Medical History in North Cork
Mallow Field Club Journal No. 19
Article by Prof. Laurence Geary, History Department, University College Cork.
Medical Charities were established in Ireland from early in the 18th century to provide free medical assistance to the poor sick. There are 4 different types of institutions:-(1) Voluntary Hospitals (2) County Infirmaries (3) Dispensaries and (4) Fever Hospitals.
The earliest were those attached to the royal residences at Tara and Eamhain Macha before the coming of St. Patrick. With the arrival of Christianity, the care of the poor and sick was in the abbeys and monasteries until they were suppressed by Henry 8th in the 1530s.
Wars in the 16th and 17th centuries led to the establishment of Military Hospitals in Ireland. However, there was no hospital for the civil population until the beginning of the 18th century when they were established in Dublin, Cork, Limerick, Waterford and Belfast.
Voluntary Hospitals depended on voluntary subscriptions for their establishment and support, though some later received a state subvention. The earliest were general ones and admission was usually restricted to curable cases mainly accidents and minor medical complaints. The general exclusion of children, women in childbirth, the infectious, the venereal, lunatics and incurables led to the establishment of specialist institutions for their needs.
Voluntary Hospitals were confined to the 5 largest cities. In 1765, an Act of Parliament provided for one Infirmary in each County. The inspiration was not entirely charitable or altruistic. The preamble says that these institutions would restore health and prolong the lives of many Irish people. The Act also said these institutions would promote labour and industry and increase productivity in the kingdom.
County Infirmaries were funded by a combination of parliamentary grants, county taxation and voluntary contributions. Admission was, in theory, restricted to poor persons suffering from non-infectious diseases and those requiring surgery. Less serious cases were attended in out-patients clinics. Individuals who could afford to pay for medical care, and incurables, irrespective of their financial standing, were debarred from these institutions. The development of county infirmaries was generally slow and uneven. Some of these institutions were temporarily housed in hired premises before more permanent structures were established.
The County Infirmary at Mallow began in 1784, almost two decades after the legislation, when the Bishop of Cloyne received an anonymous donation of £200 to establish a hospital in Mallow for the poor sick. At a public meeting in the town on July 10th 1784, a management committee was set up and an appeal for funds launched.
Members of the committee were Dr. Joseph Barry, Matthew Braddell, Sir James Cotter, Robert De La Court, William Galwey, Revd. William King, John Longfield, Adam Newman, John Newman, Dr. James O’Regan, Deham Jephson, George Stawell and Maurice Denham Jephson.
A building was hired and fitted out with one single and four double beds. This was an interim measure until the permanent structure was completed on a site donated by Sir James Cotter. Joseph Barry and James O’Regan, the medical officers, served without pay. The apothecary, David Burk, was responsible for compounding and dispensing the medicines. Susannah Nix, a widow, was appointed housekeeper at an annual salary of five guineas.
Income for the first year, including the anonymous donation of £200, was £295. The Bishop of Limerick, Lord Doneraile and Sir James Cotter subscribed £5-13s-9d each. There were thirty-four other subscribers, including nine clergymen. Expenditure on rent, furniture, beds and bedding, utensils, wages, medicine and advertising amounted to £52, which left a balance at the end of the year of £243. The accounts were passed and the medical officers thanked for their professional attendance. The governors congratulated themselves for having assisted many individuals ‘at a comparatively small expense who might otherwise be a burthen on the public’. They concluded that the hospital’s first year had been a success. They resolved to frame the subscribers’ names and to display them ‘in the infirmary hall for the inspection of the public’.
There was a credit balance of £239 in the second year and £281 in the third. The permanent hospital was opened in 1788 and at the county assizes in the summer a grand jury presentment of £50 was voted for the institution’s support. The grand jury presentment was an annual tax on the occupiers of land in the county and was fixed at not less than £50 and not more than £100 in the 1765 County Infirmary Act.
Statistics relating to patients in the Mallow infirmary were published for the first time in 1789, possibly to secure a continuation of public funding. For the year ending 10 July 1789, 329 patients were admitted; of these 280 were discharged cured and 22 as incurable; 3 died and 24 remained in hospital. In the following year, there were 521 admissions; 401 were cured and 41 relieved; 30 were discharged as incurable and another 7 at their own request; 12 died and 30 remained in hospital. Expenditure exceeded income in the second year and the governors decided to hold a fund-raising ball. By then, local enthusiasm was waning for the hospital, due perhaps to its change in status from local charity to one open to all residents of County Cork. As the interest and involvement of the local gentry diminished, governors’ meetings were poorly and infrequently attended.
The rules and regulations governing admission and conduct of patients were strict and there were several offences for which patients could be discharged e.g. alcohol use, smoking, gambling, swearing, blasphemy, lewd conversation, defacing or dirtying the premises, disobedience or impudence to hospital personnel. The hospital was reserved for the sick poor (according to the bye-laws) and a governor’s recommendation was required except for accidents and emergencies. Incurables and people capable of paying for medical attention themselves were inadmissible. When there were more applicants than beds, priority was given to the “most sickly” and then to those longest on the waiting list, those who had come the longest distance and those recommended by subscribers who had previously sent the least number of patients.
The great defect of the county infirmaries was that there was only one for each county. The Mallow infirmary was miles from many parts of County Cork. Denis Phelan, a Clonmel doctor who surveyed the medical charities in the 1830s said that sending patients to Mallow from a lot of the towns was as difficult as ‘if that institution were in Constantinople or at the western side of the Atlantic ocean’. Dr. Kiely, a dispensary doctor who lived twenty-three miles from Mallow, equated being sent to the Mallow infirmary with ‘transportation to New South Wales’.
Another investigation showed that the vast majority of patients in Mallow came from a twenty-mile radius. It was suggested that there be at least three general hospitals in County Cork – Mallow for the north and north-west of the county, one in the city for east Cork and one in Skibbereen or some other town for the west of the county. People also complained that Mallow was too small and patients were refused admission and convalescents were discharged to make way for accidents and emergencies. Dr. D.B. Bullen, a surgeon in the North Infirmary in Cork suggested that County Cork required four fifty-bed hospitals, one in Mallow, Cork city, Bandon and Bantry.
In the autumn of 1829, the trustees of the North and South Infirmaries in Cork, with support from the majority of the County Cork grand jury, applied to parliament to transfer the county infirmary at Mallow to the city and to amalgamate the three institutions into a general hospital for the city and county. The Mallow governors reacted strongly to this proposal. They told the county grand jury that 1547 patients were treated in the hospital between 1823 and 1828 inclusive and another 7074 in the out-patient dispensary. The income for the six years was £2144 and expenditure was £2055. In a petition to parliament, the governor argued that the city was fifty miles from the county’s western boundary and nearly forty miles from its eastern and northern boundaries. City patients would inevitably receive preferential treatment. The governors argued for the retention of the Mallow infirmary and the establishment of a second hospital in the west riding of the county – both to be funded by the grand jury. There was some public support for their stance.
One newspaper suggested that Mallow was the most appropriate place for the county infirmary and encouraged locals and beneficiaries to resist suggestions to ‘transplant it to the city’. The county Infirmary continued at Mallow until 1862, when it was removed to the South Infirmary building in the city.
In the eighteenth and early-nineteenth centuries, the principal infectious diseases that threatened public health in Ireland were tuberculosis, smallpox and fever (a generic term that covered typhus, relapsing and typhoid). Hunger, poverty, dirt and overcrowding were the main causes.
The Irish people had an unrivalled knowledge of fever, its symptoms and its consequences. Experience taught them that the disease was contagious and the fear of infection drove them to quarantine those who contracted the illness. By the opening decades of the nineteenth century, ‘fever huts’ were established where the sick were placed. They consisted of a few stakes, covered with long sods called scraws and a small portion of straw or rushes. The stakes and sods were usually placed against the fragment of a wall, the gable of a tumbled house or against a ditch. The middle and upper classes attempted to isolate the infected within their own homes, but domestic segregation did little to check the spread of disease.
Popular attempts to address and mitigate the impact of fever were paralleled by institutional ones. Fever hospitals were established in Dublin, Cork, Waterford, Kilkenny, Belfast and Limerick under special Acts of Parliament in the late eighteenth and early nineteenth centuries. These hospitals were complemented by three distinct types of publicly-funded fever hospitals that were established following legislation in 1807, 1818 and 1843.
There was a fever hospital in Mallow and a combined fever hospital and dispensary at Buttevant which opened in 1843.
In practical terms, hospitals were restricted to those who lived within a reasonable distance of them, so those in remoter areas were effectively excluded due to the inadequate and expensive road and transport network. This fact was acknowledged by an 1805 Act of Parliament which provided for the establishment of dispensaries throughout the country.
Dispensaries were intended to complement the county infirmaries, to provide medical and surgical relief to the poor of the neighbourhood in which they were established – so they were designed to bring relief to the door of the sick.
Dispensaries differed from county infirmaries and voluntary hospitals in that they had no wards or in-patient facilities; professional advice and medicine were provided on an out-patient basis. There was no standard principle on which dispensaries were established. The location of county infirmaries was specified by law but dispensaries could be opened anywhere, irrespective of need or demand. The only prerequisite was local subscriptions, which the county grand jury (the local taxing authority) was obliged to match. This method of funding, irregular and unreliable as it was, placed great strains on the system. It also resulted in a very uneven distribution of dispensaries – they were mainly concentrated in towns and wealthier areas where subscriptions could be more easily raised. They were scarce in the poorer and remoter areas where their need was greatest.
In the Mallow area, dispensaries were established under the 1805 Act at Rahan, Ballyclough, Catletownroche, Doneraile and Kildorrery.
The Impact of the Great Famine
In Cork city and county at the start of the Famine, there were 68 Dispensaries, 13 Fever Hospitals and 3 Infirmaries (North and South Infirmaries in the city) and the county Infirmary in Mallow.
In March 1846, it was reported to the Lord Lieutenant that fever had appeared and was spreading in virtually every county. After receiving this report, the Government concluded that the existing medical resources were inadequate to deal with the developing crisis and that additional hospital accommodation was required. A temporary Fever Bill was rushed through the House of Commons and became law on March 24, 1846. The Act stated that it was necessary to make more effective provision for the treatment of poor persons afflicted with fever and other epidemic diseases. The Government proposed to establish a Central Board of Health in Dublin with power to direct boards of poor law guardians to provide temporary fever hospitals and dispensaries in their unions. The costs would be borne by the ratepayers of the union apart from doctors’ salaries which would be paid by the Government. The Act was to remain in force until 1st September, 1847.
Between March 3rd and July 15th 1847, temporary fever hospitals or dispensaries were established in Buttevant, Doneraile, Monamimy, Ballinamona and Mallow in the Mallow poor law union.
On 5 August 1847, Captain Warden H. Flood, a poor law inspector, referred to ‘the painful state of medical destitution and the physical prostration of the peasantry’ in the locality and stated that additional fever accommodation was required. Captain Flood said that the Mallow fever hospital was full and so were the fever sheds that had been erected in the grounds of the Mallow workhouse. He proposed that two fever sheds should be erected in the yard of the Buttevant fever hospital.
On 22 April 1850, Sir Denham Norreys presented a petition to the House of Commons from some of the Mallow poor law guardians, seeking the closure of the Buttevant temporary hospital. The Buttevant people were angry at this and a counter petition was presented to Parliament deprecating the action of the Mallow guardians and the distortions contained in their petition. However, the counter petition was unsuccessful and the Buttevant fever hospital closed on 7 September, 1850.
The legislation governing the temporary fever hospitals dispensaries expired on 31 August 1850 and the Central Board of Health was disbanded. From July 1847 onwards, the board demanded weekly hospital returns and over the next 38 months 332,462 patients were treated in the temporary hospitals. The recorded number of deaths was 34,622. The overall death rate was 10.4%
The events of the mid and late 1840s exposed many of the structural, financial and administrative weaknesses in the medical facilities that were available to the poor, not only in North Cork but throughout the country. An attempt to reform the system began when the Medical Charities Act 1851 introduced a state-funded dispensary system to provide free medical aid to the poor sick and the process continued with further amendments and changes in the post-Famine period.