Enhancing care,
Advancing health science

History

This is a précis of a paper by David H Craig published in the Ulster Medical Journal 1974 vol 43 p1. The full text is available in PDF format

This is a story about a hospital that was not wanted, certainly not to begin with by the Poor Law Commissioners in Dublin. It all began in 1838 when an Act of Parliament was passed to provide for the building of Workhouses in Ireland, and to create Boards of Guardians to supervise their running. When the Belfast Board of Guardians opened for business on 11th May 1841, they slipped in half a dozen beds for the use of sick inmates - and this rapidly increased to 100 beds for all comers. The Poor Law Commissioners in Dublin kept protesting that they did not want a hospital on their hands. But nevertheless, partly in response to the clamant needs of the poor sick people in Belfast, and partly due to the enlightened efforts of the Board of Guardians, behind these entrance gates, through which such a tide of unhappy humanity must have flowed during the last 131 years, almost by accident, and with no practical help from the wealthy citizens of Belfast, there grew up almost unknown and unnoticed what eventually became the largest general hospital in the Kingdom.

The Guardians appointed Dr. Thomas Andrews to look after these beds and paid him £60 per annum. Dr. Andrews was born in Belfast in 1813. He went to Glasgow University to study chemistry, but he took up medicine, finally qualifying in Edinburgh in 1835. He came back to Belfast to practise medicine and to teach chemistry at the Academical Institution. When the Guardians made him their first Medical Officer he was only 26. He very soon gave it all up, and became a very distinguished Professor of Chemistry at Queen's University.

In Victorian times Belfast grew from a town of 30,000 inhabitants to become a city of 350,000. The mud cabins of old Belfast had been done away with, but the housing standards were pretty terrible. There were usually four rooms to a house, each about 10 feet by 7 feet, and usually two families lived in each house. But the big problem in Belfast was the lack of a water supply. No water closets, no water carriage sewage system, no piped water to any of the houses. It is not surprising that the City Fathers in Belfast had a problem with "fever".Though the Frederick Street Hospital - it was then called the General Dispensary and Fever Hospital - had been opened in August 1817 to deal with fever cases, it was full to the doors and overflowing by 1841.

In 1847 the Board of Guardians built a Fever Hospital, and enlarged it to 600 beds in the following year. Dr. Seaton Reid was appointed physician in charge. He became an accepted authority on fevers and his opinion was much sought after. He was Senior Physician at our Infirmary for about forty years. During many of his 85 years of life he conducted a vigorous correspondence with the Guardians. In February 1847 he wrote:"Urgent necessity induces me to request more extensive and suitable infirmary accommodation. The nature of the diseases makes them most offensive in smell and so many huddled together renders any attempt to supply the necessary comforts and proper medical attention utterly fruitless."

Nursing these vast multitudes under such primitive conditions must have presented some appalling problems. There are continual references to these problems in the minutes. The Master was provided with chloride of lime solution to put in the night buckets. Charred peat was tried to diminish the offensive odour arising from the privvies and the sewers. Repeated appeals were made to Mr. Lanyon the architect to improve the sewers. Frequent complaints were made to the Water Commissioners that the supply of water was inadequate. Finally a big moment in 1853 - water closets were fitted in the new buildings. But only one per 65 patients, at this stage - perhaps a little frugal.

Later Dr. Reid strikes again: "It is admitted by everyone acquainted with the arrangements of hospitals that the more crowded the sick the higher is the rate of mortality and in the Infirmary there are 100 in a space which would not admit more than 65". "I am anxious that the Board would allow paid nurses for both male and female wards as the sick, now so numerous, will never be attended otherwise". The Board appointed two paid nurses, who could read and write, at a salary of 2/6d a week. "No risk or inconvenience" they told Dr. Reid, "can arise from two young persons or even a mother and child being placed in the same bed". Dr. Reid wrote back: "I have three or four children in the same bed".

There were four outbreaks of what is described as cholera in Belfast in the early part of the century. The first case of Asiatic cholera in the outbreak which began in 1847 - Mary Sherry - came in on 9th December, having taken ill at 6 o'clock in the morning, and died at 3 p.m. that afternoon. The Guardians must have been at their wits' end, and no wonder. They had to deal with at least 15,000 cases, with nearly 3,000 deaths, on top of the usual ration of smallpox, diphtheria, scarlet fever and everything else.

Meantime the Board of Commissioners in Dublin bombarded the Guardians with admonitions. It was "inexpedient" they had told them to build a fever hospital. The Belfast General Hospital would take care of the fever cases. The Board of Guardians were at last goaded beyond endurance. They wrote a letter to the Commissioners: "The Board are of the opinion that the Commissioners interfere unnecessarily in the details of management. The Commissioners exercise power in an arbitrary way in matters which had much better be left in the hands of the Guardians, who administer fairly and considerately the trust committed to them and have more accurate means of judging on many points than a body who can only form its opinions from reports".

It is of course easy from the safe distance of about 130 years to poke fun at the efforts of our forebears. But make no mistake the Guardians did very well indeed, and Belfast owes them a debt that we are quite unaware of today. They were responsible for all the fevers which virtually means all the sickness, not only in Belfast, but in an area extending from Greencastle on the one side of the Lough to Holywood on the other. They established a system of dispensaries - some six to begin with, later eight. During epidemics some were enlarged to become small subsidiary hospitals. It was in fact a very efficient health service.

In 1849 a decision of enormous importance was made. All fevers were to be removed from the wards of the Frederick Street Hospital. Belfast, with its large manufacturing and marine population, needed a casualty hospital, where there was a reasonable chance of operations being carried out without too much risk of infection. This decision enabled surgery in the Belfast General Hospital to grow and develop, and while the work done in our Infirmary was perhaps less spectacular it was quite vital for our citizens, and especially our poor citizens in the nineteenth century.

The very first operation in our Infirmary I have found recorded took place on Saturday 5th January 1850. Surgeon Mulholland reported: "W. Smith was admitted about 5.30 p.m. with a compound fracture of the leg and great laceration of the ankle joint, received by a log of timber falling on him in a sawpit on the morning of that day. The leg required amputation. I performed the operation, assisted by Dr. Reid, and Surgeons Brown and Black. I am sorry to state that he gradually sank and died during the night. An amputation case is much required in this hospital". It is nearly 30 years later in November 1877 that I found recorded the suggestion that a separate room should be provided in which operations could be carried out.

The decision to transfer all the fever patients to the Infirmary had one unexpected result. The bed occupancy of the General Hospital fell to between 70 and 90. In order to secure recognition by the examining bodies medical schools had to have access to hospitals of at least 100 beds, so the authorities of Queen's College were anxious that the Board of Guardians should open our wards for clinical teaching. But Dr. Seaton Reid (who had been appointed Professor of Materia Medica in 1857) unfortunately was a most terrible lecturer and his poor relationship with the medical students was to have a profound effect on the relationship between the Medical School and our Infirmary for many years. The Board of Guardians decided that they would not allow any University professors to teach in the Infirmary but Dr. Reid could hold clinical classes. However Dr. Reid and the medical students did not get on any better and he stopped the classes in 1862.

In November 1863 the Board of Guardians had stopped the supply of corpses to the anatomy school on the grounds that the "procedure was objectionable and the dissection room was a source of infection". More than half of the 95 students in the practical anatomy class could not begin their studies in the autumn term in 1863. This produced another uproar and the Guardians relented, but the uneasy relationship persisted. So to the great loss both to the Infirmary and the Medical School, there was to be no systematised undergraduate teaching in our wards for another generation.

In 1853 the cholera returned and continued on until December of 1854. In this epidemic about 8,000 people were treated in our infirmary and the dispensaries, with about 2,000 deaths.

During the remaining years of the nineteenth century the quite extraordinary volume of work continued. In August 1868 Dr. Johnston, who had replaced Surgeon Mulholland told the Guardians that "The General Hospital would not take in any burns, and all such cases were now sent to the Infirmary, entailing a large expenditure of lint and stimulants as well as a prolonged stay in hospital." The Infirmary had also agreed to take in from the General Hospital "any cases of old fractures and such other tedious and incurable cases as the authorities of the General Hospital wanted to transfer". On 11th December 1882 Dr. Brice Smyth told the Guardians that there are now a vast number (1,338) of patients present in the Infirmary.

In February 1883 the Guardians installed a telephone, and in 1891 Dr. Reid reported proposed that pay beds for private patients be introduced into the Fever Hospital. The Guardians approved. Private patients came in by a separate entrance from the Donegall Road.

In the Fever Hospital, Professor Seaton Reid was battling away with his epidemics. No one seemed to pay much attention to outbreaks of measles, diphtheria, typhoid, or scarlet fever - they called it scarlatina then. But Dr. Seaton Reid did comment on smallpox.

Smallpox

From 1870 to 1872: Admitted 1,103; Died 220; Mortality 19.15%.
From December 1877 to August 1878: Admitted 115; Died 30,; Mortality 19.35%.
From May 1881 to August 1882: Admitted 547; Died 81; Mortality 14.8%.

The citizens of Belfast had to face another hazard in the declining years of the century - rabies. Between 1894 and 1897 there are records of fifteen people being admitted. Fourteen were bitten by rabid dogs and one by a rabid horse. The Guardians rose to the occasion again and sent them all off to the Pasteur Institute in Paris. Mr. Pasteur himself wrote a polite letter to the Board in July 1895. It is satisfactory to discover that all the patients apparently recovered.

Nursing in our Infirmary was slow to develop. In the early days there were paid nurses; decent, hard-working and courageous women they were, but untrained. They were very thin on the ground. In the year ending 29th September 1867, 3336 patients were treated, comprising 1695 acute contagious medical cases, and 1641 acute and chronic non-contagious medical cases. For this there were 15 paid nurses. Their task was to supervise the unpaid paupers, who lived in the wards and were given hospital diet, and in return for these privileges carried out all the actual nursing duties. These pauper attendants were far from satisfactory.

In November 1884 Miss Ellie Pirrie was appointed Superintendent and Head Nurse at a salary of £30 p.a. She was not a product of the Florence Nightingale school, though apparently she had some friendly contact with her; because in December 1884 we read of a Christmas present being sent to Miss Pirrie from Miss Nightingale for the children in the Infirmary. The month after she was appointed the Guardians approved a uniform for the paid nurses, and a distinctive apron for the unpaid female attendants.

In May 1887 the Guardians agreed to Miss Pirrie's plan to admit six suitable persons between 20 and 35 to train as probationers. The Poor Law Commissioners sitting in Dublin were most put out by these proposals and told the Guardians that they had no right to propose any such plan. But as was usually the case the Guardians seem to have got their way and nurse training began for the first time in our hospital. In July 1889 the very first nurse went down to Dublin to sit for a nursing examination. Her name was Nurse Craig and in 1892 she was appointed Superintendent. It is interesting to remember that our Nursing School was apparently the first to train male nurses.

All through this talk I have said very little about our Infirmary buildings. Mr. Lanyon designed most of them. The wards were enormous, holding up to seventy beds. The ceilings of the ground floor wards were so high that they were hard to heat. The ceilings of the top floor wards were so low that they were difficult to ventilate. But the wards were all kept spotlessly clean by pauper labour. But it is not the buildings in the hospital which are important; it is the human beings in the wards. The doctors, the nurses, and the patients, who build up the tradition of a hospital.

The physicians who made a considerable impact on their generation were Dr. Robert Hall, Dr. Gardner Robb and Dr. McLeish. Dr. McLeish is perhaps less well known than the other two, yet he deserves to be remembered because it was he who really established the Maternity Hospital in our Infirmary.

Dr. Robert Hall was appointed in 1892 at the age of 31. He introduced separate tuberculosis wards, bacteriological diagnosis and disinfection of sputum - no easy task at first. The numbers were formidable, 1900 cases of tuberculosis were nursed in the half year ending December 1899.

Dr. Gardner Robb was appointed in 1900 at the age of 34 when Dr. Bigger retired; he inherited a legacy of smallpox and typhoid as well. Dr. Bigger, in his last report in 1900, described the typhoid outbreak as "phenomenal - larger than any hospital in the United Kingdom had to deal with". Dr. Robb was responsible for the building of what we now call The North of Ireland Fever Hospital.

Dr. Lynass had been an assistant surgeon at the Belfast Hospital for Sick Children, but resigned and became our first surgeon. He was given a room - called a theatre - whose roof let in rain, and which was illuminated by gas, apparently not very well, because a complaint was soon made of poor lighting. He was however allocated two operating room nurses, and the Guardians were persuaded to put in a sterilizer for dressings. There are references in the minutes to a report he submitted to the Board of Guardians. 51 operations carried out under chloroform anaesthesia in the year ending June 1900; fractures, dislocations, burns, and the results of tuberculosis provided the bulk of the surgical problems. It would appear that no abdomens were being opened at that time, which of course is not surprising. There is however one interesting reference in these minutes. X-rays "have been successfully supplied on several occasions by Messrs. Clarke & Co. to determine the exact nature and extent of fractures, and on one occasion to determine the exact location of a bullet which was then successfully removed".

Before I do close however I must give you a glance into the future - what our new hospital will be like: twenty stories; 540 beds. Every facility that imagination and ingenuity can produce. I forget how many million pounds. We have travelled a long way from the Workhouse ward which Dr. Andrews came into that summer morning so long ago. It is a rather chastening reflection that before very many years have gone by this magnificent building may be as archaic and out of date as our old hospital is today. But as Kipling said: "Dearly Beloved, that will be another story".