A conference in Dublin this week will examine how the Irish medical system coped with its many challenges in the 19th century, writes CLAIRE O'CONNELL
SMALLPOX, WIDESPREAD death from famine “fever” and overcrowded lunatic asylums were just some of the many challenges faced by Irish medicine in the 19th century, and a conference in Dublin this week will examine how they were tackled.
Smallpox was widespread in the 18th and early 19th centuries in Ireland, but a successful vaccination programme had clamped down on the disease by the 1860s.
Then a wave of smallpox washed across Europe in the early 1870s, and Ireland was hit – more than 10,000 people died from the disease here in 1872 and localised outbreaks erupted for several years afterwards, says Dr Mel Cousins from Glasgow Caledonian University.
Isolation of patients as well as cleanliness, vaccination and disinfecting of clothing and bedding were considered important for controlling the spread of smallpox, he explains.
So during an outbreak in 1875, when a doctor in Athenry ordered the transport of smallpox patients to nearby Loughrea – despite the objections of the local and public health authorities – it sparked public disquiet that culminated in the burning of the workhouse van.
The riot prompted widespread condemnation, but thereafter the authorities arranged for hospital services to be provided for smallpox patients in Athenry.
“Whatever one may think about the action, it was clearly effective and not one single person in Loughrea caught smallpox,” says Cousins.
Three decades earlier, the Great Famine was also presenting difficulties for the public health system and the medical profession – not least because the killer famine “fever” and diseases of malnutrition were making an appearance, says Dr Larry Geary, a senior lecturer in history at University College Cork.
One of the richest sources of medical information of the time comes from a survey compiled by Dr William Wilde (father of Oscar) as editor of the Dublin Quarterly Journal of Medical Science.
In 1848, Wilde polled more than 100 doctors about their experience of famine-related illnesses in the field and he published their replies, explains Geary. “Wilde was trying to harness the experience of country doctors in particular to see if they could come up with some sort of response or analysis of what was happening,” he says. “He was trying to pin it down as much as possible.”
But the Irish medical profession was overwhelmed by the sheer scale of what was happening, and the enormity of the event tempered even the hardline political stance of another medical journal, the Dublin Medical Press, says Geary.
The journal was founded in 1839, a year after the much-reviled Poor Law came into effect, and Irish doctors were worried that the Poor Law Commission would threaten medical authority in Ireland, explains Geary.
“This was the fear, that they would lose their autonomy eventually, and that this Poor Law, which they hated in itself, was going to encroach on these medical charities,” he says.
Against that backdrop the Dublin Medical Pressenergetically queried and politicked, but as the scale of the Famine became apparent, they toned down their approach.
"Because the profession was so bowled over by what was happening, the board of the Dublin Medical Presssoftened its stance and realised the hardline attitude it had taken at the start simply wasn't sustainable."
Not only had the Poor Laws incited unrest within the medical profession, but legislation passed the previous year, The Dangerous Lunatic Act of 1838, also had a major effect on Irish medicine in the 19th century.
“It meant that any individual in the street could accuse a person of being a dangerous lunatic,” according to Dr Oonagh Walsh, senior research fellow in medical history at UCC’s department of history.
In practice, it also meant that if two justices of the peace signed an accused individual into an asylum, they had to be detained there even if they were declared sane on admission by the doctor.
Ireland was in the middle of a building boom of lunatic asylums, but the high rate of admissions under the Act meant the institutions soon became overcrowded, says Walsh.
“Some of that can be explained by communities looking on the asylum as a resource – for example, if a family was emigrating and if there was someone who may bring problems at Ellis Island, they would sometimes have that person committed and then move on.”
Treatments on offer for psychiatric patients at the time included rest – particularly for women suffering from what is now called post-natal depression – manual labour, morphene and, in some cases, alcohol. And despite the vast overcrowding and lack of medical personnel, certain doctors made supreme efforts to improve and understand the problems of patients, notes Walsh.
One doctor in particular – Fletcher in Ballinasloe – tried to improve the physical wellbeing and appearance of patients, operating on hernias, cleft palate and club foot. He also carried out post-mortems to see if mental issues left physical traces on the brain, says Walsh.
“On the whole we get a sense that the system was being overwhelmed by a tidal wave of patients and the staff were doing their best,” she says. “But the asylums also provided places where you could categorise mental illness and create a new discourse, and towards the end of the century standards improved; they were still under resourced but they were trying to impose professional standards of care.”
And despite the harsh nature of the Act and the overcrowded conditions of asylums in the 19th century, Walsh has been surprised to discover that the system was generally benevolent. “It’s much more complex and much nicer than I ever expected to find,” she says.
Cousins, Geary and Walsh are among participants in this week's conference, Science and Technology in Nineteenth-Century Ireland, which is hosted under the auspices of the Society for the Study of Nineteenth-Century Ireland with the support of the Open University and the Royal Irish Academy. The conference runs at the RIA, Dawson Street, Dublin 2, on Thursday and Friday.
See www.open.ac.uk/arts/ssnci-conference-2009