action on health reform could be viewed as radical, progressive and independent. Ireland in consequence was ahead of Britain and much of Europe in the enactment of childhood immunisation schemes. Despite this stance, it took years for a successful immunisation scheme in Ireland to be implemented. Dwyer chronicles the initiatives undertaken and reveals the many factors which helped or held back the development of immunisation in Ireland. These included obstruction by some from the wider medical community. He explores the different experiences of the major cities of Cork and Dublin and the different levels of success in implementing an immunisation programme. Explaining howmuch relied on the actions and motivation of the supervising medical officer as to whether there was successful uptake of the programme. Other problems had significant impacts such as the ill-fated Ring College incident, during which twenty-four children reportedly contracted tuberculosis and one twelve-year-old girl died following routine anti-diphtheria immunisation. Dwyer provides new evidencewhich suggests that liability lay with the local attending doctor and his advisors rather than with BurroughsWellcomewhere previous historiography has assigned the blame. Dwyer spends some time discussing the Burroughs Wellcome vaccine trials in Ireland held during the mid twentieth century. He reveals the more problematic aspects of the push to find and introduce an effective anti-diphtheria immunisation. He discloses how the rights of vulnerable children in institutional care were clearly side-lined. The scandal first came to light during the 1990s, but this study by Dwyer reveals the much wider prevalence of the practice by the company than previously thought. Furthermore, the available evidence suggests parents and guardians of children involved in trials were kept in the dark about the potentially lethal nature of the vaccines administered to the children. Dwyer points out that while the religious congregations behind these institutions have received considerable attention much less has been focused on the scientific andmedical communities behind the trials. In his opinion further investigation should focus on these communities and their actions. Dwyer also raises important questions around the ethical practices of those involved, who chose to carry out the trials on Irish children as British legislation prevented them from doing so on children in Britain. He queries why those involved deemed the children in Irish institutions as lesser beings and not offered the same protections as their British counterparts. His work fits more widely into the growing interest in recent years in uncovering institutional abuse of children in Ireland. Various reports have been published in recent years ― such as Ryan (2009), Ferns (2005) and Murphy (2009) ― which have revealed the wide extent of child abuse historically within Irish institutions. Dwyer’s book provides a well-written, thorough and thoughtful history of diphtheria immunisation in Ireland. His workmakes a significant contribution to the history of medicine in Ireland and more generally. Furthermore, the difficulties around the roll-out of immunisation schemes mirrors many difficulties experienced today, where a significant anti-vaccine movement exists. In consequence, this book provides useful and thought-provoking context to the current debate around vaccination and to the investigations into historic institutional abuse in Ireland.

中文翻译：

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黑暗回响：探索爱尔兰饥荒、死亡和叛乱的地方。通过吉莉安奥布莱恩。Pp 373. 都柏林：Doubleday Ireland。2020 年。21 欧元平装本。

医疗改革行动可以被视为激进、进步和独立的。因此，爱尔兰在制定儿童免疫计划方面领先于英国和欧洲大部分地区。尽管有这种立场，但爱尔兰成功的免疫计划需要数年时间才能实施。Dwyer 记录了所采取的举措，并揭示了许多有助于或阻碍爱尔兰免疫发展的因素。其中包括来自更广泛医学界的一些人的阻挠。他探讨了科克和都柏林等主要城市的不同经验，以及在实施免疫计划方面取得的不同程度的成功。解释在多大程度上依赖于监督医疗官员的行动和动机，以确定是否成功采用了该计划。其他问题也产生了重大影响，例如命运多舛的环学院事件，据报道有 24 名儿童感染肺结核，一名 12 岁女孩在常规抗白喉免疫接种后死亡。Dwyer 提供了新的证据，表明责任在于当地的主治医生和他的顾问，而不是 Burroughs Wellcome，以前的史学已经将责任归咎于此。Dwyer 花了一些时间讨论 20 世纪中叶在爱尔兰举行的 Burroughs Wellcome 疫苗试验。他揭示了推动寻找和引入有效的抗白喉免疫接种的更多问题。他披露了弱势儿童在机构照料​​中的权利是如何被明显边缘化的。丑闻在 1990 年代首次曝光，但 Dwyer 的这项研究表明，该公司的这种做法比以前想象的要广泛得多。此外，现有证据表明，参与试验的儿童的父母和监护人对给予儿童的疫苗的潜在致命性质一无所知。Dwyer 指出，虽然这些机构背后的宗教团体受到了相当大的关注，但很少有人关注试验背后的科学和医学团体。在他看来，进一步的调查应该集中在这些社区及其行为上。Dwyer 还提出了有关相关人员的道德实践的重要问题，他们选择对爱尔兰儿童进行试验，因为英国立法禁止他们对英国的儿童这样做。他质疑为什么有关人员将爱尔兰机构中的儿童视为次要生物，并且没有提供与英国同行相同的保护。他的工作更广泛地符合近年来人们对揭露爱尔兰虐待儿童的机构日益增长的兴趣。近年来发表的各种报告——例如 Ryan (2009)、Ferns (2005) 和 Murphy (2009)——揭示了爱尔兰机构历史上虐待儿童的广泛程度。Dwyer 的书提供了爱尔兰白喉免疫接种的详细、透彻和深思熟虑的历史。他的工作对爱尔兰乃至更广泛的医学史做出了重大贡献。此外，围绕推出免疫计划的困难反映了今天经历的许多困难，其中存在着重大的反疫苗运动。