Attended a great talk providing an overview of the establishment of the 18th Century Irish Hospital System in Ireland by Dr Susan Mullaney (RAMI/UCC) at the Edward Worth Library @ Dr Steevens Hospital in Dublin.
Mullaney is asking a basic question about the motivation behind the 1765 Act for Ireland calling for the establishment of county hospitals to provide for the welfare of the people within 1 mile of the county town in each Irish county. Prior to the act, there were a small number of hospitals in Dublin, Waterford, Cork (North and South) and Meath and Louth.
Specifically:
Waterford
Cork (North and South)
Louth and Meath
Dublin
Charitable Infirmary 1718
Dr Steeven’s 1733
Mercers 1734
Incurables 1744
Meath 1753
Mullaney presented some known background on two of the county infirmaries as background to the wider discussion.
The Louth Infirmary 1753 – 2 -12 beds 4 inpatients and 14 externs
The Meath Infirmary 1753 – 10 beds – free medicines and home visits
13 mos from 1 Oct 1753
82 inpatients
87 externs
5 incurables
Interesting note: these infirmaries were run on a subscription basis so only admitted those who were those curable and were loathe to report deaths as this was felt would ‘kill’ subscriptions.
Interesting to look abroad and realize that in England
London – 5 hospitals between 1720-45
In 18th C 29 in total in all English Provinces
13 prior to 1753
5 infirmaries in Scotland prior to 1800
France 2000 hospitals in late 18th
Paris Hotel Dieu 3500 patients (1772)
Conclusion: Ireland was surprisingly well served.
The Social Context driving the creation of infirmaries rested on:
Security of ascendancy
Penal laws
Breakdown of charitable systems
Life expectancy
60% earn less than £5
No poor law
Publick (sp) Infirmaries
Not exceeding more than 1 mile from the courthouse of the county towns
grand juries had to raise £50-£100 from local tax
Central contribution to infirmary was £100
Conrib/subscript pay for surgeons
Cork-Mallow
Dublin Excluded
Kildare-Kildare
Meath-Navan
Waterford excluded
Donegal-Letterkenny
Antrim-Lisburne
Mayo-Castlebar
Tipp-Cashel
The ethos of the infirmaries was to not admit incurables or those suffering from fever, smallpox, measles, TB…among others.
Max stay is 2 months – curable
Strict rules for admitted and for staff as well
If asked to help with work and refused – instant discharge
Donors of 20-30 guineas – Life governor/governess
The donor of 3 guineas governor for 1 year
Governors generally decided who was admitted…unless full then surgeons could make decision
Down always kept a bed for emergencies
Medicines were always free until it was realised this was a huge draw on expenses.
Surgeons became a primary caregiver and not a physician as had been the case
‘satire and mockery on a human institution’
Why was this legislation passed in Ireland?
state concern? hardly
political issue
security of assemdancy
template
disease control-was so rampant
impact of european ideas
dublin society