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Trail-blazers: Inspirational Irish women in medicine

Prof Mary Horgan, Consultant Physician in Infectious Diseases and Internal Medicine at Cork University Hospital (CUH), made history last week when she took over from Prof Frank Murray as the 142nd President of the RCPI, which was founded in 1654.

It is fitting, therefore, that St Luke’s Symposium, the College’s annual national conference celebrating achievements and advancements in medicine, featured a number of talks on inspirational Irish women in medicine.

Dr Dorothy Stopford-Price was one such figure; she succeeded in acquiring the first experimental license to work with the BCG (Bacillus Calmette-Guérin) anti-tuberculosis (TB) vaccine in 1936 and administered the first vaccinations in Ireland in 1937.

Dr Stopford-Price, a Protestant from Dublin, spent her life working to reduce deaths from TB, which was the cause of more than 4,600 deaths (600 in children) when the State was founded.

So taken by her story, Dr (PhD) Anne MacLellan wrote the book Dorothy Stopford-Price: Rebel Doctor in 2014.

Dr MacLellan delivered a presentation on “Dorothy”, as she refers to her affectionately, and the introduction of the BCG vaccination in Ireland at the Symposium’s Heritage Day.

Dr Stopford-Price was seen by some within the medical establishment as a maverick. Indeed, she was a supporter of the Irish struggle for freedom from British rule.

“She was extremely determined and saw barriers as something she would overcome, not something that would stop her in her tracks,” Dr MacLellan tells the Medical Independent (MI).

Dr Stopford-Price was always open to new ideas and kept a keen eye on developments in defeating TB in Europe, Dr MacLellan adds.

The BCG vaccine was developed in 1921 in France. Initially, it was given as an oral vaccine and was later given as an injected vaccine. She went to Norway, Sweden and Denmark and saw what they were doing with BCG vaccines in 1936.

“A part of her openness to new ideas was probably from being at St Ultan’s Hospital. It was an unusual hospital, in that it had an all-woman medical board and it looked outwards all the time… that hospital seemed to provide a place where doctors could experiment with new ideas,” Dr MacLellan remarks.

Under the tireless work of Dr Stopford-Price, St Ultan’s, a Dublin hospital for children, also made history in becoming the first Irish hospital to provide the BCG vaccination.

But Dr Stopford-Price’s path was not without its battles. She famously came up against Archbishop of Dublin John Charles McQuaid when she and her colleagues attempted to set-up the National Anti-Tuberculosis Leagues in the early 1940s.

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Archbishop McQuaid, according to Dr MacLellan, publicly called a halt to their plans and the story made national and international headlines at the time.

“He realised the need to do something about TB but didn’t want Protestant doctors to take the lead. He diverted the campaign to the Red Cross, essentially under Catholic control,” Dr MacLellan reveals.

Dr Stopford-Price also experienced opposition to efforts to establish a national BCG scheme from Dr James Deeny at the Department of Health.

But she found a champion in Minister for Health Dr Noel Browne, appointed in 1948, and he allowed her to set up the National BCG Committee in 1949, which was established outside the Department of Health management structure and headquartered in St Ultan’s Hospital.

According to Dr MacLellan, Dr Stopford-Price was very interested in tuberculin testing and found that the teenage population in Ireland were largely tuberculin-negative, which meant they were largely susceptible to getting TB; this was a cohort she was eager to vaccine.

In 1954, Dr Stopford-Price carried out an analysis of the BCG campaign in Ireland and reviewed more than 140,000 vaccinations.  The review showed that 21 cases of tubercular disease developed post-vaccination. Of these, 11 were already incubating TB (seven recovered; four died).

Of the other 10 who developed the disease some time after being immunised, five recovered, three were still under treatment, one died and one could not be contacted. There were 16 undesirable reactions.

“Overall, in a country where tuberculosis was still endemic, this was an excellent result. Dorothy never claimed that the vaccine would afford complete protection,” Dr MacLellan notes.

“However, also in 1954, James Deeny criticised the overall rate of vaccination in the first five years of the national campaign. He asserted that vaccination needed to be carried out on a ‘greatly increased scale’. Dorothy had proceeded cautiously at first and was very particular about vaccinators and their training.”

So what would Dr Stopford-Price make of the Irish situation currently, with recommendations from HIQA stating that a selective BCG vaccination programme would be more suitable for the population than universal neonatal vaccination?

“I would say she would probably be saying ‘yes, we’ve now got the disease down to a level in which we can manage it in this way’. I’m not sure she would oppose it but she would have been watching what happened,” Dr MacLellan believes.

Women in medical school

Meanwhile, Dr (PhD) Laura Kelly, Lecturer in the History of Health and Medicine School of Humanities at the University of Strathclyde, Glasgow, delivered a presentation on the subject of the admission of women to the RCPI, originally known as the King and Queen’s College of Physicians in Ireland (KQCPI).

The presentation will examine the history of women’s admission to the medical profession in Ireland in the 19th Century and is based on a paper by Dr Kelly titled ‘The turning point in the whole struggle: The admission of women to the King and Queen’s College of Physicians in Ireland, published in Women’s History Review.

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Dr Laura Kelly

“A lot of people don’t know this, but the RCPI actually had a really important role in the admission of women to the medical profession in the UK and Ireland,” Dr Kelly reveals.

“Back in the 1870s, British and Irish women could not enter medical schools, so those who wanted to become doctors would train abroad.

“However, as a result of the Medical Act, which came in 1859, doctors with qualifications from abroad were not allowed to practise in the UK or Ireland.”

At the time, there were lots of arguments against women studying medicine. According to Dr Kelly, the arguments were based on Victorian beliefs about women’s physical, mental and emotional natures, which were rooted in the physiological theories of the late 19th Century.

Medical practitioners, particularly specialists in gynaecology and obstetrics, who were beginning to notice competition from female doctors in these areas, were instrumental in the attack on the women’s higher education movement in 19th Century Britain, Dr Kelly says.

For supporters of women in the medical profession, it was women’s very natures that made them most suitable to work as doctors. For instance, advocates claimed that there was a definite need for women doctors to treat women patients, and that female doctors were needed in the missionary field.

After much campaigning, the Enabling Act was introduced in 1876, which meant that if a medical licensing body wanted to award degrees or licences to women, they could do so, but were not obliged to, Dr Kelly notes.

“The RCPI, or KQCPI, was the first medical licensing body to take advantage of this act, which effectively gave women a means of entering the medical profession,” Dr Kelly states.

“The KQCPI was very important for the licensing of early British women doctors in the late 19th Century.

“The RCPI has always been a licensing body so it provided doctors with a licence to practise medicine, subject to them having done their education elsewhere and passing their examinations.”

A qualification from the KQCPI allowed doctors to practise medicine but first they would have had to acquire a medical education. Until British or Irish universities admitted women to study medicine, a woman wishing to take the medical licence examinations of the KQCPI had first to prove that she had attained medical education at a foreign university.

The RCSI in Dublin admitted women from the mid-1880s, while Queen’s College Belfast and Queen’s College Cork admitted their first female medical students in 1888 and 1890, respectively.

In contrast, the majority of British universities did not admit women until the 1890s and 1900s, with the exception of the University of London, which decided to permit women to take medical degrees from 1878.

Dr Kelly has written two books to date, while her current project is also looking at women and the history of contraception in modern Ireland between 1922-1992.

“As part of this, I am interested in changing birth control practices, as well as the role of women activists in changing the law on contraception in 1970s and 1980s Ireland.”

Another talk on inspirational women in Irish medicine was due to be delivered at the Symposium by Mr Jeremy Dronfield, titled ‘Dr James Barry: The woman who fooled the British Army’.

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