Medical History of the Poorhouse

Medical History of the Poorhouse

From the very beginning of the poorhouse, Belfast Charitable Society was a pioneering force for medical innovation in Belfast. As poverty and sickness are inextricably linked, the Society needed to be able to care for the sick poor who would enter the house.  Before the involvement of the Society, medical relief for the poor in Belfast was practically non-existent and extremely limited.

When Clifton House first opened in 1774, it contained seven beds for the sick. These beds mark the beginning of Belfast’s hospitals, and the Society’s first medical report noted the treatment of five patients. In 1776 the Society was advertising outpatient times, encouraging the people of Belfast to visit one of ‘the medical gentlemen’ who would administer medical attention through the Belfast Charitable Society on a rotating basis. This free and accessible medical care for the sick poor of Belfast was revolutionary and revealed the deeply philanthropic nature of the Society and the physicians who donated their time and medicines. Furthermore, the doctor’s work with the poorhouse allowed them to improve their surgical skills and increase their reputation in the medical field. Doctors such as William Drennan and Alexander Haliday offered their time and resources to the Society on a rotating basis.

Medical cases within the poorhouse were varied, as recorded by the minute books. Cases involve a woman named Mary May who was struggling with severe asthma, a gentleman named Patrick McLaghlan who was suffering from cancer in the cheek, examples of lunacy and a woman dealing with a septic skin condition. This only a small sample of the cases seen by poorhouse doctors. The medical gentlemen would also deal with broken bones, crush injuries and torn ligaments caused, in part, by the emerging linen and cotton industries in Belfast.

The demand on the poorhouse for provision of the sick was unprecedented, and the Society quickly realised its own limitations. The Society, therefore, were instrumental in the creation of the Belfast General Dispensary in 1792. The dispensary, which aimed to facilitate medical relief for the poor in their own homes, was a cooperation between the Belfast Charitable Society and a range of local physicians and philanthropists including Dr James McDonnell, founder of the Belfast Medical School. Clifton House provided a venue from which the dispensary originally operated from, in return for the supply of medicine for the residents. Patients could visit the physicians operating out of Clifton House two days a week for medical advice and treatments – not unlike visiting a modern GP.  The dispensary later became part of the Fever Hospital and moved to a premises on West Street, then to Frederick Street and eventually to the site which is now the Royal Victoria Hospital.

Alongside the dispensary, the Society was closely affiliated with other innovative medical organisations in Belfast. The Lying-in Hospital, Belfast’s first maternity hospital, was opened in 1794 and had connections with philanthropists involved in the Charitable Society from whom they rented premises. The Ulster Society for Promoting the Education of the Deaf and Dumb and the Blind also leased property from the Society, as did a dispensary for the treatment of skin diseases ran by a Dr H. S. Purdon. The Purdon family were closely affiliated with the Charitable Society and often volunteered their medical services to the sick poor residing in Clifton House. It seems there were very few charitable and medical endeavours within Belfast that the Charitable Society was not involved with in some respect, including revolutionary inoculation campaigns for the young residents.

Pioneering Medical Research

William Drennan, poet, physician, and co-founder of the United Irishmen was involved in the revolutionary medical work inside Clifton House. In the late eighteenth century, Dr Drennan was attempting to inoculate the children of the poorhouse against smallpox – a disease which was incredibly dangerous in the eighteenth and nineteenth centuries with a 30% mortality rate. This variolation campaign itself was not without any risks. Unlike the safer form of vaccination pioneered by Edward Jenner sixteen years later (which used the milder cowpox as the active strain in the vaccination), Drennan used small amounts of real smallpox in ‘arm-to-arm’ exposure to immunise the patient against further illness – this campaign would decrease the mortality rate to 1-2%.

Drennan’s campaign, although somewhat risky, can only have been a success for the patients residing in the poorhouse, as the 1782 minute books resolve to thank Doctor Drennan for his scheme of inoculation:

1st June 1782

‘Resolved that thanks be returned to Doctor Drennan in the public papers for the scheme of inoculation introduced by him into this house, and that mr Crombie doe waite on him and acquaint him with this Resolution and that He send It to the paper provided that the doctor does not oppose it.’

The Society continued to record its vaccination schemes throughout the beginning of the nineteenth century thanking Doctor Haliday Jr. for his good work in his vaccination programmes, which had developed with the Jenner method using cowpox rather than the riskier smallpox.

Facing Epidemics

In 1847 – known as Black ’47 – the Society notes the loss of a Surgeon James McCleery. James McCleery was a surgeon from Portaferry who began his medical career in Belfast. He was the main attending surgeon to the male side of the poorhouse from 1835. McCleery ‘zealously and benevolently fulfilled the laborious duties of Surgeon to the male of this Charity’ until he succumbed to ‘famine fever’. He is buried in Clifton Street Cemetery and his role was taken over by his son. ‘Famine fever’ was caused by a combination of nutritional deficiencies and a raging typhus epidemic characteristic of the famine years. Over 131 doctors and their pupils across Ireland succumbed to this in 1847 alone. Clifton Street Cemetery is evidence of the many tribulations faced by Belfast during the famine period and the strain faced by the Belfast Charitable Society as they attempted to manage burials and provide coffins for the poorer Belfast communities.

Alongside the hundreds of bodies interred in the cemetery that died from fever in 1847 alone, the cemetery also contains the ‘Cholera Ground’ in which those that died in the great epidemic of 1832-33 are buried. For the safety of the residents of Clifton House, the Society decided to close its doors to new arrivals to prevent further transmission whilst still providing coffins for the Board of Health. Readings of the minute books in this period reveal the Society’s understanding of disease and transmission, as they required the isolation of patients who had potentially been exposed as well as the importance of a nutritious diet to stave off disease. The Poorhouse became one of few places in Belfast to not be completely decimated by the disease, thanks in part to its attending surgeons and healthcare systems.

The Mysterious Medical Chest

Every good attending surgeon in the nineteenth century would have their own medical chest, full of essential supplies ready to go at a moment’s notice. Recently, one such medical chest was discovered inside Queen’s Medical Library which is believed to have belonged to the Surgeon McCleery. The chest contains a range of medical equipment which would have been common to the nineteenth century travelling surgeon and would have been used within Clifton House to treat the sick poor.

Some of the most notable items contained in the chest are the surgeon’s amputation and bloodletting kits. Bloodletting was an essential part of any surgeon’s kit in this period and was used to remove ‘impure’ fluids, or bad humours, that were thought to be making the patient unwell. This procedure was dangerous and could easily result in the death of the patient and decreased massively in usage after the nineteenth century. The Bloodletting equipment was used enthusiastically by medical professionals during the cholera epidemics that ravaged Belfast’s poorest communities in this period.

An amputation kit was essential for the surgeon and a surgeon was distinguished by the speed in which they could operate. Without general anaesthetic the patient would be awake during the procedure – one can only imagine how painful and traumatic this was. To reduce the risks to the patient the surgeon needed to be quick with his saw and cauterisation. However, as antibiotics and proper hygiene in medicine were yet to exist the mortality rate of these surgeries was incredibly high. As our understanding of medicine and anatomy has progressed, both amputations and bloodletting have understandably fallen out of favour in the medical community being replaced by much safer, modern methods of treating sickness.

All of this only touches the surface of the deep and varied medical history of Belfast’s poorhouse. Further research may be warranted on the treatment of mental health – referred to as lunacy cases throughout the 18th and 19th centuries – and the way the poorhouse was, for a long while, the only place in Belfast equipped to deal with such cases. We can also consider the vast number of doctors who walked the halls at Clifton House and their legacies, especially those less famous, with links to the wider Belfast community and the Belfast Medical Society.

As the medical field in Belfast progressed so did Belfast Charitable Society. After the children left the poorhouse in 1882, more work was done to provide the elderly poor with good medical care with nurses being employed after 1892. Clifton House would adapt to the needs of Belfast until it became what it is today, working with the elderly and providing medical care in an assisted living facility.

Elizabeth Irvine (QUB Public History), April 2024

Belfast Charitable Society Belfast Poor House Clifton House News