Through The Ages: Our First Modern Hospitals – Published Limerick Life Newspaper, November 2017

There were three major features to the early decades of the 1800s in Limerick: civil unrest, hunger and sickness. The latter is no surprise, given the difficulties faced by the inhabitants of the city. In many parts, they lived cheek-by-jowl, with poor nutrition and even worse sanitation.

In the cramped confines of the old town on King’s Island, every part of life combined in the streets: fetid piles of dung mottled the cobblestones while animals were butchered and tanned, rotting vegetables were left to ferment and human waste was poured into drains. Inside the timber wattle and daub houses, life wasn’t much safer: it was permanently damp, bathing was rare and families slept together on straw beds, the same place where children were birthed and the elderly passed away. Refrigeration didn’t exist for these people, and beer was considered safer than drinking water.

One contemporary doctor described visiting a nine-foot square garret, finding 11 feverish patients of both sexes and various ages, huddled together in the presence of “concentrated putrid matter”. Unsurprisingly, life expectancy was very low in these circumstances: most men and women could only hope to live to around forty years of age. Infant mortality was a horror that was all too real. One study of a similarly impoverished area in Dublin (by Rev. Thomas Willis) found that only 67.7% of children made it to their second birthday.

Despite these challenges, the population was growing rapidly at this time – the 1831 census records some 7.5 million people on the island. This, in conjunction with urbanisation, gave rise to a pressing need for a proper medical solution for large numbers of sick people from the poorer sections of society.

The modern concept of a hospital is largely an 18th century invention, although provisions for the sick have always existed. More often than not, those who were unwell were cared for at home, by family or bainliaig (nurses, of a sort) or in monasteries or alms-houses.

Pierce Grace, the author of ‘Medicine and Doctors in Limerick’ writes that “211 hospitals existed in Ireland in the medieval period,” and most of these were devoted to looking after lepers, often linked to the Knights Templar or Knights Hospitallers of St. John. Such hospitals are thought to have existed in St. Nicholas’ parish or in Kilmurry (the records aren’t precise) and in County Limerick, in areas such as Ballylanders, Kilmallock, and of course, Hospital, which cared for lepers since 1215.

A nun of the Order of the Hospital of St. John (Knights Hospitaller)

After the Dissolution of the Monasteries in the 16th century, it was mostly every man for himself, unless you were in the army: military infirmaries had always existed, and by the 18th century, Limerick had four.

In 1772 poor houses and work houses were made mandatory, with a ‘House of Industry’ being erected in Limerick 1773, on what is now Clancy Strand. It was intended to house – and set to work – the impoverished, disabled and mentally ill. Any ‘treatment’ it provided to the latter patients would have been at best rudimentary, and at worst, cruel. It was, according to one contemporary tourist “a gloomy abode of mingled want, disease, vice and malady, where lunatics were loaded with heavy chains and fallen women bound and flogged.”

At the turn of the 18th century, medical experts realised that living in these houses was detrimental to the mentally ill. They advocated segregation within a specially-designed institution. Mr Grace points out that Ireland was the first country in the western world with a system of public asylums, building 22 in total during the 19th century. The Limerick District Insane Asylum was built on Mulgrave Street in 1826, and cost £35,490. Initially, it provided some 150 beds, later doubling in size. While the conditions would have been extremely difficult by modern standards, it was an improvement on the previous situation in the House of Industry. During his visit to the city in 1837, Jonathan Binns observed that “Limerick possesses a Lunatic Asylum, conducted on the best principles, and established on an extensive scale.”

Around this time, lying-in hospitals emerged, catering for the maternity needs of women. Prior to this, most expectant mothers delivered their babies at home, with the help of family or experienced older women who served as midwives. These hospitals were mainly designed to serve the poorer sections of society, as most wealthy families could pay for expert medical care in their own homes. In 1773 Dr Patrick Unthank and Dr Sylvester O’Halloran opened a lying-in hospital in the old English town. Only married women were accepted as patients. John Ferrar wrote about a similar hospital in Nelson Street, supported by philanthropic donations.

Much the same way as apothecaries were early pharmacists, dispensaries were something akin to GP surgeries. They were attended by a doctor on certain days, and dealt with various medical issues that didn’t require emergency or overnight care.

A women’s ward in a late 18th century hospital

It is thought that one of the earliest dispensaries in Limerick was founded by the Earl of Dunraven in the early 1800s. It would have served the people on his estate and surrounding areas.

Still there was no provision for the bulk of the population, who may be suffering from a broad range of ailments and diseases which required expert care. The solution came in the form of the voluntary hospital, i.e., one that was set up as a charitable exercise, paid for by the wealthy. The establishment of these sanctuaries for the sick wasn’t only inspired by a physical (and extremely visible) need for such, but by a thread of altruism as well. According to the author of Medicine and Charity in Ireland, Laurence M. Geary, “The voluntary hospital movement was inspired by a combination of charity and utilitarianism…philanthropy and pragmatism fused in Enlightenment thinking.”

Pierce Grace notes that in 1759, two surgeons – Giles Vandeleur and the aforementioned Sylvester O’Halloran – rented three small houses (probably in Sir Harry’s Mall), forming a small but effective hospital. That may have been a precursor to the first modern hospital in Limerick, which was established outside of the city walls, in St. Francis’ Abbey in 1765/66, with room for forty patients. The Limerick County Infirmary was led by Dr O’Halloran, and included a room to the rear where prisoners’ bodies could be dissected (presumably to aid in research and training). It was built on grounds donated by Edmond Sexton Pery, for one of his famed ‘peppercorn’ rents. It later moved to Mulgrave Street, where it remained in service until 1959.

This was followed by Limerick Fever and Lock Hospital, which was established in 1780 by Lady Hartsonge (Edmond Sexton Pery’s sister). Initially only a couple of beds in the old guard-house, it was founded to care for those sick with ‘fever’ or infectious disease, a gritty choice for a high-born lady, most of whom preferred more genteel charitable efforts such as maternity care or children’s education. It treated all manner of diseases, including typhoid, typhus fever, tuberculosis, diphtheria, smallpox, dysentery and cholera. The men and women who cared for these patients were exceptionally brave in the discharge of their duties: history records that a number of them succumbed to diseases they contracted from their patients. The hospital also had a separate section for women suffering from venereal disease such as herpes, syphilis and gonorrhoea. As a port city, sailors regularly brought to Limerick unusual strains of sexually-transmitted diseases which were not well understood at the time.

While Lady Hartstonge’s good intentions are not in doubt, it should be borne in mind too that it served the wealthy to ensure an effective quarantine situation was in place during contagion.
Fever epidemics came in waves across Ireland: one, beginning in 1817, struck 1.5 million people, leaving 65,000 dead in its wake. Another, in 1821, concentrated mostly in the Irishtown part of Limerick. In 1832, when cholera swept through the country, 953 people died Limerick hospitals, including the newly-built Barringtons Hospital, the first large-scale voluntary hospital in the city.

 

A traditional birthing scene from the 19th century

The eponymous hospital came about through the efforts of the entrepreneur and developer Sir Joseph Barrington and his sons, Matthew (Crown solicitor for Munster, who erected Glenstal Castle), Daniel (a clerk of the Crown) and Croker (a lieutenant in the Royal Navy, who built Villiers School). Matthew provided the bulk of the funding – he had become wealthy working with the Irish railways – as well as significant project management skills. That’s not to say his father didn’t provide oversight: legend has it that during construction, the old man would settle down every day to watch the proceedings from an armchair across the road, an umbrella above his head and a pipe between his lips. Costing some £10,000, Barringtons

Hospital and City of Limerick Infirmary was officially opened in 1831 with 60 beds, later increased to 120. It was designed for the poor of Limerick, but there were restrictions to entry: except for emergencies, admission was only allowed with permission of one of the governors, usually using a ticket system. This was no doubt due to the limited beds (still very much a problem today), but it may also hint at a Georgian preoccupation with segregating those whom they considered ‘deserving’ of charity, such as women and children, the elderly, and those temporarily unable to work, from those deemed to be able to help themselves, such as beggars, vagrants, addicts, etc.

The first member of staff was an apothecary, and then a matron, followed by a number of distinguished physicians, who, in the main, drew no salary. They were probably well-supported by private practice, but their charitable efforts are admirable, nevertheless. The first few nurses didn’t last terribly long: board notes recall that one was let go following “frequent instances of intoxication.”

Historian Mark Tierney listed some of the running costs of the hospital in its first year of operation, including 30 iron beds, Irish blankets, furniture, linen, flannel, coarse linen, pewter ware, night caps, frieze floor cloths, candlesticks, sconses, quills, and a ‘kack-line’ to dry clothes upon. A night watchman was also employed, at a rate of 6d per week.

 

Sylvester O’Halloran was a pioneering Limerick doctor

The period coincided with what is known as the Golden Age of Irish medicine, as a number of Irish doctors came to international attention due to their advancements in clinical methods. Three – Graves, Stokes and Corrigan – gave their names to diseases and symptoms that are now recognised the world over. Medicine at the time had moved on from the barbarous actions of the middle ages, but it was still limited in its understanding. Buchan’s Domestic Medicine 1848, for example, lists the following potential causes of illness: diseased parents, night air, sedentary habits, anger, wet feet and sudden changes in temperature. It even suggested that cholera was caused by eating ‘cold fruits’ such as cucumbers. The concept of ‘bad air’ was often cited as the cause of fever, particularly in poorer, more cramped domestic arrangements.

Prayer was a common prescription during this devout time and hospitals often provided bibles and scriptural extracts alongside bedding and meals.

Limerick Through The Ages: Our First Modern Hospitals

Barrington’s hospital continued to rely heavily on philanthropic contributions, as government funds were not forthcoming. Laurence Geary notes that the grand jury in Limerick (the local government of the day) could have apportioned £1,400 to the hospital in 1836, but chose to give instead £200, or enough to cover just 16 patients instead of 120. In 1838 the introduction of the poor rate drastically reduced all charitable donations. This was a property tax, levied in order to pay for the newly-introduced workhouses. As it was based on a valuation of assets, affluent society likely felt that they were paying enough to alleviate the suffering of the poor. By the late 1840s, subscriptions and income from local sources had fallen from £700 to just £30 per annum.

As part of the new legislation, each workhouse was to include an infirmary and a medical officer, and later, in 1843, a separate fever hospital. During the Famine years, these institutions largely took the place of the volunteer hospitals, and swelled immeasurably with the gravely ill and infirm.

Barringtons Hospital continued as a well-respected centre of public medical care until 1988, when the Department of Health ceased funding its operations. It has since operated as a private hospital, most recently under the somewhat unwieldy title of Bon Secours Hospital Limerick at Barringtons. It has come quite some distance from its establishment as a place of refuge and recovery for the poor.

Rachael Kealy

November 29, 2017

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