Dorothy Stopford Price
2014; Elsevier BV; Volume: 2; Issue: 11 Linguagem: Inglês
10.1016/s2213-2600(14)70193-6
ISSN2213-2619
Autores Tópico(s)Healthcare Systems and Challenges
ResumoIrish physician and pioneer of the tuberculin test and BCG vaccine in Ireland. Born in Dublin, Ireland, on Sept 9, 1890, she died on Jan 30, 1954, aged 63 years. Against the backdrop of two world wars, the Irish war of independence, and the Spanish flu pandemic, a formidable physician, researcher, and nationalist was to leave her mark on medicine in Ireland. Eleanor Dorothy Stopford, known as Dorothy, was born in 1890 into a middle class Anglo-Irish family. After schooling in London, Dorothy returned to Ireland to study medicine. In January 1916, she enrolled in Trinity College, Dublin, following in the footsteps of her grandfather Dr Evory Kennedy. During her years at medical school, several significant events shaped both Dorothy's skills as a doctor and her political allegiance. In her first year, Dorothy was invited to spend the Easter weekend at the lodge of Sir Matthew Nathan, who was undersecretary to the British administration. “She was accidentally at the epicentre of the 1916 Easter rising”, explains Anne Mac Lellan (author of a recent biography). “When the Easter rising broke out, Sir Matthew was called to Dublin Castle and Dorothy had quite a unique view of what happened”. The aftermath of the rising led Dorothy to challenge her support of the British regime. She subsequently joined the nationalist group for women, Cumann na mBan, and, as she informed Sir Nathan, had “cast her lot” with Ireland. Although female medical students at Trinity attended the same lectures and sat the same exams as their male counterparts, they were excluded from some social and professional associations and networks. Dorothy took great exception to this; writing to the prestigious Dublin University Biological Association, she opined that “in the last few years the political and professional position of women in the world has changed”. The Society's uncompromising response was that admission of women “would inevitably lead to the disruption or atrophy of the Association”. After World War 1, the Spanish flu hit Ireland, killing 20 000 people and infecting 600 000 more. As a third year medical student and clinical clerk at the Meath Hospital in Dublin, Dorothy was exposed to the ravages of the flu on both the living and dead. As well as tending to the victims, she did post mortems, often alone, cycling down to the mortuary late at night after her shift at the hospital. In her final year of study, Dorothy was asked by Cumann na mBan to teach a first aid course in Kilbrittain—a stronghold of the Irish Republican Army in west Cork. Although Dorothy was anxious not to jeopardise her imminent graduation from Trinity, she agreed to the assignment. After graduating, she returned to Kilbrittain to work as a dispensary doctor. “She was the only applicant for the job”, Mac Lellan told The Lancet Respiratory Medicine, “and she felt that they only gave it to her as a woman because they really had no choice”. While working there, she also acted as medical officer to the Flying Column of west Cork. “I always got the impression that she really enjoyed it”, comments Mac Lellan. “She seemed to have nerves of steel.” In 1925, Dorothy returned to Dublin to take up the post of physician at St Ultan's Infants Hospital. St Ultan's was progressive in its outlook, encouraging staff to travel to continental Europe for training and education, and operating a positive discrimination policy towards women. In the absence of antibiotics, childhood mortality from gastroenteritis, pneumonia, and tuberculosis was high. Dorothy dabbled in developing her own autogenous vaccines, for which she claimed some success albeit in the absence of much scientific proof. The defining moment in Dorothy's career came during a visit to Vienna, Austria, in 1931. There, she witnessed Professor Franz Hamburger using an ointment containing tuberculin (an extract of tubercular protein) to diagnose tuberculosis. If the child had been previously exposed to tuberculosis, most likely through primary infection, the ointment elicited a skin reaction. She wrote: “It is extraordinary that tuberculosis in children should have been a closed book to Ireland for 20 years after methods of diagnosis were well established on the continent, and at least ten years after methods of treatment had been evolved.” Dorothy returned to Ireland with a tube of Hamburger's ointment, and by 1934 she had amassed findings from 500 tuberculin tests. Dorothy's work challenged the belief at the time that most young adults in Ireland had already been exposed to tuberculosis and provided a good rationale for preventive vaccination. In 1936, Dorothy visited Arvid Wallgren in Sweden. Wallgren had introduced intradermal Bacillus Calmette-Guérin (BCG) vaccination in Gothenburg with great effect. In January 1937, Dorothy used the Swedish BCG vaccine to inoculate two infants at St Ultan's—this was the first time the vaccine was used in Ireland. However, she was concerned about overcrowding in St Ultan's because she thought it was essential that children who were vaccinated weren't exposed to tuberculosis for a period of 6 weeks so that their immunity could develop. Around this time, the so-called Ring Disaster, in which a group of school children developed tuberculosis after vaccination against diphtheria, also created doubts about the safety of vaccination in the mind of the Irish public. Unable to obtain BCG vaccine during World War 2, Dorothy continued to correspond with her medical contacts on the continent and strove to raise awareness of BCG vaccination among her Irish medical colleagues. In the early 1940s, Dorothy attempted to set up a National Antituberculosis League in Ireland, as suggested by Wallgren. The Archbishop of Dublin, John Charles McQuaid, supported the need for an antituberculosis public health campaign, but he objected to the prominence of so many protestant doctors in Dorothy's League. His intervention meant that the National Antituberculosis League, as Dorothy had envisioned it, was never established. When World War 2 ended, Dorothy began to use BCG on a wider scale in Ireland. In 1949, Noel Browne, the new health minister, asked Dorothy to head up a national committee with the aim of rolling out a mass BCG vaccination campaign. Browne and James Deeny, who was chief medical advisor to the Department of Local Government and Public Health, subsequently received much of the credit for ending the tuberculosis epidemic in Ireland. As well as her tireless work as a doctor, researcher, and advocate of BCG vaccination, Dorothy maintained a full personal and social life. She married Liam Price, a District Justice, in 1925. “Liam and Dorothy got on extremely well, but they argued about everything”, recalls Sandra Lefroy, Dorothy's great niece. They were both keen gardeners and very competitive; they each had their own patch of the garden at their country residence in County Wicklow and competed over whose was the most productive. Dorothy had a stroke in 1950, probably due to overwork and stress, from which she developed left-sided hemiplegia. Sandra remembers visits to Dorothy, who lived opposite where Sandra and her sister Penny lived with their grandmother. “She was a semi-invalid in bed a lot of the time, with complicated straps and pulleys to try to help her arm”, remembers Sandra. “The house was one of the quietest houses I've ever been in. It was full of books, all very carefully catalogued.” In 1954, before the end of the tuberculosis epidemic in Ireland, Dorothy had a second stroke and died 2 days later. Harry Counihan, Dorothy's former pupil and subsequent colleague, wrote in the Journal of the Irish Medical Association: “Her brilliant intellect, matched by her nobility of character, made her remarkable. Her honesty gave her the capacity to say ‘no’ in one word, which some found refreshing, others disconcerting. She was above all pettiness and prejudice”. Sandra remembers that Dorothy didn't suffer fools gladly: “If you'd done something stupid, she let you know about it. But we had no idea of her importance or the courage that it took to do what she did. For us, she was just great aunt Dodo.” For more on Dorothy Stopford Price see Mac Lellan A. Dorothy Stopford Price: Rebel Doctor. Sallins: Irish Academic Press, 2014For Stopford Price's letter to the Dublin University Biological Association see Price D. Testimonials. National Library of Ireland, MS 15343 (1)For the Dublin University Biological Association's response see Allen, corresponding secretary DUBA to the Secretary of the Women's Medical Students' Committee, 14 December 1918. National Library of Ireland, MS 15353 (1)For more on Stopford Price's work see Price L. Dorothy Price: An Account of Twenty Years' Fight Against Tuberculosis in Ireland. Oxford: Oxford University Press, 1957 For more on Dorothy Stopford Price see Mac Lellan A. Dorothy Stopford Price: Rebel Doctor. Sallins: Irish Academic Press, 2014 For Stopford Price's letter to the Dublin University Biological Association see Price D. Testimonials. National Library of Ireland, MS 15343 (1) For the Dublin University Biological Association's response see Allen, corresponding secretary DUBA to the Secretary of the Women's Medical Students' Committee, 14 December 1918. National Library of Ireland, MS 15353 (1) For more on Stopford Price's work see Price L. Dorothy Price: An Account of Twenty Years' Fight Against Tuberculosis in Ireland. Oxford: Oxford University Press, 1957
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