Chronic Conditions in Health and Wealth


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Lecture 4 of 4 in "Is Health Better than Wealth" series

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  • Phthisis – consumption TP
  • Chronic Conditions in Health and Wealth

    1. 1. CHRONICCONDITIONS INHEALTH ANDWEALTHWaterford County ArchivistJoanne Rothwell
    2. 2. PUBLIC HEALTHHigh 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
    3. 3. GOVERNMENT BODIESLocalBoards of Health, 1818 - dispensariesGeneral Board of Public Health – March1820 (Cholera Board in 1832) statistics and grantsPoor Law Commissioners – Local Government BoardGrand JuryBoards of Guardians
    4. 4. LEGISLATION Medical Charities, Houses of Industry 1765 – clergy of established church a corporation for the erection of Fever Hospitals 1807 Grand Juries – presentments for Fever Hospitals £100 National Vaccine Establishment, 1808 Poor Employment Act, 1817 Local Boards of Health, 1818 Central Board of Health, 1820 Poor Law Act, 1838 Vaccination Extension Act, 1840, Compulsory Act, 1863 Medical Charities Act, 1851 Public Health Ireland Act, 1878 Labourers Ireland Acts 1883-onwards
    5. 5. GOVERNMENT ROLEVaccinationControl of DiseaseHealth CareClean WaterHousing
    6. 6. MEDICAL CHARITIES Dispensaries and Fever Hospitals Funded by private subscription Uneven 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
    7. 7. VACCINATION: SLOW START 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
    8. 8. VACCINATION Medical 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
    9. 9. COMPULSORY 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 case Fine of 10 shillings for failure to vaccinate a child c.1500 prosecutions under the Act in 1870 Boosted 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
    10. 10. VACCINATION: 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
    11. 11. CONTROL OF DISEASEDispensaries 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 OfficersProvision of drugs
    12. 12. HEALTHCARE 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
    13. 13. 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”
    14. 14. HEALTHCARE: 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
    15. 15. CLEAN WATERWater Supply Schemes – private and municipalRural areas – not servicedPublic 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
    16. 16. SEWAGE SCHEMESTyphoid – outbreaks as a result of faecal matter in water supplyDungarvan SS 1901 a direct result of an outbreak of enteric fever and typhus in October 1898Public Nuisances – night soilSanitary Officers – inspections and reportsNotices and fines issued for non-compliance re: provision of facilities
    17. 17. Copyright WaterfordCounty Archives
    18. 18. HOUSING: HOVELSHousing unfit for human habitationNo standards for landlords to meetSome landlords built to good designs but no onus on them to do soOften 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
    19. 19. CopyrightWaterfordCountyArchives
    20. 20. LABOURERS IRELAND ACTS Labourers Ireland Acts 1883 onwards Housing for agricultural labourers – had to be a need for labourers in the area PLU – 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 provided Plot laid out by the PLU engineer Built to a standard set of designs Building work contracted out – signed off by the engineer On completion – applications made by labourers and assigned cottages by votes of the Board members
    21. 21. IMPROVEMENTS TO HOUSINGLabourers 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
    22. 22. 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 madeHowever, health was very dependent on wealth so,In order to be healthy it was better to be wealthy