Wednesday, July 10, 2013

Ancient hospitals - foras tuaithe.

Over a thousand years before Florence Nightingale and health insurance or national health service the ancient Irish had laws dictating hygiene standards for hospitals and persons unable to pay for their treatment were treated free of charge paid for by the community. This sets Ireland apart from the rest of Europe which too had hospitals but only for the élite except in times of war when ordinary men could be treated for war wounds in field hospitals.

Early hospitals were secular and were for the use of the people of the area and were called "foras tuaithe" or ‘House of the territory. These were distinct from monastic hospitals which came into being later.

Water, cleanliness and ventilation were the three main requirements for the foras tuaithe and it had to have four doors open, one to the north, to the south, to the east and to the west ‘so that the invalid may be seen from every side. Water was to be in the form of a stream running through the middle of the floor. The care of the sick could also be carried out in private houses but water, cleanliness and ventilation were still a requirement. The treatment of a sick man could not be carried out in the house of the man who injured him, in a place where the sick man was revolted by its dirty condition or in a place where the sick man felt further injury may be done to him.

People who could afford to pay for treatment were expected to pay but if unable to do so there was a levy put on the district to cover the cost. If the person’s illness/injury was caused by another then that person was liable for all the costs of treatment and maintenance. The Bretha Crólige (Binchy, 1938), a law tract which has been placed in the first half of the eight century gives detailed requirements about the obligations regarding maintenance of the sick and compensation in the event of injury. The cost of maintenance and fees due to the liaig is also carefully laid down. Some people were not allowed be brought away on sick maintenance i.e. a young girl before the age of consent and an old man over the age of eighty eight. In these instances food and treatment had to be brought to their place of abode. The text also tells us that there are three errors in nursing; the error of leaving the victim without food, the error of leaving him without the liaig, and the error of leaving him without a substitute. The problems associated with the latter, namely loss of income is also mentioned in this tract

‘There are seven sick maintenances most difficult to support in Irish law [in the territory]: maintenance of a king, maintenance of a hospitaller, maintenance of a poet , maintenance of an artificer, maintenance of a smith, maintenance of a wise man, maintenance of an embroideress. For it is necessary [to get] somebody to undertake their duties in their stead so that the earnings of each of them may not be lacking in his house’

Boys between the ages of fourteen and twenty were accompanied by their mother and she also stayed with her child if she was still breastfeeding.

Every patient was to be fed according to the directions of the liaig and the basic fare was two properly baked loaves of bread every day plus different condiments depending on the rank of the patient. Unlimited celery was given to patients of every social rank due to its healing properties and garlic was also recommended. Honey is approved of in one part of the text and forbidden in another section. Fish or flesh cured with sea salt and horse salt were generally forbidden but not to the noble grades who were allowed it every day from New Years Eve to the beginning of Lent and then twice a week during the summer.

Fresh meat was to be given to every one but how often is not clarified. Boys and girls between the ages of seven and ten were entitled to the fare they would receive while in fosterage. The Bretha Crólige gives the legal requirements of treatment but not the details of the therapeutic regime. It is highly unlikely that garlic was given to everyone without question as garlic would be injurious to those of choleric temperament (O’Cuin, 1415). There were also many leper hospitals but these were generally connected with the monasteries and such institutions until they were suppressed under Henry VIII.

Extracted from "An overview of the Irish Herbal Tradition. The Thread that could not be Broken" By Rosari Kingston

Image: A modern foras tuaithe - Cork Medical Centre, Cork, Ireland.