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.

Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850–2000

Prisoner Health Project: Wellcome Trust Senior Investigator Award

histprisonhealth.com

A major new research project in the history medicine has just been launched: 'Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850–2000'. This collaborative, five-year study, funded by a Wellcome Trust Senior Investigator Award, is being led by co-Principal Investigators, Professor Hilary Marland, of the Centre for the History of Medicine, University of Warwick, and Dr. Catherine Cox, Director of the Centre for the History of Medicine in Ireland, University College Dublin.

Strangely, the history of medicine, despite its strong focus on the history of institutions, has neglected the prison as a site of medical treatment. It's great to see that such an ambitious project is going to address this omission. That this is a comparative research project is also exciting; comparative historical analysis, despite its strong tradition in the social sciences and a limited recent resurgence, is long overdue a renewal.

Project aims

The co-Principal Investigators, Catherine and Hilary, are keen for the project's research to resonate with contemporary concerns in the prison service and they aim to tackle historical questions of prisoner health that are still relevant today. For example, they and their team are going to look at the high incidence of mental illness amongst prisoners, the health of women prisoners and the status of prison maternity services, as well as the response to prisoner substance abuse and the impact of HIV/AIDS. All of these topics are still major concerns in the medical management of contemporary prison populations in Ireland and England. 

Late nineteenth-century photographs of
prisoners in Reading Gaol
Berkshire Records Office P/RP1/5/2
Source: Berkshire Family Historian

Scope of project

Each of the different research strands within the project will cover the period from rise of the modern penal system during the mid-nineteenth century up to the present. Fundamental to the project is the comparative analysis of English and Irish prison services and the conceptual basis of prisoners' entitlement to health in both England and Ireland. 

Prisoner health and human rights

The project team is going to address the question of who advocates for prisoners' health, both within and without the prison service. They will also investigate the extent to which prisoners have been seen as entitled to health care and if human rights debates have had any influence on the provision of medical care for prisoners. Another principal area of historical inquiry is going to be the extent to which prison doctors have felt themselves to be constrained by dual and conflicting loyalties to the prison regime and to their prisoner patients. 

Policy workshops and public engagement

Hilary and Catherine have also said that the project is going to engage with policy makers and prison reform organisations, including the Howard League for Penal Reform. With that in mind, they are busily preparing several policy workshops and compiling a list of potential invitees. They also hope to engage with the general public and people working in the area of prisoner welfare through a series of outreach projects. Among the most interesting of these are their plans to commission both a theatrical production and a piece of artwork that will be based on their team's research findings. 

Project members

Dr. Catherine Cox, University College Dublin, Principal Investigator. 

Professor Hilary Marland, University of Warwick, Principal Investigator.

Both Hilary and Catherine are working on the relationship between the prison system and mental illness – a subject of acute contemporary relevance considering the high levels psychiatric morbidity amongst prisoners – and they are also looking at the impact of the prison on prisoner mental health. In addition, Catherine will focus on the evolution of the separate system in Ireland and its impact on mental health while Hilary will examine the question of women and mental health in the prison system.

Dr. Will Murphy, Mater Dei Institute, Dublin City University, is researching the health of political prisoners and the impact they had in shaping attitudes and practices of health and medicine in Irish and English prisons.

Dr. Fiachra Byrne, University College Dublin, Postdoctoral Research Fellow (3 years), is working on the mental health of juvenile prisoners in England and Ireland.

Dr. Nicholas Duvall, University of Warwick (year 1), University College Dublin (year 2), Postdoctoral Fellow (2 years), is going to be supporting Hilary and Catherine in their research and will also develop his own project on the health of prison officers. 

Dr. Margaret Charleroy, University of Warwick, Postdoctoral Research Fellow (3 years), is working on the management of prisoner health, disease and chronic illness.

A further Postdoctoral Fellow, who will be researching the history of HIV/AIDS in prisons under the supervision of Professor Virginia Berridge at the London School of Hygiene and Tropical Medicine is slated for appointment later this year (2015).  

Public Engagement Officers, at Warwick and Dublin, will be appointed in late 2015. They will have responsibility with implementing the project's arts and policy initiatives.

In 2016, there will be two PhDs appointed to the project. One, based at UCD, will work on prison reform movements; the other, based at Warwick, will investigate the health of women prisoners.

If you want to find out more about 'Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850–2000', you can visit the UCD project page or the Warwick project page. The project team have also announced their Advisory Board members and provide a list of recent and upcoming project activities.

For further project details or inquiries, you can contact Hilary by email at hilary.marland@warwick.ac.uk or Catherine at catherine.cox@ucd.ie

The Cork Street Fever Hospital Archive by Fergus Brady

In 2013, the Cork Street Fever Hospital archive was donated to the Royal College of Physicians of Ireland (RCPI). Following a recent funding award, the archivists at the RCPI began the process of cataloguing and preserving these extensive and important medical records. The project is now complete and the final collection list is available to browse through the online RCPI catalogue. In this month's post, Fergus Brady, Archivist, RCPI, reports on the archive and outlines the history of this fascinating Irish medical institution.

Nurses and patients on the 'lower landing', Cork Street Fever Hospital, 1903
(RCPI Archival Collections: CSFH/1/2/1/6)

RCPI win Wellcome Trust funding to catalogue Cork Fever Hospital Archive

A project, funded by the Wellcome Trust, to fully catalogue the archive of Cork Street Fever Hospital has been completed by the staff of the Royal College Physicians of Ireland Heritage Centre. As part of the project, appropriate measures were also taken to ensure the long-term preservation of the archive so that the hospital’s records will be accessible to researchers both in the present and into the future.

The origins of the House of Recovery and Fever Hospital, Cork Street, Dublin

Minutes, Governors of Cork Street Fever Hospital, 1801
(RCPI Archival Collections: CSFH/1/1/1)

The House of Recovery and Fever Hospital on Cork Street, Dublin, grew out of a series of meetings held between a group of wealthy and philanthropic men drawn from Anglican and Quaker congregations during October 1801. In the late eighteenth and early nineteenth centuries in Dublin, as elsewhere in Europe, insanitary conditions ensured that infectious diseases were prevalent among the general population. Those present at the October meetings had a clear idea of the nature and scale of such health issues, stating that ‘...no adequate Hospital accommodation has hitherto been provided for the relief of the Sick poor of Dublin afflicted with fever (especially such as may be of a contagious Nature)’. Influenced by the fever hospital movement in Britain, the provisional Committee believed that the solution lay in the ‘establishment of a House of Recovery to which patients on the first appearance of Fever might be removed’.¹

The fever hospital opens

Original entrance to the hospital, erected 1804
(RCPI Archival Collections: CSFH/7/1/6)

Less than three years later, on 14 May 1804, the newly-erected House of Recovery and Fever Hospital on Cork Street admitted its first batch of patients. As its name suggests, the hospital physically separated the sick from the convalescent by the constructing two buildings 116 feet apart in what was an early attempt at infection control.² The erection of such purpose-built buildings was intentional, as the hospital’s founders were influenced by prevailing theories regarding the control of infectious diseases.

Early years and fever epidemics

Cork Street Fever Hospital and House of Recovery, 1899
(RCPI Archival Collections: CSFH/1/2/1/5)

In the early decades of the hospital’s existence its catchment area expanded from the Dublin Liberties to the whole of the city. Hospital buildings were extended to meet the admissions triggered by the regular epidemics which ravaged the poorest districts in the city. A fever epidemic in 1817—1819 put severe pressure on the hospital, with admissions doubling in 1818. In 1826 an epidemic of typhus necessitated the erection of emergency tents. The 1830s and 1840s were periods of exceptional activity, as the number of patients admitted swelled due to outbreaks of cholera and typhus. In 1847 tents were erected and 400 emergency beds provided to allow for the admission of patients suffering from a typhus outbreak, which had been stimulated in large part by the influx into Dublin of thousands of famine-stricken refugees from the countryside. These regular epidemics took their toll on the health of the medical staff, and in particular the nursing staff, many of whom were struck down with fevers contracted during the course of their work.

The 'Red House'

Nurse and two children on the balcony of the Red House, 1909
(RCPI Archival Collections: CSFH1/2/1/6)

In the 1860s and 1870s epidemics of smallpox placed great pressure on the hospital’s resources, with a record case fatality rate of 21 per cent recorded in 1878. In the last few decades of the century measles, typhoid, scarlet fever and smallpox predominated, prompting the hospital governors to build the ‘Red House’ on the grounds of Cork Street, and to open an auxiliary hospital for convalescents at Beneavin, Finglas. In 1891, hospital reports recorded diphtheria for the first time, a disease which became a significant health problem in the early twentieth century with the arrival in Dublin of the virulent gravis strain.

The move to Cherry Orchard

Patient arriving at hospital in ambulance, 1896
(RCPI Archival Collections: CSFH/1/2/1/5)

In the early twentieth century there were two changes that significantly altered the running of the hospital: in 1904, the hospital was granted a Royal Charter under which Dr. John Marshall Day was designated first Medical Superintendent; and, in 1936, the Dublin Fever Hospital Act changed the hospital from voluntary to municipal control. This alteration sought to “make provision for the establishment of a new fever hospital in or near the city of Dublin and for the closing of the House of Recovery and Fever Hospital, Cork Street, Dublin”.³ Planning for the development of a new hospital was long and protracted, however, with both the Second Word War and a 1944 sworn inquiry into alleged maladministration in the hospital contributing to delays. Led by the efforts of Dr. Day’s successor as Medical Superintendent, Dr. C. J. McSweeney, a 74-acre site was finally secured at Blackditch, Palmerstown, Co. Dublin, and building tenders received in early 1950. The hospital board decided that as the name Blackditch evoked images of plague and death, the address of the new hospital should be changed to Cherry Orchard. In November 1953, patients and staff vacated the premises at Cork Street and moved to the new House of Recovery and Dublin Fever Hospital, Cherry Orchard.

The Cork Street Fever Hospital archive

Staff of Cork Street Fever Hospital, 1938
Dr. C. J. McSweeney, Medical Superintendent, is
pictured sixth from the right in the second row
(RCPI Archival Collections: CSFH/1/3/4/1) 

The archive of Cork Street Fever Hospital is large and varied, and consists of a series of records relating to hospital management, staff, students, patients, finances, buildings, hospital history and events. There are also records of inquiries, routine administration and domestic tasks, and individual Medical Superintendents. The run of minute books is remarkably complete, stretching from the first meetings of the provisional managing committee in 1801 to 1953, a span interrupted only by a gap of twelve years between 1828 and 1842. Similarly annual reports, which usually include medical reports, run from 1801 to 1953 with few omissions. Records relating to individual Medical Superintendents are particularly plentiful for Dr. C. J. McSweeney’s tenure (1934–1953), and consist for the most part in report books, research and teaching notes, drafts of articles and papers, and other ephemera. Patient records are, unfortunately, less comprehensive, with the earliest surviving register of patients dating from 1924 to 1929. Access to patient records and other sensitive files containing personal data are subject to Data Protection legislation and conditions laid out in the RCPI Heritage Centre’s guidelines. There are also some records across the various series which date from the decades following the transfer of the hospital to Cherry Orchard.

If you have any queries about the collection, please contact heritagecentre@rcpi.ie.

---

1. Cork Street Fever Hospital Committee Proceedings, 23 October 1801.↩
2. Patricia Conway, Sheila Fitzgerald and Seamus O’Dea, Cherry Orchard Hospital: The First 50 Years (Dublin, 2003), p.  2.↩
3. Ibid., p. 3.↩

The historical development of Irish Hospitals and the importance of their records by Brian Donnelly

In this month's post, Brian Donnelly, senior archivist at the National Archives of Ireland, outlines the development of Irish hospitals from the eighteenth to the twentieth century.

Rotunda Hospital, Dublin
(RCPI Archival collections: VM/1/4/19)

The establishment of the voluntary hospitals

The early eighteenth century saw the establishment of voluntary hospitals by philanthropists, mainly in Dublin but also in the larger provincial towns. Jervis Street hospital (the Charitable Infirmary) was the first voluntary hospital Ireland and was founded in 1718.  Many of these, like Dr. Steeven’s Hospital (founded in 1733) and Mercer’s (founded 1734) would survive into the twentieth century.  The eighteenth century also saw the establishment of specialist hospitals, most of them voluntary, such as the Rotunda Lying In Hospital, founded in 1745, St. Patrick’s Hospital for mental illness, founded in 1747 and the Westmoreland Lock Hospital, for the treatment of venereal disease, in 1792. 

A modern public health service at county level began in 1765 when a parliamentary enactment provided for the erection and support of an infirmary for each county in Ireland and also permitted support for several existing hospitals, mainly in Dublin and Cork, out of public funds.  The county infirmaries were to be maintained by grand jury presentments, parliamentary grants and local subscriptions. The grand juries were groups of landowners who were called together by the High Sheriff in each county twice a year for legal and local administrative reasons.

The House of Industry hospitals, district lunatic asylums and medical dispensaries

The Dublin house of industry, a precursor of the workhouses of the nineteenth century, was founded in 1772. This institution became in time a vast concern, providing hospitals for the sick, an asylum for children, bridewells, penitentiaries for women and young criminals, a house of industry for vagrants, and cells for lunatics.  From it evolved the House of Industry hospitals – the Richmond, Whitworth and Hardwicke - and it played a major role in establishing the first and largest of the public lunatic asylums – the Richmond Lunatic Asylum – which opened for patients in 1814. Following the report of the Committee on the Lunatic Poor in 1817, the Lord Lieutenant was enabled by statute to build asylums where he considered necessary and, over the next half century, a well-developed mental health infrastructure was in place. By 1871, twenty two asylums were being financially supported by the grand juries. In 1850 a central asylum “for insane persons charged with offences in Ireland” was opened in Dundrum. This institution, the first criminal lunatic asylum in these islands, was under the direct control of the Lord Lieutenant who appointed the staff and made regulations for its management. 

A few dispensaries were supported by voluntary subscriptions in several of the larger towns and cities from the late eighteenth century, but it was not until 1805 that grand juries were authorised to give grants to dispensaries in rural areas. By the early 1830s, there were 450 dispensaries throughout the country, administered by committees of management and supported partly by subscriptions and partly by grand jury grants. There were fewer dispensaries in poorer areas, where voluntary contributions were wanting, and where it was difficult to raise enough money to start them. Inadequate as many of these dispensaries were, they represented the first steps towards domiciliary medical treatment of the rural population.

Robert Graves (1796-1853)
 (RCPI Archival collections: VM/1/2/S/35)

The impact of epidemics on the development of medical infrastructure

Epidemic disease was a major impetus in the development of a medical infrastructure. Typhus was a major scourge in Ireland in the early nineteenth century and, while several fever hospitals had been established in the larger towns in the late eighteenth century, it was not until 1807 that legislation was passed to encourage their construction throughout the country. A fever epidemic of unprecedented proportions raged in Ireland between 1816 and 1819. Under an 1818 Act, local boards of health could be established, supported partly by grand juries, which had extensive powers to combat disease. Grand juries were empowered to make presentments equal to twice the amount raised by private subscription to build fever hospitals. In 1819, legislation enabled officers of health to be appointed in parishes and a parish health tax could be levied. 

The establishment of the Central Board of Health in 1820 marked a major step in the centralisation of medical relief and local boards of health were to play a major role in combating epidemics over the following decades. The Central Board of Health collected statistics about local health conditions, advised where local boards of health should be established and when grant to hospitals should be made. When cholera broke out in Ireland in March 1832, the Central Board of Health, renamed the Cholera Board for the duration of the epidemic, supervised measures to combat the disease which included the establishment of local boards of health. 

Dublin hospitals like the Meath were at the forefront of the fight against infectious disease from the 1820s and introduced new methods of bedside clinical training to the English speaking world.  The census commissioners noted in 1854 that to these metropolitan hospitals “the Irish School of Medicine is largely indebted for the celebrity which it has so long enjoyed”. The Meath hospital received international recognition in the early nineteenth century due to the innovative teaching methods and research carried out by its physicians, Robert Graves and William Stokes. The latter had survived an attack of typhus in 1827 and identified the first case of cholera in Ireland in 1832. This new approach to clinical training had originated on the continent and its introduction into the Meath hospital heralded what has been described as the heroic age of the Irish School of Medicine. The voluntary hospital infrastructure continued to expand during the nineteenth century and following Catholic Emancipation many Catholic religious orders became involved in founding hospitals.

The Irish Poor Law, 1838

The enactment of the Irish Poor Law of 1838 was to have a dramatic effect on the provision of public health services for the rest of the nineteenth century. The country was divided into over one hundred and fifty poor law unions each with a workhouse at its centre and administered by a board of guardians.The structure of the poor law system, being modern and efficient and more easily subject to central control, was adapted on nearly all occasions where a new local function was created or an old one modified .The Medical Charities Act of 1851 led to the modernisation and extension of the old grand jury dispensary network under the boards of guardians and made a domiciliary medical service available to large sections of the population, the destitute poor, for the first time. 

By 1852, every poor law union had been divided into a number of dispensary districts, each with a dispensary and medical officer.  Patients had to apply to a poor law guardian for a ticket every time they wanted to attend a dispensary free of charge. Committees of management were responsible to the boards of guardians for the management of the dispensaries and appointing the dispensary doctors. In 1863, the dispensary doctors were made registrars of births and deaths and of Roman Catholic marriages and the practice of registering births, marriages and deaths was standardised on the 1^st of January 1864. When registering deaths, the dispensary doctors were required to note the cause of death and duration of illness, thus enabling accurate statistics of mortality to be compiled for the first time. The registration of births enabled such measures as the compulsory vaccination of children against smallpox to be carried out effectively and by the end of the nineteenth century this scourge had, to a great extent, been eliminated.

While many boards of guardians had allowed the non-destitute to enter workhouse hospitals for treatment during the 1850s, the 1862 Poor Law (Amendment) Act officially opened the workhouse hospitals to the non-destitute sick. As a result of these developments, Ireland had one of the most advanced health services in Europe in the mid-nineteenth century, if policy and structure are to be taken as criteria. The Local government (Ireland) Act, 1898, replaced the grand juries by democratically elected county and rural district councils. The county councils took over the administration, either directly or through joint committees, of the district lunatic asylums.

Newcastle Sanatorium, Wicklow.
Image courtesy of NLI (L_ROY_05467)

Tuberculosis and the sanatorium

While Ireland had a low death rate from infectious disease in the first decade of the twentieth century, tuberculosis was the marked exception. The last years of the nineteenth century saw the first attacks made against the disease with the establishment of Newcastle Sanatorium in 1893. In 1904, the sanitary authorities of County Cork combined with Cork Corporation to establish Heatherside Sanatorium near Doneraile. In 1907, the Dublin City and County authorities established Crooksling Sanatorium. A Tuberculosis Prevention Act was passed in 1908 which gave the county councils power to provide sanatoria and brought the first veterinary inspectors into the employment of the sanitary authorities.  Peamount Sanatorium was founded in 1912 through the efforts of the Women’s National Health Association, the most formidable health pressure group of the early twentieth century.

Public health provision in post-independent Ireland

The turbulent years of the early 1920s saw some revolutionary changes in the public health system. In general, the boards of guardians outside Dublin were abolished and were replaced by county boards of health and public assistance, essentially sub-committees of the county councils. Most workhouses were closed to save money and central institutions called county homes were established in each county where the poor were to be relieved. While the newly styled county homes were to be reserved in theory for the old and infirm many soon included unmarried mothers, children and the mentally retarded.  Following the establishment of the Irish Free State the Department of Local Government and Public Health formally became, in 1924, the central government authority for local government and health administration. The Minister took over the Lord Lieutenant’s duties in relation to the mental hospitals. In 1930, the establishment of the Irish Hospitals Sweepstakes, a lottery to provide financial assistance to hospitals, provided a financial lifeline to many voluntary hospitals who were struggling to survive following a reduction in the number of endowments and bequests after the Great War.

The post-war period and declining mortality

There were significant developments in health care in the 1940s and 1950s. The Mental Health Treatment Act of 1945 modernised the legal code under which the mental services operated and provided important safeguards against the arbitrary detention of patients although the numbers of persons being treated continued to increase until, by 1959, there were 20,000 patients in Irish mental hospitals.  In the years immediately after 1945 there was a major effort to develop anti-tuberculosis services. The Tuberculosis (Establishment of Sanitoria) Act of 1945 permitted the Minister for Local Government and Public Health to arrange for the building of sanatoria and to transfer these to local authorities when completed. This was a major departure from established practice for the central authority as it stepped outside its normal functions of directing and co-ordinating the local services. Sanatoria were built at Dublin, Cork and Galway and were handed over when completed to the local authorities as was provided under the Act. 

There was also widespread building and conversion of buildings for the treatment of tuberculosis cases by local authorities.  These developments, together with the payment of maintenance allowances for dependents of persons undergoing treatment for infectious disease, mass radiography, BCG vaccination and new drugs such as streptomycin, led to a great decline in mortality for the disease and in the number of new cases appearing.  In 1947 the Department of Local Government and Public Health was divided into two separate departments. The Health Act of 1953 extended eligibility for general hospital services and maternity care to a much wider class. Health authorities were now required to provide child welfare clinic services and the school health service was improved. The dispensary service and dispensary doctors were transferred from the public assistance code to the health authorities. The old dispensary ticket system was done away with and replaced by medical cards. A more liberal code for the governing of county homes was introduced and provision was made for the development of a comprehensive rehabilitation service.

William Stokes (1804-78) and William Wilde (1815-76)
(RCPI Archival Collections: PDH/6/2/12)

1970s regionalisation and the Irish 'love affair' with the hospital bed

By the 1960s, it was felt that as the state had taken over the major financial interest in the health service there should be a new administrative framework combining national and local interests.  For technical and logistical reasons it was believed that better services could be provided on a regional rather than a county basis.  The establishment of the health boards under the Health Act, 1970, marked a major break in the link between the health services and county administration. At this time Ireland had the highest proportion of hospital beds to population in western Europe and the Irish hospital system was described as “one of a large number of small institutions scattered throughout the country”. The following decades would see the closure or amalgamation of many voluntary and state hospitals into larger units and the dismantling of the old mental hospital infrastructure.

The historical value of Irish hospital records

That Irish hospital records are of great historical interest has long been acknowledged. Dr. William Wilde, the internationally renowned nineteenth century physician and statistician, recognised one hundred and seventy years ago that the hospital registers of the Rotunda Hospital represented the ‘most interesting and earliest statistical tables on record’.  Ireland’s medical institutions, both voluntary and public, have a peculiarly rich and varied history and have played a paramount role in medical advances over the last three centuries.  While some collections of hospital archives are now safe in archival custody, many collections remain in peril. These archives have no protection under the law and it is often only through the good offices of interested hospital staff that material has been preserved. 

Brian Donnelly is a Senior Archivist at the National Archives with responsibility for Business and Hospital records. Images courtesy of Fergus Brády, Archivist, RCPI. 

Conference report: Medical training, student experience and the transmission of knowledge by Anne Hanley

In the first blog post of 2015, Dr Anne Hanley reports on 'Medical training, student experience and the transmission of knowledge' - a conference which took place at the Centre for the History of Medicine in Ireland in October and which was funded by the Irish Research Council and the Wellcome Trust. Podcasts of papers from the conference were recorded by Real Smart Media and may be accessed here. 

I recently attended the conference, 'Medical training, student experience and the transmission of knowledge, c.1800-2014' (or #MTSE14 if you want to look over our live tweets), at University College Dublin. Needless to say its focus, and the discussion generated from its wide-ranging collection of papers, was excellent and very much overdue.

Students dissecting

Medical education

Despite an ever-growing interest in the history of medicine, the subject of medical education and student experience continues to be overlooked (the last international symposium dedicated to this subject having taken place in the early 1990s). Yet throughout the nineteenth century medical education was being increasingly formalized, centralized, and consolidated. It became the backbone of one’s medical career. Strangely, however, it has occupied the negative space in histories of clinical practice and patient care. This omission is incredibly problematic (but I digress…).

So, when Laura Kelly emailed to ask if I would give a paper at a conference devoted to the history of medical training and knowledge production, I sent back an immediate and unequivocal ‘YES!!’. (There were so many excellent papers about which I want to talk that my own paper, ‘Venereology at the Polyclinic’, will have to take a back seat for now.)

An important focus of MTSE was the centrality of pedagogy. Traditionally, histories of medical education have been written as administrative histories of major teaching hospitals. They have concentrated on the big names, significant infrastructural changes, and major medical developments that altered practice in these hospitals. Rarely have such histories considered in the implications of the big names and significant changes for the day-to-day learning and experiences of students. Happily, however, historians of medicine are beginning to recognize the importance of pedagogically-focused histories and MTSE really demonstrated this change. It brought a whole host of issues to the fore and, as those of you who follow me on Twitter will have gathered, I was rather excited by the rich collection of papers.

Professor John Harley Warner delivering his keynote.
Image courtesy of Real Smart Media

John Harley Warner keynote address

We began with the keynote address from John Harley Warner, who introduced us to his most resent and gruesomely fascinating work on the photographic history of dissection in American medical schools. As Warner observed, nineteenth-century medicine was often a solitary occupation and so medical schools provided an important opportunity for group learning and for developing a collective professional identity. And this is particularly well-evidenced in the strange collections of photographs in which groups of students posed around tables upon which they were dissecting cadavers. One particularly interesting aspect of Warner’s keynote was the figure of the medical school porter who often appeared in these photographs and who Warner identified as playing a key role in the facilitation of medical education (but I’ll return to this shortly).

Attendees at MTSE.
Image courtesy of Real Smart Media.

Microbes to matron

Many fantastic papers followed, including Claire Jones’s presentation of her most recent research on the ‘Microbes to Matron’s’ project. Her focus on the pedagogy and practice of infection control in British nursing between 1870 and 1900 offers an important counterpoint to what have traditionally been male-focused accounts of medical education. It is very easy to forget that there were (and continue to be) other groups of trained medical professionals beyond doctors who provided care to a wide cross-section of the population. What also interested me about Jones’s paper were the types of sources she and her fellow project investigators are drawing upon. By using surgical nursing examinations, Jones demonstrated the increasingly active role of nurses in their own education, and in surgical practice more broadly.

Dollhouse diorama

Crime scenes and dollhouse dioramas

Similarly, Neil Pemberton’s paper on teaching crime scene investigation through dollhouse dioramas also prompted us to reconsider the role of women in medical and scientific training. By appropriating the traditional female practice of miniature making, women like Frances Glessner Lee created a new way of thinking about crime scene science. Nathalie Sage Pranchère also looked at the important role of women in medicine, speaking about the development of nineteenth-century French midwifery training. Importantly, she also described how obstetric teachers used models to develop the anatomical and obstetric knowledge of their midwifery students. As we saw with Pranchère’s paper, the role of material objects in medical training and practice is becoming an increasingly central focus of historical scholarship and this was reflected throughout MTSE. For example, Jenna Dittmar used the collections from Cambridge’s former Anatomical Museum to demonstrate how human remains allow biological anthropologists to examine the historical tools and techniques of dissection.

Speakers Greta Jones, Anne Hanley,
Nadav Davidovitch and Victoria Bates.
Image courtesy of Real Smart Media.

Spaces of medical education

Another important theme to emerge from MTSE was the different spaces of medical education. Warner described the dissection room as a space for developing collective professional identify. Michael Brown spoke about the dynamic space of the nineteenth century lecture theatre, in which students and their lecturers were appealing to culturally resonant sets of values. Clare Hickman presented eighteenth-century botanic gardens as important spaces for thinking about the material culture of medical teaching. Hickman’s paper, like Warner’s keynote, also demonstrated that the history of medical education is never simply about those who learned the art of medicine but also those in the background. Like the African American medical school porters who procured cadavers for students, gardeners were important (but silent and overlooked figures) in the maintenance of teaching spaces and the facilitation of teaching practices.

Attendees at MTSE.
Image courtesy of Real Smart Media.

MTSE demonstrated how the nature of medical training has changed over time and within distinct national contexts. Through an excellent collection of papers we explored the emergence of centralized and consolidated systems of medical training. We looked at the development of new tools of training and the different spaces in which these tools were employed. And we looked at how medical knowledge and codes of professional identity were being assimilated by medical and dental students, nursing probationers, midwives, and qualified practitioners seeking further education.

I came away from MTSE with a new appreciation for the diversity of student experiences and systems of knowledge dissemination, and will certainly be drawing upon these ideas in future. With any luck, events like MTSE will slowly begin to generate greater interest in the important place of medical training in wider narratives of medical history.

Dr Anne Hanley is an LHRI Research Fellow at the University of Leeds with particular expertise in the history of modern medicine, medical education, health policy and the history of science. She recently completed her PhD at the University of Cambridge on the development and dissemination of venereological knowledge among English medical professionals, 1886-1913. She writes a blog Clinical Curiosities and tweets at @annerhanley.