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

Abstract

Reviewed by: Strangling Angel: Diphtheria and Childhood Immunization in Ireland by Michael Dwyer Anne Hardy Michael Dwyer. Strangling Angel: Diphtheria and Childhood Immunization in Ireland. Reappraisals in Irish History. Liverpool: Liverpool University Press, 2018. x + 212 pp. $120.00 (978-78694-046-9). The development of vaccines protective against the infectious diseases of childhood has given human populations since the mid-twentieth century a protection against these infections unprecedented in human history. Historical scholarship in this area has, however, been limited, except on the subject of smallpox, a vicious killer at all ages, a vaccine against which was developed by Edward Jenner in 1796, and which was eradicated after concerted global effort in 1977. The historiography of immunization has focused largely on Jenner and on the antivaccination movements that rapidly developed to fight the compulsory vaccination of human populations. Vaccines developed to control measles, rubella, diphtheria, and polio have aroused less controversy and historical interest, but their application continues to be contested by antivaccinationists, and they continue to pose a threat to human populations. Against this background, Michael Dwyer’s study of the attempts to free the Irish cities of Cork and Dublin from diphtheria between ca. 1930 and 1965 usefully refreshes and broadens the historiography of immunization. Dwyer begins with a historical perspective on diphtheria, its appearance in Ireland in the 1740s, the difficulties in diagnosis, and the fragility of available death records. Early twentieth-century hospital records, he notes, show that the disease was very familiar to staff, suggesting that it was much more common than [End Page 283] the death records suggest. Efforts at prevention depend on an understanding of the processes of infection, and the principal factor in the spread of diphtheria is the existence, post-recovery, of a period of carrier status. Dwyer does not tell us when this was first known, but notes that “some medics” in the early 1930s (p. 58) clearly did not fully grasp the concept and that bacteriological examination before discharge from hospital and arrangements for quarantining of afflicted children took second place to traditional sanitary measures of control. When the carrier role was first recognized is unclear, but a meticulous study of “apparently healthy” schoolchildren in Dublin, published in 1931, revealed carrier status as “commonplace,” playing a significant part in spreading infection (pp. 64–65). Diphtheria was very prevalent in Ireland in the early twentieth century, and Dwyer analyzes the attempts to bring the disease under control in Dublin and Cork, misguided in the former, initially successful but undermined by the occurrence of post-treatment cases in the latter. Active immunization with toxin-antitoxin mixture began in the 1920s, but following accidents with toxic products in Massachusetts and Baden, Austria, in 1924 and 1925, the British company Burroughs Wellcome developed their own brand of vaccine for the British market. This also proved controversial, when an immunization program at Ring College, County Waterford, in 1936 resulted in seventeen children being infected with tuberculosis, and one death. The court case that followed exonerated both the drug company and the doctor concerned, damaging existing Irish immunization schemes and killing off any prospect of implementation across Britain as a whole. The episode undermined confidence in vaccination among Irish parents, doctors and legislators alike, and attendance at established immunization programs fell by 80 percent, after which the number of infections rose and the medical union became concerned about its members’ indemnity in cases of complaint, refusing to cooperate with the immunization program unless they received higher fees. Not until 1948 did the government of the Irish Republic capitulate on increased fees, and meanwhile diphtheria reemerged as a public health problem. Nonetheless, after 1948 an intensive immunization campaign was put in place, and by 1960 diphtheria rates had plummeted across Ireland. Dwyer’s account of the history of diphtheria in Ireland not only provides us with a documented history of the disease for the island of Ireland but also highlights the issues that still surrounded the disease and its prevention in the first part of the twentieth century—vaccine confidence, vaccine uptake, public apathy. Antivaccination activism does not seem to have been present in Ireland to any degree in the period covered by this story...