medicine has been practised in Ireland for thousands of years, but the modern Irish medical system is essentially a product of the post‐1700 period.
It is not easy to describe Irish medicine during the pre‐Christian era reliably, as the main sources available are myths and sagas. The
Celtic pantheon of gods included a doctor or leech (
liagh) called Dian Cecht, who cured by means of therapeutic herbs and magic. The Irish sagas refer to leeches on numerous occasions. In the most famous of the Ulster Cycle of sagas, the
Táin Bó Cuailnge, the hostile armies of Ulster and Connacht were both accompanied by leeches. Conchobar mac Nessae, king of Ulster, had his own personal leech, Fingin Faithliaig, who was in charge of the Ulster medical corps. But a leech's job had its peculiar dangers: one warrior in the Táin, informed by a succession of leeches that his wounds were mortal, killed each in turn before Fingin was able to pacify him.
Even for the medieval period (ad 500 to 1500) literary sources, such as
annals and
law tracts, are still major sources of information on Irish medicine. The Irish annals mention a variety of disorders, including plague, leprosy,
smallpox,
tuberculosis, ague (malaria), dysentery, pneumonia, gout, colic, palsy, erysipelas, paralysis, epilepsy, cancer, and flux (diarrhoea). Some of these diseases, like bubonic plague and smallpox, struck Ireland as major epidemics, creating widespread panic and disorder. Such outbreaks were seen as visitations of God, rather than as medical disasters, and from the 8th century the church sought to counter them by circulating holy relics through affected areas.
Doctors did, however, play a significant role in the treatment of wounds and injuries and of endemic diseases. Irish chieftains employed doctors as honoured members of their households. Often such doctors came from medical families, as medicine was largely a hereditary occupation. Leech books compiled over generations by medical families, such as the O'Hickeys, the O'Lees, and the O'Shiels, and mainly surviving from the late medieval period, are vital sources for the early history of Irish medicine. These show that Irish doctors were well aware of developments in European medicine, while they continued to practise their own treatments.
As important as leech books in understanding medicine in medieval Gaelic Ireland are legal tracts, setting out patients' rights and dictating the fees doctors could charge. Patients could be treated at home, in a doctor's house, or, in the case of a wound, in the house of the person who had inflicted the injury. The doctor's house had to be well ventilated and have access to a plentiful supply of fresh water. Medical fees varied according to the rank of the patient, but if the patient did not recover then the doctor could be fined.
In terms of treatments, early Irish doctors made extensive use of herbs, baths, cupping, bleeding, and sweating. Leech books often contain long lists of herbs, with descriptions of their medicinal properties and of the correct modes of preparing and administering them. Doctors carried cupping horns and probes intended to clear and clean wounds. Herbal baths and sweating houses were also employed extensively in cases of fever or skin diseases.
In the 16th and 17th centuries, with the decline of Gaelic power, Irish medicine underwent major changes. Increasing numbers of would‐be doctors began to seek training in formal medical schools. Catholic students were largely to be found in medical schools attached to universities, such as Paris, Montpellier, Reims, Louvain, Padua, and Bologna, while Irish Protestants favoured Oxford, Cambridge, Leiden, and, from the early 18th century, Edinburgh. Not until the 19th century did Irish students patronize Irish
medical schools in any large numbers.
Irish doctors, whether trained in England or on the Continent, soon felt the need of a body to represent their interests and regulate the practice of medicine. In 1654 Dr John Stearne (1624–69) established a fraternity of physicians, which received royal charters in 1667 and 1692, transforming it into the present Royal College of Physicians in Ireland. The 1692 charter stipulated that no one could practise physic in Ireland who was not a licentiate or fellow of the college, and it gave the college power to supervise surgeons, apothecaries, and midwives (see
childbirth).
The surgeons and apothecaries had already been organized before the setting up of the College of Physicians. In 1577 the
Guild of Dublin Barber‐Surgeons received a royal charter and in 1687 a further charter added apothecaries and wigmakers to the guild. But, by the 18th century, many surgeons were unhappy with their lowly status and with attempts by the physicians to control them. They therefore began to organize themselves into separate companies. This trend culminated with the granting of a royal charter to the Irish College of Surgeons in 1784.
The creation of the two colleges, which both sought to ensure that practitioners were adequately trained, helped raise the quality and status of Irish medicine. At the same time the establishment of voluntary and state
hospitals in Irish cities and towns during the 18th century gave doctors greatly increased opportunities to practise their profession.
By the early 19th century there was a recognized Irish school of medicine centred on Dublin, competing for prestige with the medical establishments of London and Edinburgh. The Irish school was particularly strong in fields like mid‐wifery and anatomy. The
Rotunda hospital pioneered with regard to the former, while the College of Surgeons set high standards in the teaching of the latter. Large numbers of Irishmen served in the British army and navy: the advent of the Napoleonic wars brought a great demand for military and naval surgeons, which stimulated the teaching of anatomy and surgery in Dublin.
A number of Dublin surgeons made significant contributions to medicine during the early and mid‐19th century. James Macartney (1770–1843) pioneered the teaching of pathology and revitalized the medical school at
Trinity College, Dublin; Abraham Colles (1773–1843) identified a common fracture of the wrist (Colles's fracture); Arthur Jacob (1790–1874), a pioneer of ophthalmology, described the neutral layer of the retina (Jacob's membrane); William Wallace (1791–1837) was the first to establish the contagious nature of secondary syphilis; Robert Adams (1793–1875) recognized the significance of disorders in cardiac rhythms; Francis Rynd (1801–61) gave the first hypodermic injection in 1844; and Sir William
Wilde was a pioneer in ear surgery.
Dublin‐based physicians also made major contributions to medicine. John Cheyne (1777–1836) made important studies of the fever epidemic of 1817–19; Robert Graves (1796–1853) identified exophthalmic goitre (Graves's disease) and published an influential collection of clinical lectures in 1843; William Stokes (1804–78) wrote the first book in English on the stethoscope and described Cheyne–Stokes respiration (intermittent breathing which usually indicates the approach of death) and Stokes–Adams syndrome (a slowed pulse with fainting attacks); Sir Dominic
Corrigan (1802–80) first recognized the signs of incompetence in the aortic valves.
Yet, despite the considerable achievements of Irish medicine and the existence of a network of hospitals, infirmaries, and dispensaries throughout the country, far more people died of disease during the
Famine of the late 1840s than succumbed to hunger. Typhus, relapsing fever, dysentery, and smallpox reached epidemic proportions and were followed by a
cholera epidemic in 1848–9. A series of Fever Acts were passed and a Central Board of Health set up in 1847 charged with establishing fever hospitals throughout the country. But these efforts were to little avail. It has been estimated that there were 2,600 doctors in Ireland in the late 1840s, some 380 of whom died in the three years 1845–7, two‐thirds of them succumbing to fever and dysentery.
A Medical Act of 1858 established a council which was responsible for compiling and policing a register of practitioners. Despite protests, women were excluded from the register and it was not until 1876 that an act was passed to remove restrictions on medical education based on sex. In 1877 the College of Physicians licensed its first woman practitioner, although women were not eligible for fellowships in the college until 1924. The College of Surgeons opened its medical school to women in 1885 and elected its first female fellow in 1893. The
Royal University agreed in principle to admit women students in 1882, but women did not begin studying medicine in Belfast until 1889, in Cork until 1892, and at Cecilia Street medical school in Dublin until 1896. Trinity College, Dublin, took even longer, not admitting women medical students until 1904.
The Famine had highlighted the inadequacies of public health in Ireland, but these inadequacies remained obvious well into the 20th century. In 1878 a major Public Health Act was passed. The act's comprehensive provisions relating to sanitation, water, food, housing, offensive trades, markets, and infectious diseases were, however, largely permissive. Many town councils and rural boards of guardians, who were charged with enforcing the act, were more concerned with keeping down the rates; and dispensary doctors, who were empowered under the act to control infectious diseases, were already underpaid and often overworked.
Poor living conditions, particularly in towns and cities, were at the root of Ireland's dismal public health record. In Dublin during the 1880s 17 per cent of infants died before reaching the age of 1 year, while in Belfast the figure was 15 per cent. (In the 1980s in Belfast only 1 per cent of infants died.) During the 1880s, similarly, 30 per cent of deaths in Belfast were due to infectious diseases, half being due to tuberculosis. The comparable figure in the 1980s was 0.5 percent.
In 1925 the Irish Free State appointed county medical officers, charged solely with promoting public health measures, and many of the provisions of the 1878 act were at last made compulsory. Even so tuberculosis, and maternal and infant mortality, remained alarmingly high throughout the 1930s and 1940s. The controversial Health Acts of 1947 and 1953, which were opposed by the medical profession and the Catholic church, who feared a state‐controlled health service, finally introduced more effective disease prevention measures. In Northern Ireland a Public Health Act of 1946 transferred powers from boards of guardians to county and borough health authorities, which opened the way for more rigorous enforcement of public health regulations.
Bibliography
Barrington, R. , Health, Medicine and Politics in Ireland, 1900–70 (1987)
Fleetwood, J. F. , The History of Medicine in Ireland (2nd edn., 1983)
Jones, G., and Malcolm, E. (eds.), Medicine, Disease and the State in Ireland, 1650–1940 (1999)
Elizabeth Malcolm
