Making an Irish Free State City – The work of the School Medical Officer

One hundred years ago this month, on 2 February 1926, City Commissioner Philip Monahan sat in his offices in Fitzgerald Park to deal with the report of the school medical service in Cork city. The report was the first of its kind to be commissioned, researched and written up by the first school medical officer in Cork.

The office of school medical officer was created under the Medical Treatment of Children (Ireland) Act in 1919 under Westminster. The model was adopted by the Irish Free State’s Ministry of Local Government, being one of the first projects to be rolled out by the ministry itself.

On 15 October 1923, the Ministry of Local Government wished to inaugurate a scheme of school medical service for Cork city and wished to hire a female candidate. This was part of a policy to hire more women in the Irish civil service. The salary was set at £500 per year. Advertisement for the job resulted in 13 applicants applying.

On 4 January 1924, Dr Timothy Donovan of Shanakiel Hospital was recommended by members of Cork Corporation. His name was put forward and was overturned by the ministry as it was not a female name.

In May 1924, the job went back out for advertisement. On 26 May 1924, Dr Annie M Sullivan from Ballintemple was appointed by councillors in Cork Corporation. This time the ministry accepted the name. Initially the ministry sought a review of the health of Cork school children. They wished to have information on defects of “eyes, ears, teeth, enlarged tonsils, adenoids, minor ailments, and conditions of uncleanliness”.

On 3 February 1926, Dr Annie O’Sullivan, School Medical Officer, submitted a report to Philip Monahan on the working of the office from the date of its inception, September 1924 to December 1925. A write-up of the report was published in the Cork Examiner on 3 February 1926.

The report details that the initial step in the survey of the schools was assisted by the school nurse. A general examination of all children present was conducted as well as a hygienic survey of the schools. In just 67 days, the number of children inspected was 11,296.

A total 2006 cases of defective eyesight were found. A total of 222 defective hearing cases were found. Nose and throat defects were found on 693 children, 7,998 with defective teeth and 1,067 with “minor ailments, impetigo, scabies, ringworm, septic sores etc”.

A total 11.8% of the children suffered from vermin contamination. A total of 75 children had issues with their lungs, 30 with their heart and 11 children with their nervous system. In terms of defective nutrition, about 8% were below the standard as judged from the average pupil inspected.

In the report Dr Sullivan offered thanks to those teachers, who took an active interest in “securing treatment of children, even reminding those who had appointments for treatment during school hours of the time of such appointments”.

Dr Sullivan discovered that though the numbers, who signed for treatment and who had received appointments at the Cork Dental Hospital on Mulgrave Street, for example, was as high as 38%, the percentage of actual attendance was only 18%. Dr Sullivan noted that many parents regarded a “visit to the dentist necessary only when the child’s tooth aches”.

A similar percentage of low attendance of children with appointments was also discovered at the Eye, Ear and Throat Hospital on Western Road. Indeed, children who received glasses often failed to wear them regularly, and if glasses were broken, the take up of children and parents asking for a replacement was low.

On 31 January 1927, Dr Sullivan’s 1926 report of the School Medical Officer was presented and was later published by the Cork Examiner on 1 February 1927. Despite appointments being made, attendance at the Cork Dental Hospital and at the Eye, Ear and Throat Hospital were still in low figures. In the case of enlarged tonsils and adenoids requiring an operating many parents of children often deferred until such time as “discharging ears or other complications had developed”.

A deeper dive into the conditions of students’ home and social conditions were outlined. Rachitic, bronchial, and tuberculosis manifestations were relatively high in children where areas of “overcrowding and insanitary conditions prevailed”.

Many children showed signs of malnutrition, defective clothing and uncleanliness. Enquiries by Dr Sullivan into the diet of malnourished children discovered that about 50% lived almost entirely on tea and bread with butter or margarine. There were vegetables and meat for dinner on Sundays only.

Since the previous year of 1926, Dr Sullivan reported that no improvements had been made in the hygienic conditions of many schools. Insufficient heating of schools was further aggravated by a scarcity for fuel during a labour strike. This resulted in many incidences where fires could not be kept on after midday. Many schools were also especially badly ventilated during the colder months due to overcrowding and insufficient means of heating.

A year later on 13 February 1928, Dr Sullivan’s annual report for 1927 was presented and was published on 14 February 1928 in the Cork Examiner. It delved into the health conditions within schools. In the case of heating with the exception of a few schools, which were heated by hot water pipes, heating was provided by means of stoves or grates in one or two classrooms.

In a large majority of schools, the school meals consisted of cocoa and currant buns, or bread and jam, or butter. The facilities in many schools did not permit the preparation of a hot meal at midday. The provision of it was hampered by the fact that the lunch break was only 30 minutes.

Dr Sullivan proposed that lunch breaks should be 1 ½ hours. She argued in her report that a child should not be allowed to go for longer than four hours during the middle of the day without a full meal and that there should be more breaks of play as the long days induced fatigue.

Dr Sullivan also noted that a majority of schools were supplied by an outdoor tap with or without common drinking mugs. The latter was condemned by medical authorities and Dr Sullivan called for the replacement as far as possible by sanitary drinking fountains which did not require drinking cups.

She also noticed that lavatory basins were generally insufficient in a number of schools. In a few schools one wash stand and an outdoor tap were the only provisions made for personal cleanliness. There were no towels and soaps in primary schools. Dr Sullivan proposed that there should be four lavatory persons for every 100 children attending a school.

Dr Sullivan also asserted that until such time as all playgrounds were paved, she deemed it practically impossible to keep the schools in a clean condition.

Dr Annie M Sullivan continued her work through the 1930s and well into the 1940s.