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.
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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?
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‘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
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