by Anna-Maria Hajba, Archivist
At the start of the nineteenth century, there were three types of medical charities in place to provide healthcare to the poor in Ireland. These included voluntary hospitals in the cities of Belfast, Cork, Dublin, Limerick and Waterford; county infirmaries which admitted patients suffering from non-infectious diseases and those requiring surgery; and fever hospitals, which were used to isolate patients suffering from infectious diseases such as smallpox, tuberculosis and typhoid fever. As a fourth type, an Act of Parliament in 1805 established dispensaries to complement the work of county infirmaries and to provide healthcare for those who did not live within a reasonable distance of a hospital. As their very name suggests, dispensaries had no sick wards or other in-patient facilities; their sole function was to dispense medicines and medical advice.1
Dispensaries were funded by local subscriptions, which the county grand jury was obliged to match.2 This was the great weakness of the system, as it resulted in an uneven distribution of dispensaries. In prosperous areas with the greatest number of well-to-do subscribers they were often crowded together, while poorer and more remote districts, where dispensaries were most required, were left unsupported.3 However, those in prosperous areas were not without their own set of problems, as our new collection, the Cratloe and Meelick Dispensary Records, quickly reveals.
The Cratloe and Meelick Dispensary Committee was established on Tuesday 6 January 1835, when a numerously attended meeting, chaired by Stafford O’Brien of Cratloe House, was held at the home of John Watson in the parish of Meelick, County Clare for the purpose of forming a dispensary in a house close to Cratloe forge. After the election of committee members, Surgeon Thomas Kane of Cecil Street, Limerick was appointed as the medical attendant.
At the second meeting, held in February, it was agreed that the dispensary would be open on Mondays and Thursdays between the hours of 10 am and 12 am, or longer if necessary. It was also agreed that treatment would be provided free of charge to patients in receipt of vouchers signed and distributed by those subscribers who contributed a guinea or more annually to the fund. Subscribers also had the power to arrange for the doctor to attend to the sick in their homes if they were too ill to visit the dispensary.
To safeguard against potential misuse of the voucher system, the committee decreed that persons holding 15 acres of more of ground would not be entitled to free medical assistance, nor was anyone else whose circumstances would enable them to pay for medical care. However, such rules were by and large ignored. Vouchers were distributed like confetti, and the committee found to its dismay that ‘many unnecessary tickets were brought to the dispensary’ by persons ‘who are able to pay a small fee for such visits & frequently by persons who have given fees to Apothecaries & others’.4 By March 1841, the committee had no option but to impose a minimum fee of two shillings and sixpence on anyone with a visiting ticket seeking medical assistance, and a more substantial fee on those who could afford it. Free services continued to be provided, but only against tickets on which the subscriber had specified that the person was too poor to pay.
Another issue perpetually troubling the committee was money, or rather the lack of it. Although the neighbourhood was not short of landed proprietors whose annual incomes exceeded £500, few were willing to contribute to the upkeep of the dispensary, even though their tenants regularly used its services. Providing this service did not come cheaply. The medical attendant received an annual salary of £65 and the fees of the apothecary, Mr Raleigh, were crippling. In October 1835, the committee received from him an invoice for the eye-watering sum of £26.11.8 for medicines supplied. In April 1839, after yet another whopping invoice, the committee had had enough of Mr Raleigh and his fees. It decided that Raleigh ‘should be discontinued as Druggist to the Dispensary’ and that ‘Surgeon Kane should order a fresh supply of medicine at some respectable establishment in Limerick.’5
The years of the Great Famine of 1845–1849 proved cataclysmic. The dispensary remained active throughout this time but struggled to make ends meet as the number of contributors continued to dwindle. The Dispensary Committee’s statistical report for 1850 speaks its own grim language by noting that the population of the two parishes was ‘now much reduced 2/3s of census of 1841’. 6 There was, however, a silver lining to this tragedy. The Great Famine exposed many of the endemic weaknesses of the medical services available to the poor and brought about a reform of the entire system. This began with the Medical Charities Act of 1851, which introduced a state-funded provision of free medical aid to the sick poor, and continued throughout the post-Famine period with further amendments.7
The Cratloe and Meelick Dispensary collection, although small, provides valuable information about the establishment of a rural dispensary and its subscribing members, ethos, funding and finances. It also contains statistical information about the two parishes and the volume of patients treated, and provides insights into which leading local families contributed or did not contribute to the funding of the dispensary. What is missing, however, are the names of individual patients or the nature of ailments and illnesses for which they were treated, but perhaps we can take the view that half a story is better than no story at all!
- Geary, Lawrence M., ‘Medical Charities in Pre-Famine North Cork’. Mallow Field Club Journal 19 (2001), p. 124.
- Ibid., p. 124.
- ‘Medicus’, Observations with Reference to the Past and Present Condition of the Medical Charities in Ireland and Suggestions as to the Best Means for Ensuring Future Efficient and Economical Administration of Medical Relief to the Sick Poor. Dublin: James McGlashan, 1851, p. 17.
- Minutes of the Cratloe & Meelick Dispensary Committee, 19 March 1841 (P26/1).
- Ibid., 15 April 1839 (P26/1).
- Statistical Report of the Cratloe & Meelick Dispensary Committee, 1850 (P26/1).
- Geary 2001, pp. 127–128.