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

1. CHRONIC
CONDITIONS IN
HEALTH AND
WEALTH
Waterford County Archivist
Joanne Rothwell

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. 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. 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. GOVERNMENT ROLE
Vaccination
Control of Disease
Health Care
Clean Water
Housing

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. 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. 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. 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. 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. 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

13. 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

14. 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”

15. 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

16. 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

17. 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

18. Copyright Waterford
County Archives

19. 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

20. Copyright
Waterford
County
Archives

21. 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

22. 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

23. 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