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[Post Famine Ireland- Social Structure
Ireland as it
Really Was.
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© 2006 by Desmond Keenan. Book available from Xlibris.com and Amazon.com]
HEALTH AND MEDICINE
Chapter Summary. This chapter deals with health and medicine in Ireland which was largely in the private sector. It deals with doctors, hospitals, nursing, midwifery, apothecaries and dentists. The hyperlinks immediately below are to the most important headings.
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Hygiene and Sanitation
Health and medicine was largely a private matter. Those who could afford a doctor were treated in their own homes. Those who could not afford a doctor relied on the apothecary or on traditional ‘cures’. The medical profession was regulated by three professional bodies, the Royal College of Physicians of Ireland, the Royal College of Surgeons of Ireland, and the Irish Apothecaries Hall, which had powers to examine and licence practitioners in medicine, surgery, midwifery, and dispensing in the Kingdom of Ireland. Public infirmaries for the poor were erected in the counties at public expense, and also charitable hospitals supported by gifts of the charitable, were built from the 18th century onwards (Keenan, Pre-Famine Ireland 391-98). Dispensaries were often attached to the public infirmaries. (These were not the same as the public dispensaries described earlier.) The Belfast General Hospital founded in 1792 divided the town of Belfast into 5 dispensary districts. It was a charitable hospital supported mainly by contributions from the public, though there were some paying patients, and nurses’ ‘flag days’ for collections from the general public survived until recently. The hospitals for the poor were very small, and the criteria for admission are not obvious. Clearly they could be used for setting or amputating broken limbs of carters or builders. Admission to the Belfast General Hospital in 1850 surgical cases amounted to two thirds of admissions. By 1875 the ratio was 60 to 40%.
Though one can gain some idea at least of the relative importance of diseases from the records of admissions to the charitable hospitals, it is difficult to get an idea of the general state of health of the population especially as matters like bad teeth, difficulty in hearing, underweight and undersize, and imperfect eyesight were scarcely counted. The first indication of the poor state of health of the nation came in 1914 when a large proportion of the volunteers for the army were rejected by the medical examiners as unfit. (They were later recalled.) But the records of the examinations of schoolchildren when the medical examination of schools was introduced in the 1920s gives us some idea of the state of a supposedly healthy group. The Report of the Armagh School Medical Officer noted that the children from the urban areas were on the whole better cared for than those in rural areas. Clothing and nutrition were better than 20 years earlier. Skin diseases were rarer than hospital experience would lead one to expect, but a high proportion of children had sight defects. Slight deafness was common, as was middle ear disease. Enlarged tonsils and adenoids, carious teeth and defective vision were the commonest defects found. The great majority of the children [between 7 and 14] had one or more carious teeth which must be attributed to faulty diet (Irish School Weekly 6 August 1932). It is rather surprising to find that urban children were slightly healthier than rural children. By that time however, bought food like white bread, tea and sugar had largely supplanted the traditional diet. The bread was often fried in animal fat.
Though cholera caused scares, the other fevers, typhus, typhoid, and scarlet fever were far more common. Smallpox still occurred. Pneumonia was regarded as very dangerous, and caused the death of young men and women, besides the elderly. Rheumatism and bronchitis were usual. Cancer was familiar, particularly in Belfast where environmental pollution was widespread. Syphilis was the most general reason for admissions after accidents which included scalds and burns. Abuse of alcohol was another reason for admission. Apoplexy (stroke) was frequent and cardiac problems, both probably caused by defective diet. Tuberculosis was becoming the great scourge. The following, the most widespread, were treated, among others in the Royal Hospital Belfast in 1888: apoplexy and paralysis 24 cases, bronchitis 103 cases, phthisis (tuberculosis) 20, pleuritis (pleurisy) 24, and pneumonia 48, cardiac 78, gastritis 61, fevers 42 (Allison, Seeds or Time, 174). Sexually transmitted diseases were obviously sent elsewhere. Gastritis evidently covered a lot of stomach complaints. Bronchitis may have been really tuberculosis as the author remarks elsewhere. Cancers were not mentioned, though what was later called lung cancer was quite frequent but may have been confused with phthisis, pleurisy or bronchitis. This figure however reflects an industrialised urban district and does not necessarily reflect rural areas. Nor was rheumatism treated in hospitals, though it was probably very general. Pneumonia was dreaded because it was known that a severe wetting could bring on a chill which could lead to pneumonia. Deaths of children were familiar, and also deaths in childbirth. An Article in The Pilot in 1838 noted premature ageing in the West of Ireland with a man of 40 looking like a man of 70. There were few really old people. Pulmonary diseases, especially consumption, (TB) was there almost unknown. But rheumatism, even crippling rheumatism, was very general. The poor could not afford doctors, but there was a great belief in the efficacy of castor oil to cure most things (Pilot 15 October 1838). It had a foul taste which recommended it, and its chief effect was purgative which would remove the ‘noxious humours’ from the body. The Irish Railway Telegraph however noted the prevalence of consumption in other parts of Ireland which claimed at least one victim in every family. It attributed its frequency to the damp atmosphere and lack of drainage (Irish Railway Telegraph 6 Dec. 1845). Ague (malaria) the curse of English armies in Ireland and the Low Countries had virtually disappeared. It had been widespread in the Fens in England in the 18th century.
The local authorities, especially the mayors of towns, had particular responsibilities with regard to the maintenance of public health, ensuring a good supply of drinking water, the scavenging of filth, the prevention of the spread of fevers through fumigation or quarantine, the inspection of fish and meat in the public markets, and the erection of temporary fever hospitals. There was increasing care for poor lunatics and lunatic asylums were built by the Grand Juries. When the Irish Poor Law was passed in 1838 provision was made for some medical attendance. Like the provision made for the education of children in the poor houses this was often minimal. Shortly afterwards dispensary districts were established all over Ireland. The Irish Government, both before and after the Union, as noted above, took matters of public health seriously. This was not a question of establishing a welfare state, but of eliminating those things which might cause disease to spread. It was once observed that those who provided clean water and sewers saved more lives than the whole medical profession. The Irish Towns Policing Act (1828) allowed every Irish town to establish a commission to provide for a supply of clean water, scavenging, lighting, etc. The provisions of this Act were extended by the Towns Improvement Act (1854). The first Act in the second half of the century was the Medical Charities Act (1851 which organised dispensary districts provided for the appointment of suitable doctors to each as medical officers, and also provided for midwives in the dispensary districts; see Dispensary Districts above. Its aim was to extend the Poor Law into a sphere, namely local medical provision for the poor, not envisaged in the original Poor Law Act. The appointments of the medical officers were made by the local Poor Law Guardians. The declaration of dispensary districts was commenced on the 30 December 1851 and completed on the 27th May 1852 (New Irish Jurist 3 June 1904). The expenses of the dispensary districts were met by the local Poor Law Guardians.
Though the workhouses were not intended as hospitals, that is what they became as poor sick people were admitted to them. See above, Poor Law Unions. Still the standard of care was low, usually carried out by healthy inmates as orderlies, but it was better than nothing. In 1862 the practice was legalised. By 1910 one third of inmates were sick people of the working classes rather than paupers (General Advertizer 26 February 1910). Gradually trained nurses were introduced in most Poor Law Unions. In 1890 the Local Government Board recommended the use of trained nurses. In 1895 the official post of nurse in the workhouse was created, and in 1897 it was forbidden to use paupers as nurses. Strangely the persistence in the use of paupers as nurses was greater in Ulster. Elsewhere, many religious nursing sisters were employed. By 1902 there were 159 Poor Law Union infirmaries in Ireland, but including fever hospitals and auxiliary hospitals 320 hospitals were managed by the Poor Law Guardians. Many of the rural fever hospitals were empty for much of the year (New Irish Jurist 10 Oct 1902). The training and registration of midwives and nurses was another object of legislation. Finally, in 1919, the Chief Secretary became the Minister for Health in Ireland. (Weekly Irish Times 9 Aug. 1919. This was a temporary measure for it was recognised that a Home Rule parliament would establish its own Ministry of Health.)
By the Public Health Acts of 1874 and 1878 the medical officers of the dispensary districts were made medical offices of health and additional salaries were paid in respect of sanitary duties. One of the most important duties of the dispensary districts was to vaccinate the poorer people against smallpox. This vaccination was made compulsory in 1853. Other Acts granted a right to remuneration from the Poor Rate for this service. The Public Health Act (1878, which followed the English Act of 1875, was the most important with regard to local government before the establishment of county councils in 1898. It established sanitary districts for purposes of public health and consolidated various provisions of earlier Acts; see Sanitary Authorities above. The sanitary laws concerned the supply of pure water, adequate street lighting, regulating public clocks, and providing and regulating markets and slaughterhouses (County Councils Gazette 5,12,19,26 January 1900). The Act vested all sewers with the local sanitary authority, with some exceptions. By the Act, within the areas, all new houses must have water closets, earth closets, or privies; scavenging and rubbish collection was made the duty of the sanitary authority, subject to orders of the Local Government Board. Those who kept pig sties and other nuisances might be prosecuted. The dispensary district, (oddly not the Poor Law Union) was made the sanitary district but large towns and cities could be the sanitary district. Providing expensive ground works like piped water and sewage obviously were not duties assigned to a dispensary doctor. Some of the built-up suburbs of Dublin outside the city boundary like Pembroke and Rathmines established themselves as sanitary authorities. The medical officers of the dispensary districts were made medical officers of health, and additional salaries were paid in respect of sanitary duties. The sanitary districts survived as administrative units even after the county councils were formed though some of their powers were transferred to Local District Councils (County Councils Gazette 2 Feb 1900). By the Public Health Acts of 1878 and 1896 the local authorities were given authority to inspect fairs and markets and remove nuisances like rubbish and authorised the making of by-laws to control all markets and fairs, prevent nuisances etc (Irish Law Times 20 January 1900). Naturally, after a fair day all dung would have to be swept up and removed. The Sanitary Authority could make by-laws to control building. It could regulate or provide cemeteries. Loans were available for the provision of clean water and sewers.
With regard to public health in rural areas, the greatest need was to provide proper housing for the poorest classes. When Ireland’s population was burgeoning before the Famine, and there were no restrictions on marriage, young couples from the poorest classes got married at an early age. Such was the fear among the clergy of extra-marital sex that they always performed the marriage ceremony when requested. Their friends and neighbours quickly built a small single-roomed hut from mud or other local materials. A chimney of sorts, a door and a small window permanently shut sufficed. Straw for a bed and a pot to boil potatoes was all that was needed. In the post-Famine years the number of these cabins decreased, though they survived in isolated places until the 1890s. Such houses were breeding grounds for consumption. In Dublin, in particular, and unlike in Belfast, very little new housing suitable for the working classes was built. Older houses were split up into single rooms, and Dublin along with Glasgow, had the worst slums in Western Europe. In both England and Ireland a large number of Housing Acts were passed to enable slums in towns to be cleared and replaced with proper affordable housing.
The Irish County Councils’ Gazette recognised that the greatest sanitary requirement in both Britain and Ireland was the provision of suitable housing for rural labourers. Many Acts of Parliament were passed but relatively little was achieved. In both countries the object of the Acts was defeated by red tape. For various reasons, the great drive to improve housing did not develop until after the First World War. The Local Government (Ireland) Act (1898) transferred the right and duties of the sanitary districts under the Labourers Acts to the rural districts. It was they, and subsequently the county councils, who constructed most of the well-known labourers’ cottages in the Irish countryside.
Another area of public health was the safeguarding of food. Tuberculosis was rife in cattle so meat inspectors had to examine meat to see if there was any tubercular infection present. More important was ensuring that milk was not infected. In the days before refrigeration warm milk being sold from door to door was an excellent medium for growing the bacillus of tuberculosis. The establishing of public analysts who could study the various foods offered for sale was a great help. The level of contamination of milk for example could be studied under a microscope. The various Food and Drug Acts tried to ensure that foods and drinks were pure and not adulterated with other substances or chemicals. Bread, butter, milk and tea were notoriously adulterated at the time. Tuberculosis had to be cured as well as prevented. Sanatoria for the cure of TB were established. It was known that regions with cold dry air hastened the cure of the disease. But in Ireland, though the air was usually damp, the treatment was to expose patients to as much fresh air and sunshine as possible in specially constructed hospitals called sanatoria. The benefits of pasteurising milk were widely disseminated. The Countess of Aberdeen devoted herself to assisting the Irish poor. She is chiefly remembered for her campaign against tuberculosis. Medical statistics showed that consumption was the greatest killer in Ireland accounting for one in six deaths in Ireland, more than all the other infectious diseases put together. The Dairies and Milkshops Order and Tuberculosis Act (1908) enforced standards of hygiene cowsheds, dairies, and milkshops.
The Health Act (1919) established a Ministry of Health for England. Ireland was included but the Chief Secretary was made Minister of Health. Public health was a pre-occupation in the whole of the United Kingdom, and Irish legislation mirrored English and Scottish legislation. [Top]
Doctors and Hospitals
Apart from charity hospitals and Poor Law Unions health was a private matter. Doctors paid for their own education and then most of them established or purchased practices in which those who could afford it paid for consultations. These came to be called general practitioners for they did not specialise in any branch of medicine. Though of course, especially in rural areas, the remuneration of a dispensary doctor was a useful addition to earnings. But one had to be a pauper, certified by Poor Law wardens, to get medical attention in that way. The minimum charge for a house visit was one guinea (21 shillings) and one got three visits for that. In a case of a serious illness the doctor might call daily and this could amount to £10 a month. For operations even for the removal of adenoids or appendixes the surgeon might charge 30 guineas. If someone went into a private hospital for the operation this cost another 20 guineas (Weekly Irish Times 2 Feb. 1907). A guinea amounted to a good week’s wages for a labourer.
Medical education in the second half of the 19th century was centred on the universities. The College of Physicians did not teach but relied on Trinity College, Dublin for instruction in medicine, and later the Queen’s Colleges, though it examined and issued licentiates. The College of Surgeons continued teaching while issuing licentiates. The examinations for licentiates and for bachelor of medicine seem to have been about the same standard, but the licentiate was essential in order to practice. Various medical schools were established as private adventures training students for the examinations of the Colleges. The Carmichael School of Medicine lasted into the second half of the century and with the Ledwich school amalgamated with that of the College of Surgeons (DNB Mapother). There was a medical school attached to Steeven’s Hospital. The chief medical schools, apart from the one in Trinity College, were the medical faculties in the three Queen’s Colleges. Indeed it may be said that the medical schools kept the Colleges afloat. St Cecilia’s College, attached to the Catholic University, gained a considerable reputation. Like Carmichael’s it was legally a private medical school preparing students for their licences from the Colleges of Physicians and Surgeons.
Apart from the county infirmaries for paupers all hospitals were private ventures or were charitable institutions treating the poor gratis. These latter survived by soliciting donations, and also by hiring out nurses, and at times took paying patients. The philanthropist, Vere Foster, spent the last thirty years of his life as a collector for the Royal (Victoria) Hospital in Belfast. When he started he made 9,000 personal calls and got over 1,000 subscribers (McNeill, Vere Foster 139). The Earl of Meath started societies in London and Dublin to raise funds for hospitals (DNB Brabazon; the most famous fund-raising venture, the Hospital’s Trust, was not started until 1930). In 1900, staff at the Royal Victoria hospital included a superintendent, a matron, a collector of subscriptions, a clerk, a dispenser, a keeper of instruments, porters, cooks and assistants, laundry maids, female servants, nurses, a messenger, a yardman, and last but not least, a surgeon and a physician (Allison, The Seeds of Time 208). Around 1900 there were 119 fully trained nurses and 34 probationers in training (op. cit. 238). The Belfast General Hospital at the time, originally with 100 beds, had by then 196 beds. In 1901 725 medical patients were admitted and 1,205 surgical patients. There were 1,654 external medical patients and 23,799 external surgical patients. 530 operations were performed. Chloroform was generally used as an anaesthetic. The average length of stay of a patient in the hospital was between 3 and 4 weeks (op. cit. 191). The number of patients treated swelled rapidly in the closing decades of the century. Many of the extern patients received dental treatment. Though quite large by the standards of the time, these general hospitals were obviously much smaller than what came later.
There were many small specialist hospitals especially in the larger cities. In 1910 there were 30 hospitals in Dublin not counting private hospitals and nursing homes. Fever hospitals and lock hospitals for venereal diseases were usually separate institutions. Lying-in hospitals specialised in maternity work. The young doctor William Smylie was rather astonished when in 1870 he commenced work in the Rotunda, an old charity lying-in hospital. Gowns, masks, gloves and other 20th century refinements were unknown. In the wards there was a fire before which sat a group of students and nurses. On either side of the fire sheets were being dried. There were no basins, soap, or water. The expectant mother was fully clothed. For the medical examinations she lay down on a bed and was covered with a blanket. The doctor dipped his fingers in a tub of lard and felt under the blanket. He then wiped his fingers in a towel and proceeded to examine the next patient (‘Sir William Smyly’ in Lyons, Brief Lives, 90). When Sir William became Master of the Rotunda in 1889 he introduced drastic changes including proper living quarters for nurses and proper labour wards, building on the improvements of his two predecessors, Lombe Atthill and Arthur Macan (DNB Atthill, Macan). Listerian principles of antiseptic surgery and the use of carbolic acid for purposes of sterilisation were gradually introduced into all hospitals after 1877 (DNB Lister, J.). The use of radium to treat cancer was introduced by John Joly in Steeven’s Hospital in 1896 and led to the establishment of the Irish Radium Institute in 1914 (Encyclopaedia of Ireland ‘Irish Radium Institute’; ‘Surgery’). The purpose of the Institute was to provide radioactive material in fine glass needles, namely radon gas derived from radium salts. Anaesthetics were first used in Ireland in 1847 and blood transfusion in 1870. The leading Irish doctors and surgeons were equal to any in the world.
St Mark’s Ophthalmic Hospital was founded and supported by Sir William Wilde (father of Oscar, DNB Wilde). Another was the Royal Victoria Eye and Ear Hospital. Again there were special hospitals for consumption. Lunatic Asylums were re-named psychiatric hospitals. Private hospitals and nursing homes were used by richer people who had to undergo surgery, as surgeons became more convinced of the need for hygiene, the use of disinfectants, and the sterilization of instruments which could best be done in an operating theatre.[Top]
Nursing and Midwifery
Nursing orders of men and women had existed in Catholic countries for centuries, and Florence Nightingale received her first glimpse of what a hospital should be when she visited a hospital run by the French Sisters of Charity of St. Vincent de Paul in Alexandria in Egypt in 1850. On her way back to England she was impressed also by the work being done by Protestant deaconesses at Kaiserwerth near Düsseldorf in Germany and trained for four months to be a nurse. Nurses in Britain at the time were untrained working-class women and were rather what were later called ward maids. She regarded nursing as a vocation or ‘calling’ suitable for young ladies of good family. It also offered an escape from the dullness of home life. Nightingale conceived nursing as a Protestant version of a Catholic hospital run by nuns with a very strict discipline under an all-powerful matron who corresponded to the Mother Superior.
Before 1860 when the Nightingale school of nursing was established in London, nurses in the United Kingdom were recruited from among servant girls, and most of them were illiterate, careless, personally dirty and incapable of little else than performing the work of a charwoman (Allison, Seeds of Time, 227). Not all were like this, and in the General Hospital in Belfast, nurses had to be able to read and write. Assistant nurses washed and swept the wards and lobbies, emptied slops and other ‘nuisances’, carried food up from the kitchens, and fed the patients if necessary. Basic nursing changed little as the Irish nurses from the Voluntary Aid Detachment found when they went to assist in military hospitals in France during the First World War. Nursing was very far from being a graduate profession. Nursing, as understood at the time, was little more than providing personal services to the sick, ensuring they were clean and comfortable, assisting them to eat and use the toilet, assisting in the giving of medicines prescribed by the doctor, and attending the doctor when he examined or treated a patient, removing uneaten food, excrement and vomit, making beds and so on. The boundary between a nurse and a servant was hard to define. Who made the beds, changed the bed linen, or swept under the beds? A nurse’s duties were carried out by orderlies in the armed forces and other inmates in poorhouses. How the duties were carried out depended to a large extent on the kind of person recruited for nursing duties.
Florence Nightingale was impressed by the way the French Sisters managed their hospital, but also by the way the German deaconesses were trained. Obviously, there are good ways and bad ways of doing anything. Many of the deaconesses were peasants, but she considered that the vocation was eminently suited to ladies of middle class families who wished to carry out the ‘Corporal works of mercy’ in an organised and systematic fashion. She also regarded it as a suitable career for women, and also believed that nurses should be trained and managed by nurses, not by doctors or military officers. Much later, when Listerian practices were adopted in hospitals great emphasis was placed on making the hospital wards and everything in them as aseptic as possible. In 1860 Florence Nightingale was able to open her school of nursing in St Thomas’ Hospital in London. The course was composed of a preliminary instruction in anatomy, physiology and the principles of hygiene, followed by lectures on medicine and surgery, and then by practical clinical instruction in the wards until the ‘probationers’ were regarded as being sufficiently proficient. Miss Nightingale also stressed the benefits of fresh air, particularly the need for fresh air in wards, light, warmth, quiet, and cleanliness.
In the General Hospital in Belfast nursing seems to have been quite well organised from the start under a head nurse. The latter was required to see that all patients on reception were thoroughly washed and clean, and supplied with clean linen and bedding, and that their clothes were ticketed and stored. The washing presumably was restricted to face and hands, except for the removal of blood, the rest of the body being taken care of by changes of linen underwear. From 1832 until 1851 the Head Nurse was a lady called Miss Anne Marshal whom Allison considers a pioneer of nursing in Belfast. Formal training of nurses in the new Nightingale system commenced in 1872. Gradually, a fairly standard uniform for nurses emerged, with caps, long skirts to the floor and long sleeves (Allison, Seeds of Time, 228, 231, 233, 236). Each hospital in each city had distinctive trimmings, and nurses’ uniforms were as varied and distinctive as those of the various military units.
By the end of the century it was widely accepted that only trained nurses should be employed in hospitals, but untrained nurses still formed the great majority in poorhouse infirmaries. In 1890 the Local Government Board issued a circular recommending the appointment of trained nurses in these infirmaries, and in 1895 the post of nurse was formally established in them. In 1897 another Order forbade the use of untrained nurses, but this was objected to widely especially in the North of Ireland (New Irish Jurist 10 Oct. 1902). Jubilee nurses were started as a charity to provide trained nurses to make visit to households. An appeal in Ireland in 1897 (diamond jubilee of Queen Victoria) raised £19,000 and by 1901 there were 78 jubilee nurses in Ireland. In Dublin alone they made 50,000 house visits (Church of Ireland Gazette 16 Aug 1901). Besides the Jubilee nurses there was also the Dudley nurses called after a scheme of Lady Dudley, the wife of the Lord Lieutenant, to provide district nurses in the more remote districts of Ireland (Fingall, Seventy Years Young 283). In 1916 the Notification of Births (Extension) Act (1916) allowed local authorities to provide maternity care and care of children up to the age of 5 by providing a medical officer and a nurse in maternity centres in their districts (Weekly Irish Times 24 June 1916).
The Weekly Irish Times in 1906 commented on careers for girls in nursing, the one occupation which women rule. At the head of the army nurses was the Matron in Chief and a matron was also in charge of the nursing staff in large hospitals. Training time was three years in the big hospitals, two years in Poor Law and fever hospitals, and one year in children’s or cottage hospitals. Those girls ambitious to become matrons should get their training in a big general hospital with at least 100 beds. The big hospitals in Belfast, Dublin, and Cork provided training equal to the best in the United Kingdom. A House of Commons committee recommended state registration of nurses, and also that the three year training period should be universal. Nurses were paid £5 a year in their first year, £10 in their second, and £15 in their third, but everything was provided for them. The best paid branch was the army where a staff nurse was paid £40 rising to the £300 of the Matron in Chief (Weekly Irish Times 20 Jan. 1906). Costs of training were very variable. Some of the larger hospitals charged stiff fees. In others the fee was low or non-existent, but the probationer had to sign for four years. After the first two she was sent out to nurse rich private patients whose fees were payable to the hospital. This in effect meant a two-year training course.
The nurses in the Irish Nursing Association were in favour of the College of Nurses and in favour of state registration of nurses (Weekly Irish Times 25 Mar 1916). Though Florence Nightingale opposed state registration of nurses, this cause was successfully championed by Esther Gordon Fenwick of Morayshire in Scotland who trained at the Royal Infirmary, Manchester (1878-9), and then became a sister at the London Hospital. She founded in 1887 the (Royal) British Nurses' Association, the first organisation of professional women to receive a royal charter (1893); the Matrons' Council of Great Britain; the National Council of Nurses of Great Britain and Ireland; and, somewhat later, in 1926, the British College of Nurses. She also acquired the Nursing Record which became the British Journal of Nursing and which she edited almost until her death. Her most important work, however, lay in her leadership of the movement for the state registration of nurses, a movement which met with the strong and active opposition of Florence Nightingale, and which lasted for thirty-four years before the passing of the Nurses Registration Act (1919), when Mrs. Fenwick became a member of the first General Nursing Council (DNB Fenwick).There were six Irish representatives on the National Council of Nurses which was not an official body.
An Irish College of Nursing was established in 1917 and met to discuss the conditions of Irish nurses. It noted that their work was hard, their working life short, and there was no provision for old age. The nurses work on Sundays as on other days, and had one day off a month. A trained nurse could earn up to £50 a year, when a skilled typist could earn £200. Despite their low income they were regarded as being in the professional class and expected to contribute to charities (Weekly Irish Times 1 Mar 1919). The Registration of Nurses (Ireland) Act (1919) was passed at that time, and qualified registered nurses could add the letters SRN (state registered nurse) after their names. The Act provided for the establishment of a General Nursing Council for Ireland to form and keep registers of nurses similar to those in England and Scotland. It had power to make rules regarding admission and removal of nurses, these rules to be approved by the Chief Secretary and then laid before Parliament (Irish Law Times 1920 ‘Public Statutes’).
Even more than with nursing midwifery was left in the hands of local ‘handy women’ who were supposed to know about those matters. The rich could afford an accoucheur, a doctor specialising in obstetrics, and the very poor went to a lying-in hospital like the Rotunda in Dublin. When the Royal University was established in 1880 changes in the medical curriculum meant that gynaecology and ophthalmology had to be taught to all medical students in the Queen’s Colleges. In England in 1882 Sir Francis Champneys became a member of the board of the Obstetrical Society in London, held examinations for midwives, and issued certificates. In Great Britain, the first Midwives Act (1902) set up a Central Midwives Board to prescribe the training of student-midwives in hospitals, license candidates, and regulate the practice of all such certified midwives. This was a great advance, for at that time the great majority of births in the United Kingdom were home births attended by midwives. This Act did not apply to Ireland and it was not until 1918 that the Midwives (Ireland) Act (1918) was passed establishing a corresponding Irish Central Midwives Board. It was to act through county councils and county borough councils. All non-registered midwives were excluded. Up to then any crossing sweeper could set up as a midwife. Qualified midwives from England, Scotland and the colonies were free to register in Ireland (Weekly Irish Times 24 Nov. 1917). In practice state registered nurses took the midwifery course and in 1922 the Northern Ireland Government formed a joint council for nurses and midwives (Irish Law Times 16 Dec. 1922). These Acts, of course, just made best practice of some into the law for all and conditions in maternity hospitals were no longer in the primitive conditions they were in 1870. As there were 551 midwives employed in 746 dispensary districts (74%) we can assume that the medical officers provided some sort of training for them if they were not already trained nurses. In 1903 the work of the Obstetrical Society was taken over by Central Midwives Board (DNB Champneys). [Top]
Apothecaries and Dentists
Though in theory apothecaries were different from physicians and surgeons in practice many doctors and surgeons compounded their own medicines. And on the other hand the apothecary was the poor man’s doctor who knew what the common remedies for most common complaints were, and maintained a supply of the ever useful castor oil and similar purgatives like Epsom salts, opium, calomel, bark, and quassia. Nevertheless, as the nineteenth century wore on it became more common to leave the compounding and dispensing of medicines to the apothecaries. The doctor just wrote out a prescription to take to a chemist (Weekly Irish Times 26 Dec. 1908). Later still compounding was taken over by huge drugs firms who made up and packaged pills, potions, and ointments in huge factories. Oddly, in the Medical Charities Act (1851 apparently no explicit provision was made for appointing a dispenser, only a medical officer, though the courts in 1902 held that the Local Government Board had such a power (New Irish Jurist 1902, Reports). In 1852 the figures were 776 medical officers, but only 38 apothecaries. Presumably the apothecaries were in the larger districts in cities. In 1904 there were 746 dispensary districts in Ireland, with 810 medical officers, and 47 compounders (Weekly Irish Times 30 April 1904). Larger hospitals also had compounders (Allison Seeds of Time 171). The vast majority of the apothecaries, or chemists as they came to be called, were owners of shops.
The Dentists’ Act (1878) regulated the practice of dentistry. It allowed the setting up of a body to regulate the practice of dentistry and to keep a Dentists’ Register of qualified dentists. The British Dental Association was formed the following year (DNB James Smith Turner). In 1879 the Irish College of Surgeons instituted a diploma in dentistry (DNB Mapother). Student dentists could be Articled (apprenticed) to practising dentists. In the 20th century it was regarded as a suitable and highly remunerative job for women, the costs of qualifying being about the same as for doctors (Weekly Irish Times 1 July 1916). By 1920 Queen’s University Belfast established a special school of dentistry. In 1921 a Dental Board was established to regulate dentists registered under the 1878 Act.