The Therapeutic Revolution in Belfast, 1910s-60s: Medical Utopia or Dystopia?

by Ian Miller, Ulster University

Belfast Health Week

In June 1933, Ulster Hall hosted an event named Belfast Health Week. The Week was intended to ‘impress upon the general public the social and individual importance of hygiene, emphasizing the positive benefits of health rather than the negative results of disease’. Through films, lectures and exhibits, visitors learnt about the healthiest ways to live. Stalls were set up by the Red Cross, Institute of Hygiene, Dental Association, Food Education Society, National Baby Week council, among many others.[1]

At the time, exhibits were a popular format of public health education which introduced visitors to quite new concepts such as germs, microbes and viruses. Public health officials were moving away from tackling unhealthy aspects of urban environments: sewage, water closets, polluted rivers, etc… They had a new strategy: convincing people to adopt healthy behaviours and lifestyles. New technologies aided them, as visitors could now watch films, then a new innovation, to visualise how diseases emerged, spread and killed.[2] The popularity of the Health Week also suggests that Belfast’s denizens were no longer complacent about their health prospects. Fatalistic attitudes about illness and untimely deaths being natural were falling out of fashion. Doctors, too, began to hope that germs, viruses and infections could be safely managed.

Health Improvement

Germs had first been identified in the 19th century, but doctors remained unable to cure the infected until the 20th. For now, the focus was on prevention. Health advice focused on stopping germs spreading and improving physical health to guard against infection. New publications emerged including Belfast Health Journal which instructed readers on matters such as healthy diets, water purity and healthy lifestyles.[3]  In the early 20th century, health visitors called to mothers’ houses to offer advice on post-natal health, nutrition, hygiene and infant management, all to improve the health of the future generation.[4] Interested mothers attended ‘babies clubs’ to receive further information.[5] These schemes were led by respectable female groups with strong state ties such as Women’s National Health Association and republican groups including United Irishwomen and Maud Gonne’s School Dinners Ladies Committee.[6] Some infant welfare initiatives were driven by eugenics agendas but nonetheless had practical benefits, particularly in working class communities.[7]

Image: Principal Causes of Death during the Year 1909, Report of the Medical Officer of Health, Belfast County Borough (1909). Wellcome Collection. Attribution 4.0 International (CC BY 4.0).

Governments also brought in legislation. In the early 1900s, medical inspection schemes and free meals were introduced in schools.[8] The 1907 Notification of Births Act (1907) and Nursing Home and Midwives Act (1929) improved prospects for the new-born.[9] Between 1922 and 1947, Northern Ireland’s infant mortality rate fell by 31 per cent, from 77 to 53 infant deaths per 1000 births.[10]

Improvements were made to Belfast’s physical environment. The Irish Times commented in 1933: ‘crowded alleys and lanes – all that was left of the picturesque, but unhealthy, old Belfast – have been cleared away to make room for commercial buildings’.[11] Privies and ashpits were replaced with flushing toilets, helping vanquish typhoid fever from the city.[12] Moreover, outbreaks could now swiftly be identified and traced back to their source (often, a dubious milk supply).[13] The invention of trams and cars encouraged suburban living. People no longer needed to live crowded together in the city centre or the streets adjoining their work places.[14] Citizens began to think in terms of keeping healthy, rather than just avoiding disease.

In 1922, Medical Superintendent of Health, Dr HW Baillie, happily reported that ‘never before in the history of Belfast was there so low a death-rate’ from almost all diseases.[15] Aside from occasional devastating outbreaks, infectious disease no longer affected daily life in Belfast to the extent which it once had. Occasional influenza outbreaks occurred, causing some sections of society to close. In January 1929, over 100 influenza deaths occurred in Belfast, including four in the family of James Jackson, a well-known fish merchant.[16] On 26 January, the Ulster Herald reported that 100 people were ill in the infirmary wards, and 120 RUC men, 80 tram workers and 20 female telephone exchange workers being off sick.[17] During Winter 1930-31, Belfast was ravaged by a combined epidemic of influenza, measles and diphtheria.[18] But (until COVID), no disease reached epidemic proportions again.[19]

A ‘Golden Age’ of Medicine

This period from around the 1910s to 1960s is often called the ‘therapeutic revolution’, ‘epidemiological transition’ or ‘golden age of medicine’. These decades witnessed a radical change in human experience: infections became both preventable and curable. A string of scientific developments promised to usher in a new health utopia in which no-one died from infectious disease.[20] Given how horrifically infections had ravaged industrial Belfast, this was a monumental change in day-to-day life.

Between the 1920s and 1960s, vaccines appeared for diphtheria, tetanus, tuberculosis, typhus, whooping cough, influenza, yellow fever, polio, measles, mumps and rubella. The downward trend of disease incidence was sensational.[21] In 1913, Emile von Behring developed effective immunisation against diphtheria. By 1930, Belfast had stocks of diphtheria available for emergencies at six depots.[22] In the 1930s, extensive efforts were made to immunise the city’s children against diphtheria, despite some public suspicion.[23] Between October 1936 and May 1937, 4,215 children completed an immunisation course with Behring’s anti-toxin. By 1944, over 65,000 infants and children had been immunized against the so-called ‘destroyer of little children’, around half of the city’s youthful population.[24] By the 1950s, diphtheria outbreaks were a surprise, rather than the norm.[25]

Vaccines did not cure diseases, but prevented their occurrence. Still, relatively little could be done for a person already sick and infected. However, in 1909, Paul Ehrlich developed a ‘magic bullet’ (Salvarsan) which targeted syphilis microbes without harming the human host. Syphilis was now curable. In the 1930s, sulphonamide drugs were developed that helped cure pneumonia, meningitis, gonorrhea and dysentery. But the most important development was undoubtedly the accidental discovery of penicillin by Alexander Fleming in 1928, an anti-biotic developed for mass production during World War Two. Penicillin could cure all manner of infections. News spread quickly, and the public pressured manufacturers to make it available for non-military use.[26] In 1943, another anti-biotic – streptomycin – was discovered. This could cure tuberculosis, the killer disease of the Victorian period.[27]

Image: Sir Alexander Fleming Giving a Lecture to QUB Students. © National Museums NI.

In 1945, a medical trial took place at Royal Victoria Hospital. Sufferers of bacterial endocarditis (a blood infection which settles in the heart) were injected with penicillin. The results were positive. Previously, this disease was thought to have a 100% fatality rate. Now, it could be easily managed with an anti-biotic injection.[28] Local trials also revealed penicillin’s effectiveness in treating pneumonia, sore throats and abdominal inflammation.[29]

Hidden Epidemics

The world was quickly changing. A ‘therapeutic revolution’ was occurring. However, the promised medical utopia didn’t materialise quite as planned. People lived longer, but died instead from other problems, usually chronic lifestyle-related problems that affect us later in life. A ‘hidden epidemic’ of chronic health problems emerged. In 1960, in an inaugural academic lecturer, Social and Preventive Medicine Professor, John Pemberton, acknowledged improvements in living conditions, diet, housing, pharmaceutical abilities and knowledge of health, but turned his attention instead to the subject of ‘disease in an affluent society’.[30]

As early as 1937, Belfast’s Medical Superintendent of Health had warned of the ‘cancer menace in Belfast’.[31] While some cancers were connected to occupational health hazards, the existence of an ‘ageing population’ increased cancer’s prevalence as cause of death, simply because cancer is more common in older age. In the 1950s, lung cancer was identified as smoking-related, Northern Irish doctors noted a sharp increase in ‘bronchogenic carcinoma’, a once rare disease.[32] Heart problems also increased due to diet, and also ageing. By the 1960s, heart disease was Northern Ireland’s leading cause of death. A Cardiac Flying Squad was established, developed by Royal Victoria Hospital heart specialist, Frank Partridge, which rushed out to help and save those suffering a heart attack.[33] Diabetes incidence rates also rose dramatically.[34] As seen earlier with the Belfast Health Week, public health advice was still moving towards positively promoting health instead of warning of disease’s dangers.

Image: Defibrillation equipment. The portable cardiac defibrillator was developed in Belfast by Professor Frank Pantridge. In 1965, he installed his first version in a Belfast ambulance. Wellcome Collection. Attribution 4.0 International (CC BY 4.0).

Quality of life became a major issue for those who reached old age. Due to the therapeutic revolution, the elderly population expanded. A 1946 Nuffield Hospitals report warned that many elderly citizens were living in appalling housing conditions unable to properly care for themselves. Whereas the management of deadly diseases such as tuberculosis had once been the priority, now provision for the aged was a major concern. Financial aid was not enough, warned Dr Duncan Lees in 1946: Improved living conditions and home help were also needed. Lees estimated that 14,500 elderly people were living alone in Northern Ireland in a single room, cottage or lodging.[35] Evidently, the epidemiological transition brought with it new concerns about the well-being of an ageing population.

By the 1980s, doctors and the public were using terms such as ‘the quiet epidemic’ and ‘the impending crisis’. Medical advancement had increased (western) prospects of surviving to old age. But the downside was a population now suffering and dying from cancers and heart attacks, or reaching old age but becoming susceptible to falls, stroke and dementia. Freedom from infection did not necessarily translate into good quality of life. For many, it involved a descent into health decline, disability and dependency.[36]

© The Author(s) 2021. Published by the Epidemic Belfast team on behalf of Ulster University. Any unauthorised broadcasting, public performance, copying or re-recording will constitute an infringement of copyright.

[1] ‘Belfast Health Week’, Weekly Irish Times (10 June 1933); Medical Superintendent Officer of Health Report for Belfast for the Year 1933 (Belfast: John Adams, 1934), pp. 22-3.

[2] Jennifer Lisa Koslow, Exhibiting Health: Public Health Displays in the Progressive Era (New Brunswick, NJ: Rutgers University Press, 2020).

[3] Linen Hall Library holds a number of Belfast Health Journal editions.

[4] Belfast Newsletter (23 September 1909).

[5] ‘The ‘Babies Clubs’ of Belfast’, Slainté (January 1909), pp. 13-14.

[6] Ian Miller, Reforming Food in Post-Famine Ireland: Medicine, Science and Improvement, 1845-1922 (Manchester: Manchester University Press, 2014), chapter 7. See also Lindsay Earner-Byrne, Mother and Child: Maternity and Child Welfare in Dublin, 1922-60 (Manchester: Manchester University Press, 2007).

[7] Greta Jones, ‘Eugenics in Ireland: The Belfast Eugenics Society, 1911-15’, Irish Historical Studies, 28 (May 1922).

[8] ‘Health of School Children: Medical Inspection in Belfast’, Weekly Irish Times (17 July 1905).

[9] Medical Superintendent Officer of Health Report for Belfast for the Year 1930 (Belfast: John Adams, 1931), p. 6.

[10] E.A. Cheeseman, ‘A Statistical Review of the Trend of Infant Mortality in Northern Ireland during the Period 1922 to 1947’, Ulster Medical Journal, 18:2 (November 1949), p. 192

[11] ‘Health in Belfast’, Irish Times (26 August 1933).

[12] Medical Superintendent Officer of Health Report for Belfast for the Year 1911 (Belfast: W. & G. Baird, 1912), p. 39.

[13] ‘Outbreak Traced to Dairy’, Irish Times (17 September 1935).

[14] Medical Superintendent Officer of Health Report for Belfast for the Year 1933 (Belfast: John Adams, 1934), p. 8.

[15] Medical Superintendent Officer of Health Report for Belfast for the Year 1921 (Belfast: W. & G. Baird, 1912).

[16] ‘Four Dead in One Family’ Irish Independent (29 January 1929).

[17] ‘Influenza Epidemic’, Ulster Herald (26 January 1929).

[18] ‘Call for Medical Assistance: Epidemics in Belfast’, Irish Times (11 February 1931).

[19] ‘Influenza in Ireland: Epidemic in Two Cities – Many Victims in Cork and Belfast’, Irish Times (6 January 1937).

[20] Allan M. Brandt and Martha Gardner, M., ‘The Golden Age of Medicine?’, in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century (London: Routledge, 2000).

[21] Gareth Millward, Vaccinating Britain: Mass Vaccination and the Public since the Second World War (Manchester: Manchester University Press, 2019).

[22] Medical Superintendent Officer of Health Report for Belfast for the Year 1930 (Belfast: John Adams, 1931), p. 70.

[23] ‘Combatting Diphtheria: Belfast City Council Declares War on Child Peril’, Irish Press (25 December 1936); Medical Superintendent Officer of Health Report for Belfast for the Year 1936 (Belfast: John Adams, 1937), pp. 9-10. See also Michael Dwyer, Strangling Angel: Diphtheria and Childhood Immunisation in Ireland (Liverpool: Liverpool University Press, 2018).

[24] Medical Superintendent Officer of Health Report for Belfast for the Year 1944 (Belfast: Graham and Heslip, 1945), p. 4.

[25] ‘Diphtheria Outbreak in Belfast’, Irish Press (7 August 1959).

[26] Robert Bud, Penicillin: Triumph and Tragedy (Oxford: Oxford University Press, 2009).

[27] Greta Jones, ‘Captain of All these Men of Death’: The History of Tuberculosis in Nineteenth and Twentieth Century Ireland (Amsterdam: Rodopi, 2001). See also Jeremy A. Greene, Flurin Condrau and Elizabeth Siegel Watkins, Therapeutic Revolutions: Pharmaceuticals and Social Change in the Twentieth Century (Chicago: Chicago University Press, 2016).

[28] ‘Great Penicillin Success in Belfast’, Irish Independent (31 December 1945).

[29] ‘Fatal Heart Disease Yields to Penicillin’, Irish Press (29 December 1945).

[30] Linen Hall Library, BPB1960.4. John Pemberton, Disease in an Affluent Society (Belfast: Queen’s University of Belfast, 1960).

[31] ‘Cancer Menace in Belfast’, Irish Independent (18 August 1937).

[32] ‘Cancer of the Lung in Northern Ireland’, Ulster Medical Journal, 25:2 (November 1956).

[33] ‘Belfast’s Cardiac Flying Squad is Saving Many Lives’, Irish Independent (10 November 1967).

[34] E. M. Crawford, ‘Death Rates from Diabetes Mellitus in Ireland 1833-1983: A Historical Commentary’, Ulster Medical Journal, 56:2 (October 1987), pp. 109-15; Lauren Young, ‘Diabetes in Twentieth-Century Ireland’. Unpublished Master’s thesis. Ulster University, 2019.

[35] ‘The Problem of the Aged in Northern Ireland’, Ulster Medical Journal 15:2 (15 November 1946), p. 150.

[36] R.W. Stout, ‘Ageing in the 80s’, Ulster Medical Journal, 54:2 (October 1985).