HC Deb 07 February 1843 vol 66 cc226-36
Mr. French

said, he had entertained hopes that some measure for the better regulation of the Irish medical charities would have been brought forward on the responsibility of her Majesty's Government. He trusted, that the most helpless class in the community, the destitute sick poor of Ireland, would have had the powerful advocacy, and the official influence of the noble Lord, the Secretary for that country exercised in their be half. An intimation had lately been made, through Mr. Hall, one of the Assistant Poor-law Commissioners in Dublin, that it was not the intention of her Majesty's Government to propose any legislative measure on the subject of these charities during the present Session of Parliament, which induced him (Mr. French) to renew his exertions to correct those evils that, from personal experience, he knew belonged to the system under which these charities were at present administered. In taking this course, he did not conceive he was about to place himself in a position hostile to the Government. Though the noble Lord was not prepared to originate, there was no reason, if he and his Colleagues approved of the details, why they should not support a measure having for its end so desirable an object. The necessity for a change in the fiscal and other arrangements of the medical charities in Ireland had long been universally admitted; a large sum of money, upwards of 200,000l., was annually raised, nominally for the relief of the sick poor, from which they derived little, if any proportional benefit. This sum would, he conceived, if secure, which it was not, and under proper management, be sufficient to attain the end sought for that really efficient medical aid, eleemosy nary aid, might be afforded to all those sick poor whose circumstances legitimately entitled them to apply for it, without any additional burthen being imposed on the country; but at present there was neither check over nor audit into its expenditure, and the extent to which the funds were misapplied would appear incredible, were not the evidence on this point so full and so satisfactory as it was. It was not necessary to detain the House by a recapitulation of the various acts of Parliament under which these institutions were at first created and still existed; it would suffice to lay shortly before them the number and nature of the medical establishments in Ireland. There were for gratuitous relief to the sick poor in Ireland 41 infirmaries, 88 fever hospitals, 626 dispensaries, 11 lunatic asylums, and 9 institutions in Dublin supported by Parliamentary grants, making altogether 774 establishments. The annual expenditure was, for infirmaries 45,006l. 9s., of which sum 2,877l. was from private subscriptions, 3,172l. 8s. 2d. from Parliamentary grants, and the remainder made up by a grand jury assessment. For the fever hospitals, the annual cost amounted to 27,038l., of which, 7,168l. came from private sub scribers. The balance was made good by the county-rate. The cost of the dispen saries was 73,100l.,—34,727l. from subscribers, the remainder county-rate. The lunatic asylums cost 39,184l., all paid by county assessment. The Dublin hospital cost 38,835l., which was an annual grant from Parliament; showing a total annual expenditure of 223,165l. 10s. for these establishments. The number of persons annually relieved by them, were admitted as intern patients in the infirmaries, 18,939; in the fever hospitals, 41,694; the lunatic asylums, 2,311, and the Dublin hospitals, 12,128; showing of intern patients a total of 75,122; independent of which, according to the average of three years ending 1838, they would find 1,200,000 persons had received relief from the dispensaries. He felt confident, that all parties in the House would coincide in the necessity of institutions so numerous and so important as these being placed on a proper basis, and that the funds for their support should be applied to well-regulated and useful purposes. He trusted, that the acknowledged evils under which the country was suffering would not be increased by deferred legislation on this important subject, and that the noble Lord, the Secretary for Ireland, would not, to suit either the views or devices of the Poor-law Commissioners, consent to any further delay. It might certainly add to their chance of fixity of tenure in office could they get so important a branch of the public service as medical relief within their grasp; but this was no longer practicable, nor, if practicable, would it be desirable. In a country like Ireland, where so large a proportion of the population was placed at the extreme verge of existence, and where every failure of the crop on which they relied for support was uniformly accompanied by visitations of pestilence and famine, the establishment of well-regulated medical charities, by which the progress of contagion might be checked, became an object of the utmost importance, one which addressed itself no less forcibly to the powerful instinct of self-preservation than to the charitable feelings of every Member of the community; whether owing to the dampness of the climate or to the nature of the food on which they subsisted, the population of Ireland were frightfully subject to fever. In a pamphlet published by Drs. Baker and Cheyne, he found that in the space of two years and a half whilst fever was raging there, 1,500,000 persons, nearly one-fourth of the population, were attacked by it, of which number 65,000 died. The House had for the first time an opportunity of judging of the nature and extent of the medical aid afforded to the sick poor in Ireland; hitherto the inquiries on that subject had been partial and confined to districts — that lately carried on by Dr. Corr and Mr. Phelan had extended to every portion of the country. The report of those gentlemen clearly proved the existence of every abuse hitherto charged against the administration of the medical charities; it showed also the utmost anxiety on the part of the medical profession and the public for the immediate alteration of a system under which the remuneration of a medical officer was made to depend, not on his professional character, not on his professional services, but on the number of subscribers he had succeeded in obtaining for the institution to which he was attached—under which the public were annually forced to pay large sums of money they knew to be almost uselessly and unprofitably expended, a system under which the medical treatment of upwards of 1,000,000 persons was thrown into the hands of those from whom no professional qualification was required by the law. Strange as it might sound, there were at that moment several persons presiding over dispensaries in Ireland, not having any qualification to practice in medicine, in surgery, or in pharmacy. The distribution of these dispensaries was most unequal, owing to the necessity of a subscription being obtained previous to the formation of a charity; the poorer districts, which required them most, were left wholly unprovided; in one part of the country they were crowded together; in another there were populous districts of ten and twelve miles square without any medical establishment whatsoever; here they were in proportion of 1 to every 4,000 souls; there, 1 to 120,000. Antrim, with a population of 317,000, had 18, being as 1 to 17,606 of its inhabitants. Down, with a population of 352,000, had but 15, as 1 to 23,468. Longford had 5, as 1 to 22,511. Leitrim 7, 1 to 20,218. Whilst Kildare with a population of 108,424, had 15, being as 1 to 7,228. Kilkenny, with a population of 169,945, had 20, as 1 to 8,497. West meath had 17, as 1 to 8,051. Meath 27, as 1 to 6,543. The fever hospitals were as unequally distributed; in Armagh, there was 1 to 220,000 souls; in Clare, 1 to 258,000; in Donegal, 1 to 289,000; in Mayo, 1 to 366,000; whilst in Kildare they were in the proportion of 1 to 36,000; in Kilkenny, 1 to 33,000; in Wexford, 1 to 26,000; in Carlow and Wicklow, 1 to 20,000; and in Longford, Louth, the Queen's County, and Roscommon, with an aggregate population of 615,503, there was not a single establishment of the kind. There were 209 towns in Ireland, with populations varying from 1,000 to 17,000, without a fever hospital. The cost of patients in the different infirmaries and fever hospitals varied in a most extraordinary and unaccountable degree. In Longford it amounted to 3l. 5s. per head; in Wexford, 3l. 2s. 2d.; in Baltinglass, county of Wicklow, to 4l. 8s. 6d.; in Donegal, to 4l. 15s. 11d.; in Tyrone, to 5l 13s. 3d.; and in Drogheda, to 6l.: whilst in Antrim it was but 1l. 19s. per head; in Cavan, 1l. 8s. 5d.; in Kilkenny, 1l. 13s.; in Westmeath, 1l. 1s.; and in Cork but 1l. 6s. In the fever hospitals, in the same manner, it would be found the cost of patients per head was on an average—in Clare, 19s.; in the city of Cork, 15s. 2d.; in the King's County but 14s. 7d.; while in Ballinasloe it was 2l. per head; in Cork, 2l. 10s.; in Bray, 4l. 14s. 11d.; and in Celbridge it rose to the enormous sum of 7l. 14s. 7d., 7l. per head more than at Shinrone. In the lunatic asylums, the cost for each patient varied in the same manner. For in stance, in Belfast, which had accommodation for 250 patients, the average cost was 16l. 2s. 6d., whilst in Clonmel, which could only accommodate ninety-six, it was 25l. 14s. 5d. There was a great disproportion between the salaries of the officers, and the accommodation of the institutions, were calculated to afford. The manager of the Carlow asylum, which received the smallest number of patients, was paid the highest salary. Notwithstanding the 6th and 7th of William 4th, c. 116, which declared the maximum distance the medical officer could legally reside from the institution with which he was connected to be 5 miles, he found at Abbeyfeale, in the county of Limerick, that the medical officer resided at a distance of 13 miles; at West Cove, in the county of Kerry 14 miles; at Glennemada, in Galway, 18 miles; Ardare, in Donegal, 14 miles; Atlea, in Limerick, 12 miles; Dunmere, in Galway, 11 miles; Doonbeg, in Clare, 11 miles; Kilmanagh, in Kilkenny, 11 miles; Riverstown, in Sligo, 13 miles; Tarmonbary, in Long ford, 13 miles; Dromore West, in Sligo, 21 miles; Arran, in Galway, 40 miles; Bingbamstown, in Mayo, 50 miles. Great as such abuses as these must appear to be, they were fully equalled by the abuses re- lative to the supply of medicines. He found by the report of the commissioners, page 207, that at Foxford, in the. county of Mayo,— There was scarcely any medicine, although the large sum of 78l. 17s. 11d. was alleged to have been paid for it within the year, and payment for the carriage of 30 cwt. of medicine from Dublin was charged in the account. In Dunmore, in the county of Galway, carriage of 17 cwt. of medicine within the year was charged; 9l. 18s. 9s. for lard, 2l. 8s. 6d. for candles. In West Cove, county of Kerry, the medical man was discovered furnishing in correct accounts: charging 16l. 6s. 7d. for me dicine, for which the druggist who supplied the institution had charged but 7l. 14s. In Pallaskenny, county of Limerick, the medical officer was permitted to sell the dispensary medicines, reserving to himself three-fourths of the money so received. At Ardfort, in the county of Kerry, not-withstanding the remonstrances of the subscribers, the dispensary medicines were kept in the doctor's private shop, mixed with his own. At Cookstown, in the county of Tyrone, the medicines were limited to a few articles, wanting some of the most necessary; those few thrown together in great disorder. Inquiry was made where the remainder was kept? and the reply was, there were no more; it then came out that though the gross expenditure of the institution for the last three years had amounted to 324l. 17s. 9d., the cost of medicines during the same period was but 13l. 2s. 9d. In the Kenmare and other dispensaries the doctor was bound to provide 15l. worth of medicine; the remaining portion of the funds went to him for salary. In Caherciveen the doctor paid himself 100l.; the remainder, were it much or were it little, was to supply medicine. The commissioners stated the appearance of the stock of medicine left no doubt of the insufficient supply for the sick poor. In Killala, Ball, Letterburn, &c., though large sums were charged for medicine, the stock on hand was scanty, the bottles and drawers were empty, nor were there any arrangements by which the medicines, if ever they were there, could be properly preserved. Could there exist a second opinion of the necessity of abuses such as these being at once put a stop to? It might be urged, that by the 46th and 47th clauses of the Irish Poor-law, the Legislature had decided that the medical charities in that country should be placed under the control of the Poor-law commis- sioners; that the nature of the relief for which these institutions were intended was in itself, virtually, a portion of the Poor-law; that pauperism, in many instances, arose from neglected disease or accident; that, as the source was checked, so in proportion would the result be diminished; that the systems were almost inseparable. Notwithstanding the plausibility of arguments such as these, he did not mean to propose the establishment of any connection between these charities and the commissioners,—first, because the medical profeesion in Ireland had, from one end of the country to the other, protested against it; and, secondly, because he believed it would prove fatal to the charities, were they in any manner to be connected with those whose ignorance and whose arrogance had rendered them strongly distasteful to every class of the Irish people, whose cumbrous and expensive machinery could not be much longer maintained, unless the nation was to be rendered bankrupt, and the soil again, as I it unfortunately had been, stained with, the blood of the people. There was, however, in the bill proposed by him many of the provisions contained in that introduced by the noble Lord, the Secretary for Ireland during the late Session of Parliament. There was the formation of an unpaid board in Dublin as a central or governing body, by which the future regulations for the management and control of the medical charities would be directed —a board not having the power to interfere with the fiscal authority of grand juries, but from the nature of its duties enabled to afford those bodies considerable assistance in their decisions relating to grants of money for charitable purposes, and to secure its efficiency, it was to be a mixed board of which the President of the College of Surgeons, the President of the College of Physicians, and the Governor of the Apothecaries Company, were to be ex-officio members. He proposed the appointment of lour medical inspectors, at 600l. each per annum; in the words of the noble Lord, where the institutions appeared inadequate to the wants of the people, he proposed to give power to the grand juries to present for additional establishments, on the certificate of the Lord-lieutenant of such necessity. He proposed, that in future no unqualified person should be elected as a medical officer to any of these charities. The sole expense of the machinery of this bill would be the salaries of the medical inspectors, a secretary, and the clerks that might be required in the office of the medical board. That expense, he calculated, would be 600l. a-year each for the four inspectors and the secretary, making 3,000l. a-year; and for office, clerks, travelling expenses, say 1500l. a-year more, making altogether 4500. a-year. He did not consider it expedient that the country should be subjected to any additional expense for this purpose; but, as he had no doubt a very considerable saving would be effected by this means in the expenditure of the funds of these institutions, it was reasonable that those funds should contribute to this charge. He found, that 5d. in the pound, on the average annual receipts, would give a sum of 4,600l., which would be quite sufficient for the purpose. By a competent medical inspection, at uncertain times, professional exertion would, he considered, be stimulated, and efficiency and regularity in the management of the medical institutions secured; the medical officer neglecting his duties would be liable to detection and removal, a check would be established on the irregularity of his attendance, particularly in domiciliary visits, a point at present much complained of, and a stop would be effectually put to the abuses of pluralities and non-residence, in neither of which cases could the duties be fairly attended to or faithfully discharged. The want of inspection had long been felt, and during the last thirty years, various attempts had been made by Parliament to provide for it; from the want of it had resulted the wasteful expenditure of the public money, and the giving relief to those whose circumstances did not entitle them to apply for it, thereby depriving of the use of these charities their proper and legitimate objects. The principle of inspection had been adopted in the army, in the navy, in the police, and in the national schools, and had worked in the most satisfactory manner; it was equally, if not more imperatively called for, over the medical charities, and had been recommended by every person who had turned his attention to the subject. The College of Surgeons, the College of Physicians, the grand juries, and all the corporate bodies had passed resolutions in favour of it, the prayer of all the petitions presented to the House were for it— it had been adopted by the late, and was contained in the bill prepared by the present Government. From the establishment of medical inspection, he not only anticipated the advantages he had mentioned, but also others from the accurate knowledge which the central board by this means would obtain of the medical statistics of the country. They would be enabled to take precautions, and prepare measures against the sudden outbreak of contagious disease, the absence of which had frequently been severely felt. It was said, that the source of all knowledge was experience; in no branch of knowledge was it so valuable as that of medicine. If the definition was correct, that the art of the physician consisted in the accurate investigation of the phenomena of disease, and the influence of remedies upon it, it became a science of observation; how much would that science be advanced by the accumulated experience of the medical officers throughout Ireland, recorded in the tables, it would be the duty of the central board to prepare, documents which must prove a valuable acquisition to the public in general, and to the profession in particular? He should conclude by expressing a hope that the measure he had proposed would be as favourably received by her Majesty's Government, and the House, as he had reason to know it would be by the medical profession and the public at large in Ireland. The hon. Gentleman concluded by moving for leave to bring in his bill.

Lord Eliot

did not rise for the purpose of opposing the motion of the hon. Gentleman, for he quite concurred with him that the subject was one of vast importance and deserving of the utmost attention of the House. In much that had fallen from the hon. Gentleman he entirely concurred. The hon. Gentleman had drawn a very faithful picture of the abuses which at present existed in the administration of medical charities in Ireland. He had been so strongly impressed with the number and the magnitude of the evils which prevailed, that he had been most desirous to find a remedy for them, and accordingly he desired the Poor-law commissioners to prepare a bill embodying the recommendations they had made, to him upon the subject. Certainly he considered medical relief as much a part of the Poor-law as any other kind of relief whatever—it was considered so in England, and it was ad- ministered under the regulations of the officers appointed under the Poor-law Act, and he confessed he saw no good reason why the practice should be different in Ireland. Medical relief, like relief given in any other shape, must be afforded at the expense of the rate-payers, and it ought to be administered under the same control. The bill which he had drawn up was submitted to the consideration of the profession and the country. It met with much opposition, and afterwards underwent considerable modification. He must say that that bill had not received fair consideration; and agitation was got up against it; yet those who were most opposed to it, although invited to do so, never sent in one single suggestion for its amendment. The medical profession and a large portion of the magistrates of the country were opposed to the bill, yet not one suggestion was offered. He was not prepared to agree to another bill founded upon a different principle, although he had no objection to its being laid before the House. He would only caution the hon. Gentleman that he would find it much easier to point out the evils and abuses of the present system than to find a remedy for them. The hon. Gentleman found that it was so; for, although he had fully stated the abuses of the system which prevailed, he had very lightly passed over the plan he proposed to substitute for it. He proposed that the whole management of the medical charities should be confided to an unpaid board sitting in Dublin, the greater part of whom were to belong to the medical profession. Now, where would he find gentlemen who would devote the time necessary to overlook the accounts of upwards of 600 charities? Unless provision was made for remuneration upon a liberal scale, it would be impossible for him to obtain gentlemen to fill the office, for it would occupy their whole time. The plan would never work. The presidents of the College of Physicians and Surgeons were to be ex officio members of the board; but those officers were removed every year, and of course, they could obtain no knowledge upon the subject of their duties. The hon. Gentleman had lost sight of the great grievance, which was that three fourths of the whole amount expended was taken out the pockets of the poorer cess-payers. How was that master grievance to be remedied? The hon. Gentleman proposed still to leave the power of levying such sums as they thought proper to the grand juries; but were there no longer to be any voluntary subscriptions, and, if so, how did he propose that the sums levied should be spent. When the hon. Member came to put his ideas into a practical form, he would find that they would be considered much more objectionable by the great body of the respectable population than the present system. But as the hon. Member had not stated by what machinery he proposed to carry out his ideas, it was useless to attempt to allude to that part of the subject. Thus much, however, he had thought it fair to say, to remove from the hon. Gentleman's mind any unfounded anticipations of Government support which might have been entertained.

Mr. French

thanked the noble Lord for his frankness and courtesy, and considered that the discussion of the objections urged, many of which he was sure he could prove unfounded, had better be postponed till the bill was presented to the House.

Bill to be brought in.