¿,.0 - NU1 MAYNOOTH Ollsscil na fitiresnn Ma Nuad The Dublin Medical Press and medical authority in Ireland 1850 -1890 By Ann Daly M.A. THESIS FOR THE DEGREE OF Ph.D DEPARTMENT OF MODERN HISTORY NATIONAL UNIVERSITY OF IRELAND MAYNOOTH HEAD OF DEPARTMENT: Professor R.V. Comerford. Supervisor of Research: Dr. Dympna McLoughlin. January 2008 Acknowledgements This work could not have been completed without the assistance of a number of people. I would like to thank Robert Mills and the staff of the Royal College of Physicians Dublin for the generous help offered to me while researching this thesis. I am also indebted to Mary O’Doherty, archivist of the Mercier Library of the Royal College of Surgeons, Dublin for her help in locating research material for this thesis. Thanks also to the staff of the National Library, Kildare Street and the staff of Maynooth University Library for assistance and support. The patience and understanding of Eamonn Gaffney and Maire Ni Bhroithe of Co. Meath V.E.C. was also invaluable to the completion of this study. I wish to sincerely thank Professor Vincent Comerford and the staff of the Department of Modern History, NUIM for their encouragement and expert advice. I wish to acknowledge in particular the support and guidance of my supervisor, Doctor Dympna McLoughlin, without whom this project would not have begun. I would also like to acknowledge the support of Niamh Barker, Clodagh Daly and Omagh Daly. Their voices echo in many sections of this study. Finally and perhaps most of all, I wish to thank Joe Daly, for teaching me that life is not a race but a marathon. Stride for stride, it is his pace that I hope to find. Ann Daly January 2008. This is for my mother Catherine Ann Magner Daly My promise true. INTRODUCTION Nineteenth-century Ireland saw the rise of modern Irish nationalism, sweeping changes in land reform, the growth of a new bourgeois class and the parallel decline and collapse of eighteenth-century social structures. In short, it was a period that crystallised the major social features of modem Ireland. R.V. Comerford asserts that the preoccupation with the ‘mythic march of the nation’ has detracted from the importance of the latter half of the nineteenth century.1 This study seeks to highlight the significance of this time period in relation to laying the foundation stones for a centralised and modern health-care system. This system in turn would ensure that the figure of the doctor was a real presence in the lives of the public and, as the Dublin Medical Press indicates, it bolstered the perception of the medical practitioner as moral guardian of society in general. This thesis is not a study of the medical profession in Ireland in the nineteenth century. Though the structures and the hierarchical and elitist nature of the medical establishment are explored, it is the doctors’ widening perception of their role in society, so carefully documented in the Dublin Medical Press, that the study seeks to highlight. That is not to say that the thesis is the study of the Dublin Medical Press itself.2 Rather, the Dublin Medical Press is examined in this study as a framework of 1 R. V. Comerford, ‘Ireland 1850-70: post famine and mid Victorian’ in W. E. Vaughan (ed.), A new history o f Ireland v: Ireland under the Union, I 1801-70 (Oxford, 1989), p. 372. 2 A notable study of this publication has been done. See Robert J. Rowlette, The Dublin Medical Press and Circular, 1839-1939: a hundred years in the life of a medical journal (London, 1939). 1 the developing moral role of the medical profession in Ireland in this period. Unlike other contemporary Irish medical publications (see below), the Dublin Medical Press defined itself as a ‘medico-legal’ publication, an ambiguous term that legitimated discussion on a broad range of topics but with particular emphasis on public morality. Essentially, it is the profession’s preoccupation with matters unrelated to health that forms the bulk of this study. Gender roles, lifestyle choices, customs and habits were all given generous column inches in the journal. This study seeks to explore the evolving moral role of medicine and, more importantly, how medicine became a formidable force as a moral authority in Ireland in the second half of the nineteenth century. To address the question of medical authority in Ireland properly, one must examine the position of the profession at the beginning of the nineteenth century, before the catastrophic effects of the Great Famine. By 1841 the population of Ireland had increased at an alarming rate: the population was estimated at 8,000,000.1 The disparity between the British and Irish economies was considerable and was reflected in the fact that one-third of the Irish population was dependent solely on potato farming. Industry remained largely undeveloped, with the exception of the north of the country where the linen industry flourished. The demographic increase was concentrated in the poorer sections of society, mainly the cottier class. Thus, in this context of a burgeoning landless peasantry, medical care for the poor was becoming burdensome for Ireland’s relatively small group of gentry and middle 1 R. B. McDowell, ‘Ireland on the eve of the famine’ in R. Dudley Edwards and T. Desmond Williams (eds), The Great Famine: studies in Irish history, 1845-1852 (Dublin, 1994), 2nd edition, pp 3^1. 2 Oliver MacDonagh, ‘Ireland and the Union, 1801-1870’ in Vaughan, New history of Ireland v, pp liv-lvi. 2 classes. There was a need for a national system of medical charity that would provide health care for a substantial element of the population that could not afford to pay for it. Unlike its near neighbour, Ireland in the nineteenth century did not have a considerable stratum of landed gentry who could shoulder the weight of charitable health care. By the 1840s the foundations of a centralised health care system had been laid in Ireland. The Act of Union had had little impact on the administration in Dublin. R. B. McDowell points out that from the beginning of the nineteenth century there were persistent efforts in parliament to secure a systematic and structured civil service in Ireland.1 Much responsibility was placed in the hands of the grand jury, a group of landed gentry of the county, who, with little or no training, presided over such matters as the support of hospitals, asylums and dispensaries as well as repair of roads, construction of buildings in the county and imposing taxation in the form of grand jury presentments. Three different types of medical institution were founded: dispensaries, infirmaries and fever hospitals. In 1805, legislation stated that if a dispensary was set up voluntarily, the grand jury could annually make a grant equal to its subscriptions. As a result dispensaries increased rapidly in the 1830s.2 Similarly, the Infirmaries Act of 1765 stipulated that an infirmary be set up in every county, and the Fever Hospital Act 1807 provided that grand juries could present up to £100 at each assize.4 Thus, on the eve of the Famine there existed the rudiments of a national health-care system, 1 McDowell, ‘Ireland on the eve of the famine’. 2 Ronald D. Cassell, Medical charities, medical politics: the Irish dispensary system and the Poor Law 1836-1872 (London, 1997), pp 2-3. 3 5 & 6 Geo. Ill, c. 20(1765). 4 Cassell, Medical charities, pp 15-16. which, unlike the British equivalent, was already heavily dependent on government subscriptions. Moreover, those receiving gratuitous medical aid were not limited to impoverished beggars, as was the case under the English Poor Law; rather, due to the impoverished condition of the population, medical charities on Ireland incorporated a much larger portion of society. This facilitated the growing sphere of influence of the medical profession. The sheer magnitude of the Famine illustrated clearly the need for this health-care system, already partly subsidised by the government, to be centralised into a national framework. This would become a reality in 1851 with the Medical Charities Act.1 The Irish medical profession was determined that an outside authority, such as the Poor Law Commissioners, would not dominate, and doctors ensured that their voice was heard in all legislation related to medicine. Irish medical men were determined that nothing should jeopardise their position and reputation in society. The ensuing legislation allowed the Irish medical establishment considerable sway, and thus established the profession as a force to be reckoned with. The Medical Charities Act of 1851 enabled a total of 723 dispensary districts to be created with 960 dispensaries, and in the next twenty years the system continued to expand.2 Thus it is not difficult to imagine the scale of medical influence in the lives of ordinary Irish people in the nineteenth century. As that century progressed, a medical authority replaced the power of the ascendancy in medical institutions and this added to the public profile of the profession. The Medical Registration Act of 1858 made mandatory the registration of all licensed 1 14 & 15 Viet., c. 68 (1851). For discussion of the significance of this act see Chapter 2. 2 Cassell, Medical charities, pp 92-93. medical practitioners and set up the General Medical Council to set minimum standards. The act primarily introduced a single medical register for all qualified practitioners, reflecting further movement towards unification and standardisation of training. This emphasis on credentialism and qualification fortified the authority of the profession in the eyes of the public. Consequently, the confidence of the profession in Ireland was strengthened until it perceived its role to extend far beyond the healing art.