ON 15 November 2016 John McDonough, Director of the National Archives of Ireland, launched the recently completed Survey of Hospital Records in Ireland at the Royal College of Physicians.
The survey, which was funded by the Wellcome Trust, provides details of the extant public hospital archive for each county from the eighteenth century up to the foundation of the Regional Health Boards in 1970.
Senior Archivist Brian Donnelly, who was primarily responsible for the survey, uncovered a wealth of extant materials, ranging from 3D objects to hospital registers and personnel files.
These materials have survived by chance in some instances, but primarily through the intervention of local champions and hospital administrators who recognised their value and found some out-of-the-way place to store them over the years.
While such measures have safeguarded some of our medical heritage, sadly much has been lost.
Historical hospital records can be classified as medical or mental health archives and date from the early eighteenth century.
The former constitute the most substantial body of records and have their origins in the 1851 Medical Charities Act, which placed medical care for the poor under the remit of the Poor Law.
Services were made available in over 700 dispensary districts and in workhouse or union hospitals, so the records have enormous local, genealogical and medical research value.
Services for the treatment of mental illness gradually expanded following a parliamentary inquiry in 1804, and the foundation of the Richmond (Grangegorman) Asylum in 1814 marked the beginning of a wave of public asylum building.
Asylums and union hospitals were imposing architectural structures that changed the contours of their respective physical and socio-cultural landscapes and both had profound impacts on the Irish psyche.
Following the Report of the Commission on the Relief of the Sick and Destitute Poor including the Insane Poor in 1927 union hospitals became county homes or county hospitals depending on their location and state of repair.
Asylums continued to provide mental health services but were beatified by the Saorstát; the Connaught Asylum in Ballinasloe became St Bridgit’s, Killarney became St Finan’s, and so on.
What these records can tell us about the history of social class, attitudes towards the body, gender, power and mental health is really quite profound.
In the 1970s and the 1980s administrative changes under the regional health boards heralded significant changes and in that process several bodies of records were lost.
Some of the old workhouses were razed to the ground; for example, the former workhouse in Tralee (which was renamed St Catherine’s under the Saorstát) was replaced by Tralee General Hospital.
Continuity in staffing and the nature of psychiatric care has ensured the survival of most nineteenth-century mental health records and their transfer to appropriate archival care.
But the vista for medical records is grim, dispensary records in particular have had a very uneven survival rate, and several bodies of extant hospital records still occupy that out-of- the-way room.
In other jurisdictions historical records have a clear statutory identity. Historical Irish medical records fall outside current legislation and are mainly inaccessible to researchers in the medical humanities.
The National Archives Act, 1986, extends to all major government departments except health, which places the archives, data owners, custodians and users in an unusual medico-legal predicament.
For records that have been transferred to an appropriate repository, current access arrangements are ad hoc and for the most part inadequate. Owing to the lack of legal clarity a combination of freedom of information and data protection mechanisms have been used to manage access to records over 100 years old.
In legal terms the 100-year rule applies to census records only but it is used as a best practice mechanism for other data types.
The recently-published General Scheme of the Health Information and Patient Safety Bill contains a number of provisions relating to personal health information of deceased individuals but no legal distinction has been made between historical and modern data.
We call upon Minister Harris and the government to take this opportunity to make legal provision for historical records, to clarify how we can proceed with conservation, preservation and the process of making accessible these fascinating testimonies that have yet to reveal their full value to medico-legal, social, economic and cultural research.