Pre-Independence

Pre-Poor Law

The present-day health service developed a number of different tracks in a relatively ad hoc manner. The first voluntary hospitals originated in the 18th century.

Several more, principally in Dublin, emerged in the 19th century. Many were founded by religious orders.

Apart from voluntary hospitals, there was no general hospital service as such. By the  1830s,  a number of county infirmaries and a few hospitals existed.

In parallel to the poor law system, the grand juries were separate local government institutions that built and maintained roads, public buildings, and the like. In the 19th century, grand juries contributed towards the cost of county infirmaries.

Poor Law Workhouses

The origins of the modern hospital system lay in the poor law institutions established under legislation enacted in 1838. These institutions created poor law unions/districts with a Board of Guardians throughout the country and placed a duty on the poor law commissioners to house the destitute in workhouses. Over 100 were built. The primary focus was not on medical care but on maintenance.

The workhouses were deliberately designed so as to discourage recourse. They have a notorious history.

They were not intended to provide medical services. However, hospital services came to be based increasingly in workhouses.

Dispensaries & Medical Officers

Later, poor law legislation placed a duty on the poor law commissioners to ensure that the Board of Guardians provided dispensaries and appointed medical officers.

The Poor-law legislation divided the country into various unions. Each poor law union is divided into a number of dispensary districts. The poor law commissioners appointed medical officers who provided medical services to the sick and poor in the district. Tickets were issued to establish qualification. Poor law medical officers were also entitled to undertake in private practice.

The dispensaries originated in the 18th century in conjunction with county infirmaries. The Grand juries originally maintained them. Responsibility was passed to the poor law guardians in the middle of the 19th century.

The dispensary system doctors were made the Registrars of Births, Death and Marriages (for catholic marriages) under 1863 legislation.

The dispensary doctor registrar was subject to the superintendent registrar, who was generally an officer of the poor law union. The entire system was under the registrar general a government appointee.

The early 20th-century system of county hospitals grew out of the poor law system.

Mental Health

Mental Health Services in the 19th century were primitive and penal. In the early 19th century, mental abnormality was viewed increasingly as a disease that might sometimes be cured and merited care and attention.

A number of lunatic asylums were established in the 19th century. 60 District unit lunatic asylums were established together with a number of private asylums. The district asylums care dealt with the so-called mentally handicapped and mentally ill.

The workhouse provided special separate accommodation for those classed as having a mental handicap. Many came to be housed in workhouses rather than in lunatic asylums. Many became institutionalised within workhouses.

1850s-1890s

In the middle of the 19th century, health services such as they existed were administered by a number of bodies. The Poor Law Guardians for each union comprised were elected by local ratepayers and justices of the peace. There were 126 poor law unions in the 26 present-day counties.

At the government level, the Lord Lieutenant and his officers were responsible for lunatic asylums. The Poor Law Commissioners had a superintendent role over the poor law system. The purpose was to ensure uniform poor law services and exercise control over the poor law unions providing the services.

In 1872, the  Irish Local Government Board was established and remained the central authority for the administration of local government and health. The health functions were ultimately passed to the Department of Local Government in 1923 and to the Department of health, the newly established Department of Health in 1946.

Medical superintendent officers were appointed in the major cities to supervise local medical officers of health. Outside of these areas, the district medical officers were under the auspices of the local government board.

Sanitary Services

The latter half of the 19th century saw the development of sanitary services. The primary purpose was to prevent the occurrence and spread of infectious diseases, which were commonplace. The smallpox vaccine was introduced in 1878.

The sanitary authorities were put in place under the Public Health Acts. Their principal function concerned sewage, water supplies, lighting, removing nuisances and providing amenities. Personal health services were not a significant part of their functions.

Under the Public Health Acts, Municipal Corporations and Town Commissioners already in existence were appointed as sanitary authorities.  The board of guardians became the sanitary authority for rural areas and smaller towns.

The organization of sanitary authorities was consolidated in the radical Public Health (Ireland) Act 1878. This established rural and urban sanitary authorities throughout Ireland.

The local government board made regulations relating to infectious diseases. It also administered early food hygiene legislation. The sale of contaminated food or food unfit for human consumption was prohibited, and legislation was established to counter it.

1898 Reorganisation

At the end of the 19th century, the Local Government (Ireland) Act established county councils and urban and rural district councils. These were elected directly. They took over the functions of the rural sanitary districts and sanitary functions from the poor law guardians.

The 1898 Act merged the grand juries into the sanitary and poor law unions to form county councils, rural district councils and urban district councils. The poor law guardians retained their original function of providing relief to the poor, including medical relief.

The County Councils took over the district lunatic asylums.

Government finance for medical services was minimal in the 19th century. The primary source of revenue was the local authority, through what became the local authority rate.

Medical Education

The Royal College of Physicians in Ireland and the Royal Collegiate of Surgeons were charted in the 17th and 18th centuries, respectively. The medical register was first established under the Medical Act in 1858, which applied to the whole of the UK.

The Royal Collegiate of Physicians and Surgeons, the Medical School of Trinity College and the Apothecaries Hall to hold to recognise for the purpose of issuing qualifying diplomas to permit registration. The Pharmaceutical Society of Ireland  was established under 1875 legislation.

Early 20th Century

The National Insurance Act introduced by the Liberal government in 1911 was not extended to Ireland to any significant extent. It instituted an insurance-based system to provide benefits to employees on illness. It also provided for medical care based on panels of general practitioners.

The proposal was strongly opposed by the Catholic hierarchy as being unsuitable to Irish conditions. The Irish Party opposed the inclusion of medical benefits so far as Ireland was concerned.

The Tuberculosis Prevention (Ireland) Act 1908 gave councils powers to provide sanitoria to combat tuberculosis.

The councils were given powers under legislation to make arrangements for the health of expectant nursing mothers and children under five years in 1915 and 1919. Councils were required to provide medical inspections of children attending national schools.

Nurses were registered by the General Nursing Council of Ireland after 1919.