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Prior to the mass social acceptance of childhood immunization in the 1940s, diphtheria was one of the most prolific child killers in history. The formation of a leathery membrane in the lower airways induced death by suffocation and earned diphtheria the moniker ‘strangling angel of children’. It showed scant regard for social status and infiltrated Europe’s royal palaces as sinuously as her slums and hovels. For parents and children of nineteenth and early twentieth-century Ireland, diphtheria represented the ‘most dreaded disease of childhood’ however, for their modern-day counterparts’ diphtheria has been relegated to a somewhat obscure disease. Few Irish doctors have seen a case of diphtheria, let alone treated one. In Ireland, diphtheria has been consigned to history, and so too have the horrors and mass fatalities once associated with it. But how was this achieved? Was active immunization received with open arms by public health authorities, the wider medical community, and the general public? This book tackles these questions by undertaking the first historical examination of the issues that underpin the origins of active immunization in Ireland. It explores the driving forces that shaped the national childhood immunization programme, and those that opposed them. In addition, it examines the complex social implications attendant on the introduction of this mass public health intervention.

The opening chapter rescues diphtheria from obscurity, offering a rationale as to why Irish health authorities opted to embrace a new and radical public health intervention and why they set the eradication of diphtheria amongst the first of their national goals. A study of surviving statistical data relating to infectious disease in nineteenth and early twentieth-century Ireland does not suggest that such an intervention was warranted. However, despite the distinct lack of diphtheria notifications recorded in this period, this chapter will show that diphtheria was indeed a major child killer.

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 three examines the rollout of anti-diphtheria schemes in the Irish Free State. It argues that a successful – albeit small-scale – anti-diphtheria scheme undertaken in Dundalk, Co. Louth, in 1927 influenced the introduction of new legislation designed to accommodate the rollout of a state-backed national anti-diphtheria immunization programme. An overview of the national picture is complemented by more in-depth analysis of local initiatives implemented by ‘front line’ medical officers in Dublin and Cork. These case studies highlight the dissimilar results obtained by a frugal and limited intervention in Dublin compared with the more comprehensive mass immunization scheme implemented by public health authorities in Cork. This chapter suggests that Cork city was the site of the largest anti-diphtheria immunization scheme ever undertaken in Ireland and Britain, the success of which drew national and international attention