy of Medical Laboratory Sciences) and a historian (PhD from the Centre for the History of Medicine in Ireland at the School of History and Archives, UCD).