Set in Stone

Not all of the RCSI hospitals are still in operation but their sites remain hugely signi cant in the built environment, evocative of their 300-year-old teaching and research tradition. Antonia Hart explains

In Ireland, as elsewhere, the care of the sick was traditionally provided by religious orders. As the 17th century gave way to the 18th, the increasing problem of providing for the sick poor, in particular, could no longer be ignored, and the establishment of the rst Irish hospitals began.

Initially, they were all in

Dublin. Some were publicly funded, like the Foundling

Hospital and Workhouse (1703) in James’s Street, while other voluntary hospitals were kickstarted by private legacies and fundraising. Among these were the Charitable In rmary, later known as Jervis Street (1718),

Dr Steevens’ (1733), and the Mercer (1734). ese were followed by others like St Patrick’s (1746), for mental health patients, and the Rotunda (1745), known widely as the rst lying-in hospital. Actual medical care was scant enough, but over these 50 years, the notion of healthcare, and the physical embodiment of it, in hospital buildings, had taken root. In 1765, parliament enacted groundbreaking legislation providing for the establishment of county in rmaries in 30 of the 32 counties, and the Royal College of Surgeons itself came into being in 1784, beginning an association with training and practice in Irish hospitals which has lasted for nearly 240 years. Not all of the RCSI hospitals are still in operation, of course, but their sites remain evocative and signi cant elements of our built environment, and their 300-year-old teaching and research tradition remains vibrant in today’s medical landscape. e Richmond Hospital served the population of Dublin for almost 200 years before its closure in 1987. Its origins lay in the House of Industry set up in 1773 in Channel Row (now North Brunswick Street), designed to provide accommodation and employment for the most vulnerable and disadvantaged.

Dr Daniel Rainey o ered his services, from the outset, as physician without any payment, and he helped to establish it as a centre of research and teaching, delivering the hospital’s rst paper, on the post-mortem process, in 1775.

Eventually, separate institutions developed to provide the House of Industry’s distinct services. ese included the Hardwicke Fever Hospital and the Whitworth, as well as the Richmond. e Richmond prided itself not just on its progressive approach, but also on being a superb teaching hospital. It is no surprise that in the early days some of the demonstrations students Dr Steevens’ Hospital, founded in 1733, now the Health Service Executive (HSE) administrative headquarters. observed were harrowing in the extreme. In 1825 a 14-year-old boy had a portion of his lower jaw removed. He ‘seemed to su er the most severe torture’, newspaper reports noted, and a watching student later wrote that he ‘screamed and struggled’, though he later walked out of the room alone, waving away o ers of help. e operation was performed by Mr Richard Carmichael, and was so well attended by an eager audience of surgeons and students that Carmichael struggled to get su cient elbow room to work. Just over 25 years later, Mr John MacDonnell read about the use of ether in a medical journal. e following day he built the necessary apparatus and tested it on himself, and on the day a er he administered ether to Drogheda girl Mary Kane before a successful amputation of her arm. e following year, Mr John Hamilton amputated a forearm, while his patient bene ted from a chloroform-soaked handkerchief. Doctors at the Richmond were slow to embrace Sir Joseph Lister’s use of antiseptics, but they were quick to follow Sir omas Myles, who availed himself of the Richmond’s kitchen re, boiling his instruments in a kettle. A marvellous image of surgery in progress survives in the RCSI heritage collections: a detailed photograph of Richmond doctor, Dr Emily Winifred Dickson being examined performing surgery there in 1896. Dr Dickson was the rst female fellow of the RCSI, and other photographs from the Richmond at that time show her surrounded by male colleagues. Apart from its forward-thinking approach to what we now call healthcare, its

ALUMNI MEMORIES

“ e Charitable In rmary, Jervis Street. My rst exposure to clinical medicine. I’ll never forget the wards, Matron, and the patients’ looks of total trust and con dence in me, the beginning of the true responsibility in medicine as my career.”

Dr David Crooks (1989)

liberal and non-denominational outlook, and the 200-year history which resulted in its becoming one of the great teaching hospitals, the Richmond has given us a Dublin landmark. e warm red brick of its broad façade, unexpectedly ornate, with pavilions and arcades, now houses the Richmond Education and Events Centre, opened by the Irish Nurses and Midwives Association (INMO) in 2018.

Two hundred years of healthcare seems like an impressive heritage, but the site of Dublin’s Mercer Hospital has been used to treat the sick since at least the 13th century, when a leper hospital was operated there. In the early 18th century, Mary Mercer ran a girls’ shelter on the site, later converting it to a ten-bed hospital. Mary Mercer died soon a erwards, without having made nancial provision for the hospital’s future, but a combination of fundraising (including one third of proceeds of the première of Handel’s glorious oratorio Messiah in Fishamble Street in 1742) and gi s enabled the hospital to continue, and be extended to house 30 patients. Mercer’s, or the Mercer as it became more commonly known, had to be rebuilt in 1757, once the smell from the sewer became so noxious that some of the governors refused to enter the building. e Mercer – like most hospitals – was no stranger to controversy. On top of repeated scu es and stand-o s between sta members around clinical teaching, the late 19th century saw a protracted inquiry into the behaviour of Mr Edward Stamer O’Grady, the hospital’s senior surgeon. He was accused of ‘unbecoming, violent and insulting behaviour’ to the matron and nurses, to the point where the matron resigned, and it became next to impossible to recruit nurses. He was also supposed to have ‘insulted his professional colleagues’, and ‘outraged their feelings’. No-one wanted to work with him, and students complained that he delivered no clinical teaching worth mentioning. e row dragged on for ten years, until the Governors ‘evicted him from his surgeoncy’, although he continued to visit patients, never mentioning to them that he was no longer on the sta . e irresistibly dramatic details of this HR horror story should not detract from the Mercer’s reputation as a teaching hospital. From the founding of RCSI in nearby York Street, a close association was inevitable and bene ted both organisations. roughout the 19th century, the Mercer remained one of the main teaching hospitals for surgery. When the Mercer was closed in 1983, RCSI bought and restored

After services were transferred to the Beaumont Hospital, the Jervis Street Hospital closed in November 1987, and the site of the hospital was redeveloped to create the Jervis Shopping Centre with only the facade of the original hospital remaining. the building, now home to a medical library and the heritage collections of the College. Fittingly, the Mercer Medical Centre operates as a modern GP practice on the ground oor, meaning Dubliners can still access healthcare on this old city centre site. In 1718, six surgeons pooled their private funds to set up the Charitable In rmary. When its Inns Quay site had to be given up for the construction of the Four Courts, the in rmary moved to 14 Jervis Street, the old townhouse of the Earl of Charlemont. Conveniently, he had packed up and vacated the premises in favour of the spanking new Charlemont House, the architectural centrepiece of what was then Rutland Square (now Parnell Square, with Charlemont House now home to the Hugh Lane Gallery). Like the Mercer, the Charitable In rmary bene ted from the proceeds of the Messiah’s 1742 première, to the tune of £127, and a charitable lottery also provided £805. ese funds made all the di erence to the hospital’s survival, THROUGHOUT THE 19TH CENTURY, THE MERCER REMAINED ONE OF THE MAIN TEACHING HOSPITALS FOR SURGERY.

ALUMNI MEMORIES

“Mercer Library was a second house for me, I believe I spent more time in it than home.” Dr Ahmad Bouskandar (2015)

“You always bumped into someone you knew, whether dashing to the train station, or down Gra on Street. Parties in the Mercer or loud groups in e Swan. ” Dr Sarah O’Malley (1992) Mercer’s Medical Centre opened in 1990 on the site of the old Mercer Hospital.

The original Louth County Hospital was designed by William Smith; St Patrick’s Hospital, not only the fi rst psychiatric hospital in Ireland, but one of the fi rst in the world, still serves its original purpose. and as a non-Catholic hospital, even a er the Sisters of Mercy arrived in 1853 to take charge of nursing at the hospital, it played an important role in the city’s healthcare. Like the Richmond, research and development were core activities in the hospital, and important to its sta members. Heart specialist Sir Dominic Corrigan was appointed physician there about 1830, and although he only had six beds, he had plenty of opportunity to observe the variety of heart and lung conditions that intrigued him: in 1832 he wrote the paper on aortic regurgitation that made him famous. He tended to kindness and reassurance, and was thoughtful of patients’ feelings as well as their illnesses, being ‘careful never to allow a patient to see him looking at his watch’.

Jervis Street, as it came to be known, was Dublin’s main emergency hospital, and its doctors and nurses showed their commitment to emergency care beyond the hospital walls. During World War 1, it established a temporary outpost in the form of a Red Cross Emergency Hospital at Dublin Castle, where the converted rone Room made an airy ward. In April 1916, when violence erupted across the city, all the hospitals were packed, with Jervis Street being the busiest due to its location so close to Sackville Street (now O’Connell Street). e hospital sta coped day and night, on top of their normal work, with 45 fatalities and 550 injured, almost all of them su ering bullet wounds, and the pressure was intensi ed in the later part of the week by the knowledge that machine guns were trained on the building. Meanwhile, a mobile rst aid unit treated patients in the Sackville Street area. Sta ed by three Jervis Street doctors, wearing red crosses on white coats, they carried the worst cases to the hospital itself.

In 2020, 100 years a er Bloody Sunday, Dr John Latham recounted how, as a surgical intern at Jervis Street in 1978, he had carried out an elective procedure on an elderly man with noticeable scarring on his neck. e patient had been in the crowd in Croke Park on 21 November 1920, and the scars were from a machine gun wound. He had been treated at Jervis Street, and as John Latham wrote, ‘he was now lying in the same ward, and at the same end of the ward, facing the same large picture of the Sacred Heart, where he had found himself during the recovery from his bullet wound 58 years previously’.

As well as accident and emergency care, Irish hospitals have always played their part in managing public health crises. In recent years, public health policy has been discussed around every breakfast and dinner table in the country, but of course public health crises did not start with COVID-19. ey have come in many forms, including epidemics of transmissible diseases, from the 19th-century scourges of cholera and smallpox, through polio and endless variations of in uenza. By 1947, tuberculosis represented a signi cant

THE BEAUTY OF THE BUILDING SPARKED A VOGUE IN THE NEIGHBOURHOOD FOR BUILDING IN THE SAME TASTE.

public health problem in Ireland, and in an attempt to curb it and incentivise treatment, a new Health Act (the same piece of legislation in which the then health minister Dr Noel Browne sought to introduce the doomed mother and child scheme) introduced a welfare payment to the family for anyone undergoing tuberculosis treatment. is, predictably enough, had the e ect of putting sudden pressure on existing services and facilities, and Browne suggested that a Chest Hospital be built to accommodate 250 in-patients. Waterford County Council agreed to carry out this project and provide a hospital with a catchment area taking in Kilkenny, Wexford, Tipperary, Carlow, and Waterford itself. Ardkeen Chest Hospital opened ve years later, but by 1959 incidence of tuberculosis was declining and the County Hospital was transferred to Ardkeen. Services and facilities were added, including, in 1965, Ireland’s rst psychiatric unit in a general hospital, under the experienced eye of Professor Tom Lynch. In its 21st-century incarnation, University Hospital Waterford has 500 beds and 1,800 sta , and is the busiest hospital outside Dublin. Despite huge changes and its new name, you will still o en hear it referred to as Ardkeen.

In Dundalk, the name of the county hospital continues not just in common usage, but also on an original plaque on the old building in the town. Louth County Hospital originated as one of the old county in rmaries, actually preceding the 1765 legislation which provided for them. Originally established in 1753, the old in rmary was replaced in 1834 by a neo-Tudor building of red clay brick, with sandstone cloisters, designed by English architect omas Smith. William Makepeace ackeray, never short of an opinion, wrote of his Irish travels in e Irish Sketchbook in 1845, and he had plenty to say about his visits to both the old and the new hospitals. e governors of the new hospital were in a state of ‘no small agitation’ because of criticism that the new build was a waste of money, given that the old one was perfectly t for 50 patients. ackeray disagreed. He found the building deeply unpleasant, ‘damp and unwholesome’. He wrote that Smith’s building in the Crescent replaced ‘a small dirty house in a damp and low situation, with but three rooms to accommodate patients, and these evidently not t to hold y, or even een patients’. As to wasted money, in the grand tradition of building projects, Smith’s estimates were lower than the nal spend, but the excess on the £3,000 build was only three and sixpence, ‘a wonder of cheapness’ in ackeray’s view, and anyone’s. e

new hospital was provided ‘with every convenience for men and women, with all the appurtenances of baths, water, gas; airy wards, and a garden for convalescents; and, below, a dispensary, a handsome board-room, kitchen, and matron’s apartments’. He also noted with approval that the beauty of the building had sparked a vogue in the neighbourhood for building in the same taste. e hospital lasted in these elegant new quarters for over 100 years, but in July 1959 a completely new county hospital was opened on the Dublin Road, slightly less of a wonder of cheapness, and more of an overrun, at half a million pounds, but similarly purpose-built. e new hospital ourished, and Smith’s lovely building was le to decay until the 1980s, when the county council did battle against dry rot, carried out some restoration work, and began to use it as o ce space for planning and motor tax. As the century turned again, the nearby Dundalk Grammar School, founded even earlier than the original in rmary, bought the building to convert for use as a boarding-house for pupils, and so now it is full of people and beds again. e facade still bears the old name ‘Louth Hospital’.

Louth County Hospital has had some services cut back in recent years, including the accident and emergency department, now replaced by a minor injuries clinic, and signi cant reductions in maternity services. Patients in need of these services now go to Drogheda, to Our Lady of Lourdes Hospital, recently designated the acute hospital for the north-east. Our Lady of Lourdes was opened in 1955, shortly before the new Louth County Hospital. It was founded by the Catholic congregation the Medical Missionaries of Mary, as a missionary training hospital, and maintained a strong Catholic ethos. As everywhere, modernisation is sought throughout the now 340-bed hospital. A large expansion project in 2019 saw the hospital shortlisted for several architectural awards, and in recent years there have been discussions about changing the name to something more secular, re ecting the fact that it is no longer owned by the order, and the changing nature of the provision of healthcare in the State.

In the 1970s, preparations began to replace older hospitals like the Richmond and Jervis Street with a large modern hospital, and in 1987, Beaumont opened. It was built about 5km from the city centre, in Glasnevin, and as the chairman of the Board, Niall Weldon, wrote in 1992, its primary purpose was as an acute public hospital and teaching institution. In its rst year, Rory O’Hanlon, then Minister for Health, commissioned the hospital to run a pilot development scheme, modelling its organisational structure and IT systems, introducing ALUMNI MEMORIES a new era of structured “Running for the 16A bus to monitoring and evaluating make it to Prof Hill’s early cost-effectiveness and ward round at Beaumont.” Dr Mohomed Vahedna (2011) e ciency. It was an optimistic start, but within ve years serious challenges arose, bringing public scrutiny in the shape of a ministerial Committee Beaumont Hospital of Inquiry, and Medical Council tness to practise inquiry.

Beaumont had been envisaged as a lean, economical, progressive organisation, in the vanguard of the country’s modernising health service. It had also inherited a long tradition of pioneering healthcare from both the Richmond The Rotunda Hospital has provided an unbroken service and Jervis Street, and it to women and babies since its foundation in 1745 and has occupied its present premises since 1757. ran with this tradition, making research and innovation central to its ALUMNI MEMORIES ethos. It is now the main teaching hospital of the “Hospital days in Drogheda with Mr Sheehan (surgeon) - we were the rst students to University, and the Smur t attend the Drogheda hospital.” Building, opened in 2000 Dr Solly Gardee (1969) (and signi cantly extended in 2018), is home to Ireland’s first clinical research centre on a hospital site. Beaumont Our Lady of Lourdes Hospital, Drogheda is a huge operation, with 820 beds and 3,000 sta , o ering acute care over 54 medical specialties. It is ALUMNI MEMORIES the National Referral Centre “Eating chips in the old for Neurosurgery, Renal and Pancreatic Transplantation doctors’ res in the Richmond a er A&E was cleared at 3am.” Dr Aidan Ward (1977) and Cochlear Implantation. is large-scale contemporary hospital would be a wonder to those who, in the early 18th century, opened the rst Irish hospitals, funded on a wing and a prayer, based on the convictions that caring for the sick is fundamental to the way we live, and that e ective training as a doctor requires observation of medicine in action, The Richmond Hospital is now home to the INMO Education and Events Centre. and hands-on experience. e legacy we enjoy 300 years later is the great teaching and research complexities of human health has been transmitted tradition of these hospitals, and the fact that their through the centuries to the newest hospitals and commitment to mapping new paths through the modern medical practice. ■