Parochial Officers of Health in pre-Famine Dublin by Ciarán McCabe

In this month's blog Dr Ciaran McCabe, an Irish Research Council funded postdoctoral fellow  (NUI Galway), considers the oft-neglected figure of the parochial health officer and his role in the prevention of contagion and fighting fever epidemics in early nineteenth-century Ireland. In 2011, Dr McCabe successfully completed a MA thesis at the Centre for the History of Medicine in Ireland, UCD, on the impact of the 1817-19 and 1826-27 fever epidemics on the Cork Street Fever Hospital, Dublin. 

Preventing the Danger of Contagion and Other Evils

The Fever Act of 1819 empowered parish 

vestries to elect unpaid officers of health

From the middle of the seventeenth century, civil parish vestries in Ireland carried out functions which we would today associate with local government services: fire-fighting, tree planting, public lighting, and the repair of roads. Parishes also undertook to provide some assistance to local parishioners in distress and this relief included the support of local 'foundlings', the purchase of coffins for local paupers, payments of cash to widows and the maintenance of an alms-house, typically inhabited by local widows. Parish vestries were of such importance as units of local government that it was upon them that powers were bestowed for the prevention of contagion in response to the 1817-19 fever epidemic. The 1819 Fever Act empowered parish vestries to elect unpaid officers of health, who had the authority to direct that tenements, lanes and streets be cleaned, and that nuisances be removed from the streets. These officers also had the power to apprehend and dismiss from the parish 'all idle poor Persons, Men, Women, or Children, and all Persons who may be found begging or seeking Relief' in the interest of 'preventing the Danger of Contagion and other Evils'.¹

Officers of Health: Respectable Parishioners

The positions of officers of health were filled by respectable parishioners, who also typically served as churchwardens, sidesmen and overseers. To these men (and they were invariably men), such voluntary service gave them an opportunity to display their civil responsibilities, as well as asserting their prominence within the community. Toby Barnard has argued that 'as in England, so in Protestant Ireland, a willingness regularly to assume the burdens of parochial office may have helped the middling sort to define and so distinguish themselves from the lower ranks'.² Among the officers of health in St Michan's parish in the 1830s were Mark Flower of Old Church Street and merchant William Hill of 47 Pill Lane, who also served together as sidesmen and overseers of licenced houses.³ In some instances, parishioners who were qualified medical practitioners  were elected to serve as officers of health, such as David Brereton MD in St Michan's in 1831.⁴ In St Thomas's parish in 1828, four of the ten elected officers of health were medical practitioners.⁵

The Fever Act (1819)

A notice issued by the officers of
health in St Werburgh parish,
November 1831

The Fever Act was passed in June 1819, by which point the nationwide fever epidemic had petered out. With the emergency over, parishes were slow to fill the positions of officers of health, which, while not encompassing any salary, required the levying of a parish cess to cover expenses. Shortly after the legislation was passed, the Head of Police wrote to each of the Dublin parishes, reminding them of of their duties to elect officers under the new Fever Act.⁶ In St Catherine's the first officers of health were appointed two months after the legislation was passed while it took nine months for the first officers to be appointed in St Werburgh's parish.⁷ Such delays could be criticised, yet on the other hand, given that the worst of the epidemic had passed, parishes were understandably reluctant to assume additional expenditure on unnecessary undertakings.

Cholera Epidemic

Freeman’s Journal, 17 November 1831. The parish vestry 

of St Anne’s in Dublin city appointed officers of health in 

late-1831, following reports that cholera had reached

 England and was believed likely to spread to Ireland

For the first decade after the enactment of the 1819 fever legislation, many parishes avoided filling these positions. Parish expenditure had to be raised through the taxation of local parishioners, who, in some cases in Dublin city, paid up to sixteen different taxes to various local authorities.⁸ The significance of the 1819 Fever Act, empowering parish vestries to spearhead the local responses to epidemic disease, was not realised until more than a decade after its enactment, when cholera made its first appearance in western Europe. In late-1831, when reports reached Ireland that cholera had been identified in England, parish vestries throughout the country held emergency meetings, drawing on their powers under the 1819 act and rapidly appointing officers of health as a measure to prevent – albeit unsuccessfully – the introduction and propagation of cholera.

To Guard Against Contagion

In St Andrew's parish in December 1831, a cess was levied on parishioners to enable the work of the officers of health by means of 'cleansing & whitewashing the dwellings of the poor in order to guard against contagion'.⁹ Two weeks earlier in St Catherine's parish, the sum of £50 was levied on parishioners following reports 'that a pestilential has raged in several parts of Europe form sometime under the name of Cholera Morbus, which it is feared may shortly extend its ravages to this Kingdom'.¹⁰ Cholera eventually reached Ireland in the spring of 1832 and throughout the epidemic, parochial officers of health carried out measures to mitigate the impact of the contagion. A question which remains unanswered is how the parochial officers of health interacted with other authorities, such as the state-run Board of Health. The rejection in October 1832 by officers of St James's parish of the Board of Health's right to interfere in parochial matters suggests the existence of inherent tensions between these parties, yet the extent to which this single instance is representative of a wider trend is as of yet unclear.¹¹

A dead cholera victim in Sunderland, 1832. Following the outbreak of cholera in north-east
England, Irish parish vestries rushed to appoint officers of health. Wellcome Images

The Decline of the Parochial Officer of Health

Some parishes continued to appoint officers of health throughout the 1830s but the practice declined by the 1840s; yet there are some instances of officers being appointed by parishes in Ulster into the 1850s.¹² The power of parish vestries to appoint officers of health was repealed by the 1866 Sanitary Act,¹³ which extended earlier legislation for England to Ireland and was passed at the height of yet another cholera epidemic. Responsibility for sanitary regulations was transferred to a new Public Health Committee, which operated under the auspices of Dublin Corporation.¹⁴ As well as reflecting wider developments in public health reform in this period, the decline of the parochial officer of health was also a symptom of the gradual removal of civil functions from Irish parish vestries. Although constituting relatively short-lived positions with limited powers, and whose efficacy in mitigating the impact of contagion is difficult to gauge, parochial officers of health remain an interesting and neglected part of the social and medical landscape of nineteenth-century Ireland.

Dr Ciarán McCabe

Dr Ciarán McCabe is an Irish Research Council Government of Ireland postdoctoral fellow at the Moore Institute, NUI Galway. In 2015 he was awarded a PhD by Maynooth University for his thesis which examined begging and alms-giving in pre-Famine Ireland. He is currently writing a monograph arising from his doctoral research. Dr McCabe holds a Masters in the Social and Cultural History of Medicine from the Centre for the History of Medicine in Ireland (CHOMI), UCD and also serves as compiler for Irish History Online.

---

1 An act to establish Regulations for preventing Contagious Diseases in Ireland', 59 Geo. III, c. 41 (14 June 1819).^↩
2 Toby Barnard, A New Anatomy of Ireland: The Irish Protestants, 1649-1770 (New Haven and London), 2003), p. 242.^↩
3 St Michan's parish, Dublin, vestry minute book, 7 April 1828 (Representative Church Body Library (RCBL), St Michan's parish, Dublin, vestry minute books, P 276.05.5; ibid., 23 December 1828; ibid., 9 April 1832; 20 April 1835. Hill also served as churchwarden: ibid., 4 April 1836.^↩
4 St Michan's parish, Dublin, vestry minute book, 23 November 1831.^↩
5 St Thomas parish, Dublin, vestry minute book, 7 April 1828 (RCBL, St Thomas's parish, Dublin, vestry minute books, P 80.5.2).^↩
6 Saunder's Newsletter, 19 August 1819.^↩
7 St Catherine's parish, Dublin, vestry minutes, 24 August 1819 (RCBL, St Catherine's parish, Dublin, vestry minute books, P 117.05.7); St Werburgh's parish, Dublin, vestry minutes, 25 March 1820 (RCBL, St Werburgh's parish, Dublin, vestry minute books, P 326.05.2).^↩
8 Jacinta Prunty, Dublin Slums, 1800-1925: A Study in Urban Geography (Dublin, 1998), p. 67.^↩
9 St Andrew's parish, Dublin, vestry minutes, 12 December 1831 (RCBL, St Andrew's parish, Dublin vestry minute books, P 059.05.2).^↩
10 St Catherine's parish, Dublin, vestry minutes, 28 November 1831.^↩
11 The Pilot, 12 October 1832.^↩
12 Belfast Newsletter, 28 August 1851, 14 April 1852, 3 May 1854.^↩
13 'An act to amend the Law relating to Public Health', 29 & 30 Vict., c. 90, s. 69 (7 August 1866).^↩
14 Prunty, Dublin Slums, pp 70-71.^↩

A Knight at the Theatre: the Adelaide Hospital and Denominational Divisions in Dublin's Voluntary Hospitals by Robbie Roulston

One of the characteristic features of Dublin's voluntary hospitals has been their long-standing denominational divisions. In this month's blog post Dr Robbie Roulston, UCD, writes about Dublin's Adelaide Hospital, the 'most anti-Catholic hospital in the whole of Dublin', and the government's consternation arising in 1950 when the Irish President, Séan T. O'Kelly, received an invitation to attend one of the hospital's fundraising events. 

Adelaide nurses, on the main
staircase of the hospital,1950s

Dublin's Adelaide Hospital

The Adelaide Hospital was founded in 1839 in Dublin for the treatment of poor Protestants in Ireland. As such, the royal charter it was granted placed denominational restrictions on the patients which should be admitted to the hospital. Similar restrictions applied to staff and management. However, what was unusual was the fact that this charter remained in place until 1980.

A 'bitter anti-Catholic reputation'

Such restrictive policies were not unknown to Irish policymakers and caused a considerable degree of tension. In June 1950, the Adelaide Hospital Society issued invitations to various dignitaries for the Gala American Concert, a fundraising event for the Adelaide at the Theatre Royal, in Dublin. Invitations were sent to the Taoiseach, Fine Gael’s John A. Costello, and his wife; to members of the Government; and to a number of Army Officers. All of these officials declined the invitation owing to what the Secretary to the Government described as ‘the bitter anti-Catholic reputation of the Hospital’.

A Knight of Columbanus

Medical students, Adelaide Hospital, n.d.

When an invitation for the President of Ireland, Fianna Fáil’s Seán T. O’Kelly, arrived the government assumed that he too would refuse the invitation. O’Kelly had strong Catholic credentials. He had been one of the few Knights of Columbanus in Eamon de Valera’s cabinet and a proponent of Catholic morality in Irish medical ethics and foreign policy during his career. He had form in condemning restrictive policies in hospitals and twenty years earlier had condemned hospitals which employed religiously restrictive admissions procedures. He had argued then that ‘These barriers are a relic of bygone days and they should be a relic of bygone days.’

'Things had changed now'

The President, Séan T. O'Kelly and Mrs. O'Kelly attend the Gala
American Concert to launch the Adelaide Campaign (1950).
L. to R.: The American Ambassador (Mr. George Garrett);
Lord Farnham (President of the Hospital); Mrs. George Garrett;
The President; Mrs. O'Kelly, Mr. Edward Bewley (Chairman).

The presidential O’Kelly, however, was mellower than his former self. When an official in his office approached O’Kelly on the subject, informing him that the Adelaide ‘has the reputation at the moment of being the most anti-Catholic hospital in the whole of Dublin’, O’Kelly responded that he was aware of this. He acknowledged that there was a time when a Catholic priest would not be allowed inside the hospital, but he pointed out that ‘things had changed now to the extent that Catholics are admitted and priests are permitted to see them and administer the sacraments.’

The government remained uneasy and the subject moved up the ladder of protocol when the Taoiseach raised it with O’Kelly the following day. O’Kelly remained firm and informed Costello that he had already accepted the invitation and had promised to go, and that he intended to honour that promise.

O’Kelly continued to attend Adelaide functions when invited and newspapers reported on him attending the Gala American Concert in 1950, a Joseph Szigeti violin recital in 1952, and an Arthur Rubinstein piano recital in 1954.

'She would bid him take out his cheque book'.
Cartoon of Adelaide Hospital nurse collecting funds.
Drawn by Adelaide doctor, n.d.

A slight against the President

All of this proved very uncomfortable for Irish officials. At the Rubinstein concert the order in which the dignitaries were listed was perceived by officials as a slight against the President – the British ambassador had been listed ahead of the Irish President! A series of notes were passed between the Office of the President, the Chief of Protocol in the Department of External Affairs, and the Irish Embassy in London to see what conventions held there. In the end it was ruled that the ‘the matter is one of tact and good taste rather than of a definitive rule.’ The officials concluded that the Adelaide Hospital erred in a lack of the former rather than by a breach of the latter.

It was decided that no formal protest should be made to the organisers of the concert, but that in future the President’s attendance at such events would be organised more closely with the Secretary to the President to ensure that protocol was followed more strictly.

Ending religious restrictions

Adelaide Hospital nurses in class, n.d.

In the end, the state’s real power to affect change in the management of the hospital would not lie in attendance or non-attendance at its functions or in furious memoranda on the finer points of protocol. Cash was king, and only as the Adelaide’s financial position slid from bad to worse could the state exact the concessions favoured by Irish policy makers and politicians, which was to open up admission and recruitment policies to all people irrespective of their religion. The Adelaide chose to ignore these demands while it was independent of state supports, but as it grew needy it softened its stance on various matters and relaxed most of its religious restrictions.

Dr Robbie Roulston's recently completed PhD thesis is entitled, "The Church of Ireland and the Irish State, 1950–1972: Education, Healthcare and Moral Welfare." He has taught on the history of Protestants in twentieth century Ireland in the UCD School of History and Archives. Currently, he holds a position with UCD's Academic Secretariat, working in the areas of higher education policy, governance, strategy.

Below, you can listen to Robbie's presentation at the CHOMI Seminar Series, 3 April 2014, on the Adelaide Hospital

CHOMI Seminar Series, Thursday 3 April 2014
Dr Robbie Roulston (University College Dublin)
"The most priceless possession of Protestants in this country”: the Adelaide Hospital and upholding Protestant healthcare in Ireland 1950-1972.
5 pm, K114, School of History & Archives, UCD.

‘Funding Dublin’s Hospitals c.1847-1880’ by Joseph Curran

In this month's blog post, Joseph Curran, a graduate of the MA in Social and Cultural History of Medicine at UCD, writes about his MA thesis 'Funding Dublin's Hospitals, c.1847-1880'. The blog post examines some of the themes that emerged from the thesis, highlighting the importance of studying hospital finance and why Dublin makes an interesting case study.

Post-Famine Dublin possessed more voluntary hospitals than any other Irish town. Thom’s Directory for 1850 listed nineteen voluntary hospitals operating in the city and many more were established in the next three decades. These institutions varied significantly in scale and function. They included general hospitals such as the Meath and Dr. Steevens’ Hospitals, as well as specialist institutions including the Westmoreland Lock Hospital which treated female venereal disease patients, several maternity hospitals, and a number of ophthalmic institutions. Histories of individual Dublin hospitals have been written which contain valuable information on their day-to-day activities, however they rarely reveal the common challenges faced by the city’s hospitals. Although finance might appear to be a topic far removed from hospitals’ ‘real’ work, recent studies by Keir Waddington and Sally Sheard have shown how examining hospital funding sheds light on these institutions’ interactions with their surrounding communities. From the 1860s hospital managers throughout the United Kingdom were under pressure to improve their institutions’ sanitary arrangements and nursing services. Examining hospital finance allows one to assess the financial impact of such reforms and the role played by the institutions’ ‘paymasters’ in promoting such changes. It makes it possible to examine how receipt of income from different types of sources affected hospital administration.

Dublin presents a particularly interesting case for the study of hospital finance. As David Durnin has pointed out, the city was home to Ireland’s medical elite and its voluntary hospitals were places of medical education. Dublin’s hospitals attracted many students in this period because of their prestigious educational reputation and they gained financially from medical students attending for clinical instruction. Educational activity subsidised hospital services as the institutions’ medical officers performed their duties free of charge while receiving income from student fees. In some hospitals a portion of these fees was also donated to the institution. Receipt of educational income created demands on resources which could interfere with the wishes of the hospitals’ other paymasters. For example, those making charitable donations to the hospitals were often allowed to recommend patients for treatment. Medical officers, however, wanted to prioritise cases they considered interesting from an educational point of view and they sometimes disagreed with lay donors about which patients should be admitted. Studying hospital finance sheds light on how such conflicts affected the administration of Dublin’s hospitals.  

Dr. Steevens’ Hospital, Dublin. This hospital was one of several Dublin hospitals in receipt of annual Parliamentary grants in the post-Famine period. Image courtesy of Wellcome Library.

Mary E. Daly highlighted the importance of religious tensions in shaping social life in post-Famine Dublin. Many of the city’s hospitals, including Dr. Steevens’ and Sir Patrick Dun’s, had historic links with the Church of Ireland. A smaller number of hospitals, such as St. Vincent’s and the Mater, were managed by Catholic religious orders. Examining hospital finance reveals the effects of religious affiliation on the institutions’ interactions with the outside world, and in particular, on their managers’ fundraising efforts. In her study of medical provision in Huddersfield and Wakefield, Hilary Marland pointed out that unlike other types of charities, hospitals and dispensaries gained the support of both Anglicans and Non-conformists in these religiously-divided towns. Studying hospital funding allows one to compare this with the situation in Dublin, did Dublin’s hospital managers emphasise their institutions’ links with one religious group to attract donations, or did they try to appeal to donors of all denominations? 

Studying the finances of Dublin’s hospitals also illuminates the effects of an unusual income source. Nine Dublin hospitals received annual grants from Parliament in this period, a situation almost unique in the United Kingdom. In 1848 a Parliamentary Select Committee recommended the grants be reduced annually until they ended. However this led to protests in Dublin and the decision to withdraw the grants was reversed in the mid-1850s. These events provide an opportunity to examine ideas advanced by those defending what was, at the time, a very unusual form of hospital income. Most British contemporaries would have considered the Parliamentary funding of hospitals to be unacceptable. How did those defending the grants make their case? Did their arguments reflect a greater ideological acceptance of central state involvement in healthcare provision in Ireland compared with the rest of the United Kingdom? Or did the protestors argue that Dublin’s hospitals were special cases entitled to income that would be otherwise objectionable? 

‘Public Engagement’, extract from an advertisement for a bazaar in aid of the Mater Hospital, 

Freeman’s Journal 10 January 1860.

Hospital managers had to appeal to the public in ways consistent with contemporary social expectations, note, for example, the involvement of ‘Ladies of rank and distinction’ in aiding the event. 

Image courtesy of the Irish Newspapers Archive.

As well as shedding light on ideas, analysis of Parliamentary funding reveals how this type of finance affected hospital administration. A supervisory body, the Board of Superintendence of Dublin Hospitals, was established in 1856 to monitor the grant-aided institutions. Gerard M. Fealy highlighted the Board’s role in promoting change in sanitary provision and nursing arrangements at the supervised hospitals. Indeed the Board not only influenced hospitals by inspecting them and offering advice, it published annual reports containing details of hospital income, expenditure, and treatment outcomes, something which brought much information on the supervised hospitals before the public. Hospital managers were aware of the potential importance of this information as many of them also had to appeal to the public for donations. Bad publicity from any source might make such donations less likely. Indeed several Dublin hospitals were also supervised by other funding bodies including Dublin Corporation. Receipt of income from a diverse range of sources created many obligations which directly affected hospital administration in Dublin and shaped how the institutions’ managers interacted with the wider world. The study of hospital finance is not simply the examination of ‘dry’ statistical data far removed from the institutions’ ‘real’ business, rather it reveals key issues in hospital management and provides a convenient way of highlighting the common challenges faced by a city’s hospitals.  Dublin provides an especially interesting case for such a study.    

Joseph Curran is a doctoral student at the University of Edinburgh. His PhD explores philanthropic networks in Dublin and Edinburgh between 1815 and 1845. The aim of the project is to examine what involvement in charitable activity reveals about elite social life in each city. Joseph's PhD research is funded by the Economic and Social Research Council and the Jenny Balston Scholarship. He may be contacted by email at j "dot" s "dot" curran "at" sms.ed.ac.uk