CHRONIC CHRONIC CONDITIONS IN CONDITIONS IN HEALTH AND HEALTH AND WEALTHWEALTHWaterford County Archivist Joanne Rothwell

PUBLIC HEALTHPUBLIC HEALTHHigh mortality rates and high rates

of fever in Ireland – clearly linked to poverty

Tackling public health required tackling poverty

Increasing government role Improving living conditions Legislation

GOVERNMENT BODIESGOVERNMENT BODIESLocal Boards of Health, 1818 -

dispensariesGeneral Board of Public Health –

March1820 (Cholera Board in 1832) statistics and grants

Poor Law Commissioners – Local Government Board

Grand JuryBoards of Guardians

LEGISLATION LEGISLATION Medical Charities, Houses of Industry1765 – clergy of established church a corporation for

the erection of Fever Hospitals1807 Grand Juries – presentments for Fever Hospitals

£100National Vaccine Establishment, 1808Poor Employment Act, 1817 Local Boards of Health, 1818Central Board of Health, 1820Poor Law Act, 1838Vaccination Extension Act, 1840, Compulsory Act,

1863Medical Charities Act, 1851Public Health Ireland Act, 1878 Labourers Ireland Acts 1883-onwards

GOVERNMENT ROLE GOVERNMENT ROLE Vaccination Control of Disease Health Care Clean WaterHousing

MEDICAL CHARITIES MEDICAL CHARITIES Dispensaries and Fever HospitalsFunded by private subscriptionUneven distribution – clustered in wealthier

areas Medical Charities Act, 1851 – “act to provide for

the better distribution, support and management of medical charities in Ireland” – hospitals and dispensaries under the Poor Law Unions

Medical Charities Commissioners By 1857 770 doctors through the dispensary

system

VACCINATION: SLOW VACCINATION: SLOW STARTSTART Inoculation – practised in the 18th century. In 19th century increasing evidence of dangers, doctors petition against it

Vaccination – 1796 Jenner, 1808 Free Vaccinations, poor uptake

Vaccination Extension Act, 1840 Operated by Board of Guardians – Workhouses (stigma) Vaccination Stations – away from Workhouse door so

patients didn’t mix with paupers Contracted to dispensary doctors- or if unwilling to accept

contracts to apothecaries 1 shilling/6d a head- poor terms. Slowed implementation

considerably Costs to PLUs – avoided implementation Famine - collapsed

VACCINATIONVACCINATIONMedical Charities Act – Commissioners pursued

vaccination Prosecution of inoculators No extra fees to Dispensary Doctors for

vaccinations Act to further vaccination in Ireland, 1858- new

vaccination stations and separate fee of £1 for every 20 cases to doctors

Doctors vaccinated in peoples homes – following up unvaccinated cases

Improvements in the rates of vaccination

COMPULSORY COMPULSORY VACCINATION VACCINATION

Compulsory Vaccination, 1863 – within 6mths of birth, inspected 1 week after vaccination and cert issued to parent and the registrar

Dispensary doctors paid 1 shilling per caseFine of 10 shillings for failure to vaccinate a childc.1500 prosecutions under the Act in 1870Boosted vaccination numbers by over one third

in Ireland Dispensary doctors became registrars for

vaccination – recording the outcome having carried out the vaccination

Prosecutions – defaulters persuaded by the dispensary doctors rather than prosecuted

VACCINATION: SUCCESSVACCINATION: SUCCESS“near approach to the total extinction

of small-pox” Annual Reports of PL Comms 1867-1870

1500 deaths pa in 1850s to less than 900 by 1864, 20 deaths in 1867

1871/2 Smallpox epidemic (4000 dead) – increase in vaccination as a result

Irish system praised by English medical men where the paperwork was split between practitioner and registrar

CONTROL OF DISEASECONTROL OF DISEASEDispensaries and Fever Hospitals

under Local Boards of Health – part funded by Grand Jury but mainly reliant on private subscriptions

Depended on advocacy and powerful supporters

Medical Charities Act, 1851 – control of dispensaries to Poor Law Unions

District Medical OfficersProvision of drugs Sanitary Officers

HEALTHCAREHEALTHCARE 4 January 1851 28,922 patients were registered in 163

workhouse hospitals – 14% of the workhouse population on that day

Increasing healthcare role of Workhouses – less “able bodied inmates”

Boards of Guardians tended to use inmates as nursing staff/attendants – extra rations

“...generally taken from the lowest class, restrained by no sense either of decency or religion, loud voiced, quarrelsome and abusive...”

1861 Limerick Board of Guardians were the first to win permission to allow nuns to nurse in the workhouse hospital

“highest moral qualities” By 1895 63 Boards and by 1903 84 Boards were employing nuns

as nurses Competency – Training Night Nursing 1881 Medical Press and Circular called for probationary nurses to

be trained in workhouses 1890s – Trained nurses

TRAINED NURSES TRAINED NURSES Freeman’s Journal, 1895“What is a trained nurse? a chit of

a girl with a paper certificate from some Dublin Hospital where, according to the hospital doctors, not even the medical student is properly taught his business, or, a devoted nun who has been attending the sick and assisting their medical attendant for years”

HEALTHCARE: DOCTORSHEALTHCARE: DOCTORS Medical Charities Dispensary Doctors – additional duty to own

private practices. PLU Dispensary Doctors – initially thought to be lesser experienced

and qualified doctors i.e. couldn’t get enough patients as private practitioners

Quality of doctors – Dr. Baylor, Lismore Doctors built up good reputations within their dispensary districts Additional assistance called in by dispensary and Fever Hospital

doctors where required e.g. Amputation – a bill of £3:3:0 was furnished the Guardians by Dr. Currey, Lismore for amputating the arm of John Carthy at the Lismore Union Workhouse on 19th February 1875. “The Board consider the bill should be paid by the person who engaged his services on that occasion and not by the Guardians”

Sending cases to specialists for treatment e.g. Workhouse Drs. sent cases to Waterford Infirmary or to Dublin hospitals for treatment

Doctors advocated for improvements to diet, living conditions and access to healthcare for their patients

CLEAN WATER CLEAN WATER Water Supply Schemes – private and

municipalRural areas – not servicedPublic Health Act, 1878 – PLUs

funding water supply schemes. Funded by Local Government Board

– loans funds New schemes Extensions from existing schemes Water Testing – safe water

SEWAGE SCHEMES SEWAGE SCHEMES Typhoid – outbreaks as a result of faecal

matter in water supplyDungarvan SS 1901 a direct result of an

outbreak of enteric fever and typhus in October 1898

Public Nuisances – night soilSanitary Officers – inspections and reportsNotices and fines issued for non-

compliance re: provision of facilities

Copyright Waterford County Archives

HOUSING: HOVELSHOUSING: HOVELSHousing unfit for human habitation No standards for landlords to meetSome landlords built to good designs

but no onus on them to do soOften labourers built their own

shanty houses on the farm Surveys carried out among landlords

prior to introduction of Labourers Ireland Act, 1883 – developing a standard

Copyright Waterford County Archives

LABOURERS IRELAND LABOURERS IRELAND ACTSACTS

Labourers Ireland Acts 1883 onwards Housing for agricultural labourers – had to be a need

for labourers in the areaPLU – determined if there was a need for labourers

cottages, reports from relieving officers and engineers, set up a scheme and advertised it.

CPO of land for cottages – disputes with landowners Initially cottage with ½ an acre but later 1 acre

providedPlot laid out by the PLU engineerBuilt to a standard set of designsBuilding work contracted out – signed off by the

engineerOn completion – applications made by labourers and

assigned cottages by votes of the Board members

IMPROVEMENTS TO IMPROVEMENTS TO HOUSINGHOUSINGLabourers cottages set a standard

Relieving Officers – visited poor in their homes and reported on living conditions

Problems with labourers cottages – PLU liable for repairs

Problems with private homes – relieving officer or sanitary officer could report and fine offenders

Outbreak of disease – Sanitary Officer responsible for arranging for all bedding etc. to be burnt and house to be whitewashed

CONCLUSION CONCLUSION Is Fearr an tSláinte ná na Táinte? –

in the 18th and 19th centuries poverty was directly responsible for poor health and increased exposure to disease

Improvements were madeHowever, health was very

dependent on wealth so,In order to be healthy it was better

to be wealthy