By David Durnin
“I was just wasting my time remaining in Ireland. I became very restless. I wanted to get away. Anywhere out of Dublin.”[i]
These were the words of James Abraham, an Irish doctor who received his M.D. from Trinity College, Dublin in 1908. Abraham was one of the many medical men – physicians, general practitioners and surgeons – who left Ireland shortly after graduation to pursue a medical career abroad. Following the outbreak of the First World War, Abraham enlisted in the British Army medical services. He was part of a contingent of approximately 3,000 Irish medical personnel who left Ireland and participated in the conflict.[ii] In the following post, I argue that the First World War temporarily alleviated the overcrowding of the Irish medical profession. However, in the long term, the conflict exacerbated the problem and encouraged the long-term continuation of Irish medical migration.
From the late nineteenth century, middle-class men in Ireland became increasingly attracted to the prestige and potential income associated with medical careers. Therefore, in line with trends evident in other western countries, the numbers of new students entering medical schools throughout Ireland rose to unprecedented levels as the century progressed.[iii] As such, Ireland’s reputation as a centre of medical education developed, and according to historian F.O.C. Meenan,“Dublin was the leading centre of world medicine” for a brief phase in the middle years of the nineteenth century.[iv] While this is debatable, there is no doubt that popularity of medical education in Ireland grew.
By the early twentieth century, Ireland had several medical schools including those that were part of the Catholic University of Ireland, Queen’s Colleges of Belfast, Cork and Galway, the Royal College of Surgeons in Ireland and Trinity College, Dublin. Graduates of these schools found employment in hospital jobs, general practice and poor law posts.[v]
However, there were insufficient opportunities in Ireland to cater for the streams of newly-qualified medics emerging from Ireland’s educational institutions. Consequently, many Irish doctors moved abroad to earn a living.[vi] From 1860 to the middle of the twentieth century, approximately 41% of graduates from Ireland’s medical schools were working abroad.[vii] Among this group were those who secured commissions in the British Army medical services.
Irish doctors had a long tradition of involvement in the British Army but during the First World War medical migration trends were exacerbated and doctors departed from Ireland in greater numbers. On 6 August 1914, Trinity College, Dublin, the Royal College of Surgeons in Ireland and the Apothecaries’ Hall of Ireland launched the first Irish medical recruitment campaign of the war. Through adverts placed in the national newspapers, they publicly requested recently-qualified medical practitioners who were not in permanent employment to send their names and educational qualifications to the institutions’ registrars. These details were forwarded to the War Office, which then offered commissions to the doctors.[viii] The Irish response to the early recruitment campaign was “large and immediate”.[ix] By 1918, following peaks and troughs in the patterns of enlistment, approximately half of Ireland’s medical profession had enlisted into the British Army to serve in the First World War.[x]
This departure of such a large proportion of doctors abroad had a significant impact on civilian medical provision. The Irish medical profession went from a state of severe overcrowding to reporting shortages of doctors in several locations, primarily in rural areas. In November 1917, for example, the Cashel Board of Guardians in County Tipperary complained to the Local Government Board (responsible for sanctioning local medical appointments) that the war had left Fethard district – an area with a population of approximately 4,000 people – without a doctor. As a result, physicians from neighbouring districts had to travel to Fethard to provide medical care. Arrangements like this had been trialled in other counties during the war and proved to be wholly unworkable as doctors complained that the travel requirements were simply too great to provide a satisfactory service. Consequently, newly-qualified Irish medical graduates seized the financial opportunity of this new scarcity and established private practices in areas in need of medical expertise, and secured hospital posts that had been previously oversubscribed and unobtainable. For the duration of the war Ireland’s medical profession was no longer overcrowded, but catered for those emerging from the country’s medical schools who did not wish to migrate.
Following the end of the war and subsequent demobilization, British Army doctors returned to Ireland. However, private practitioners found that new practices had been established in their absence. In the summer of 1919, an anonymous demobilised medic wrote a letter to the British Medical Journal:
I, like the majority of medical officers while serving temporarily in the army or navy, heard on all sides about the great shortage and urgent need for doctors in civilian work. But on being demobilized, I find to my surprise that (I am only speaking for my own town) there is no shortage of doctors at all – on the contrary there is an increase, and yet there are large numbers of medical officers still being retained with the troops, both at home and abroad. Apart from this, there are also those who can never return, having given up their lives for their country, but whose absence should still further increase this shortage. I understand that I am by no means alone in this experience, and that doctors who have served are now finding out on their return that, with only the nucleus of their old practices left, they have to face the opposition of new-comers, who have already comfortably established themselves in the immediate neighbourhood.
Those who returned to dispensary posts also experienced their own difficulties. During the immediate post-war period, the salary for state positions in Ireland was so low (the rate of pay, £170 to £220, had remained the same for many years but the cost of living had increased considerably due to war) that it became a significant issue for the medical profession. Indeed, some poor law medical officers, such as those in Bawnboy, County Cavan, went on strike.[xi] At a meeting of the Nenagh Board of Guardians, in County Tipperary, Dr. Thomas Hennessy, Secretary of the Irish Medical Association, addressed the board on the subject of dispensary doctors’ remuneration. He argued that the salary scale for medical officers was outdated and did not reflect the quality or expertise of their work. It also compared unfavourably with salary scales for other medical posts. He insisted that the scale was particularly unsuitable for doctors who had returned from war:
army authorities were offering between £600 and £700 per year to doctors just qualified … Irish doctors were paid by the Indian Medical Service £700 and £800 a year… If an Irish doctor selected to live in his own country he was sure they [the guardians] would make it worth his while and that he would not have to go elsewhere.[xii]
In a letter to the British Medical Journal, a disabled veteran doctor described the salaries offered to the returned as “so miserably small that it would not tempt a rat-catcher in his own profession”.[xiii]
Increased professional competition and unsatisfactory wages for state posts prompted many demobbed army doctors to pursue careers outside of Ireland, continuing the flow of Irish medical migration. Dr Charles Benson, assistant surgeon at Sir Patrick Dun’s Hospital, Dublin, argued that “the industrial districts of England will be able to offer financial attractions to doctors quite beyond those obtainable in very many of the dispensary districts in Ireland”.[xiv] Many physicians established private practices or secured hospital posts in Britain. Francis Crosbie, a Trinity College, Dublin graduate who had worked in the National Hospital for Consumption for Ireland prior to enlisting in the RAMC, established a general practice in the London borough of Ealing.[xv] John Green, who had joined the RAMC prior to the outbreak of war, secured hospital appointments in London and Wolverhampton, set up a private practice in Monmouth, and then went to practise in Worthing.[xvi] There are numerous other examples, including Irish doctors who travelled to other countries throughout Europe, as well as Asia and India.[xvii] Ultimately, then, the First World War had only alleviated the overcrowding of the Irish medical profession for the duration of the war, and ensured that Irish medical migration would continue throughout the twentieth century.
David Durnin currently lectures in the School of History, University College Dublin and is the co-editor of the recently-published volume Medicine, Health and Irish Experiences of Conflict, 1914-45 (Manchester University Press, 2016).
[i] J.J. Abraham, Surgeon’s Journey (Heinemann, 1957), 71.
[ii] David Durnin, ‘Medical Provision and the Irish Experience of the First World War’, (PhD Thesis, University College Dublin, 2015).
[iii] Anne Digby, Making a medical living: doctors and patients in the English market or medicine, 1720-1911 (Cambridge University Press, 2002), 140.
[iv] F.O.C. Meenan, Cecilia Street: the Catholic University School of Medicine, 1855-1931 (Gill and Macmillan, 1987), 4.
[v] The Irish Poor Law Act introduced a nationwide system of poor relief and medical officers were employed as part of the system. For more, see Virginia Crossman, Poverty and the poor law in Ireland, 1850-1914 (Liverpool University Press, 2013). Also see Ronald D. Cassell, Medical charities, medical politics: the Irish dispensary system and the poor law, 1836–1872 (Boydell Press, 1997), 78-108.
[vi] Greta Jones, ‘Strike out boldly for the prizes that are available to you: medical emigration from Ireland, 1860-1905’, Medical History 54 (2010), 55-74.
[vii] Jones, ‘Strike out boldly’, 55.
[viii] Irish Times, 6 Aug. 1914.
[ix] Anon., ‘Ireland’ in British Medical Journal, 2798, no. 2 (1914), 346.
[x] Durnin, ‘Medical Provision and the Irish Experience of the First World War’, 22-49.
[xi] Anon., ‘Ireland’ in British Medical Journal, 3011, no. 2 (1918), 299.
[xii] Nenagh Guardian, 20 Dec. 1919.
[xiii] Anon., ‘Shortage of doctors’ in British Medical Journal, 3054, no. 2 (1919), 64.
[xiv] Charles M. Benson, ‘The effect of war on the medical profession’, Dublin Journal of Medical Science, Cxli (1916), 94.
[xv] Francis Crosbie (Royal College of Physicians of Ireland, Kirkpatrick Index, TPCK/5/3).
[xvi] John Green (Royal College of Physicians of Ireland, Kirkpatrick Index, TPCK/5/3).
[xvii] Sources: Royal College of Physicians of Ireland, Kirkpatrick Index, TPCK/5/3; British Medical Journal, 1917-1935.