The County Infirmaries

Where Dublin led, the rest of the country followed. As with the Dublin hospitals, those throughout the country were largely the result of private enterprise and public subscription. Parliament, by an act of 1765, 5 Geo. III, c. 20, amended in 1767, 7 Geo. III, c. 8, attempted to provide a framework for the development of county infirmaries and, although the facilities and accommodation were totally inadequate to the need, by the end of the century almost every county had its infirmary.

The 1765 legislation acknowledged the inadequacy of the funding for the existing public infirmaries at Dublin, namely the Charitable Infirmary, Mercer’s and the Hospital for Incurables, as well as the two public infirmaries at Cork, the North and South Infirmaries, and made provision for £50 p.a. to be paid out of the Treasury to supplement their budgets.

The statutes made the clergy of the Church of Ireland a perpetual corporation for the erection of infirmaries, and qualifications were laid down for additional Governors by subscription. Meetings required a quorum of five and were to be held quarterly, when the Treasurer would present his accounts. No person was to be admitted unless the Governors certified that he was a proper recipient of the charity, although the surgeon had discretion over emergency admissions.

Parliament allocated £100 for the surgeon’s salary and the Grand Jury was to supplement this with a grant towards the hospital’s expenses. It was hoped that private charity would provide the remainder, and in some cases it did. For example, by the end of the century Belfast had in addition to a general infirmary a fever hospital, both largely dependent on public support.

Records for the establishment of the Co. Down Infirmary illustrate how the system operated. On 21 April 1767 the gentlemen of the County of Down met at Downpatrick, the county town, to establish an infirmary. They raised £810 10s 9d: £688 from subscriptions, a ball at the summer assizes raised £28, the county presented £50 from the cess, a ball at the Lent assizes raised a further £33 12s. Arrangements were made for collecting boxes to be put at the doors of the parish and the Presbyterian churches, in the market place and in the infirmary. By 14 July 1767 the Governors had taken a three-year lease of a house and appointed a housekeeper on a yearly salary of £10 with board. At this point the Governors and Governesses declared that the infirmary was ready for the receipt of patients. The surgeon, on a salary of £100 p.a., was not to absent himself from the hospital for more than 48 hours without written permission.

The standing committee was to meet every fortnight at the infirmary, and more often if required. No member of the infirmary staff on pain of expulsion was to take a fee or gratuity from a patient. The duties of the staff and patients were carefully spelt out, as was the diet. Certain types of patients were excluded, for instance maternity cases, fevers, those in the last stage of consumption or incurable cases, for whose rejection a written explanation was required. There were to be no visitors before 11 a.m. or after 8 p.m. This pattern was repeated with varying degrees of efficiency and enthusiasm throughout the country.