Medical charities, medical politics: the Irish dispensary system and the poor law, 1836–1872

This volume marks a welcome addition to published research on the establishment of a system of state medicine in Ireland during the nineteenth century. The author's objective is to explore the significance of the Medical Charities Act, 1851, and to analyse its effect on medical relief and epidemic control in Ireland up to the conversion of the Poor Law Commission to the Local Govemment Board in 1872, and he achieves this most acceptably. Medical provision for the poor before the introduction of a Poor Law to Ireland in 1838-in particular, county infirmaries, fever hospitals and dispensaries-is discussed adequately in the opening chapter, providing an informative and essential background to the principal focus of the book. The various commissions investigating the plight of the Irish poor during the 1830s and 1840s and the subsequent political debate towards imminent reform are given due prominence and are dealt with in such a way as to maintain the reader's interest. The need for unity among members of the medical profession and the influence of the medical joumals are highlighted as significant factors in the deliberations, and appropriate biographical comment on the principal characters of the period under review, both medical and political, is proffered either through the text or in explanatory footnotes. In addition to the horrors presented by a starving population, the Great Famine of the 1840s created massive medical relief problems for the authorities. The numbers of fever victims overwhelmed the existing institutions and the scale of the emergency combined with the breakdown of medical charities provided considerable scope for the extension of Poor Law medical care. Various fever Acts were passed, and the appearance of cholera produced the Nuisances Removal and Diseases Prevention Act of 1848. This was a centralizing measure which gave the lord lieutenant and the Central Board of Health power to place any area of the country under the authority of the Act, which required boards of guardians to clean streets and public places, remove nuisances, bury the dead and provide medical facilities, medicines and care for those in need. With the advent of the Famine, the Poor Law Commission-since 1847 organized separately from that in England-became increasingly involved in medical care and in public health. The author devotes two substantial chapters to the Medical Charities Act of 1851 (usually referred to as the Dispensary Act) and its significance in the development of Poor Law medical relief and public health in Ireland from its implementation until the 1870s. This Act marked a significant shift in the nature of poor relief in Ireland, concentrating in the Irish Poor Law Commission medical relief and public health powers unprecedented in that country and unparalleled in the rest of the United Kingdom until the establishment of the English Local Govemment Board in 1871. The discussion in these chapters is comprehensive and wide ranging, covering topics such as administrative organization, personnel, medical qualifications, statistics on mortality and morbidity, vaccination and inoculation. Throughout the book there are useful comparisons drawn between the situations in England and Ireland, with policies in the latter frequently presented as being influential in the development of health services in the former. The final chapter is devoted to a more specific analysis of the Irish system in relation to reform in England between 1866 and 1876. Ronald D Cassell has provided us with an excellent account of medical charities in Ireland in the nineteenth century. Painstakingly researched, cogently argued and carefully balanced, it incorporates a range of social, medical and political issues which are integrated in a very readable text. It is a valuable contribution to the scholarship of this period.