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DUBLIN HOSPITAL SUNDAY FUND—VOLUNTARY HOSPITALS AND HEALTHCARE c. 1870

By Joe Curran

Above: Florence Nightingale—one of the most influential voices for hospital reform in the nineteenth century. (NPG)

Recent controversies about the costs of the new Children’s Hospital and the control of the National Maternity Hospital highlight the significance of healthcare funding and management. Debates about such matters are not new. Though the reduction of human misery is the shared goal, these debates have incorporated other matters, including finance, hospital administration and religious conflict. These issues are not specifically Irish concerns; disputes about all of them have frequently arisen in many parts of Britain as well as Ireland, especially during the second half of the nineteenth century. Until then, ‘modern’ voluntary hospitals, primarily philanthropically funded institutions, were intended to provide free care for those who could not afford to be treated at home. In an age where a drawing room was considered as good an operating theatre as any, hospitals were not perceived to offer great advantages.

Hospitals were transformed during the second half of the nineteenth century. There was a major drive towards ‘hospital reform’, with a focus on sanitary improvement. Florence Nightingale was one of the most influential voices in this regard and her Notes on hospitals, which argued for an increased ‘circulation of air’, enjoyed wide public attention. The new buildings or renovations required to produce these conditions imposed significant financial demands, as did a growing interest in improving nursing care and providing more structured training for nurses. Reformers’ other interests also had an impact on hospital finances, not least their efforts to introduce standardised accounting methods to increase transparency and accountability to hospitals’ donors.

HOSPITAL SUNDAY FUNDS

Above: Cardinal Cullen—mocked what he believed were the Dublin Hospital Sunday Fund’s tokenistic attempts at inclusion. (Pontifical Irish College, Rome)

Hospital reformers and philanthropists responded to pressures for change and mounting costs in a variety of ways. Some complained of hospital ‘abuse’—that hospitals were providing free care for an increasing number of patients who could afford to pay. This led to greater investigation of patients’ backgrounds and attempts to make more patients contribute financially. Other responses included efforts to develop new funding streams such as ‘Hospital Saturday Funds’, which were organised working-class collections. Another centralised funding model was the ‘Hospital Sunday Fund’, which raised money through collections on one Sunday of the year in every place of worship in a town or city. The amount collected was then distributed among participating hospitals. The first Hospital Sunday Fund was established in Birmingham in 1859 and by the late 1870s funds were operating in many large towns, including Manchester, London and Liverpool, as well as in smaller urban centres.

Hospital Sunday Funds were an example of what historian Keir Waddington has called ‘indirect philanthropy’. Instead of making their donation directly to individual hospitals, donors would give to a central fund whose administrators would then distribute the proceeds. Some reformers perceived Hospital Sunday as a possible vehicle through which changes in hospital administration could be promoted. They believed that a fund with a potential income of several thousand pounds could put more pressure on recipient institutions to introduce desired changes than could individual donors. Such measures were not universally welcomed. Many hospital managers feared financial losses if donors transferred their contributions to these funds. Waddington has noted that the funds were deemed ‘bastard benevolence’ by some sections of the press, which claimed that they undermined the role of the individual ‘active citizen’.

Fund organisers were, however, eager to involve a wide range of donors and, though not immune from religious conflict, British Hospital Sunday Funds were self-consciously multidenominational. The Liverpool Hospital Sunday Fund, for example, received donations from the places of worship of Baptists, Anglicans, Presbyterians, Independents, the Society of Friends, Jewish congregations, Roman Catholics, Greek Orthodox Christians, Unitarians and Methodists, amongst others. The funds strove to involve as many denominations as possible in what were often religiously divided towns and cities.

DUBLIN—CITY OF HOSPITALS

Nineteenth-century Dublin was one of the larger urban centres in the contemporary United Kingdom and c. 1870 was home to over 25 voluntary hospitals. These numbers do not include infirmaries attached to Poor Law workhouses, but they do incorporate many small to medium-sized general hospitals. Some of these had been founded in the eighteenth century, while others were much younger institutions. There were also a growing number of specialist hospitals, including ophthalmic and orthopaedic facilities.

Above: The Mater Misericordiæ Hospital, Eccles Street. Cardinal Cullen’s opposition to the Hospital Sunday Fund was fuelled partly by his own intransigent personality but it was aided by the increasing power of Catholics in Dublin, which allowed them to stand apart from the fund. The Mater (opened 1861) was a testament to Catholics’ growing philanthropic resources. The hospital took a non-sectarian approach to patient care, but its construction was recognised as primarily a Catholic endeavour. (NLI)

In 1874 a group of high-profile Dublin citizens, led by philanthropist Lord Brabazon (1841–1929), came together to establish the Dublin Hospital Sunday Fund. Although they were motivated by similar aims to their British counterparts, the Dublin fund was not designed as a substitute for direct subscriptions to hospitals. In fact, it encouraged such benefactions by distributing the fund’s income among participant hospitals according to a formula that was partially proportional to the amount that each hospital raised for itself. This did not, however, prevent several of the city’s hospitals protesting what they perceived to be a threat to their income in the fund’s early years.

Above: : The former Adelaide Hospital on Peter Street in 1989. Founded in 1839 on Bride Street, financial difficulties saw it close during the Famine but it reopened in 1858 on Peter Street. It later relaxed its ban on treating Catholic inpatients. Restrictions on the employment of Catholic staff lasted longer; such conditions controversially persisted into the twentieth century, even in some of London’s most ‘non-sectarian’ hospitals. (RTÉ Archives)

OPPOSED BY CARDINAL PAUL CULLEN

Religious matters distinguished Dublin’s Hospital Sunday Fund from its British counterparts. The fund’s founders had hoped that it would be an interdenominational scheme operating throughout the Dublin diocese, and they wrote to the boards of management of Dublin’s many hospitals, inviting them to participate. They also sought the approval of the Catholic and Anglican archbishops of Dublin. Whilst the latter was supportive, the Catholic archbishop, the formidable Cardinal Paul Cullen, saw things differently.

Cullen outlined some of his thoughts on the scheme in a letter to the Irish Times in January 1874. Echoing the complaints of several hospital managers, he explained that the ‘Catholic hospitals’, the Mater and St Vincent’s, would not participate because the fund posed a threat to their income. Cullen’s letter also claimed that, as these hospitals provided care without proselytism, ‘it was not desirable to submit them to experiment’. The implication was that participation would subject these institutions to increased Protestant influence. This drew on real and imagined fears that charity was used for proselytising purposes, concerns that pre-dated claims of Famine ‘souperism’. Though medical philanthropy was less subject to such claims than other forms of charity, concerns about the targeting of vulnerable patients persisted.

The Dublin Hospital Sunday Fund report of 1876, outlining the sums distributed to the participating hospitals. (NLI)

Cullen’s personal correspondence sheds greater light on his motivations and on Dublin’s unique religious environment. He appears to have done some research on how Sunday Funds operated elsewhere. His papers contain a report detailing the donations of Liverpool’s many denominations, including Catholics, to that city’s Sunday Fund in 1872, and a letter about London’s Hospital Sunday Fund from a Fr Johnson, based at the Catholic archbishop’s house, Westminster. Johnson praised the fund and argued that involvement had gained ‘much esteem’ for the city’s Catholics. For frequently maligned Irish Catholic communities in large British towns, participation provided a significant reputational boost.

Cullen, however, was not won over by these positive reflections. He mocked what he believed were the Dublin fund’s tokenistic attempts at inclusion. Writing to Monsignor Kirby at the Irish College in Rome, Cullen claimed that the meeting establishing the fund had been held in what he called the ‘Protestant Hall, Molesworth Street’, and just three Catholics had attended. In an effort to appear multidenominational, each of these Catholics was elected to the fund’s managing council.

Cullen’s decision was significant both financially and for the fund’s reputation. The absence of collections from Catholic churches on Hospital Sunday meant that vast numbers of potential donors were lost. An official inquiry of 1887 into Dublin’s hospitals argued that the fund would ‘more than double’ its income if the Catholic Church agreed to join. The fund’s council also tried to mitigate the significant reputational impact by arguing that, although the institutional Church was not involved, individual Catholics made ‘bountiful contributions’ to it.

ADELAIDE CONCERNS

By examining some other controversies relating to the fund we can better understand Cullen’s reasoning, while still acknowledging that he blocked a potentially massive multidenominational partnership. Cullen worried about ceding control to Protestants, but the managers of the Adelaide Hospital had different concerns. The Adelaide was founded to ensure that Protestant patients would not be required to witness Catholic ceremonies or be exposed to conversion attempts by Catholic priests and nuns, risks that its managers claimed Protestants faced in the city’s other (non-Catholic) hospitals. The Adelaide treated Catholic outpatients, but in the 1870s it did not accept Catholic inpatients because fulfilling any of their requests to see a Catholic priest would have violated the hospital’s raison d’être.

The Adelaide’s managers worried that, because several Catholics donated to the fund, their hospital’s participation would be conditional on its admission of Catholic inpatients. The fund’s managers, however, went out of their way to reassure the Adelaide. The managers publicly stated that they regretted the non-participation of Catholic churches and hospitals, but they do not appear to have made any public efforts to persuade Cullen to reconsider. By contrast, in its first annual report, the fund’s council singled out two non-participants, the Adelaide Hospital and the Meath Hospital, and outlined how much money each would have received from the fund if they had been involved. This was making a very public invitation to an institution that many considered sectarian! The action stemmed from growing anxiety among the fund’s managers, as they had so far attracted fewer institutions than expected. Nevertheless, when the Adelaide began to participate from 1876 onwards, it was given assurances that it would not have to change its religious policies. In the process, an element of sectarian bias was introduced into the scheme.

Hints of sectarianism even found their way into the fund’s own publications. Its 1881 report contained a record of a proposal made by several Protestant clerics who suggested that, since most of the fund’s income was donated by Protestants, participating hospitals should be required to reserve wards for members of Protestant denominations. This proposal was rejected, and some of the fund’s prominent supporters, such as obstetrician Evory Kennedy, publicly re-emphasised the Dublin Hospital Sunday Fund’s commitment to supporting care for members of all religions without distinction. Such debates, however, are likely to have inadvertently connected the fund with sectarianism in the public mind.

SURVIVAL AND SUCCESSES

Although the ambitions of its founders were not fully realised, the Dublin Hospital Sunday Fund survived for over 50 years and had some notable successes. Like funds elsewhere, it attempted to shape hospital administration. In 1878 its council argued that:

‘… as through their hands a sum of nearly £4,000 a year is voluntarily contributed to the funds of the participating hospitals, they are bound to have regard to the efficiency of the arrangements for the care of patients in these institutions’.

While it did not have powers to direct the management of the institutions aided, the fund’s control of significant amounts of money and its publication of reports allowed it to influence hospital practice.

It made particular efforts to promote nursing reform. It established a committee to consider the subject and in 1879 published a dedicated report analysing the nursing arrangements in participating hospitals. By 1882 the fund had established a system of bonus payments for the hospitals that had adopted its recommendations. An increasing number of hospitals qualified to receive the nursing bonus, and by 1888 the fund’s managers considered that the nursing arrangements in all participating hospitals had met its standards. The influence on hospital managers was reflected in comments made by Justice Fitzgibbon, a governor of the City of Dublin Hospital, Baggot Street, in 1887:

‘In the case of the City of Dublin Hospital, the adoption by the Board of the present system of nursing was no doubt influenced by their desire to obtain a larger share in the distribution of that fund [the Hospital Sunday Fund] by effecting improvements in a branch of their administration in which they had been found deficient’.

Indeed, despite many factors limiting the Dublin fund’s influence, it remained more interested in reform than some of its counterparts. For example, in 1885 the London fund had declared that ‘matters relating to the internal administration of hospitals are beyond the jurisdiction of the Hospital Sunday Fund’. The Dublin fund, for all its problems, proved to be more ambitious.

Joe Curran is an Irish Research Council Government of Ireland postdoctoral fellow at Trinity College, Dublin.

Further reading

M. Daly, ‘Catholic Dublin: the public expression in the age of Paul Cullen’, in D. Keogh & A. McDonnell (eds), Cardinal Paul Cullen and his world (Dublin & Portland, 2011).

G. Fealy, A history of apprenticeship nurse training in Ireland (London & New York, 2006).

K. Waddington, Charity and the London hospitals, 1850–1898 (Woodbridge & Rochester, 2000).