CHAPTER SIXTH.

RISE, REVOLUTION, AND PRESENT POSITION OF THE MEDICAL CHARITIES IN IRELAND.

§ 1. It would be almost impossible to form a correct notion of the third and last Parliamentary movement for a reform of medical relief in England, without a previous survey of the very striking changes which had been then recently effected in the administration of the corresponding department in Ireland.

For many years preceding these changes, the sick poor, in most parts of the Sister Island, had been treated in county infirmaries, fever hospitals, and dispensaries, instituted and maintained under a series of Acts of Parliament.

The infirmaries of Ireland were the older institutions; but as the present sketch refers primarily to the extern class of poor patients, we must first notice the dispensaries,*—those institutions to which, in fact, the important enactment of 1851 was finally limited.

If we except the inmates of the new workhouse infirmaries (parts of Union Workhouses set apart for the sick and infirm), and those of the still newer Union Fever Hospitals, established under recent Acts for the relief of the poor in Ireland, the destitute, and indeed the labouring classes generally, were aided by a State provision of medical care wholly unconnected with a Poor Law.

* Dispensaries in Ireland were established by Acts of Parliament, in 1805 and 1818, which empowered Grand Juries to originate "Dispensaries in parts of counties too distant from the infirmaries to allow the poor of those districts the advantages of immediate aid and advice and to supply medicines and medical and surgical aid and advice to the poor of the place and its neighbourhood wherein they were established."

For this and other information I am indebted to an able pamphlet by "Medicus," Dublin, 1851.

OFFICIAL INQUIRIES AND PROJECTS.

205

But beside the precedents for a change in the superintendence of medical relief, which were established by the last-mentioned institutions, the thin end of the wedge which was to shiver in pieces the old system of medical charities, was inserted by the first Irish poor-relief enactment (1888). By this, the Poor-Law Commissioners were empowered to "inspect and examine into the administration of" the Irish medical charities.

The Poor Inquiry Commission in 1835 had already made out a very strong case for Parliamentary intervention; and the PoorLaw Commissioners, in their elaborate Medical Charities Report of 1841, while confirming previous exposures of inefficiency and mismanagement, recommended, as they were probably expected to do, that the principal share in the management of these charities should be vested in themselves.

Nevertheless, two Parliamentary Committees* thoroughly reinvestigated the subject; and their reports will be found to contain many materials of great value towards a settlement of this difficult question, without handing over the management of sanative institutions to central and local Poor-Law Boards.

Indeed, the Medical Charities Bill of 1850,-a measure which disappeared among the usual "droppings" at the close of the session, would have vested the government of infirmaries, fever wards, and dispensaries, in a separate Board, to be styled "Commissioners of Health."

Had a judicious constitution been devised for the Central Board (although in that case it would probably have become too good a measure to pass into lawt), we might possibly now have been able to refer to medico-sanitary legislation for Ireland, as a plea for "Justice to England."

But official influence, professional misconceptions, and government prejudices, combined to deteriorate the character of the

* One of the House of Commons in 1843 and one of the House of Lords in 1846. "The late Sir Robert Peel, speaking of the Encumbered Estates Act, said it was so very good a measure that he really wondered how it had ever passed.” ”Chadwick On the Civil Service, 1855, p. 221. Papers, &c. Supra cit.

206

ACKNOWLEDGED DEFECTS.

Bill; and the Act of the following session (1851) brought all the dispensaries of Ireland under Poor-Law direction.

§ 2. Let it not be forgotten that the medical charities of Ireland constituted a national provision for the public safety, which by no means involved the reliance of the recipients and administrators of medical aid upon poor-rates, parish-officers, or Boards of Guardians; nor had it the slightest tendency to pauperize those whom it benefited.

Whatever defects there might have been in the old system, and they were many and serious, experience leaves no doubt of the superiority of that one great principle,—a principle which was unfortunately sacrificed in order to solve temporary difficulties, and to cure some acknowledged abuses in practice.

It was quite true, that the localization of those institutions was capricious and irregular; that the boundaries of their respective districts were either imperfectly or not at all defined; that their benefits were very unequally supplied to the island at large; and that the poor in many places were entirely beyond the reach of aid.

It was also proved that the funds of the dispensaries were uncertain, and failing year by year; that the "county cess," on which the main burden lay, was raised solely from occupiers, and left wealthy absentee proprietors free from liability; that medical officers were frequently reduced to the degrading, if not demoralizing, position of being compelled to solicit from the gentry of their districts, a sufficient amount of annual subscriptions to secure a corresponding grant from the county grand jury; that a more safe, honest, and uniform method of maintaining these charities was essential to their efficiency; and that a compulsory tax, fairly levied upon the whole community, without absolutely excluding voluntary contributions, ought to form the financial basis of their support.

It was further shown, that they were lamentably in need of control and inspection by specially qualified medical authorities, men of "character and standing," unfettered by private or pro

PARLIAMENTARY CONCLUSION.

207

fessional bias, and rendered as independent as possible of corrupting influences.

Such were the premises, generally admitted; but these by no means justified the conclusion at which the Legislature arrived -namely, that the whole medical and sanitary care of the poorer classes, not merely of workhouse paupers, should be controlled by Boards of Guardians, or committees of such Boards, under the Poor-Law Commissioners; that the entire cost of this provision, including the salaries of the medical officers in each district, should be defrayed exclusively by poor-rates raised in that district; and that all voluntary aid, hitherto afforded by the independent and educated classes of society in the support and management of these institutions, should be rejected.

On this last point, indeed, a stand was made in the House of Commons. A proposition was made by Mr. Vesey, that an annual subscription of 11., or a donation of 10l., should entitle the donor or subscriber to serve on the committee of manage

ment.

The objection urged by the Government was, that the amendment, if adopted, would limit the power of the Board of Guardians over the Dispensary Committees; the very reason why it should have been passed.

Mr. Sidney Herbert, with his usual comprehensiveness of view and nobleness of purpose, supported the amendment. But the pauperizing party were too strong, and the amendment was defeated by a small government majority.

§ 3. The question naturally occurs-Why were the dispensary surgeons so clamorous for the Bill of 1851.

But probably

Drowning men, we are told, catch at straws. no class had suffered more than the dispensary surgeons from that aggravation of national distress which was caused by the great famine, and two successive pestilences, devastating the island, from 1846 to 1850. They also apprehended, and not without reason, a total failure of resources for the maintenance of their dispensaries.

208

SUFFERINGS OF MEDICAL STAFF.

They had, moreover, endured with vexation and disappointment, the peddling and oppressive operation of the three temporary Fever Acts, by which, in succession, the Legislature had endeavoured to mitigate the horrors of those calamitous years.

A stranger medley of incongruous administrative machinery was perhaps never before created by sanitary legislation, than that which struggled, miserably and ineffectually, in 1847 and 1848, to do something by way of relief and prevention, at the expense chiefly of the doctors; for they suffered personal risk and loss in addition to their share of the public burthen: while the last of those temporary measures, by concentrating certain powers in the Poor-Law Commission, served, at least, to check abuses, and to favour an approach to order and efficiency.*

These circumstances may partly account for the almost unanimous support which the Irish doctors† gave to a measure for converting the national dispensary system into a branch of poorlaw relief.

Like the frogs in the fable, not being content with the log of a grand jury system, they were, in reply to their complaints, handed over to the stork of a poor-law government.

The bait of a medical commissioner and five medical inspectors, was too enticing to be withstood; and the unsatis

"The two first temporary Acts proved inadequate, as was apparent in Dublin and in other cities and large towns; but in rural and remote districts, where means were crippled and resources were unavailing, disease pursued its course—the people perished through want of proper relief, and their medical attendants fell from the effects of contagion. Adverting to the incongruous materials for working the second of these Acts, it is not difficult to account for such results; that machinery comprised Relief Commissioners, Relief Committees, Finance Committees, Boards of Guardians, and the Board of Health. Every proceeding under the Act, to be complete, required the united action of these distinct bodies, whose co-operation was demonstrated by endeavours to shift and shake off responsibility; while the Board of Health, although complaints were constantly pouring in, had no power to prevent the greatest extravagance on the one hand, or the greatest cruelty to the poor on the other.' They had no legal power to enforce or even to superintend the carrying out of their own recommendations.”—Observations by "Medicus,” Dublin, p. 34. 1851.

"With a shortsightedness for which," said an eminent Irish surgeon, "I could

never account.