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Published online by Cambridge University Press: 11 July 2017
The creation of a network of county infirmaries was a remarkable achievement in late eighteenth-century Ireland. Supported by grants from parliament and the county grand juries, each hospital was managed by governors whose subscriptions entitled them to appoint the medical staff and decide on the patient population. While the laudable aim of the legislators was that the infirmaries would be ‘a means of restoring the health and preserving the lives of many’, the reality was quite different. In 1788 the prison reformer, John Howard, and the inspector general of prisons, Sir Jeremiah Fitzpatrick, delivered a damning report to parliament on the state of the county infirmaries. They described good care and governance in a minority of institutions, but most were in a very bad state; they noted decayed and broken buildings, dirty or no bedding, poor food, lack of regulation, financial malfeasance, few patients and absent staff. Based on their report, this paper argues that the county infirmaries benefited the governors and the staff considerably, and had little impact on the health of the nation. However, providing a hospital and trained medical professionals in every county was a significant step in the formation of the Irish institutional healthcare system.
1 National Aeronautics and Space Administration, ‘Five millennium catalogue of solar eclipses’ (http://eclipse.gsfc.nasa.gov/SEcat5/SE1701-1800.html) (11 May 2015).
2 Commons’ jn. Ire., xii, appendix, p. dcccl.
3 Ibid.
4 John Howard, An account of the principal Lazarettos in Europe with various papers relative to the plague together with further observations on some foreign prisons and hospitals and additional remarks on the present state of those in Great Britain and Ireland (2nd ed., London, 1791), p. 96.
5 Belfast Newsletter, 23 Sept. 1788.
6 Commons’ jn. Ire., xiii, appendix, p. cxcv; The thirty-fourth report of the Commissioners of Accounts of Ireland, pp 52–3, H.C. 1809 (297), vii. 348.
7 Commons’ jn. Ire., xii, appendix, p. dcccl.
8 Ibid., pp dcccxliii–dccclii.
9 J. D. H. Widdess, The Royal College of Surgeons in Ireland and its medical school, 1784–1966 (Edinburgh, 1967); idem, A history of the Royal College of Physicians of Ireland, 1654–1963 (Edinburgh, 1963); idem, The Richmond, Whitworth & Hardwicke Hospitals: St Laurence’s Dublin, 1772–1972 (Dublin, 1972); J. F. Fleetwood, The history of medicine in Ireland (Dublin, 1983); J. B. Lyons, Brief lives of Irish doctors, 1600–1965 (Dublin, 1978).
10 Important contributions published over the past twenty-five years include: Eoin O’Brien, Conscience and conflict, a biography of Sir Dominic Corrigan 1802–1880 (Dublin, 1983); idem, The Charitable Infirmary, Jervis Street, 1718–1987 (Dublin, 1987); F. O. C. Meehan Cecilia Street, the Catholic University school of medicine, 1855–1931 (Dublin, 1987); Davis Coakley, The Irish school of medicine (Dublin, 1988); James Deeney, To cure and to care (Dun Laoghaire, 1989); J. B. Lyons, The quality of Mercer’s, the story of Mercer’s Hospital, 1734–1991 (Dublin 1991); Davis Coakley, Irish masters of medicine (Dublin, 1992); D. J. O’Sullivan, The Cork school of medicine (Cork, 2007); P. M. Bennis, St John’s Fever and Lock Hospital, Limerick, 1780–1890 (Newcastle-upon-Tyne, 2007); Eugene Nolan, Caring for the nation: a history of the Mater Misericordiae University Hospital (Dublin 2013).
11 Most of the publications have concentrated on the period 1600 to 1970, but Fergus Kelly, Aoibheann Nic Dhonnchadha, Charlie Dillon and Maria Kelly have all explored aspects of medicine and disease in Ireland before the seventeenth century: Fergus Kelly, A guide to early Irish law (Dublin, 2009); Aoibheann Nic Dhonnchadha, ‘Irish medical writing, 1400–1600’ in Angela Bourke (ed.), The Field Day anthology of Irish writing (5 vols, Derry & Cork, 1991–2002), iv, 341–57; Charlie Dillon, ‘Medical practice and Gaelic Ireland’ in James Kelly and Fiona Clark (eds), Ireland and medicine in the seventeenth and eighteenth centuries (Farnham, 2010), pp 32–52; Maria Kelly, A history of the black death in Ireland (Stroud, 2001).
12 Ruth Barrington, Health, medicine & politics in Ireland, 1900–1970 (Dublin, 1987); F. W. Powell, The politics of Irish social policy, 1600–1990 (Lewiston, 1992); R. D. Cassell, Medical charities, medical politics, the Irish dispensary system and the poor law, 1836–1872 (Rochester, 1997); Elizabeth Malcolm and Greta Jones (eds), Medicine, disease and the state in Ireland 1650–1940 (Cork, 1999); Tony Farmar, Patients, potions & physicians, a social history of medicine in Ireland (Dublin, 2004). In 2006 historical studies into Irish medicine received a significant boost with the foundation of the Centre for the History of Medicine in Ireland based in University College Dublin (http://www.ucd.ie/history/chomi/) (4 Dec. 2015).
13 He also provided an overview of nineteenth-century fever hospitals and dispensaries in the same work: L. M. Geary, Medicine and charity in Ireland, 1718–1851 (Dublin, 2004).
14 Kelly and Clark (eds), Ireland and medicine.
15 Catherine Cox and Maria Luddy (eds), Cultures of care in Irish medical history, 1750–1970 (Basingstoke, 2010); James Kelly, ‘“Bleeding, vomiting and purging”: the medical response to ill-health in eighteenth-century Ireland’ in Cox and Luddy (eds), Cultures of care, pp 13–36; idem, ‘Health for sale: mountebanks, doctors, printers and the supply of medication in eighteenth-century Ireland’ in R.I.A. Proc., sect. C, cviii (2008), pp 75–113.
16 James Kelly, ‘“Drinking the waters”: balneotherapeutic medicine in Ireland, 1660–1850’ in Studia Hib., xxxv (2008–9), pp 99–146.
17 Gabrielle Ashford, ‘Children’s smallpox and inoculation procedures in eighteenth-century Ireland’ in Anne Mac Lellan and Alice Mauger (eds), Growing pains: childhood illness in Ireland, 1750–1950 (Dublin, 2013), pp 19–36.
18 Susan Mullaney, ‘Charles Lucas and medical legislation in eighteenth century Ireland’ in Irish Journal of Medical Science, clxxxiv (2015) pp 555–6; Susan Mullaney, ‘“A means of restoring the health and preserving the lives of his majesty’s subjects”: Ireland’s 18th-century national hospital system’ in Canadian Bulletin of Medical History, xxix (2012), pp 223–42.
19 Andrew Sneddon, ‘State intervention and provincial health care: the county infirmary system in late eighteenth-century Ulster’ in I.H.S., xxxviii, no. 149 (May 2012), pp 5–21.
20 Roy Porter, The greatest benefit to mankind (London, 1997), p. 198; Aoibheann Nic Dhonnchadha, ‘The medical school at Aghmacart, Queen’s County’ in Ossory, Laois and Leinster, ii (2006), pp 11–43.
21 Census of Ireland for the year 1851. Part III. Report on the status of disease, p. 91, [1765], H.C. 1854, lviii. 95.
22 William Tighe, Statistical observations relative to the county of Kilkenny made in the years 1800 & 1801 (Dublin, 1802), p. 516.
23 Mullaney, ‘“A means of restoring the health and preserving the lives of his majesty’s subjects”’, pp 223–42; C. C. Ellison, ‘County Infirmary’, Navan and District Historical Society (http://www.navanhistory.ie/index.php?page=county-infirmary) (26 Nov. 2015); John Ferrar, The history of Limerick, ecclesiastical, civil and military, from the earliest records to the year 1787 (Limerick, 1788), p. 218; Samuel Lewis, A topographical dictionary of Ireland (2 vols, London, 1837), ii, 693; Fleetwood, The history of medicine, pp 95–113.
24 An act for erecting and establishing publick infirmaries or hospitals in this kingdom, 5 Geo. III, c. 20.
25 Geary, Medicine and charity, pp 40–53.
26 Census of Ireland 1851, pp 96–9; Thirty-fifth report accounts of Ireland, pp 115–17.
27 An act to amend an act made the last session of parliament for erecting and establishing publick infirmaries or hospitals in this kingdom, 7 Geo. III, c. 8.
28 Report of the poor law commissioners on medical charities Ireland, pursuant to the 46 th section of the act 1 & 2 Victoria. c. 56. Addressed to the most noble the marquess of Normanby, her majesty’s secretary of state for the home department, p. 84, [324], H.C. 1841, xi. 653; The thirty-third report of the Commissioners of Accounts of Ireland, pp 113–16, H.C. 1808 (28), iii, 635–8.
29 An act for extending to the county of Waterford, the different laws passed in this kingdom for erecting, establishing and regulating public infirmaries or hospitals, 39 Geo. III, c. 17.
30 An act for explaining and amending an act passed in the fifth year of his present majesty’s reign entitled, an act for erecting and establishing publick infirmaries or hospitals in this kingdom, 13 & 14 Geo. III, c. 43.
31 The Dublin voluntary hospitals were the Charitable Infirmary (1718), Dr Steevens’ Hospital (1733), Mercer’s Hospital (1734), the Hospital for Incurables (1744), the Rotunda Lying-In Hospital (1745), the Meath Hospital (1753) and St Patrick’s Hospital (1753). See: O’Brien, The Charitable Infirmary, p. 5.
32 Commons’ jn. Ire., ix, p. 29.
33 Finn’s Leinster Journal, 25 May 1774; 13 & 14 Geo. III, c. 43.
34 Mullaney, ‘“A means of restoring the health and preserving the lives of his majesty’s subjects”’: pp 223–42.
35 5 Geo. III, c. 20.
36 Diarmuid Ó Grada, Georgian Dublin: the forces that shaped the city (Cork, 2015), p. 152.
37 Oliver MacDonagh, The inspector general: Sir Jeremiah Fitzpatrick and the politics of social reform, 1783–1802 (London, 1981), p. 316.
38 Belfast Newsletter, 14 Aug. 1792.
39 Reports, presented to the House of Commons, from the Commissioners of the Board of Education in Ireland. I. Free schools of royal foundation. II. Schools of Navan and Ballyroan, of private foundation. III. The Protestant charter schools, pp 28–9, H.C. 1809 (142), vii, pp 488–9.
40 Sneddon, ‘State intervention and provincial health care’, pp 5–21.
41 Cassell, Medical charities, p. 3.
42 5 Geo. III, c. 20.
43 Cassell, Medical charities, p. 5.
44 Porter, The greatest benefit, p. 298.
45 David Dickson, New foundations: Ireland, 1660–1800 (Dublin, 2000), p. 85.
46 Geary, Medicine and charity, pp 40–53.
47 Freeman’s Journal, 15 Aug. 1767.
48 Belfast Newsletter, 15 May 1767.
49 Census of Ireland 1851, pp 96–9; Thirty-fifth report accounts of Ireland, p. 97.
50 5 Geo. III, c. 20.
51 Cassell, Medical charities, p. 3.
52 Lindsay Granshaw, ‘The rise of the modern hospital in Britain’ in Andrew Wear (ed.), Medicine in society (Cambridge, 1992), pp 197–218.
53 5 Geo. III, c. 20. Notwithstanding the directive regarding fees, the deputy treasurer in Wicklow was being paid £10 a year when Fitzpatrick visited it in June 1787 (Commons’ jn. Ire., xii, appendix, p. dcccxlviii).
54 Belfast Newsletter 14 Aug. 1792, 4 Aug. 1797.
55 The parliamentary register, or history of the proceedings and debates of the House of Commons of Ireland (17 vols, Dublin, 1782-1801), viii, 437–8; An act for the more effectually regulating and providing for the relief of the poor, and the management of infirmaries and hospitals, in Ireland, 46 Geo. III, c. 95.
56 5 Geo. III, c. 20.
57 List of infirmary surgeons, 1766 (Royal College of Surgeons in Ireland, RCSI/MS/79).
58 7 Geo. III, c. 8.
59 C. A. Cameron, History of the Royal College of Surgeons in Ireland and of the Irish schools of medicine including numerous biographical sketches also a medical bibliography (Dublin, 1886), p. 110; An act for the further regulation of public infirmaries or hospitals, 36 Geo. III, c. 9.
60 An act to amend several acts for erecting or establishing public infirmaries or hospitals in Ireland, so far as relates to the surgeons and apothecaries of such infirmaries or hospitals, 53 Geo. III, c. 62.
61 7 Geo. III, c. 8.
62 5 Geo. III, c. 20. Edward Foster, who was a physician, thought that surgeons should only receive £60, ‘very sufficient in proportion of £100 to a physician’. See: Edward Foster, An essay on hospitals or succinct directions for the situation, construction and administration of the county hospitals (Dublin, 1768), appendix, p. 7.
63 Thirty-fourth report accounts of Ireland, pp 5–81.
64 Commons’ jn. Ire., xii, appendix, pp dcccxliii–dccclii; Howard, An account of the principal Lazarettos, p. 85.
65 Belfast Newsletter, 13 May 1788.
66 Commons’ jn. Ire., xii, appendix, pp dcccxliii–dccclii.
67 Freeman’s Journal, 18 July 1795.
68 Belfast Newsletter, 16 Mar.1792.
69 Finn’s Leinster Journal, 6 Sept. 1783.
70 Ibid., 6 Aug. 1774.
71 Fourteen governors-for-life made a once-off subscription of twenty guineas each and eight annual governors subscribed three guineas each (Commons’ jn. Ire., xiii, appendix, p. cxcv; Thirty-third report accounts of Ireland, pp 117–18; Tighe, Statistical observations, pp 516–18).
72 Edward Foster, An essay on hospitals, appendix, p. 7.
73
In the House of Commons report on charter schools to which Howard and Fitzpatrick also contributed, the cost of maintaining a pupil for a year was estimated at £7 17s.
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d., while Timothy Corcoran later gave it as £8 17s. 9¼d. See: Commons, jn. Ire., xii, appendix, p. dcccxxx; Timothy Corcoran, State policy in Irish education (London, 1916), p. 178.
74 Ó Grada, Georgian Dublin, p. 49; Tighe, Statistical observations, p. 498; Dickson New foundations, p. 111. In 1884 the average cost nationally per patient was £2 5s. 4d. and £19 10s. 5¼d. per bed. See: Hercules MacDonnell, ‘Statistics of the county infirmaries, Ireland’ in Journal of the Statistical & Social Inquiry Society of Ireland, viii (1884), pp 541–3.
75 Mullaney, ‘Charles Lucas and medical legislation in eighteenth century Ireland’, pp 555–6.
76 Finn’s Leinster Journal, 6 Sept. 1783.
77 Belfast Newsletter, 14 Aug. 1792.
78 Sylvester O’Halloran in Limerick mentioned many of the compounds he used in treating his patients. These included: powders of nitre, laudanum, valerian, castor, thebaic tincture, decoction of Peruvian bark, wine, green tea and nervous julap. See: Sylvester O’Halloran, A new treatise on the different disorders arising from external injuries of the head illustrated by eighty-five selected from above fifteen hundred practical cases (Dublin, 1793).
79 Commons’ jn. Ire., xii, appendix, pp dcccxliii–dccclii.
80 Porter, The greatest benefit, pp 266–71; Kelly, ‘“Bleeding, vomiting and purging”’, pp 13–36.
81 O’Halloran was a prolific medical innovator and author. He performed numerous experiments and wrote a number of books on cataract and glaucoma, the methods of amputation and the management of head injury, as well as a treatise on air. His writings also influenced those who founded the Royal College of Surgeons in Ireland. See: O’Halloran, A new treatise, p. 4; J. B. Lyons, ‘Sylvester O’Halloran (1728–1807)’ in Irish Journal of Medical Science, xxxviii (1963), pp 217–88.
82 O’Halloran, A new treatise, pp 2–5. In modern medicine the mortality following serious head injury is approximately twenty-five per cent. See: B. J. Zink, ‘Traumatic brain injury outcome: concepts for emergency care’ in Annals of Emergency Medicine, xxxvii (2001), pp 318–32.
83 Finn’s Leinster Journal, 2 Sept. 1772.
84 Ibid., 17 Oct. 1772.
85 Ibid., 1 Feb. 1772.
86 Freeman’s Journal, 3 Jan. 1795.
87 O’Halloran, A new treatise, p. 210.
88 Belfast Newsletter, 10 Aug. 1795; Finn’s Leinster Journal, 3 Aug. 1799.
89 Tighe, Statistical observations, p. 518; Belfast Newsletter, 14 Aug 1792, 4 Aug 1797.
90 Ashford, ‘Children’s smallpox and inoculation procedures in eighteenth-century Ireland’, pp 19–36.
91 Freeman’s Journal, 8 Apr. 1777.
92 The report also contains observations on a number of schools and orphanages, and these have been excluded from this analysis; Commons’ jn. Ire., xii, appendix, pp dcccxliii–dccclii.
93 C. J. Woods, ‘Fitzpatrick, Sir Jeremiah (c. 1740–1810)’, in D.I.B; MacDonagh, The inspector general, pp 19–22.
94 Howard, An account of the principal Lazarettos, p. 81.
95 Commons jn. Ire., xii, p. 426.
96 Ibid., appendix, p. dcccxlvi.
97 Ibid.
98 Ibid., p. dcccxlvii.
99 Ibid., appendix, p. dcccxlviii.
100 Ibid., p. dcccli.
101 Ibid., pp. dcccxlvii, dcccxliv.
102 Ibid., p. dcccl.
103 Ibid., p. dcccli.
104 ibid., p. dcccxliii.
105 Howard, An account of the principal Lazarettos, p. 90.
106 Commons jn. Ire., xii, p. dcccxlix.
107 Ibid.
108 Howard, An account of the principal Lazarettos, pp 86–7, 92–3.
109 Commons’ jn. Ire., xii, appendix, pp dcccxliii–dccclii; Howard, An account of the principal Lazarettos, pp 78–100.
110 Thirty-third report accounts of Ireland, pp 67–126; Thirty-fourth report accounts of Ireland, pp 5–84; Thirty-fifth report accounts of Ireland, pp 56–139.
111 Howard, An account of the principal Lazarettos, p. 93.
112 Commons’ jn. Ire., xii, appendix, pp dcccxlvi, dccclvi.
113 Ibid., p. dcccl.
114 Thirty-fifth report accounts of Ireland, p. 76.
115 History Links Project, ‘Lifford Community Hospital: over the years’ (http://history-links.blogspot.ie/2010/06/lifford-community-hospital-over-years.html) (16 July 2015).
116 Commons’ jn. Ire., xii, appendix, p. dcccxlvii.
117 An act to explain and amend the provisions of certain acts for the erecting and establishing public infirmaries, hospitals, and dispensaries in Ireland, 3 & 4 Will. IV, c. 92.
118 Commons’ jn. Ire., xii, appendix, pp dcccxlv, dcccxlvii.
119 Ibid., xii, appendix, p. dcccxlix. Fitzpatrick noted that there was a housekeeper, nurse-tender, maidservant and porter as well as the surgeon.
120 Foster, An essay on hospitals, p. i.
121 Various institutions were established during the eighteenth century to deal with these specific problems.
122 David Fleming and John Logan (eds), Pauper Limerick; the register of the Limerick house of industry, 1774–1793 (I.M.C., Dublin, 2011), pp xi–xxix.
123 Farmar, Patients, potions and physicians, pp 64–5; James Kelly, ‘Domestic medication and medical care in late early modern Ireland’ in Kelly and Clark (eds), Ireland and medicine, pp 109–35; Kelly, ‘Health for sale’, pp 75–113; Kelly, ‘“Bleeding, vomiting and purging”’, pp 13–36; Geary, Medicine and charity, p. 5; Medicine and recipe book, Boyle family, c.1675–c.1710 (Wellcome Library, MS 1340, pp 156–8).
124 Granshaw, The rise of the modern hospital, pp 197–218.
125 Commons’ jn. Ire., xii, appendix, pp dcccxliii–dccclii.
126 Howard, An account of the principal Lazarettos, p. 84.
127 O’Halloran, A new treatise, pp 15–17.
128 Ibid., pp 293–4.
129 Commons’ jn. Ire., xii, appendix, p. dcccxlvii.
130 Ibid.
131 Geary, Medicine and charity, p. 49.
132 Sneddon, ‘State intervention and provincial health care’, pp 5–21; Commons’ jn. Ire., xii, appendix, pp dcccxliii–dccclii.
133 Census of Ireland 1851, pp 96–9; Belfast Newsletter, 14 Aug. 1792, 4 Aug. 1797.
134 Parl. reg. Ire., ix, p. 328.
135 Commons’ jn. Ire., xiii, appendix, p. cxcv.
136 36 Geo. III, c. 9.
137 Edward Ward, The parish gutt’lers: or, the humours of a select vestry (Dublin, 1725), p. 18.
138 Parl. reg. Ire., viii, pp 437–8.
139 Commons’ jn. Ire., xii, appendix, pp dcccxliii–dccclii; Belfast Newsletter, 14 Aug. 1792.
140 Toby Barnard, A new anatomy of Ireland: the Irish Protestants, 1649–1770 (London, 2003), pp 13–20.
141 Commons’ jn. Ire., xii, appendix, p. dcccxlvi.
142 Michel Delon (ed.) Encyclopedia of the Enlightenment (2 vols, New York, 2013) i, 233–4.
143 Barry O’Donnell, Irish surgeons and surgery in the twentieth century (Dublin, 2008), pp 47–50.
144 Geary, Medicine and charity, pp 55–7.
145 Local Government (Temporary Provisions) Act, 1923, 1923/9 [I.F.S.] (28 Mar. 1923). I would like to thank Professor Bernadette Whelan and Dr John Logan of the Department of History at the University of Limerick for their comments on earlier drafts of this paper.
