'To Supply the Sick Poor'

'At a numerous and highly influential Meeting of the Nobility, Clergy and Inhabitants' of Carmarthenshire held at the Guildhall, Carmarthen on Saturday 24 October 1846, Sir John Mansel, Bart., High Sheriff in the chair, unanimous expression was given to the view that 'the want of a Public Infirmary to supply the sick poor with gratuitous Medical advice on Surgical treatment has been long and grievously felt in this Town and County'. It was further felt that this want, already urgent, would be aggravated by 'the increased number of casualties which may naturally be expected to occur' during the prosecution of 'the Great Public works about to be commenced in this county'.

This meeting was the first step towards the foundation of the Carmarthen Infirmary, and then on the proposition of D. A. Saunders Davies, Esq. M.P., seconded by David Morris Esq. M.P. it was unanimously carried — "That an Institution which in other counties has proved under the Divine Blessing eminently successful in mitigating human misery and corporal sufferings, is imperatively demanded by the wants of this County and Town, and that a benevolent project, fraught with such prospective advantages to the cause of suffering humanity, specially commends itself to the sympathy and cooperation of the Ministers of Religion of every denomination and they are hereby earnestly requested to extend their utmost influence in their various localities and respective spheres of labour to promote the humane objects of this meeting". In the subsequent discussion it was stated — "That it is a duty incumbent on everyone whom God has blessed with the means, and especially on the great landed proprietors, to contribute to the Building of the Projected Infirmary". Subscriptions of £20 per annum to the Building and Endowment Fund secured membership of the committee and the medical practitioners of the town and county of Carmarthen were thanked "for the kind and liberal tender of their gratuitous professional services when the Infirmary is opened for the reception of Patients". Various suggestions were put forward for the acquisition of a suitable building including the Carmarthen Barracks, but matters were left to the General Meeting on 7 July 1847. It was then resolved that the Borough Gaol be converted into a temporary infirmary and the offer of the Town Council to allow its use rent free was accepted. The committee appointed for making alterations to that building comprised — Sir John Mansel, Bart., Daniel Prydderch, Esq., The Ven. Archdeacon of St. Davids, Thomas Charles Morris and William Morris the Bankers, the Mayor of Carmarthen Wm. George Thomas, Mr. Lewis Morris and the Rev. D, A. Williams as well as the "medical gentlemen" resident in the town. Following an inspection by the sub-committee it was resolved to reduce the height of the walls surrounding the Borough Gaol and the Town Council gave permission for fixtures to be removed on termination of occupation. Rules were made up and printed — "Rules of the County and County of the Borough of Carmarthen Infirmary". Mr. John W. White, Chemist and Druggist, Guildhall Square, was appointed Secretary and circulars requesting subscriptions were sent out. Over three hundred persons responded from Carmarthenshire and beyond. According to the rules unanimously adopted by the general meeting any person making a single donation of fifty guineas "shall be eligible to serve as President of the Institution for life; or subscribing annually the sum of Ten Pounds, shall be eligible to serve as President during the continuance of such subscription. That any person making a single donation of Ten Guineas shall be a Governor for life; or subscribing annually One Guinea shall be a Governor during the continuance of such subscription".

The officers of the Institution consisted of at least two physicians, two surgeons, a resident surgeon and apothecary, a treasurer and secretary. The general committee of the Presidents, Vice-Presidents and Governors was to be held on the Friday of the April Sessions, at which meeting a House Committee of twenty one Governors was to be appointed for the following year. The latter was to meet at the Infirmary every Tuesday at 11 o'clock a.m. with powers to examine and discharge tradesmen's accounts, for regulating the admission and discharge of patients and to deal with the administration of the Infirmary generally. With regard to the finances of the Infirmary no part of the Permanent Capital invested by the Trustees was to be sold unless four fifths in number of the Presidents, Vice-Presidents and Governors for life authorised such a transaction. All sums of money belonging to the Institution except annual subscriptions and other sums in the hands of the Treasurer were to be laid out upon good security, and the income used for the purposes of the Institution.

According to Rule 17 the Secretary was to solicit the Vicar of St. Peters, the several clergymen and ministers of the different Meeting Houses for religious worship in the town and county, to preach a sermon once in each year, and use their best endeavours with their congregations to promote collections for the benefit of the Institution.

Every clergyman or Minister was thereby entitled to the same power of recommending Patients for admission as private individuals subscribing the same amount, and of voting at all meetings of the governors. But no person was allowed to vote whose name had not been upon the books and his subscription paid for the same, at least three calendar months.

Persons wishing to visit their friends were not allowed to enter the Wards without the permission of the House Surgeon or the Physician and Surgeon attending the patient. And amongst the numerous duties of the Physicians and Surgeons was to visit the Dispensary together, every month at least, to examine drugs and medicines, an inventory of which was to be kept by the Secretary. The diet of patients was a matter to he referred to the Medical Staff and "no other provisions or liquors be brought into the House, or given to the Patients, on any pretence whatever". A table of rules and orders relating to the conduct of Patients and servants was to be hung up in each ward. In particular Rule 29 said "That any Officer or Servant who shall give to, or receive from, any Tradesman, Patient or Stranger any fee, reward or gratuity of any kind, directly or indirectly on account of the Institution, and any Patient giving any fee, reward or gratuity to any Officer or Servant shall be liable to instant dismissal; and the friends of Patients are desired not to give any money or make presents to any of the Nurses or Servants".

A register was to be kept by the House Surgeon, with the names of patients with their respective parishes, ages and diseases, times of admission, the names of the recommending governors and the time and cause of discharge.

No person was eligible to the office of Physician who was not bona fide a member of a British University or otherwise legally and properly qualified to fill the post, and the Infirmary Surgeon had to give satisfactory proof that he was a Member of the College of Surgeons of London, Edinburgh or Dublin. The medical cases belonged to the Physicians and the Surgical cases to the care of the surgeons — "and it is left to the gentlemanly candour of both parties to call each other in, to consult on cases requiring it". A second opinion was to be called in, in cases of difficulty, the ordinary hour of dressing the Surgeon's patients be at eleven o'clock daily, and in all cases where differences arose after consultation "the opinion of the majority present shall be binding — and if the votes were equal the physician in medical cases and the surgeon in a surgical case would have the casting vote".

No capital operation was to be performed without a previous consultation, for which the summonses were to be sent out the day before, except in cases of immediate necessity. No person was allowed to witness operations without the consent of the faculty, "...who are requested to make the Institution as available as possible to the Profession, by inviting their medical brethren to see the operations performed, and the most interesting cases admitted into the Institution".

The body of a patient who had died in the House was not to be subject to examination, unless the Physician or Surgeon was present, and only with the express consent of the friends and relatives of the deceased. Rule 43 stipulated "That every Surgeon using the Instruments belonging to the Institution, shall immediately afterwards cause them to be replaced, clean and in proper order in the repository". Again physicians and surgeons were to compile a Pharmacopoeia and, subject to the confirmation of the Committee, a general diet scheme for the use of the Infirmary.

Surgeons had the liberty of bringing two pupils to see the practice of the Institution and be Infirmary pupils. They were to obey the instructions of the House Surgeon and whilst keeping the rules of good behaviour — "shall not conduct themselves disrespectfully or improperly towards any Officer of the House or Matron or any Servant, Nurse, or Patient; they shall not obtrude themselves unnecessarily into any part of the House to which their duties do not lead, such as, the dispensary, kitchen or household apartments". Rule 48 was more specific — "Thev shall not at any time go into the Women's wards unaccompanied by the House Surgeon, or Matron, except in a case of absolute necessity: nor remain at the Infirmary, unless especially ordered to do so, after four o'clock in the afternoon. They shall perform no operations, except the trivial ones of bleeding, extracting teeth etc.". The other pupils of the surgeons were allowed to dress the patients requiring it, to watch operations being performed and become pupils of the House after one year of apprenticeship. If any pupil "forgot himself as to appear in the House when in a state of inebriation", he was to be dismissed instantly, without the possibility of reinstatement on any account.

In addition to the qualifications mentioned earlier the House Surgeon and Apothecary was to be a certificated Apothecary, unmarried and free from the care of a family, and once elected was to continue in the office for five years, was not to practise out of the House, nor be engaged in any other business. His salary was to be £100 per annum and his duties included "the fixing of tickets" over each bed specifying the name and age of the patient, the date of admission, the physician or surgeon by whom attended and the diet prescribed. He was to visit the wards every morning not later than nine o'clock, make up the medicines and keep a diary of his cases, and keep a diet list, order book for instruments, drugs, spirits, brandy or wine for the use of the dispensary. The House Surgeon had to keep a register of in-patients and carried out many other administrative tasks. He was to inspect all the medical and surgical instruments, utensils and articles when brought into the house and — "reject such as are not proper, and use all the means in his power to prevent damage, waste and embezzlement". Gaming was strictly forbidden. Patients, nurses, servants, pupils and apprentices were under the supervision of the House Surgeon. He was to keep letter books — both of letters received and the replies sent.

The House Surgeon was permitted to take two apprentices "whom he shall bind himself to transfer to his successor" — and who were to serve at least five years apprenticeship. Each apprentice was to be provided by his parents or guardians with board, washing and lodging, and had to pay a premium of not less than £50 to the funds of the Infirmary, with an addition of £30 to the House Surgeon at the time of executing the articles, and a further sum of £20 also to the House Surgeon at the expiration of his apprenticeship.

Rules 71 - 104 relate to the admission and discharge of patients. No patients were to be "admitted or assisted with advice, medicine or bath, who are able to assist themselves, or pay for the relief afforded them". Patients were only admitted on the recommendation of a President, Vice-President or Governor (except in urgent cases). Every subscriber of one guinea annually was to be entitled to have three out-door patients constantly on the books, and every subscriber of two guineas annually was to be entitled to recommend one indoor patient in the year, and three out-door patients constantly on the books — and so on — "so that every subscriber of ten guineas annually shall be entitled to recommend four in-door patients in the year, and out-door patients without limitation". In varying degrees these privileges were extended to — the physicians and surgeons of the Carmarthen Infirmary, the Head Officer of any parish or district or of any society or public company subscribing or making a donation to the Infirmary. Preference was always to be given to the cases of the greatest urgency, and if a patient, within a period of two months, did not receive positive benefit, he was to be discharged. Rule 90 stipulated — "That no woman big with child, no persons disordered in their senses, or who have the small pox, epilepsy, itch, or any infectious distemper nor any person who is apprehended to be in a dying state or consumptive state, or who may receive equal benefit as Out-patients, shall be admitted, or permitted to continue as in-patients".

According to Rule 91 — "All persons admitted as In-patients must bring at least two shirts or shifts; and if they live at distant places, the persons recommending are requested to send before hand, directed to the Secretary, (post paid) a short statement of their case, drawn up by their medical attendant, in order that some judgement may be formed whether they are proper objects for the charity, and that an answer may be returned when they can be admitted, but the House Committee are to be at full liberty to reject such patients if it shall appear that their cases have been misrepresented. And all persons recommending a patient were to 'deposit with the Secretary One Guinea as a Security for the expense of the funeral, if the Patient die, and of his journey home if cured'.

No in-patient was to leave the Infirmary without leave of the Physician or Surgeon, nor sleep out of the Hospital. They were not to swear, use abusive language, or behave themselves indecently in any other way, on pain of expulsion. Playing cards, dicing or smoking were not allowed. Such patients as were able to work to assist the matron, nurse or other servant were to nurse the other patients, washing and ironing the linen, washing and cleaning the wards. No patient was to be out of bed after 8 p.m. in winter nor after 9 p.m. in Summer; all patients who were allowed to quit their beds were to rise by seven o'clock in Summer and eight in Winter.

Any patient who did not exactly conform to the rules was in danger of being discharged under disgrace, and such irregularity would render them "incapable of future admission to the benefits of this charity". The number of Patients discharged cured during the preceeding month was to be delivered to the Vicar of Carmarthen, with a request for him on the first Sunday in each month to return thanks on behalf of those who so desired. Similarily patients of other religious persuasions should, on their recovery, return thanks in their respective places of worship. Out patients who attended at the Infirmary for advice, medicine and bath, were to attend punctually at the time appointed by the medical officers; and no fresh medicines were to be given to them until they returned all phials, gallipots and other things suppled with.

Lastly rules 105 - 108 govern the duties and responsibilities of the matron, nurses and servants. The matron was to be unmarried and between the ages of 30 and 60, and without the care of a family. In keeping an inventory of all the goods brought into the House — she was to weigh and measure all provisions, keep an account thereof, receive no article without a bill or parcels without the price affixed. She was to visit the wards in the morning, dinner time and in the evening, and see that the wards and other apartments together with the beds, clothes, linen etc were neat and clean, and that no sand be used. The matron distributed the provisions according to the Diet table; kept all the keys of the House and supervised all the staff, reporting cases of misbehaviour to the House Committee; seeing to it that the doors were locked at nine o'clock at night and opened at seven o'clock in the morning.

Nurses and servants were — to obey the House Surgeon, Matron and their superiors generally, to be diligent and attentive to the wants of the patients, and show neither partially nor ill will towards any of them. Wards were to be cleaned by them before seven in the Summer and eight in Winter. No items of foul bed linen or bed clothes were to be kept or to remain in the wards, but had to be taken immediately to the wash house. Every Friday morning the respective wards were to be scoured with soap and warm water or lees. Moreover nurses and servants were to adopt every means in their power to promote cleanliness in the person of the patients, and ventilation in the wards as well as punctually administering the medicines according to directions. Any nurse or servant disobeying any order they received from their superiors or neglected their duties would he immediately discharged.

These rules were printed and published by J. White, Printer, Carmarthen and circulated to subscribers by the police.

At a meeting of the general committee held on 15 July 1847 it was decided to prepare for two sick wards and room for twelve in-patients, accomodation for the House Surgeon and the 'usual offices'. The first trustees of the foundation were the Lord Bishop of St. Davids, the Rt. Hon. Geo. Rice Trevor, David Saunders Davies, Esq M.P., William Morris, Esq., and Daniel Prydderch. The first house committee consisted of -

Capt. Philipps,
John Lloyd Price, Esq,
Colonel Love,
W. Owen Price, Esq.,
Capt. J. Bankes Davies,

and Messrs. - E. H. Stacey, W. G. Thomas, Job Jones, W. Gwynne, J. Rowlands, Lewis Morris, George Davies, Wm. Carver, Wm. Norton, Charles Brigstocke, John Lewis Philipps and the Revs. Archdeacon Bevan and D. A. Williams.

From now on the house committee met every week and decided on matters of policy and needs of the new Infirmary. Mr. Collard's tender was received for altering the Gaol and the supervision of carpenters, masons and labourers. A window in the Surgery was to be inserted as being 'absolutely necessary' and on the outside of the building a board was put up inscribed with the words "County and County of the Borough of Carmarthen Infirmary, supported by Voluntary Contribution". The clerk Mr. White was paid one guinea for writing out a fair copy of the rules and regulations, and the whole of the building was whitewashed and coloured and essential repairs made to the roof.

In due course the following basic equipment was provided — 6 iron bedsteads, 2 pairs sheets each, blankets, quilts, 5 chairs and a table for each of the rooms in the back wards; for the matron's room a tent bedstead with bed, bed clothes, oak drawers table, chairs, washstand and ware and bedside carpet. For the House Surgeon's room similar items were ordered — "with a little extra carpet", while an iron bedstead was to be got for 'the surgery boy' with other furniture as in the patients rooms.

On 14 September 1847 it was agreed to advertise in the local press for a House Surgeon and Matron, the 'house' was to be thoroughly cleaned and washed out, while the following sums of money were allocated — £200 for furniture, £100 for medicines, bottles, fixtures for dispensing including water pipes, a washing trough and stone, £100 for surgical instruments, splints etc. and a sum 'not exceeding £4' for painting windows and doors in the Infirmary.

By the Autumn of 1847 work was proceeding well on the conversion of the Borough Gaol with "comfortable wards and compartments for the relief of the sick poor". The finances were such that the treasurer purchased £1500 worth of India Bonds — £1000 of which were to be the permanent capital of the institution. For the first year of its existence £500 was earmarked for running expenditure. It was felt that the post of House Surgeon should be advertised in The Welshman, Carmarthen Journal, Lancet, Medical Times, Medical Gazette, Bristol Mercury and The Guardian. The Matron's salary was fixed at £20 a year, and she was to be assisted by two nurses earning respectively £12 and £10 a year.

As the committee was inexperienced in administering a hospital the secretary was requested to write to his counterpart at the Swansea Infirmary to ascertain such matters as — the length and breadth of patients iron bedsteads, their cost and where they could be obtained from. Other items of equipment were obtained and comprised — 16 pairs of sheets @ 2/4d per pair, 8 do. @ 2/8d, 16 counterpanes @ 3/4 ea. from Messrs. Davies, Bros., 48 yards of towelling (patterns to be submitted to the next committee meeting) 1 table for each ward 6' x 2½', 2 benches the same length as the tables, 1 night chair for each bed, 6 pewter urinals, 1 towel horse for each ward, 12 jack towels, 2 large folding screens lined with green serge, 4 wash hand basins and ewers, 4 soap pans, 1 large kitchen table, 1 bench, 1 small table, a shelf over the fire place in the kitchen, 1 kitchen fender and fire irons, 1 covered roasting apparatus, 1 boiler, 1 set iron saucepans, 1 iron fountain about 4 gallons, 4 hanging lamps for each ward, 6 iron candle sticks, 6 brass upright candle sticks, 6 bed chambers, 10 candles with extinguishers, 4 common iron fenders for each ward with fire irons, 2 doz. iron table spoons, 2 doz. plated tea spoons, 2 doz. tin pannikins, 2 doz. knives and forks, 1 pair of carvers and steel, 1 meat saw, 1 cleaver, 1 grid iron, 1 paste board, 1 chopping block, 1 frying pan, 1 warming pan, 3 pairs snuffers, 1 bellows, 6 smoothing irons, 3 tin jugs, 1 knife box, salt box, 1. rolling pin, 4 washing tubs, 2 pails, 1 large rope mat.

The Matron's room was to be furnished with — 1 common Pembroke table with drawer, a fender and fire irons, 1 ink stand, 1 writing desk, while the servant bedrooms had in them 2 flock beds, 1 table and chamber utensils. Most of these items were obtained locally from Mr. Bagnall's and Mr. Edward Jones' "commercial establishments". For the outside yard the following items were deemed necessary — 1 coal hammer, 1 shovel, 2 sweeping brushes, 1 hand brush and 3 brooms.

By the end of 1847 the new establishment was taking shape — "the whole of the chimney was swept", in the dispensary, counters, drawers and shelves were painted by Mr. Brigstocke. Messrs. Joshua and John Evans' tender to make 3 iron bedsteads at 20/- ea. was accepted, with another tender for 3 iron bedsteads with a curtain @ 24/-ea.

The post of Infirmary porter at a salary of £10 per annum was advertised — the successful candidate was to be "without incumbrance" and in addition to his salary was to have "rations of the house". On 30 November 1847 Thomas Jones of Llanboidy was appointed to the post — "subject to his testimonials, which he must produce, being approved"; and in the same meeting the committee decided that 8 windsor chairs left in the Infirmary by Jones, the gaoler be purchased of him at the price asked, namely, £1.15.0. Jones had acted as temporary porter and was paid £3 for his services, and Price the late gardener at the gaol was prepared to sell the committee a feather bed which he no longer wanted.

In order that the Infirmary could be opened by Christmas Day 1847 the secretary wrote to the Narberth, Llanelly, Llandovery, Carmarthen and Newcastle Emlyn Unions requesting their co-operation and subscriptions. An advertisement in the Carmarthen Journal and Welshman informed the public that the Infirmary would be open for the reception of patients on Christmas Day. And thus with Mrs. Rowlands as matron and Elizabeth Williams as nurse, and Mr. Howell Evans of Cynwil Elfed as House Surgeon the Carmarthen Infirmary was opened. But a great deal needed to be done again before the Infirmary was properly equipped. At the weekly house committees further items were ordered e.g. — linen bandages, tow and wadding from Mr. Hughes, pillow cases, table cloths, house flannel, rollers blinds and an ironing blanket from Mr. Stacey; cupboards were installed in the consulting room and pantry — and following replies from the Swansea Infirmary the Swansea Diet Table was adopted at Carmarthen.

From the Infirmary minutes little information is available about the scientific and technical apparatus of these early days. There are however a few sparse refrences e.g. — Grays Supplement to the Pharmacopoeia and Phillips' Translation of the London Pharmacopoeia were ordered from Mr. Spurrell, a tin stomach bath was supplied by Mr. Williams for £4.0.0, Mr. Jenkins, the surgeon made a present of an "Instrument for Restoring Suspended Animation", surgical instruments costing £15 came from Messrs. Evans & Co., Old Change, London, the dispensary was fitted with a pill machine, medicines came from the Apothecaries Hall, London, Thomas Charles Morris, Esq., added to the literary a copy of Munro's "The Nervous System". But it was in June 1850 that it was decided "that 4 thermometers be procured as soon as possible". In November 1850 a Galvanic Battery (repaired at a cost of 12/- two years later) was obtained and in the following month £10.3.10 was spent on an "electric machine". Sometimes expense was avoided when gifts were made e.g. a Mrs. Griffiths made a present of 2 cases of surgical instruments.

In April 1851 the "medical gentlemen" were asked about the advisability of purchasing a "vapour bath", and five pairs of crutches of various sizes were authorised by the Committee. Later on a "hydrostatic bed" costing £9.0.0 was ordered from Messrs. Spencer and Co., and a set of pulleys for dislocation were obtained. Although the members of the house committee were laymen, every item of expenditure had to be approved by them e.g. on 5 May 1852 they refused to pay for certain text books, viz. Coopers' First Lines in Surgery and Graham's Chemistry, Vol. I. In May 1855 it was reported that the "water bed" leaked, and from what the porter said it had never been water tight, but a solution was found to the problem when a quantity of oil cloth was bought for the house surgeon to make the necessary repairs.

As has been seen from the summary of the rules of the infirmary the day to day administration of the Infirmary was carried out by the medical and other staff subject to the approval of the house committee which met every week. The year's progress was reported to the annual general meeting who could authorise any major departures in policy. As far as one can make out those attending the annual general meeting acted as a rubber stamp to what had been carried out during the year. The agenda invariably was the same over the years — the appointment of a house committee, formal thanks to Archdeacon Bevan for his attention to the spiritual wants of the inmates, thanks to the medical officers for their "indefatigable services". Gratitude was expressed to clergy and dissenting ministers who had advocated the interests of the — "Institution and promoted congregational collections in aid of its funds". And in April 1849 special mention was made to those ladies — "who so kindly and zealously promoted the Bazaar for the benefit of the Infirmary and carried out so beneficial a result", whilst the thanks of the meeting was offered to "those Noblemen and Gentlemen whose exertions and liberal subscriptions were the means of founding the Infirmary which has already been productive of so much benefit to the sick poor" — and the medical officers of the town were also praised for "rendering their gratuitous and valuable services" for the same cause. In April 1851 an earnest appeal was made — "to those gentlemen connected by property with this town and who have not contributed to the Funds". The treasurers Messrs. Morris the Bankers took a prominent part in guiding the slender financial resources of the Infirmary and their expertise was invaluable. Usually the meetings ended with thanks to Sir John Mansel, Bart., "for his able conduct of the chair". This pattern was followed without a break.

But the daily problems of the Infirmary are best illustrated by the minutes of the weekly House Committees, (except on 15 November 1849 there was no meeting of the Committee as it was "thanks-giving day for the cessation of cholera") and from them one can obtain a closer look at — the patients, the premises, weekly expenses, matters of general discipline and a number of incidental details.

Subscribers to the funds were allowed to nominate the names of deserving cases for treatment, and it was important that subscription did not lapse. Consequently from time to time reminders had to be sent out before the "temporary intake of patients". Recommendations were made by Mr. John Colby of Ffynone, John Johnes of Dolaucothi, David Saunders Davies of Pentre and others. But Thomas Davies, admitted an in-patient on the recommendation of Mr. Colby on 2 November 1855, had left the Infirmary after a stay of 8 months owing to intoxication. In one instance the solicitude of the gentry had been unnecessary as out-patient No. 2169 was recommended to be discharged "it appearing since his admission that his grandfather David Evans of Tirbach has sufficient means to pay for Medical Advice".

In December 1852 a resolution was passed that a "book be kept by the house surgeon in which he shall enter the names of all patients who are relieved during the intervals between each committee meeting....".

An "inventory book" was to be kept giving details of "clothes, money and other effects which the in-patients may have on entering the Infirmary". And in July 1853 the question of admission of patients from "works and mines" was raised. This development would mean that firms and other commercial magnates would subscribe to the Infirmary, and thereby be able to send their workmen to it in the event of an accident. This applied as well to poor law unions and one James Hughes of Llanelli was requested to "attend the Infirmary to be examined by the medical gentlemen ... to determine whether his case be fit for admission according to the rules of the establishment". In fact "all accidents of whatever nature are at all times admissable to this Infirmary" and the secretary was directed to "communicate this resolution to the proprietors of works and to solicit subscriptions to the friends of the Infirmary". At this time there was an increase in the number of applicants for treatment, and so the committee decided that no patients were to be admitted — "to the benefits of the Carmarthen Infirmary without their personal attendance before the Committee and provided that the Committee be satisfied of the fitness of the parties". Out-patients could be visited by the doctor in their own homes under special circumstances and never except at the request of the committee. Thus for example we read the following out-patients being attended to at home — David James, a smith residing in Blue Street, David Lloyd of Priory Street, Rachel Bona in Goose Street, Evan Rees in Pensarn, Sarah Bartlett in Conduit Lane, John Driscoll in Dame Street and Joanna Donoghue in Kidwelly Fach. The increasing demand for attendance by out-patients resulted in instructions to the House Surgeon not to supply medicine or advice except on recommendation of the committee, and in August 1857 the House Surgeon was authorised to visit patients at home in cases of cholera.

Although the Infirmary was a charitable institution, it is interesting to note that to ensure uniformity in the admission of pauper patients, it was ordered that 'in future no pauper in receipt of parochial relief be admitted as an outdoor or indoor patient" unless he was recommended by the clerk of the union to which he belonged. With regard to patients' needs the House Surgeon was requested by the committee to furnish a list of those who were supplied with wine and beer, and the actual quantities given to each for the week. Other patients recommended by various subscribers were more in need of a change-of-air rather than hospital treatment, and following the decision of the general committee in April. 1851 Charlotte Lewis an in-patient was removed for a change-of-air to such a place as Mr. Rowlands one of the surgeons directed. On 14 July 1852 on the proposal of Mr. C. Diggle Williams, seconded by the Rev. Dr. Lloyd it was resolved that ". . . in as much as it is the opinion of the medical gentlemen who have examined John Roberts of Cwmcarnhowell, Llanelly, he is not likely to receive benefit from the Infirmary but that the sea side will be more advantageous to his case". And a fortnight later it was resolved that — "one shilling and sixpence per week for one month be given free to Thomas Morgans from the funds of the Infirmary to assist him in procuring board and lodging at the seaside" and David Evans was given '1/6d per week for one month' for the same purpose. On 22 June 1853 Elizabeth Evans and Maria Williams were discharged, and sent to the seaside, their allowance being 15/- each out of the 'subscription fund made for that purpose'.

The number of patients in the early years averaged about 15 in-patients and about 65 out-patients per week. The duration of each patient's stay was kept constantly under review owing to the demand for beds and treatment. Some concern was expressed in May 1849 when ". . . the committee appointed to examine the average weekly expenditure in the Infirmary for the last twelve months have to report that during the first three months of the term, there was no account kept of the number of inmates in the House in the matron's weekly statement . . .".

There had been dissatisfaction for some time concerning the supply of drugs to patients. It appears that the procedures had been abused, and on 23 October, 1847 the drugs sent by the Apothecaries Hall were to be used carefully, and the House Surgeon was '... particularly instructed not to give advice or supply medicine to patients except on the recommendation of the committee ... and at the request of the medical gentlemen . . . and that the names, and residence of the parties thus recommended be kept by the House Surgeon and placed before the committee'.

There were other problems, too, especially concerning the behaviour of the 'inmates'. Smoking was strictly forbidden '... in any of the Public Rooms of the Institution and no patient was allowed to smoke within the walls of the establishment'.

On 13 December 1854 a complaint was received that someone had been smoking in the men's wards, and the patients were informed that the next culprit committing such a nuisance would be expelled. In January 1855 the matron had complained of the insolent behaviour on the part of the patients, and on being reprimanded for their misconduct 'they expressed their sorrow and promised amendment'. But the smoking habit could not be eradicated easily for Mr. George Bagnall reported in the following month '... a slight smell of stale tobacco smoke perceptible in the wards upstairs' for which the patients had been cautioned. But the warning had been of no avail as John Evans an in-patient had been found guilty of tobacco smoking and had been abusive as well. He was therefore ordered to be discharged forthwith, and the secretary was to inform Miss Lloyd who had recommended his admission. In April 1857 one James Jones was expelled for the same reason, but there was a worse case in October 1858 when Edward Richards was immediately discharged because he was drunk and abusive to the matron.

As we have seen it was the duty of the house committee to meet once a week and a few examples may be given to illustrate matters usually uder discussion. The agenda followed the same pattern -

1. House Surgeon's report, number of patients etc.,
2. The visitors' report for the preceeding week;
3. Nomination of visitors for the following week, and names of new patients submitted.
4. The authorisation of payment of bills for the week -

e.g. 17 May 1849

12 July 1849

13 April 1853
At this meeting the visitors' report was satisfactory, no male or female bed was vacant, the matron was to provide Bed Tick for one of the new rooms, tenders for printing the Report of the Treasurers and Committee were received from Messrs. R. Jones, W. Spurrell and Messrs. White and Son.

The report of the general meeting was advertised in the two Carmarthen newspapers, the expense not to exceed £2.2.0 each. Estimates were requested from three different masons for — whitewashing and colouring the buildings, and the following payments authorised -

29 June 1853

Tenders for supplies were accepted as follows -

Beef @ 5½d per lb.
Mutton @ 6½d per lb.
Sugar @ 4d per lb.
Rice @ 2d per lb.
Soda @ 8/- per cwt.
Treacle @ 20/- per cwt.
Best Soap @ 44/- per cwt.

And since June 1852 the desirability of obtaining stores to the Infirmary by contract had been the committed policy, and printed forms for that purpose were to be procured by the secretary like those already in use at the workhouse. Moreover 100 handbills advertising for the supply of stores by contract were to be distributed by the porter. Not all the foodstuffs received were satisfactory, and on one occasion on 3 May 1854 the matron complained that the tea supplied was not equal to the sample and the secretary communicated with Mr. E. M. Richards requesting him to send tea of a better quality in future. Other matters which may be mentioned include — hanging a bell in the committee room, a wooden rail on the staircase instead of a rope, apothecaries scales were bought costing 6/6d, a pestle and mortar for 4/6d, — 'that a book be procured and placed in the Hall of the Infirmary to be called the Visitors' Book'.

In January 1854 the Rev. Dr. Lloyd gave notice that he would propose a resolution to rescind the order made previously to allow supper to be given to the patients. Eventually he got his way and the patients' meals were breakfast, dinner at 1.30 p.m. and tea at 6.00 p.m. The committee kept a vigilant eye on expenditure and were provided with abstracts of weekly expenditure (see example on following page).

Once a week visitors, being members of the house committee, made a tour of inspection of the Infirmary and interviewed the patients. Their reports were invariably that conditions were satisfactory in the Infirmary. But from time to time there are numerous indications that the premises were inadequate, unhygenic and primitive by accepted standards.

The borough gaol itself was an unsuitable building, and it was as late as 1851 — some years after the Infirmary was opened — that steps were made to have proper ventilation for the wards. Indeed on 25 September 1851 the — 'medical gentlemen having called the attention of the committee to the offensive and unhealthy smell arising from the Public Slaughter House, the committee deem it their duty to represent the matter to the Town Council and earnestly to request that some steps be taken to remedy the evil complained of. The committee feel deeply convinced that the stench which has for some time pervaded the atmosphere throughout the whole neighbourhood of the said slaughter house is most prejudicial to the public health and especially to the inmates of this Infirmary'. This resolution was passed to the Mayor and Council.

A month later Mr. Collard's estimate not exceeding £2.10.0 for ventilating the men's wards was agreed to. Messrs C. Diggle Williams and C. Brigstocke the visitors in the first half of May 1852 observed that the yard was in a dirty state and should be cleaned up, otherwise everything else was satisfactory. On one occasion a visitor, the Rev. H. W. Jones was pleased with everything he had seen, but considered it expedient to divide the male and female wards. The committee acted promptly and on 23 March 1853 — 'The committee for the division of the men's from the women's wards recommend that it be effected by placing an Iron Gate now in the ward across the upper passage, that the gate be kept locked and that the men use the yard to the south and the women that to the north, that the key to the division gate be kept by the Surgeon or Matron, and not on any account be given to the patients'.

At the same meeting it was considered advisable to 'place an ashpit in the yard to receive the cinders to prevent them being carried about the yard'. Moreover the wash house and coal yard were to be whitewashed, and the drain in the yard covered. In January 1855 a rule was made that 'the straw from the patients' beds be carried away by the Scavenger with the ashes instead of being burnt on the premises'. In the summer of 1854 it was observed 'that one of the privies had overflowed' and should be repaired. But the problem persisted, for on 19 September 1855 the committee decided that because the privies were constantly in need of repair, an estimate be requested of the cost of connecting them to the town drains.

It is not surprising that in these conditions epidemics could easily become serious. A contagious disease had broken out in August 1853 and a recommendation was made for 'the immediate dismissal of as many patients as can bear removal ... all the patients except Thomas Owen, Jonah Davies, Ann Davies and Elizabeth Rattenburg'; also that the house be forthwith effectually cleansed and washed under the superintendence of Messrs J. J. Stacey, George Davies, J. Hughes and J. W. White'. And there is further evidence of the bad conditions prevailing in the Infirmary e.g. in October 1853 the Rev. Dr. Lloyd having visited the premises during the previous week reported that— 'the smell in the male ward was so bad that he could not remain a minute in the room'. But the problem continued, and was especially bad because of the — 'offensive exhalation in the room occupied by Thomas Owen only, attributable to the circumstances of the patient drawing his urine'. In future the house surgeon or his pupil was to attend to him as often as was necessary. At the same time it was reported that the 'House was overcrowded' and in January 1854 there was another complaint of — 'a considerable degree of Effluvium in the male ward'.

In Mr. Bagnall's report, 8 February 1854, the 'offensive Effluvium in the male ward from patient Thomas Davies' was brought to the attention of Mr. Rowlands so that he might 'abate the nuisance by the removal of the patient or otherwise as he may recommend'. In March overcrowding was more serious and in the female ward one of the women patients was sleeping with the nurse in consequence of a patient being admitted with an accident.

From its commencement the Infirmary was largely supported by voluntary subscription, and the list of subscribers shows how the initiative came from the landed classes, the clergy and well-to-do business men. But other means were resorted to; for instance, in April 1848, Thomas Charles Morris, the treasurer, proposed at the annual general meeting that the secretary be paid a commission of 5% on the collections of the yearly subscriptions — 'such allowance to commence retrospectively in addition to his yearly salary of £20'. Six hundred copies of the report and two hundred circulars were addressed to the clergy and ministers of the county to make known the purpose and needs of the Infirmary. In July 1848 the Bishop of St. Davids preached a sermon in aid of the institution at St. Peter's Church, Carmarthen, and the committee had it printed at its own expense.

George Chilton, Esq. and Q.C. made a handsome donation of 25 gns. to the funds. Public spirited ladies organised bazaars to help the Infirmary. In April 1849 the Directors of the Talbot Steam Packet, Co. made a liberal offer of a pleasure excursion to Ilfracombe for the benefit of the funds and the sum of £19.4.6 was contributed. In August 1850 the gentlemen of the Dream Boat Club made a 'handsome donation of £6.18.6 to the Infirmary'. In December 1851 Mr. Brinley Richards offered his services at a concert held for the benefit of the Infirmary. The secretary was instructed to write to Mr. Richards to 'insure the pianoforte sent for the concert', the expense to be defrayed by the committee. The concert was a great success and others who took part were the Carmarthen Musical Society conducted by Dr. Westfield, and Messrs. Broadwood and Son were paid £2.17.0 for the carriage, etc of the piano. In August 1852 John Johnes, Esq. of Dolaucothi, was thanked by the committee for his 'liberal donation of twenty pounds (the first fruits of his office of Recorder)' to the Institution. Mrs. Wood of Cwm left a legacy of £500. It was felt that donors should be remembered for their generosity, and on 11 May 1853 the secretary was instructed to procure a board for a list of benefactors to the Infirmary, bearing the title — "A list of bequests to this infirmary". Mr. Isaac Davies, cabinet maker provided a design for this board for £5.10.0 and this included gold lettering, but if it was to be made in mahogany there would be a further charge of £1.1.0.

Sometimes gifts instead of money were received, and second hand items were also acceptable, for example in February 1855 Mrs. Morgan of Alltygog gave a quantity of old linen for the use of the inmates.

In March 1855 £50 was received by the will of Charles Diggle Williams, Esq, the Carmarthen solicitor and former governor of the Infirmary. This sum was invested in Consols, and the committee further resolved that with regard to the investments of the Infirmary the Bishop of St. Davids be asked to prepare a petition in the House of Lords against the Charitable Trusts Bill which would place the real estate or stock in the public funds of charities under the control of the Charity Commissioners.

At a committee held 12 September 1855 an application was made by Mr. Ribbans 'that the junior warden for the time being (in perpetuity) of the Freemason's Lodge of St. Peter's, No. 699 be instituted a Life Governor of the Carmarthen Infirmary on payment of £10.10.0 to the funds of the Institution'.

Lastly, we read that the Rev. Dr. Lloyd gave a public lecture which produced £7.0.0 towards the funds of the Infirmary, also that the old custom of asking prominent clergy, like the Revs. Gwyther Philipps and J. H. A. Phillips, to preach sermons at St. Peter's Church in aid of the institution continued. Appeals for subscriptions were circulated throughout the county, and local ministers and clergy organised collections and this continued until a state hospitals service was introduced after the 1939-1945 war.

From time to time there are references in the minute books to staff appointments and the problems that arose occasionally in connection with them. In October 1847 an advertisement was put in The Lancet, Medical Times and Medical Gazette for the post of House Surgeon. One of the House Surgeons appointed was Mr. Howell Evans of Cynwil Elfed. He suffered a serious illness in March 1850, and the house committee decided 'to procure a person for a few weeks to take his place to allow him leave of absence to remit his health'. In his place a Mr. Owen Robert Owen was temporarily appointed.

On 24 April 1851 it was resolved that 'the House Surgeon be requested not in future to attend any out-patients under any consideration whatever as great inconvenience results from such a practice'. In 1853 we read: 'it having been proved before the committee that the House Surgeon had neglected his duty in not attending a patient who had been burnt and thereby seriously injured, and that he had kept irregular hours and greatly neglected his duty, it is resolved that the secretary give the House Surgeon notice to resign his situation in three months'.

In June 1854 the house committee were compelled 'to investigate the charge of irregularity that had taken place in the Infirmary'. In the spring of 1855 the house surgeon had been absent on two occasions from the Infirmary and the committee had to take action; consequently on 21 February Mr. Howell Evans tendered his resignation, and an advertisement for a successor was published in the two local Carmarthen papers, The Cambrian, Caernarvon Herald, The Times, Bristol Mercury, The Lancet and Medical Times, and also in a conspicuous place in the Apothecaries Hall. When the secretary received applications he was instructed by the committee 'to inform the candidates for the situation of House Surgeon that there was no local candidate and that it will not be necessary to canvass the subscribers but the appointment will be given to the party who is best qualified' and that their personal attendance was not necessary. But before the new House Surgeon was appointed Mr. Howell Evans was again reprimanded for not attending his duties, and his excuse was that 'he had been called away to a case of labour, no other surgeon being in town'.

In the first week in May 1855 the new House Surgeon was appointed — a Mr. George Stratton Symmons — for a term of three years at an annual salary of £100. But within a fortnight of commencing duties he fell foul of the committee and was reprimanded for being absent from the Infirmary from 6.00 p.m. on Saturday until 2.00 p.m. on Monday, attending a patient for a private practictioner. When he was reminded of the rules and conditions of appointment Symmons said they were 'unwarrantable and uncourteous', to which the committee replied that they were neither. And there were other occasions when the House Surgeon had absented himself from duty.

Surgeons and physicians were allowed to have apprentices and pupils, and the surgeon was empowered to give the friends of an apprentice an undertaking to permit him to leave the Infirmary at the end of three years for the purpose of prosecuting his studies at the London or other hospitals. As in the case of other staff, advertisements were put in the local papers. In July 1850 William Jarrett Lewis and Thomas Charles Hughes were admitted pupils of the institution, and in May 1851 Abel Evans was received into the Infirmary on trial with a view to his being apprenticed at the institution. Thomas George Bowen was admitted a pupil in December 1852. A request by Abel Evans to be allowed to leave the Infirmary to continue his studies in London before the three years pupilage were completed, on the understanding that he made up the lost time during vacations, was turned down by the committee. Other apprentices mentioned were Mr. Richard Instance in 1856, and Caleb Gargery a pupil in 1857.

The matron and nurses were recruited locally and, as in the case of the senior medical staff, there were problems of discipline. In April 1849 a nurse was immediately discharged, the matron having made a complaint against her for disobedience, but she was allowed a month's wages in advance.

In May 1849 Charlotte Jenkins was engaged as nurse 'for one month on trial provided her testimonials from Swansea are satisfactory'. We know next to nothing of the qualifications expected of the matron and nurses. When Mrs. Rowlands resigned in January 1850, it was resolved — 'that this committee cannot receive the resignation of Mrs. Rowlands from the office of matron without expressing their satisfaction with the efficient and economical manner in which she has conducted the business of the Infirmary.' In 1854 a notice appeared in the Carmarthen Journal and The Welshman for a nurse 'not under 30 years of age and conversant with the Welsh language'. Her salary was to be £14 per annum with board and lodging.

In addition to the 'medical gentlemen', matron and nurses, there were what may be described as the ancillary staff. A few months after the opening of the Infirmary on Christmas Day 1847 Thomas Williams the porter was given notice to quit and Samuel Evans, late Sergeant in the 61st Regiment, was appointed to replace him. There were three servants, who were allowed two shillings a week for beer, in addition to their wages.

A barber visited the Infirmary twice a week to shave the patients, and during the week ending 30 November 1845 [45? -- ChrisJones^?] he was paid three shillings.

The house porter appointed in October 1851 was John Arthur. He remained in the post until July 1854, and was given £2 in full satisfaction of his wages, £1 being deducted because he did not give the usual month's notice. When the post was advertised, the notice stated that the successful candidate must be 'between 30 and 50 years of age and that an old soldier will be preferred'. As a result John Davies was appointed porter at a salary of £12 a year 'with rations'.

When the post of porter became vacant once more in January 1859 there were three applicants. The committee wished to interview Mr. H. Howell of Newcastle Emlyn if he was unmarried, but he declined. Mr. Joseph Morgan was considered too old at 55 and Thomas Miriam aged 20 was interviewed by the committee. Lastly there are references to a resolution of the committee 'that the matron should have discretionary power to employ assistance every week if necessary to wash clothes', 8 pence per week was allowed for beer for the female servants, and on one occasion when a nurse was ill one of these female servants took over the duties.

For some time there was a feeling that the building of a new infirmary could not be delayed much longer, and on 21 September 1853 a sub-committee comprising Messrs. J. J. Stacey, George Davies, Thomas Charles Morris, George Spurrell, C. Brigstocke and the Rev. D. A. Williams was chosen to ascertain what sites were available for the erection of a new infirmary. It was felt that a field belonging to Capt. Williams seemed suitable; even so the committee refrained from making a hasty decision and it was on 11 October in the following year that '. . . the Ven. Archdeacon Bevan, Mr. T. C. Morris and Mr. E. H. Stacey be requested to wait upon Earl Cawdor, the Lord Lieutenant of the county, during the approaching Quarter Sessions to ascertain from his lordship the intention of the county with regard to the interest of the trustees of the Carmarthen Infirmary in the Barracks'. Negotiations continued for the next few months, it being left to Mr. T. C. Morris to deal with any difficulties with the county magistrates, but without success. Consequently at the Annual General Meeting in April 1855, it was decided to proceed with the building of a new infirmary on a piece of ground in Priory Street as previously recommended, and a special appeal was to be made to the public for subscriptions 'without touching the present capital of the institution'. In April 1856 special thanks were accorded Messrs. Morris, the Bankers, for their exertions on behalf of the Infirmary and the annual general meeting authorised the treasurer (Thomas Charles Morris) to offer the sum of £500 for the ground in Priory Street, 'being the sum at which Mr. Goode valued the property on behalf of the charity commissioners'. On 7 January 1857 a special general meeting of governors and subscribers was held at the 'Town Hall' with the following present -

Earl Cawdor (Chairman)
The Lord Bishop of St. Davids
Sir John Mansel, Bart.
Thomas Charles Morris
William Morris
Rev. D. A. Williams
Dr. Lawrence
Capt. J. G. Philipps
R. Goring Thomas
David Morris, M.P.
George Goode
George Thomas
George Davies
C. Brigstocke
W. G. S. Thomas
George Bagnall
George Spurrell
G. S. Symmons
John Johnes
Ven. Archdeacon Bevan
Rev. T. Warren
J. J. Stacey
E. H. Stacey
J. Hughes
R. M. Davies
John L. Philipps
S. Tardrew
J. J. Walter Philipps J. Rowlands

Plans for the new building were examined and accepted, a building committee was to obtain tenders, but the most pressing matter was the need to increase the number of subscribers. A few of those closely involved with the new infirmary had given their services gratis, such as Mr. George Goode, who had returned £5.5.0 to the funds. In February 1858 the treasurers Messrs. Morris were authorised to sell £700 of India bonds to meet the expenses of the building committee, and shortly afterwards to sell out the capital of the institution as was required.

By April good progress was reported and in July the committee were in a position to thank the Town Council for their interest and help over the years. A letter was sent to the Mayor and Town Councillors of Carmarthen:

Gentlemen,

The House Committee of the Carmarthen Infirmary are happy in being able to state that the New Infirmary having been completed and being fit for occupation the Patients and the whole Infirmary establishment have been removed there and that therefore having now no further need of the old Borough Gaol they beg to restore it for the use of the corporation. The House Committee avail themselves of the present occasion of again expressing the deep sense they entertain of the kindness and liberality of the Town Council in permitting the Institution to have the gratuitous use of the Borough Gaol for a period of more than ten years, this has been the means of affording to the poor of the Borough and County that assistance in the time of their sickness and greatest of need, which has so highly been appreciated by them, and which could not otherwise have been extended to them for a great portion of that time at least, and has materially assisted in the erection and completion of the large and commodious building which is now devoted to their use. The House Committee on this occasion not only express their own sentiments but express those of the Subscribers generally as will be seen by the resolution passed at their last General Meeting a copy of which they beg to enclose. Signed on behalf of the Committee Carmarthenshire Infirmary,

George Spurrell.

July 7 1858.

And thus it was that the new Infirmary came into being. According to the Carmarthen Journal, 'The new building is now occupied having been entered upon several days past. This noiseless event it is hoped is the commencement of a better state of things. The building is situated in a most salubrious and unexceptionable place and the whole premises are everything that could be desired. The committee having admirably performed their part, it only remains for the public to contribute liberally to make this institution what it should be. It cannot for a moment be imagined that any lack of funds will be permitted to prevent the Infirmary doing all the good it is capable of, but that it cannot effect without an increased amount of subscriptions'. A week later it was reported that 'The committee of the Infirmary have made arrangements for a public meeting in the Grand Jury room to devise means to augment the funds of the Institution to that degree which is indispensable if the full benefit of the Infirmary are to be enjoyed by the County'.

House Committee meetings continued to be held once a week and their decisions were very much as before — a wheelbarrow was to be bought, the house female servant was allowed ale at 8d per week, the matron could employ a charwoman once a fortnight to help with the cleaning. Sweeping brushes, stair brushes, pots, pans, an iron bound box with handles for the disposal of ashes, linseed meal, an umbrella stand, a visitors book, a collection box, spittoons, bed pans, hand bidettes were acquired. The over-riding problem was finance, and eminent clergy continued to preach sermons on behalf of the institution, more subscribers were canvassed and from time to time there were generous gestures from prominent people, In October 1858 Sir James Williams, Bart., Edwinsford made ". . . a munificent addition to the income of the Institution by his most liberal appropriation of the game on the Derllis estate for a term of years, such an aid being at the present time of peculiar value because of the pressure on the funds . . .".

In November a letter was received from Messrs. Garaways of Bristol intimating that they were giving about 100 ornamental shrubs for the grounds of the infirmary to be planted by Mr. James Parry, who was paid £2.5.0 for his work together with board and lodging in the Infirmary until the work was completed. The ground at the rear of the building was made into a kitchen garden and in the spring of 1859 garden seeds worth 1/4¼d were bought along with garden posts costing £2.2.7.

For a century the Infirmary continued its work and was supported largely by voluntary effort throughout the county. Local collectors went from house to house for meagre contributions. Prominent public figures served on the house committee, acted as visitors and organised functions to raise funds to meet the rising costs and the demands of more and more people and of more educated medical profession with advanced skills and techniques. After the end of the war in 1945 Parliament passed legislation bringing about a National Health Service and Hospitals as institutions have over the years become more complex. Each year brings an acceleration of new medical knowledge requiring new treatments that were unknown a few years ago. The role of hospitals inevitably changes with the times, but the basic function remains that of the prevention and cure of disease and the amelioration of human suffering. When the Carmarthen Infirmary was founded, it was perhaps not much more efficient than a medieval almshouse — "a public infirmary to supply the sick poor" — yet it was an important milestone towards the kind of modern hospital that has emerged in the last decades of the twentieth century.
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