Open Wards and Tuberculosis

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Open Air Wards

‘At first it was thought that the patients would not like it, especially in the winter time, but this was found not to be the case, and during both winter and summer there is keen competition for a bed in the open-air ward.’

Kirkpatrick (1924), History of Dr Steevens’ Hospital, p. 321.

Photograph of the Open Air Ward c. 1924 (from Kirkpatrick’s History).

This image of an open air ward at Dr Steevens’ hospital dates from the early twentieth century. The proposal to develop an open air ward came from one of the hospital’s leading orthopaedic surgeons, Robert Lafayette Swan (1843-1916), who was a keen advocate of the importance of fresh air in a patient’s recovery. Swan practised what he preached for, as his colleague Kirkpatrick recounts, ‘for many years at his house in the country he had slept in an open shed in his garden’. In 1910 Swan persuaded the Governors of the Hospital to set up an open air ward on the south side of the hospital which could accommodate ten patients.

Swan’s career intersected with Dr Steevens’ Hospital in a number of ways: he had initially entered the hospital as a pupil in the Medical School (in 1859) and had subsequently been awarded the Senior Cusack Medal for his studies. The hospital officials were evidently keen to keep the brilliant young doctor at Dr Steevens’ and by 1867 he had been appointed to the position of resident surgeon there. In 1873 he became lecturer on descriptive anatomy in the medical school and by 1891 he was visiting surgeon to Dr Steevens’ Hospital. By the time of his death in 1916 he was recognised as a leading orthopaedic surgeon, not only of Dr Steevens’ Hospital but of the city of Dublin.

Swan’s plan for an open air ward was perhaps more radical than the variations available elsewhere. However, as Casey (1984) notes, the concept of an open air veranda was accepted by other Dublin hospitals in the later nineteenth century: by 1879 Jervis Street had introduced an airing space for patients while Sir Patrick Dun’s had copied the idea by 1887 and the Meath Hospital followed suit by installing an Open Air veranda in their new 1896 wing.

The Open Air wards at Dr Steevens’ were again put to use in the mid twentieth century. This time it was in the fight against tuberculosis which, as Malcolm and Jones (1999) point out, had been ‘the leading cause of death in nineteenth-century Ireland.’ Thomas Wrigley Grimshaw had been instrumental in drawing attention to the rising epidemic of tuberculosis in nineteenth-century Ireland and had played an important role in subsequent attempts to prevent the spread of tuberculosis (or consumption as it was also known). Usually hospitals such as Dr Steevens’ did their best to avoid cases of pulmonary tuberculosis (given the fear of infection), but exceptions were made for non-pulmonary tuberculosis. This was because tuberculosis of the bones and joints was considered to be less contagious and, it was hoped, might be cured by surgical intervention. It is striking that in the case of the twelve year old Maureen Madden (whose account of her time at Dr Steevens’ Hospital may be found on the fascinating online exhibition: ‘Tuberculosis in Ireland: Children in TB Hospitals in 1950s Dublin’), her tuberculosis was in her spine.

Kirkpatrick, T. P. C. (1924; reprinted 2008) The History of Doctor Steevens’ Hospital Dublin, 1720-1920 (Dublin).
Malcolm, Elizabeth and Jones, Greta (1999), Medicine, Disease and the State in Ireland 1650-1940 (Cork University Press).
Obituary of Robert Lafayette Swan, British Medical Journal Nov 18, 1916; 2 (2916): 706–707.
Tuberculosis in Ireland: Children in TB Hospitals in 1950s Dublin

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