Anatomy of a Dublin hospi­tal dates back to 1703

A new book chron­i­cles the his­tory of St James’s Hospi­tal, which started out as a work­house

The Irish Times - Tuesday - Health - - Health History - Dr Muiris Hous­ton

Ifirst walked the wards of St James’s Hospi­tal in April 1983. It was a big mo­ment for our small group of med­i­cal stu­dents. Up to that point, our teach­ing had been based in lab­o­ra­tory and lec­ture the­atres; now we were to see real pa­tients for the first time.

The TCD med­i­cal school build­ing was an un­pre­pos­sess­ing pre­fab, but one with a cu­ri­ously wel­com­ing in­te­rior. In fact, all of St James’s had a wel­com­ing air. It was if the egal­i­tar­ian prin­ci­ples upon which the hospi­tal was founded were em­bed­ded in the stone walls, seep­ing out to im­bue new ar­rivals with a friendly “can-do” op­ti­mism.

Davis and Mary Coak­ley out­line the early be­gin­nings of the hospi­tal – just a decade ear­lier – in their new book, The His­tory and Her­itage of St James’s Hospi­tal, Dublin. “At the time of its es­tab­lish­ment in 1971, there were 1,270 beds in St James’s. These were housed in seven dis­tinct hospi­tal build­ings on a 60-acre site. Most of the build­ings were old and sep­a­rated from each other by open spa­ces con­tain­ing fine trees . . . Dur­ing the bleak win­ter days it was far from an ideal ar­range­ment as staff hur­ried be­tween build­ings and pa­tients were fer­ried around the site in am­bu­lances for dif­fer­ent pro­ce­dures.”

Cold win­ter nights weren’t much fun ei­ther. As an in­tern (first year post-qual­i­fi­ca­tion), nightly on-call for­ays from the doc­tors’ res­i­dence to the wards or to the ca­su­alty depart­ment while frozen to the bone made you wish for a more in­te­grated hospi­tal.

In fact, I was an in­tern to one of the book’s au­thors in the mid-1980s. Davis Coak­ley was a consultant physi­cian in geri­atric medicine in St James’s and pro­fes­sor of med­i­cal geron­tol­ogy in Trin­ity Col­lege Dublin. As well as beds for acutely ill older pa­tients, he and his consultant col­leagues looked af­ter pa­tients in the long-stay units – peo­ple who could no longer man­age to live in­de­pen­dently in the com­mu­nity. It was a busy job.


I have two stand­out mem­o­ries: one was the Fe­bru­ary week­end when I thought the grim reaper was on call with me. A flu out­break had hit the long-stay wards; by the time Sun­day night came I think I had cer­ti­fied about 10 pa­tients dead and had done my best to com­fort rel­a­tives of the de­ceased.

And then there was the night I ad­mit­ted an older man with a se­vere case of the DTs (delir­ium tremens). He proved re­sis­tant to the usual treat­ment: the only way to calm him down was to give him a con­tin­u­ous IV dose of a much older and less pre­cise med­i­ca­tion. In the days be­fore pro­gram­mable pumps, this ne­ces­si­tated me sit­ting be­side him for the re­main­der of the night with my thumb del­i­cately placed over the giv­ing set, minutely ad­just­ing the dose so that the pa­tient didn’t ex­pire from res­pi­ra­tory de­pres­sion (too much) or climb through the sec­ond floor win­dow to get away from his demons (too lit­tle).

But the his­tory of St James’s stretches back to 1703, when an act was passed to build a work­house on its site. Just un­der 30 years later a foundling hospi­tal was added to the work­house.

When the Dublin Foundling Hospi­tal was closed in 1829, the build­ings were used to house the South Dublin Union Work­house. The work­house played a cru­cial role dur­ing the Great Famine, giv­ing shel­ter to thou­sands of starv­ing peo­ple. The build­ings of the work­house were com­man­deered by the 4th Bat­tal­ion of the Ir­ish Vol­un­teers dur­ing Easter Week 1916. Af­ter In­de­pen­dence the South Dublin Union was re­named St Kevin’s Hospi­tal and be­came a mu­nic­i­pal hospi­tal for the poor of the city.

In 1971 three of the old­est vol­un­tary hospi­tals in Dublin – Mercer’s, Sir Pa­trick Dun’s and Bag­got Street hospi­tals, amal­ga­mated with St Kevin’s to form St James’s Hospi­tal. Over a very short pe­riod of time St James’s be­came the largest teach­ing hospi­tal in Ire­land.

It is now a fine in­sti­tu­tion. The Coak­leys have writ­ten a com­pre­hen­sive his­tory of how this came about, and en­gag­ingly out­line its her­itage. Their book would make a wel­come gift for his­to­ri­ans and health pro­fes­sion­als.

The His­tory and Her­itage of St James’s Hospi­tal, Dublin, by Davis and Mary Coak­ley (Four Courts Press) is¤36.

The vaults of the foundling hospi­tal on the site of St James’s Hospi­tal in Dublin.

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