In Georgian Dublin, going into hospital was signing a death warrant - which is why it was usually the poor who did so, writes Eileen Battersby

No one wants to be a patient in a hospital. At present, to enter a hospital in this State is akin to asking to be neglected, abandoned and humiliated, through no fault of the staff. The Irish medical system is a mess, to such an extent that when a newspaper described a woman waiting for a long-deferred operation as being "condemned to death", no one could dispute it.

Yet for all the current horrors, there is little comfort to be had from looking at the way it used to be. According to Gary Boyd, in his shockingly graphic yet hugely entertaining account of the efforts to establish hospitals in Georgian Dublin, anyone entering a hospital in Ireland up until the end of the 19th century (and in the light of the present day, beyond that), was signing their own death warrant. Only the poor went to hospital, where they were at the mercy of whoever attended them. The wealthy took their chances at home in their own beds, being treated by their physicians.

Boyd, a lecturer in the School of Architecture at University College Dublin, has looked beyond the architectural splendour of Georgian Dublin in the fourth volume in the series, The Making of Dublin City.

Despite the beautiful buildings, the elegant streets and the perceived grandeur of life as lived by the Ascendancy in a city that was hailed as an endorsement of empire, the fact remains that the pleasure of the few was built upon the suffering of the many.

The underbelly of 18th-century Dublin seethed with prostitution, infant mortality, syphilis and, above all, the desperate, doomed poor. The expansion of the great estates forced farmers and their families out of the countryside and into the city slums.

Young girls and women frequenting the pleasure gardens often ended up diseased, pregnant or, in many cases, dead. Childbirth mortality or complications arising from sexually transmitted diseases secured their release from further suffering, but they left behind a large contingent of orphaned infants; hence the pressing need for the Dublin Foundling Hospital opened early in the 18th century.

Bright and early on June 4th 1751, one of Ireland's many unsung heroes, Bartholomew Mosse (1712-59), surgeon, male midwife and resourceful entertainment impresario, greeted a group of city dignitaries, including the lord mayor, who had crossed the Liffey to watch the laying of the Rotunda Hospital's foundation stone across the road from the New Pleasure Gardens in Great Britain Street (now Parnell Street).

Mosse was the founder of the Lying-in Hospital, which he had opened on March 15th 1745 in a rented house in George's Lane (now South Great George's Street) and which was the first maternity hospital in the British Isles.

The timing of the Rotunda ceremony was deliberate. It was the birthday of the then Prince of Wales, later to be King George III. Mosse was the host and provided his visitors with a fine breakfast, followed by "genteel and liberal entertainments." He knew what he was doing. Boyd quotes Mosse whispering to a colleague that he was only worth £500, whereas the new hospital (designed by Richard Cassels) would cost £20,000 to build.

The ironies are multiple: the Rotunda Hospital would be built cheek by jowl with the Pleasure Gardens, and many a pregnancy begun there would conclude in Mosse's new hospital, which finally opened in 1757. It was financed in part from the proceeds of the Pleasure Gardens and of other entertainment ventures.

Though the hospital was purpose-built for a practical function, its Palladian style offered an aesthetic dimension, gracing an area of elegant residences. But the background to the hospital's creation is a story of absolute squalor.

Previously, hospitals were often established in domestic premises and were very small. The Charitable Infirmary founded in Cook Street in 1718 only had four beds, as Boyd points out. Hospitals also tended to relocate from time to time.

In contrast, Dr Steevens's Hospital, Mercer's Hospital and St Patrick's Hospital were purpose-built and designed by architects. They were built without complications, courtesy of legacies bequeathed by single benefactors and administered by committees.

Boyd's colourful narrative doubles as atmospheric social history and makes effective use of the sources of the day, including the Rotunda's records, prints and drawings and accounts such as one midwife's story: "The uterus still gave way before my hand and retreated quite up into the belly as it were. I could not imagine how this should happen - till I had brought away everything, on putting up my hand I found the uterus fairly torn from the vagina at the back part."

In many instances the women, so often single mothers, are treated as livestock by male midwives. And it is the women, both those giving birth and the prostitutes scouring Monto, the red-light district, for work, who emerge as heroes and victims of Boyd's book - along, of course, with Mosse, who died destitute and misunderstood at the age of 47.

It was Mosse who initiated a revolution in obstetric care. More than a century after his death, Sir William Wilde, himself a medical innovator, would hail his achievement. Almost 300 years on, in the wake of the Dr Michael Neary revelations, we must still ask why giving birth leaves women so vulnerable?

Dublin 1745-1922: Hospitals, Spectacle & Vice, by Gary A Boyd, is published by Four Courts Press, €19.95 paperback, €45 hardback