By Professor James Anderson
From "Ireland's Hope: A Call to Service", 1913
Within the brief limits assigned to me I purpose dealing with one aspect only of this subject. It seems to me that I can best serve the interests of this conference by placing before you a brief sketch of the present methods by which in Ireland the State provides for those unable or unwilling to provide for themselves—and not all those methods either, for with Old Age Pensions and the Insurance Act I do not intend to deal. The scope of my paper is bounded by the four walls of our Poor-Law administration —with this proviso, that I shall avail myself of this opportunity of making some suggestions, with a view to the reform of the existing state of affairs.
The key-stone in the arch of our Poor-Law system is the Union Workhouse, an institution foisted on an unwilling country in 1838 by Lord John Russell, in spite of the protest of the famous Irish Commission which sat from 1833 to 1836. This Commission was opposed to the introduction of the Workhouse system to Ireland as being quite unsuited to the needs of the country, and recommended instead a series of remedial measures, designed chiefly to widen the field of employment for the people. Many of these recommendations have since become law. Yet, notwithstanding the opposition of this body of Irishmen, the Workhouse system was introduced by the English Government of the day, and although it has been condemned by several subsequent Royal Commissions which have dealt with Poor Relief in Ireland it still remains, apparently, as firmly rooted as ever. If the Workhouse could articulate we might fancy it uttering as its cry of defiance to its would-be levellers— "Royal Commissions may come and Royal Commissions may go, but I go on for ever!" But we shall see.
To-day in Ireland we have 159 Workhouses, containing from 40 to 50 thousand souls. From a classified return issued for the Viceregal Commission on the Poor-Laws, which deserves some attention, it appears that, on the 11th of March, 1905, our Workhouses contained 45,195 inmates. A scrutiny of this return reveals the essential and vital defect of the Workhouse system—the confining together within the same building, and under the control of the same officials, so many different classes with wants differing so widely, each class requiring a distinct and separate method of treatment. Here we find housed together in the closest proximity the sick, the aged, the respectable and the vicious, the healthy and the infirm, the children and the insane, epileptics and the mothers of illegitimate children, wastrels and vagrants and the deserving able-bodied poor compelled to take refuge there in times of stress. This is the Poor-Law problem—this is the evil legacy handed on to us as the fruit of hasty and ill-considered legislation—this is the wrong thing it remains for us to set right. The present system is indefensible, but it is buttressed behind a wall of officialdom which has proved strong enough to defend it against the half-hearted assaults hitherto directed against it. We allow the Workhouse to remain because we have not brought our minds to realize the true state of affairs that exists behind its gloomy walls; and because we, as a nation, have not properly recognized our civil and moral obligations to the less fortunate ones that have fallen in the fight.
I here append a copy of the return referred to above—it is worth reading—
Number of Inmates in Poor Law Union Workhouses and Fever Hospitals on the 11th March, 1905:—
|Sick||Medical and Surgical||7,054||6,802||13,856||14,491||Sick|
|Fever and Infectious||349||286||635|
|Aged and Infirm||Healthy||6,234||3,470||9,704||14,380||Aged and Infirm|
|Ailing and Feeble||1,863||2,323||4,186|
|Sane Epileptic||291||272||463||463||Epileptic (sane)|
|Mothers of Illegitimate Children||...||2,129||2,129||2,129||Unmarried mothers|
|Casuals or "Ins and Outs"||410||403||813||4,667||Able-bodied paupers|
|Vagrants and Tramps||726||152||878|
Since the issue of this return the number of the aged and infirm inmates in workhouses has shewn a tendency to decrease owing to the operation of the Old Age Pensions Act: the same tendency is to be observed in the case of the children, owing to the increasing favour with which the "boarding-out" system is beginning to be regarded by Poor-Law Guardians—otherwise the numbers have remained practically stationary.
It is somewhat startling to find from a perusal of this return that, after all, the Union Workhouse is not chiefly a refuge for the tramp and the vagrant, for the whole able-bodied pauper class as shown in the return amounts to little more than one-tenth of the total; the remaining nine-tenths are composed of the sick (one-third of the whole), the aged (also one-third), the children and their mothers, the insane and the epileptic. For each of these latter classes I venture to express the opinion that no worse institution could be devised than the normal Union Workhouse.
Let us take in order each class mentioned in the return, consider the position of each under the present system and, if it is not satisfactory, suggest an alternative.
(1) The Sick.
The first class mentioned is the sick, and, as we have noted, this class constitutes about one third of the whole. But there are a great many inmates of Workhouse Hospitals that are not, properly speaking, cases for Hospital treatment at all: a great many are old and infirm people—mainly bed-ridden, for whom there is neither proper accommodation nor attendance provided in the ordinary Workhouse ward and who are therefore transferred to the hospital where they get more attention. It is reckoned that almost fifty per cent, of those classed as "sick" in Workhouse Hospitals come under this description. The Viceregal Commission on the Poor-Laws estimated that in 1905 there were almost seven thousand of such cases in Workhouse Hospitals. These cases, it is submitted, are not fit subjects for Hospital treatment and their presence in the Workhouse Hospital is detrimental to the nursing standards of the institution and prejudicial to the attention which ought to be given to the proper Hospital cases. We shall proceed to suggest how the needs of these people are to be met when we come to our next heading—viz.—the aged and infirm. The patients in fever hospitals account for six or seven hundred of the total, and the remainder—about seven thousand—are the sick poor who are too far away from the County Infirmary to avail themselves of it, or for whom it is not available, owing to lack of room. For my part I do not think it fair that the respectable poor, who in days of health and strength are able to avoid attaching to themselves the Workhouse stigma, should find themselves, in days of weakness and pain, compelled to seek a refuge inside Workhouse walls.
I believe that there ought to exist proper and adequate hospital accommodation for our sick poor, freed from the Workhouse taint. Every one of our poor should have at their disposal in times of need a properly equipped and efficient hospital. At the present time they have no guarantee that such will be the case. In county towns where there is a County Infirmary, and in the few large cities we possess, their wants, on the whole, are fairly met; but elsewhere, in many districts, the nearest Workhouse Hospital may be at a considerable distance from them or may be a very inefficient institution; for Workhouse Hospitals vary greatly—a few are very good, a few are very bad and most of them are indifferent. I believe that the nursing of the sick poor requiring treatment in Hospitals ought to be removed from the care of the Guardians and that Workhouse Hospitals as such should cease to exist.
In every county in Ireland the care of the sick ought to be in the hands of one co-ordinated and central authority. If this were so, much waste caused by the present duplicate system would cease and our hospitals be better equipped. The County Council should, in each county, be the body primarily responsible for the nursing of the sick, and a representative County Committee should actually control the hospital administration under their aegis. A similar committee at present exists to discharge the functions of the County Council under the Insurance Act, including the provision of sanatoria for consumptives. The functions of this committee might naturally and suitably be extended to include the care of all the sick and the control of the means to be provided for the due exercise of that care. Under this system the County Hospital or Infirmary would form the centre and pivot of the hospital system for the county, and the present Workhouse Hospitals, separated from the Workhouse administration, would be the District Hospitals for the county. Minor operations would there be performed, and cases requiring major operations would be all sent to the County Hospital. This County Council Committee would also take over the management of, and, if advisable, supplement the number of, Fever Hospitals; where necessary they would institute new District Hospitals, or, if the requirements of the locality could be so met, Cottage Hospitals; the entire nursing staff of the whole county would be under their control. To local representatives on the County Committee might be given a certain right of nomination of probationers—but the subsequent placing of the nurses would be entirely a matter for the County Committee. They would also take over the control of the District Nurses and, where possible, extend the work of those nurses who have done such splendid work in the homes of the poor. Thus we might hope to have in every county of Ireland a thoroughly equipped and uniform system of hospital accommodation and a complete and efficient network of institutions, working in harmony and not over-lapping, engaged in a task which our nationhood demands, whether looked at from the higher standpoint of moral duty, or from the lower one of natural efficiency and true economy, not to speak of what ought to be the first requisite, Christian Citizenship.
To my mind the benefits that would flow from the separation of hospital nursing from the Workhouse would in themselves be a sufficient reason for making the changes proposed. In the Report of the Viceregal Commission on the Poor Laws (Pars. 98, 99, and 100) these benefits are clearly set forth and are worthy of special emphasis:—
"An obvious sequence of the complete separation of the Poor Law Hospitals from the Workhouse is that pauper nursing would completely disappear and that even the discharge of menial duties by Workhouse inmates would no longer be possible. There would not be any able-bodied ward in connection with the hospitals, and therefore the sources of supply of inmate-assistants would be cut off. Those who are familiar with pauper nursing and pauper attendance will understand the benefits that would be gained by this change."
"Another benefit that would follow from the establishment of District Hospitals is the impossibility of persons drifting from the sick wards of a Workhouse into the healthy wards and remaining there as ordinary Workhouse inmates. When under the existing system a sick person becomes convalescent, and when, as often happens, the sick wards are overcrowded by the sick and the feeble bedridden, convalescent patients are sometimes sent from the sick wards to the aged and infirm wards in the Workhouse itself until they are fit to be discharged. Such an occasion is sometimes the first introduction to the Workhouse wards of a hitherto independent person. If District Hospitals were established the sick would remain in their wards, as in the case of an ordinary general hospital, until they are fit to be sent home or to a convalescent institution if such were established."
"The complete separation of the District Hospital from the Workhouse would, we believe, lead to further great saving in expenditure. Under the present system people who are not suitable inmates for hospital wards do undoubtedly find their way there in very large numbers, and their maintenance as hospital patients costs much more than if they were inmates of the aged and infirm wards in the healthy portion of the Workhouse. It is suggested that in future only the sick in need of medical care or skilled nursing should be admitted into hospital ....
What may look like laxity in admitting many cases to hospital that do not require either medical attention or skilled nursing, must, however, be largely attributed to a very natural, proper and humane feeling that, if the aged and infirm people, who are perhaps bed-ridden or very feeble, were relegated to the healthy infirm wards in many Workhouses, they would not receive such attention as would enable them to spend the end of their lives in reasonable comfort. In very few Workhouses could the feeble or bed-ridden aged and infirm receive the domestic care that is needful, unless there were a duplication of the nursing or attending staff; and this we think is often a reason why the feeble who are not sick are in some Workhouses given a refuge in the sick wards. We estimate from enquiries made by us that out of the total number (13,750) of 'sick' in Workhouse Infirmaries on the 11th March, 1905, not more than 6,708 were proper cases for sick wards."
But no matter how perfect the system may be, in the long run what counts most in successful administration is the personnel behind it. And the success of any such scheme as that I have outlined would largely depend on the members of the Medical Profession on whose shoulders the burthen involved in its working would, in the main, rest. Now, Workhouse Doctors in Ireland are—like Workhouse Hospitals—good, bad and indifferent; and the advantages of a systematic and uniformly efficient hospital accommodation would be largely neutralized unless there were also throughout the country a prevailing standard of efficiency amongst the Doctors responsible. I believe that this desirable end could be best achieved by the establishment of a State Medical Service. The present methods of manning the Medical staff of the Workhouse Hospitals do not tend to secure the selection of the best man from the applicants for a vacant position. It is unfortunately true that with us Workhouse and Dispensary Doctors are appointed, not on their merits, but, largely, on the merits or demerits of their friends; and it is an open secret that in many places, more especially in the Province of Connaught, such appointments are bought and sold and the place reserved for the highest bidder. By the institution of a State Medical Service, entrance to which should be by competitive examination—with the sole restriction that Irishmen only should be eligible—these abuses would be put an end to. This new service would be paid by the State and controlled as to position, salary and promotion by a Central Council sitting in Dublin. The officers of the Service would discharge the medical duties appertaining to the nursing of the sick poor in the County and District Hospitals; they would also act as Dispensary Doctors; others of their number would be responsible for the medical oversight of the Sanatoria and the Consumptives, under the provisions of the Insurance Act; they could also discharge a number of duties in which a great deal of public money is at the present time dribbled away, e.g., they would act as Coroners, and as medical officers to His Majesty's gaols and other public institutions; and they might also be available as officers of Public Health.
Charlotte Milligan Fox, sister of the poet Alice Milligan, was a founding member of the Irish Folk Song Society and an indefatigable field collector of Irish traditional music. Her singularly important work on Irish haprers is here presented for the twenty-first century reader. This edition of Annals offers a much greater number of illustrations than were included in the original 1911 publication, a full biographical introduction, an extensive bibliography of the writings of Milligan Fox and an appendix discussing the variant texts of Arthur O’Neills Memoirs.
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