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Chapter two will discuss how, from the 1880s, diphtheria increasingly became an urban disease in Britain, Europe and America, and it is unlikely that Irish urban centres managed to avoid this ominous trend. The introduction of the Infectious Disease (Ireland) Act in 1906, and the mandatory obligation this legislation placed on local authorities to notify outbreaks of infectious disease, exposed the true prevalence of diphtheria in Ireland. The burgeoning, albeit reluctant, acknowledgement by local authorities in Dublin and Cork that diphtheria was endemic in their districts brought with it realization that a comprehensive public health response was required. Radical reform of public health administration and service provision in the newly independent Irish Free State, meant that Irish health authorities were well placed to take advantage of cutting edge laboratory-based measures to control infectious disease. It examines the development of anti-diphtheria antitoxin and its application as a preventive measure on a mass scale in New York in the early 1920s before considering how this radical public health intervention was received by health authorities and medical professionals in Britain and Ireland. This chapter will show how Irish health officials and medical officers eschewed the reticence of their British counterparts, readily abandoned traditional sanitarian approaches to disease control and embraced new public health methodologies in a bid to protect child life.

Chapter four suggests that although the practical application of anti-diphtheria immunization in Cork achieved good results, its success was qualified somewhat by the limitations of Burroughs Wellcome’s anti-diphtheria serum TAM. To reduce the occurrence of post-treatment diphtheria cases – occurrences which undermined public confidence in active immunization – field epidemiologist Jack Saunders introduced an experimental ‘one-shot’ Burroughs Wellcome anti-diphtheria antigen in Cork. This chapter explores the development of Burroughs Wellcome’s Alum-Toxoid anti-diphtheria antigen and the relationships that developed between the British pharmaceutical company and Irish medical officers: the former eager to field trial experimental anti-diphtheria serums unrestrained by restrictive British legislation and the latter eager to embrace any solution, however radical, to leverage a modicum of control over diphtheria and its often-fatal consequences, even if this meant side-lining the rights of vulnerable children residing in state-run institutions.