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Chapter Twenty Six

               Medicine and Public Health

Summary of chapter. The practice of medicine was largely a private matter, the Government only giving charters to regulatory bodies who licensed practitioners. The training of these was often rudimentary but in the course of the century the chartered bodies raised their standards, and medical education improved. The Government also had to provide for public health, like insisting on the quarantine of ships, and providing fever hospitals. It also ensured that a minimum of medical assistance was provided for the destitute.

(i) Medical Practice and the Medical Profession

(ii) Public Health

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(i) Medical Practice and the Medical Profession 

††††††††††† One of the most important laws concerning the practice of medicine was to be found in Canon Law. It was the prohibition on clerics of shedding blood. This was extended to include such minor incisions as were made in bleeding. Most university students in the Middle Ages enrolled themselves as clerics while studying to avoid military service, an enrolment with merely involved wearing the tonsure, i.e. shaving the head at regular intervals. (Latin tonsura means shearing.) The effect of this was that medicine, which meant the study of the Latin and Greek authorities, could be taught and studied at universities, but even in important matters surgery was left to barbers, at least among Christians. The study of surgery was therefore conducted by apprenticeship, while medicine was studied at university and medical degrees in the subject were awarded. A contemporary rule of thumb in the eighteenth century stated that doctors treated externally while surgeons treated internally. 

††††††††††† By its charter granted by Elizabeth I, Trinity College, Dublin was enabled to grant degrees in medicine, but the faculty was not organised until the 1620's. The prestige of the medical faculty of Dublin University rose. In the eighteenth century many Irish students went to Scotland to study, but by 1825 most Irish students were studying in Ireland. When the Queen's Colleges were established they were allowed faculties of medicine, but the numbers of students attending them was very small. 

††††††††††† Shortly after this date some of the medical faculty considered that there should be some form of regulation of the practising physicians in Ireland, and about the middle of the seventeenth century they organised the College of Physicians of Dublin. In the eighteenth century, three professorships in physic, chirurgy and midwifery, and pharmacy with materia medica were endowed by Sir Patrick Dun in the College of Physicians. Towards the end of the century the Irish Government entrusted it with a general supervision of surgery and pharmacy as well. 

††††††††††† The charter of the College was re-granted and extended by William and Mary at the end of the century, and from them it took its clumsy name The King's and Queen's College of Physicians. (A college in this sense is an organised body of persons with particular rights and duties.) By this charter the College was empowered to grant a licence to practice medicine anywhere in the kingdom of Ireland to graduates in physic of the universities of Dublin, Oxford, and Cambridge. Later they were allowed to grant licences to graduates of Scottish universities. (After 1852, by reciprocal arrangements graduates of the above universities could practice in Ireland while graduates of Dublin University could practice elsewhere in the British Isles.) Until 1761 the College acted also as the examining body for the medical faculty of the university, but after that date the two bodies grew apart. Lectures were given in its own School of Physic from 1786. 

††††††††††† The School of Physic Act (1800) joined the two bodies again to manage a new teaching hospital of Sir Patrick Dun, and the Dun bequest was transferred to it. This hospital pioneered clinical medicine, i.e. teaching medicine at the bedside of patients instead of from textbooks alone.All doctors practising in Ireland therefore had degrees in medicine. Two other private schools of medicine were founded. The first was called the Original School of Medicine. The other was founded by Richard Carmichael in the Richmond Hospital and was known as the Carmichael School. Carmichael insisted on very searching examinations of candidates. 

††††††††††† In the Middle Ages barbers practised hair cutting, surgery, and dentistry, and in England Edward IV incorporated a Company of Barber-surgeons in 1461 with powers to licence practitioners. Under Henry VIII the name was changed to the Company of Barbers and Surgeons, and barbers were restricted to dentistry. Surgery began to be respectable in the eighteenth century when John Hunter began his systematic investigations of anatomy. Surgeons thereafter were often men with university degrees. Earlier bone-setters set broken bones while surgeons were responsible for the amputation of limbs or the extraction of bullets, besides bleeding. Surgeons therefore more properly belonged to the army and navy, and the training given to these was often rudimentary. During the Napoleonic Wars Wellington was squeamish about dealing with wounded and so neglected them. Napoleon on the other hand gave every encouragement to his famous surgeon Baron Larrey and his 'ambulances' for removing the wounded from the field. 

††††††††††† In Ireland a charter of Elizabeth I regulated barbers and surgeons, but few people were satisfied with this arrangement. In many places there were no guilds, and so no guild of barbers. Even if the guild was present it usually had no Barbers' or Surgeons' Hall. Also it was increasingly felt that surgery belonged more properly to medicine. The Charter to the College of Physicians in 1692 recognised this and gave to it a general supervision of surgeons and midwives as well as physicians. The College was empowered to licence surgeons and midwives after examination. By 1720 the surgeons of Dublin had formed a society of their own and their connection with the guild of barbers virtually came to an end. An Irish Act of 1765 allowed only duly licensed surgeons to practice their profession in county infirmaries. In 1784 a separate charter was given to the Irish College of Surgeons and gradually it became the teaching, examining, and licensing body for surgeons. In 1791 it was awarded the bodies of executed criminals for dissection. 

††††††††††† In 1811 a Dublin surgeon described the system of apprenticeship for aspiring surgeons. A young boy of about fourteen is taken away from his classical studies and apprenticed to the local surgeon-apothecary. He then spends seven years chatting to the kitchen staff. After that time he comes to Dublin where he spends about seven months studying bits of anatomy, surgery, materia medica (herbs and drugs), physic, chemistry, midwifery, physiology, and 'God knows what else besides' (SNL 7 Nov 1811). The acerbic comments need not be taken too seriously for by 1830 Irish surgeons were regarded as among the best in the world. It does however illustrate the system of education. The apprenticeship fees were £248, about a year's salary for a quite high official. No examination was held at the end of the apprenticeship. (The Irish Secretary, defending the practice, noted that when examinations actually were held elsewhere they were regarded as formalities. This was true also of many universities at the time.) 

††††††††††† The Royal College of Surgeons opened a small college for instruction in Dublin in 1792, and in 1805 moved it to a new and larger premises in St Stephen's Green. By law the bodies of executed criminals had to be handed over to the surgeons for the study of anatomy, but the supply never equalled the demand. This was the age of the 'resurectionists' who dug up newly interred corpses. 

††††††††††† A new charter was given to the College in 1828 allowing it to grant licences in surgery and midwifery, and the practice of holding examinations was then introduced. 

††††††††††† For most people at the time, in Ireland as elsewhere, the apothecary or pharmacist was a more familiar figure than the doctor or surgeon. Apothecaries were not mentioned in the charter given by Elizabeth I to the barber-surgeons. In England apothecaries were separated from the guild of grocers in 1617. They were placed in the guild of barber-surgeons by the charter of James II in 1687. An Act of 1692 required apprentices to have a knowledge of Latin, something that was not required of surgeons. Pharmacopeias, or books on drugs, were written in Latin. In 1709 Alexander Pope ironically observed that they learned their art by studying doctors' bills. In 1692 the apothecaries in Ireland, like the surgeons, were placed under the general supervision of the College of Physicians. 

††††††††††† In the early eighteenth century the apothecaries were still numerous in the guild of barber-surgeons, but like the surgeons they formed a grouping of their own which was given a charter as a separate guild in the city of Dublin in 1745.An Act was passed in 1735 for the inspection of drugs because of numerous frauds. The charter establishing the Apothecariesí Hall(a name derived from the trade guilds) in 1791 gave the Hall the right to regulate the affairs of apothecaries. Qualified practitioners who were not freemen of Dublin were admitted. The Hall was largely a licensing body and its failure to actively prosecute unlicensed pharmacists (usually surgeons) lessened its authority. Training was by apprenticeship, and an attempt to establish a school of pharmacy failed. 

††††††††††† By 1850 medical degrees in medicine and surgery were being awarded by the universities. The College of Physicians granted licences to practice in medicine and midwifery. The College of Surgeons granted licences for surgery and midwifery, and the Apothecaries' Hall granted licences to apothecaries or chemists. 

††††††††††† The founding of hospitals for the sick poor ('A Hospitall or spittle for poore folkes diseased.') was a popular form of charity. Hospitals were founded for the treatment of the poor for the rich were treated in their homes. The most famous of the Dublin hospitals were Dun's, Mercer's, Steeven's, and Swift's (St. Patrick's). Many county infirmaries were begun originally as private charities but were enabled to benefit from charges on the county. A lock hospital, one for the treatment of venereal diseases, was opened in Dublin was opened as early as 1755. It was intended for women who became infected through nursing infected children, or were infected by their husbands, and also for the husbands of women who were infected while nursing. The Rotunda was a lying-in or maternity hospital. All hospitals at the time depended to a large extent on charitable donations from the public and what could be raised by fund-raising events. The Rotunda was famous for musical events in its great hall. County infirmaries have been treated under the administration of counties.Institutes to assist the blind and deaf were added. As noted earlier the Government took special care to see that proper provision was made for the treatment and safety of lunatics. 

††††††††††† Midwifery was a branch of medicine to which Irish doctors devoted much attention. They trained not only medical students but also those men and women who wished to practice as midwives. Vaccination against smallpox by means of the cowpox was introduced into Ireland following the successful experiments of Edward Jenner in 1796. The previous rather risky practice of inoculation with a mild form of smallpox had been introduced to Ireland about 1740, indeed a book on the subject had been published ten years earlier. A 'Cowpock Institute' was established in Dublin in 1804 to prepare a vaccine (Latin vacca a cow) from the cowpox disease. Packets of 'infection' could be dispatched by post to any part of Ireland at a cost of 2/6 a packet. 

††††††††††† Nursing became a respectable occupation for young ladies earlier in Ireland than in England. For centuries there was in the Catholic Church a tradition of religious Orders nursing the sick. Immediately after the Napoleonic Wars when communication with the Continent was resumed Archbishop Murray of Dublin took advantage of a stay in Rome to procure approbation for a religious Order of women to perform charitable works outside their convents, for example in schools, prisons, and hospitals. During the great cholera epidemic in Dublin in 1832 the city was presented with the spectacle of young religious women volunteering to work in the fever hospitals. In 1834 a religious Order opened a Catholic hospital of its own. 

††††††††††† There was a considerable body of pragmatic knowledge on the treatment of diseases like fevers. Doctors, especially army doctors, had great experience in these matters. The cause of fever might be unknown but its connection with dirt was noted. It was also known that fever could be contracted from dirty clothes though the connection with fleas was not spotted. The distinction between infection and contagion was known namely that a disease could be communicated from one person to another either by an infection in the air or by physical contact. Remedies therefore suggested themselves. The air could be kept pure by proper ventilation. Wards could be washed down with vinegar and their walls whitewashed. Patients and their bedclothing could be kept clean. Light foods and plenty of drinks could be provided. 

††††††††††† Taking the waters in spas, so popular in the previous century was gradually giving way to sea-bathing that was considered more efficacious especially when the water was cold.  

††††††††††† It is safe to assume that the distribution of medical services closely followed the distribution of schools, namely that they were fairly abundant (by the standards of the time) in the north and east, but more or less non-existent in the far west and south, unless perhaps the local clergyman had studied a little 'physick'. 

††††††††††† We know little of the distribution of various diseases. From passing references it would seem that tuberculosis and rheumatism were very prevalent in rural areas. The agues or malarial fevers noted by Defoe as prevalent in the marshlands of England were not commented on and seem to have been absent. Fevers and venereal diseases were afflictions of the towns, as were also various alcohol-related diseases. The steady consumption of alcohol required a steady cash income. Over-eating and poor diet seem to have caused many deaths from apoplexy (strokes) and heart attacks (coronary thromboses) among the middle classes. (Bleeding was the classic remedy for relieving high blood pressure.) 

††††††††††† The ordinary people put their faith in traditional herbs or failing these in numerous and diverse charms. Carleton notes an herb garden kept by a farmer's wife. The houseleek was a specific for sore eyes, and tansy for worms in children.Bogbane was regarded as efficacious for heart complaints, while 'rosenoble, Solomon's Seal, and burgloss' treated other afflictions. Some of these herbs may have had curative properties; for example the foxglove contains digitalis a steroid which can be used as a heart stimulant. 'Cures' were often entirely irrational like getting a posthumous child to point seven gooseberry thorns at a stye to cure it. Superstition could be seen in the application of a piece of paper with the first chapter of the gospel of St John printed on it.[Top] 

(ii) Public Health 

††††††††††† It was always the duty of local and central authorities to take public measures to ensure the health of the public. In towns and cities the corporations were bound to provide an adequate supply of clean water, and also to remove dirt and other nuisances which might lead to the spread of disease. The authorities seem to have taken their duties seriously. In Dublin early in the century the Corporation negotiated with the Grand Canal Company for an adequate flow of fresh water through the canal from which the citizens might draw. They also began to provide sewers under the streets and to replace the elmwood pipes for the supply of water with metal mains. In Belfast a private charity undertook to supply the growing towns with freshwater. In Cork there was a pipewater Board consisting of twelve commissioners. The Towns Policing Act of 1829 was to ensure that there was a proper local authority to carry out these functions. 

††††††††††† The Government was chiefly concerned with the prevention of the spread of fever especially from abroad. If foreign plagues threatened it established quarantine stations, and appointed medical inspectors along the coasts. It could also authorise the setting up of local and national boards of health. Such boards were empowered to acquire and manage fever hospitals, to clean the streets, to fumigate houses, and to whitewash the homes of the poor.

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Copyright Desmond J. Keenan, B.S.Sc.; Ph.D. ;.London, U.K.