Union and unions: science and medicine in and around Ireland, England and Scotland, 1850-1900
Kieran Fitzpatrick (Wellcome Unit for the History of Medicine, Oxford) discusses his focus on ‘unions’ when analysing Irish medical communities between 1870-1920.
How do ideas underpin what health is and who is healthy? This is one of a couple of broad questions that underpin my currently-under-development doctoral thesis at the Wellcome Unit for the History of Medicine, Oxford. Focused on the lives and careers of Irishmen who served in the Indian Medical Service between 1870-1920, one of the ways in which my work helps to answer the broad question posed above is through the use of ‘unions’ as a concept for understanding the circulation of knowledge – via institutions and personnel – amongst the constituent nations of the Union of Great Britain and Ireland.
So here we have two inter-related concepts using similar terms; ‘Union’ is singular, upper case and political; this broad Union framed ‘unions’, which were multiple, lower-case and not political, at least not directly. In the case of my work, the latter were medico-scientific and were sustained by interactions at a number of removes, two of which I will discuss here in relation to the institutions and personnel of public health in ‘these islands’. The first involved exchanges between municipal bodies of public health, especially those in Dublin (the Public Health Committee) and their equivalents in cities such as Liverpool and Glasgow. The second involved the shaping of Irish medical school curricula through interactions between Irish universities – Trinity College Dublin – and high-ranking members of the English medical elite, specifically Cambridge’s George Edward Paget.
In the later decades of the nineteenth century, Dublin’s Public Health Committee were keenly aware of the need to tap the intellectual resources of equivalent bodies elsewhere in the Union in order to combat the challenges to human health that they perceived to be most pressing, namely those produced by industrial capitalism. In December 1880, the Committee sent a deputation to the great industrial cities of Scotland and northern England (Glasgow, Edinburgh, Bradford, Manchester and Liverpool) in order to enquire into questions of ‘domestic scavenging and [the] construction of abbattoirs’ as well as ‘other sanitary matters’. Over a number of weeks, these men noted the scale of the boroughs of these cities, their populations and, where data was available, their valuations. On top of this statistical basis, they constructed an image of how their sister municipalities dealt with the removal of human waste, the proportion of city streets that had been macadamised, and consulted with Borough Surveyors on the prime material to be used for paving.
What the interests and activities of this deputation show us is the common emphasis placed on certain types of ‘health challenges’ in the latter nineteenth century; for municipal health bodies, their social and political thought was based on perceiving how the material changes induced by industrial capitalism impacted upon human health. Christopher Hamlin has noted that British public health in the early nineteenth century was defined by two questions, one of which was how the ‘moral economy of medicine was to mesh with the political economy of industrial capitalism’. From the evidence of the Dublin deputation, there was an amount of epistemic splash from those earlier decades into the latter portions of the century. What Hamlin does not account for is how municipal bodies in urban Ireland sustained these conceptions of health and contributed to a continuity of policy reactions to them.
Discussing the appropriate boundaries of public health also influenced ‘union’ debates about medical school curricula in Ireland. A decade before the deputation’s presence in Glasgow and Liverpool, an extensive correspondence had taken place between the board of Trinity College Dublin’s School of Physic and George Edward Paget, then a physician at Addenbrook’s Hospital in Cambridge and, after 1872, Regius Professor of Physic at the University. Over the period January to July 1870, Paget implored the School of Physic to found a Qualification in State Medicine, which was later to become the Diploma of Public Health. Paget’s influence moved the Professors in the School to ‘recommend the Board of Trinity College to take steps to institute a qualification in State Medicine, in the University of Dublin.’ By July of the same year, a curriculum had been put in place for the qualification, although it was not until five years afterwards that the program of study was published in Trinity’s annual calendars. Although Ireland’s material experience of the nineteenth century was not defined by industrialisation to the same degree – or in the same fashion – as either England, Scotland or Wales, Paget was a keen promoter of the inclusion of public health education in medical school curricula, and later used his high office at Cambridge to integrate the fields of sanitary science, medical jurisprudence and midwifery into the university’s formal educational framework. However, he used Dublin as a proving ground for his ideological commitments, incorporating the city into a field of policy creation that was a reaction to a uniform understanding of the effects of industrial modernity.
Recent reference has been made to the existence of an ‘Irish school of medicine’ in the wake of Ireland’s famine experience of 1845-52; one concerned with creating a synergy between modernity on the one hand, and traditional Irish folk medicine on the other. Whilst more work remains to do on establishing precisely how that school functioned, we should leave enough conceptual room in this field for a second, eminent medical mentalité. That mentalité was conditioned to think of health in terms of progress, cleanliness and health as a function of computations between social class and urban geography. Furthermore, this collective mindset was reliant on unions between England, Ireland and Scotland for the direction of its public health policy, the formation of its medical school curricula and the maintenance of prestigious relationships between members of a medical and scientific elites. It was out of this epistemological context that the subjects of my thesis came and acted as the media through which these ideas and concepts were transplanted to India and accepted, challenged and modified; over the coming years I am looking forward to seeing how those processes occurred.
 ‘Report of Deputation of Public Health Committee, Who were requested to visit Glasgow, Edinburgh, Bradford, Manchester and Liverpool, and to enquire into the questions of domestic scavenging and construction of abattoirs, and other sanitary matters’, Reports and Printed Documents of the Corporation of Dublin, Vol. 1, No. 33 (1880), pp. 209-227.
 ‘Report of Deputation’, p. 210, 211, 214.
 Christopher Hamlin, Public Health and Social Justice in the Age of Chadwick Britain 1800-1854 (Cambridge, 1998), pp. 14-15.
 ‘Professors’ Minute Books 1863-1895’, TCD MUN/MED 10/1 (1 February 1870), ff. 37-8.
 Barry Crosbie, Irish Imperial Networks Migration, Social Communication and Exchange in Nineteenth-Century India (Cambridge, 2012), pp. 170-71 & p. 189.
Kieran Fitzpatrick is currently in his second year of doctoral research at the Wellcome Unit for the History of Medicine, Oxford. Under the supervision of Professor Mark Harrison and with financial support from the Wellcome Trust’s medical humanities funding stream, his research looks to investigate the lives and careers of Irish surgeons in the Indian Medical Service, 1870-1920. Prior to arriving in Oxford, he received an MA in History from NUI Galway (2012) and completed a BA in English Literature and History at the University of Limerick (2011).