A local historian digs into the treatment of tuberculosis in Ireland

At Blanchardstown Library earlier this month, independent historian Alan Carthy gave a talk about a public health crisis of times past: tuberculosis.

Back in the mid-1800s, one in every 8.75 deaths in Ireland was from tuberculosis (TB), or consumption, as it was called then, he says.

Carthy has studied the treatment of tuberculosis in Ireland extensively, focusing on medical care in Leinster from the 1890s to the 1970s.

His research uncovered how, in the 1940s, plans for a large-scale treatment facility in Santry fell through, costing the government time and money, because of bureaucratic failures.

Carthy says mistakes like this are still inherent in large government departments, and similar blunders have been made much more recently, like the placement of the new children’s hospital in Dublin, which he believes to be controversial.

TB in Dublin

TB is a disease of the lungs, but it can affect other parts of the body. Symptoms include fever, cough, weight loss, and blood in the sputum.

Although Carthy studied how TB was treated in Dublin in the late 19th and early 20th centuries, the disease had been around much longer than that. It was in Dublin as far back as the 1500s and 1600s.

“We can’t call it an epidemic because it was endemic in the population,” he says. Once it got into a population, it stayed there.

The city’s climate provided an excellent breeding ground too.

Sunlight kills the mycobacterium, or germ, that causes TB. But in damp, dark conditions, the bacteria can survive for months, says Carthy. Those were the conditions in much of the city’s housing in the past – damp tenement buildings with little sunlight.

Normally, the disease transferred through droplets in the air, from an infected person’s coughs or sneezes. The droplets would also land on surfaces. The floor, for one.

“In the tenements in Dublin, there were people living on top of each other. A whole family could be living in one room, or if they were extremely lucky, two rooms,” he says. It spread easily to the rest of the family – sweeping the floor could cause the germs to become airborne, and easily inhaled.

It was only in the mid-1800s, says Carthy, that scientists discovered it was an infectious disease. Antibiotic treatment was discovered in the 1940s, but it wasn’t until the 1950s that scientists found a very effective combination of drugs.

Before that, he says, the primary treatment was rest.

A Dublin Sanatorium

“Here, they were treating everyone in sanatoria,” Carthy says. They were long-term care facilities for people with TB, before the days of antibiotics.

As early as 1935, he says, the Irish government was developing a plan to build four large regional institutions where people with TB could rest and recover. One of them was to be in Dublin.

But, as Carthy found in his research, the machinations of government moved slowly.

In 1943, the Irish Red Cross recommended that five large institutions be built around the country.

The health minister Sean MacEntee decided three regional sanatoria should be built, including one with 1,000 beds in Dublin, says Carthy.

The government passed emergency legislation to speed the process along, Carthy says. Previously, local authorities had the power to acquire sites and provide equipment for sanatoria.

But to bypass delays that would have been caused by red tape, those powers, which included the power to acquire land by compulsory purchase order, were transferred to the health minister in 1945.

But, Carthy says, “Even with legislation passed, it can take a long time to implement these things, especially where health is involved.”

“Everything in health takes time,” he says, because there are important elements to coordinate: facilities, staff, and equipment/medicines.

Carthy says it’s an example of the government taking action quickly to pass legislation. “They have done it again now with the coronavirus, but again, with all these things, the implementation of the legislation is the issue.”

After a site in Ballyfermot fell through, in April 1945 the health department looked elsewhere – at a plot owned by the psychiatric hospital at Grangegorman. That site was in Santry.

Santry Court was a 222-acre estate and period residence that the Grangegorman authority had bought from the Domville family years earlier, Carthy says.

Back then, Santry was remote. It needed extensive groundworks to install roads, sewers, and water lines, before any buildings could go up. P.J. Walls and Bros won the contract to build the facility and do the site works for £75,000.

“£75,000 was a lot of money in the late ‘40s,” Carthy says.

Building An Airport

Meanwhile, the nearby Collinstown Airport (now Dublin Airport) was a small aerodrome with grass runways and not a lot of air traffic, says Carthy.

But in 1946, the government decided it should be expanded to accommodate transatlantic air traffic. Plans for three concrete runways were drawn up, Carthy says.

So the Department of Industry and Commerce was proceeding with plans for the airport, while the Department of Local Government and Public Health was going ahead with ground works for a sanatorium less than a mile away. Neither government department knew of the other’s plans.

One of the new runways would begin less than a mile from the sanatorium site, which would be directly under the path of approaching flights. Aircrafts would be passing between 200 and 500 feet above the facility.

The noise would have made it impossible for patients to get the rest that was so essential for their treatment at the time, Carthy says.

A government official from the Department of Industry and Commerce noticed the extensive groundworks taking place at the sanatorium site, very near to the airport.

“He spotted it on the bus going into work,” Carthy says.

“A phone call from an official in the Department of Finance to Dr James Deeny, the chief medical officer in the Department of Local Government, revealed the dilemma,” Carthy says. Deanie informed the health minister.

Deeny took decibel readings of planes taking off and landing, which showed the two projects weren’t feasible. The minister that would head the newly created Department of Health and Social Welfare was left to sort it out, Carthy says.

In February 1947, the new Minister for Health, Dr James Ryan, told his staff to find a new site and quietly stop working on the old one, Carthy says. Plans for the Santry sanatorium were abandoned.

But over £40,000 had already been spent on the “debacle.”

“The new minister said to stop the work and tell no one; they’ll never find out,” says Carthy. “They never actually put up any buildings.”

But in May 1947, the story broke in the news.

“It was effectively a scandal at the time, spending all this money on something because they didn’t know what was going on,” he says.

The plans were shifted to a site in Blanchardstown, where Connolly Hospital now stands.

But when it was first completed in 1955, it was a facility dedicated solely to the treatment of TB, with 26 separate buildings and accommodation for 540 patients and hundreds of staff.

Was anyone ever held to account for the expensive mistake in Santry? Carthy says the answer is no.