Strangling Angel: Diphtheria and Childhood Immunisation in Ireland by Michael Dwyer

Abstract

Reviewed by: Strangling Angel: Diphtheria and Childhood Immunisation in Ireland by Michael Dwyer Mary Hatfield Strangling Angel: Diphtheria and Childhood Immunisation in Ireland By Michael Dwyer Liverpool: Liverpool University Press, 2018. x + 212 pp. Hardback £85.00. Michael Dwyer's debut monograph documents the history of diphtheria and the campaign to implement anti-diphtheria vaccination in the Irish Free State. Offering a new analysis of the Ring College disaster and the role of the British pharmaceutical company Burroughs Wellcome in Ireland's immunization initiatives, this book is an innovative and insightful study into the history of vaccination and public health policy. As the question of compulsory vaccination once again looms high on the public agenda, Dwyer's work casts a historical light on the challenges of pursuing innovation in public health policy while also ensuring protection of the vulnerable and individual rights. The volume is the first to focus on diphtheria in Ireland and the development of a vaccination. Given the extent of the disease and its fatality rate, this is a welcome addition to the literature on vaccination and childhood health in Ireland. The study utilizes Irish newspapers, government reports, and public health records to trace efforts taken to mitigate this childhood disease and the challenges and failures of early immunization campaigns. The book is not a social history of the disease, and therefore limited attention is paid to how parents and children experienced diphtheria or thought about the risks and rewards of vaccination. This study focuses on public health officials, on the medical community, and the scientific development of an antitoxin. [End Page 471] Dwyer makes a strong case for the prevalence of diphtheria as one of the deadliest childhood diseases, though it was often misclassified and underreported during the late nineteenth and early twentieth centuries. The book argues that Irish health policies were radically progressive, influenced by American and specifically New York's public health schemes. The Irish were one of the earliest European nations to adopt and implement childhood immunization. However, their progressive stance masks a darker history of vaccine experimentation carried out on children in Irish industrial schools, as well as the administration of experimental vaccines to children with limited parental consent. The vision of a diphtheria-free Ireland meant that some physicians took risks that were likely unacceptable to wider Irish society but were considered necessary among British and Irish medical communities. Dwyer focuses on the aggressive schemes launched in Cork and Dublin to bring about a bacteriological revolution. The vigor of such health policies was largely connected to the personality of the acting medical officer. Jack Saunders's energetic and extended appointment in Cork from 1929 to 1957 enabled a long-term commitment to childhood immunization schemes. The early successes of anti-diphtheria immunization were brought to a halt with the Ring College disaster in 1936–37. After a routine anti-diphtheria immunization by a local Waterford doctor, twenty-four children reportedly contracted tuberculosis and one 12-year-old girl died. The existing historiography relating to the Ring incident has insisted that Burroughs Wellcome mistakenly supplied a bottle of live tuberculosis in lieu of a bottle of the anti-diphtheria serum. Dwyer suggests that the local doctor and his advisors conspired to cover up initial negligence in administering the immunization and subsequently failed to provide medical treatment to the affected children in order to avoid blame. Perhaps the most striking element of the episode was the collusion of medical and school authorities to prevent parents from knowing that their children had been diagnosed as tubercular. Legal action against the prestigious Wellcome company produced an inconclusive verdict, and the real effect of the Ring College disaster was an 80 percent decline in children presented for immunization the following year. Dwyer's concluding chapter follows the development of vaccination schemes in Ireland until the 1960s, providing insight into the gradual acceptance of diphtheria immunization and the decline of the disease. There is a noticeable lack of tables and charts throughout the volume. These would have been very useful to contextualize and compare incidences of disease and immunization rates. There are several long sections in chapters [End Page 472] 3 and 4, drawn from yearly reports...