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“Strike out Boldly for the Prizes that are Available to You”: Medical Emigration from Ireland 1860–1905

Published online by Cambridge University Press:  17 May 2012

Greta Jones
Greta Jones
Affiliation:
*Greta Jones, PhD, University of Ulster, Centre for the History of Medicine in Ireland, Shore Road, Newtownabbey, County Antrim BT37 0QB, UK; e-mail: [email protected]
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Information
Medical History , Volume 54 , Issue 1 , January 2010 , pp. 55 - 74
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Copyright © The Author(s) 2010. Published by Cambridge University Press

References

1 Ireland experienced general emigration after 1850 leading to a decline in her population over much of the nineteenth and twentieth century. Medical emigration was, however, unique in certain respects. Unlike most emigration, it was the professionally trained who left. The peak of medical emigration and its destinations also show patterns quite distinct from that of the emigrant population as a whole.

2 Report of the Commission on Higher Education 1960–67, 2 vols, Dublin, Stationary Office, 1968, vol. l, p. 246. The commissioners suggested that in the preceding decade emigration was around 25 per cent of all medical graduates from the Republic.

3 The context in which these schools operated changed over the years. Students at the Queen's Colleges at Cork, Galway and Belfast were until 1879 graduates of Queen's University of Ireland. The Colleges and the Catholic Medical School were brought together in the Royal University of Ireland in 1879, whose first graduates appeared from 1883. Then, following a major reorganization of Irish higher education in 1908, Cork, Galway, and the Catholic University Medical School became the National University of Ireland, and Queen's College, Belfast, became the Queen's University of Belfast. Schools, however, continued to produce their own graduation lists in their annual calendars and these have been used for this study.

4 The National Insurance Act of 1911 allowed for medical treatment for insured persons in certain working-class trades and occupations and, therefore, represented a significant expansion of state funded medical care available outside the Poor Law system. The significance was most felt in working-class districts which had a proportion of insured persons. This meant the social and economic geography of general practice changed.

5 For a history of the various schools, see J D H Widdess, A history of the Royal College of Physicians of lreland 1654–1963, Edinburgh, E and S Livingstone, 1963; Charles A Cameron, History of the Royal College of Surgeons in Ireland, Dublin, Fannin, 1916 (lst ed. 1886); Peter Froggatt and Barry Bridges, The Belfast Medical School 1835–1985, Belfast, Ulster Medical Journal, 1986; John A Murphy, The College. A history of Queen/University College Cork, 1845–1995, Cork University Press, 1995; Donal McCartney, UCD: A national idea: the history of University College Dublin, Dublin, Gill and Macmillan 1999; F O C Meenan, Cecilia Street; the Catholic University School of Medicine 1855–1931, Dublin, Gill and Macmillan 1987; Tom Dunne (ed.), The National University of Ireland 1908–2008, University College Dublin Press, 2008.

6 Before 1889, the College was named the “King and Queen's College of Physicians of Ireland” with licentiates being designated LKQCP.

7 Calculated from 209 entries for place of study for first year registrants in the Medical and Dental Student's Register, published annually by the General Medical Council, 1865.

8 Ibid., 1865.

9 At this point UCD medical schools begin to produce their own graduation lists. A few Catholic University students are designated graduates of the Royal University from 1883, but most appear on the RCS lists as well.

10 M Anne Crowther and Marguerite W Dupree, Medical lives in the age of surgical revolution, Cambridge University Press, 2007, Table 1.4, p. 23.

11 Less than 1 per cent of the total cohort, ibid., Tables 6.1, 6.2, p. 177.

12 Ibid., p. 253.

13 Laura Kelly, ‘Irish medical students at the University of Glasgow 1859–1900’, M.Litt thesis, University of Glasgow, 2007, pp. 61–2, Table 3.2. Over 100 students were examined.

14 Information based on the Medical Directory. His father Henry was a doctor also; his main career was spent on the Isle of Man.

15 566 graduates were examined between 1860 and 1950 every five years as well as every ten years after graduation. Between five and ten years emigration outside Ireland increases. Around one in four had moved between the five year and the ten year cut off date. 102 graduates between 1860 and 1890 were examined both ten years and twenty years after graduation. Between the ten and twenty year cut off point movement diminishes. Excluding an additional number who drop off the register, there was a 10 per cent movement out of Ireland and a 3per cent inward movement, mainly returnees from army or Indian medical service. This leaves further migration out of Ireland of around 7 per cent.

16 Of the 976 graduates 1860–1905, 130 are “not in” the Medical Register, 316 are in Ireland, 530 outside Ireland.

17 Between 1860 and 1905 only one graduate was traced to Scotland and three to Wales.

18 See Crowther and Dupree, op. cit., note 10 above, pp. 320–24, on the movement of medical personnel to China ports, and Anne Digby's study of doctors emigrating from Britain to South Africa before 1910, ‘“A medical El Dorado?” Colonial medical income and practice at the Cape’, Soc. Hist. Med., 1995, 88(3): 463–79.

19 Crowther and Dupree, op. cit., note 10 above, Table 1.4, p. 23. Seventy-one per cent of the Glasgow cohort and 38 per cent of the Edinburgh were born in Scotland, though, as with TCD, a proportion born overseas might very well have family connections to Scotland.

20 Between 1860 and 1890, 124 first year entrants to Trinity College medical school were examined. Only four gave their birthplace as England, and, of these, two were external students. Of the other 13 born outside Ireland, all except one—born in Brussels—were from the colonies or ex-colonies and, in some cases of parental occupation such as minister, shipmaster or army officer, it is likely that their fathers had some connection to Ireland or to Trinity. See Trinity College Dublin Manuscripts Room, TCD MS 758, an index of matriculations for the Trinity College School of Physic or Medicine, 1850–1915.

21 In the case of the medical schools of the Queen's Colleges local recruitment was much more common. For example, of the 456 students attending Queen's College, Belfast, 1908–9 (all faculties), only 25 were from outside Ireland (11 from England). 94.5per cent were Irish born, and 90 per cent, or 410 of the total, were from the nine counties of Ulster and only 21 from other parts of Ireland. The report of the president of Queen's College Belfast for the year 1908–9, PP 1909, vol. XX, Cd. 4831 (715), p. 25, Table I.

22 Anne Digby, Making a medical living: doctors and patients in the English market for medicine, 1720–1911, Cambridge University Press, 1994, Table 5.2, p. 144. This is based on an analysis of practices for sale. See also eadem, The evolution of British general practice 1850–1948, Oxford University Press, 1999.

23 Digby, Making a medical living, op. cit., note 22 above, p. 145.

24 Report of the Committee to inquire into the causes which tend to prevent sufficient eligible candidates from coming forward to the Army Medical Department, PP 1878–9, vol. XLIV C.2200 (44) pp. 304–5.

25 Digby, Making a medical living, op. cit., note 22 above, p.143, This is calculated for single handed practices.

26 Report, op. cit., note 24 above, Appendix D ‘Selection from replies on the probable average earnings of civil medical practitioners’, p. 304.

27 Ibid., p. 304.

28 Ibid., p. 304.

29 All population figures have been taken from W E Vaughan and A J Fitzpatrick (eds), Irish historical statistics: population, 1821–1971, Dublin, Royal Irish Academy, 1978. The Irish Medical Directory (published by the Irish Medical Association, IMA) has been used for 1875 and 1895 and cross-checked with the list for Ireland from the UK register. What comes to light from the cross-checking is that compiling directories is not an exact science and, whilst the figures for doctors are roughly comparable, sometimes names are in one directory but not another. Given the probability that the IMA was likely to have more up-to-date knowledge and, for example, published rates of remuneration for all individual public appointments, their names have been used.

30 The population is given as 3,911 in the Irish Medical Directory for 1873, but Vaughan and Fitzpatrick's corrected figures have been used in the subsequent account. Ballinasloe is not typical in the sense that only around a third of the Irish population were living in towns of over 2,000 in 1900. The small country town was, however, an important part of Ireland's geographical and social landscape. Ballinasloe can also be singled out in having one of the largest lunatic asylums in Ireland.

31 For example, in the 1875 Irish Medical Directory's town list mentions two doctors not on the British town list, one of whom, however, is a recent graduate and one an elderly doctor who graduated in 1838. Both subsequently disappeared very quickly from the Irish list,

32 There were eleven doctors listed between both town lists of which eight were new names and three also appear in the 1875 Irish Medical Directory. Two of these, however, were recorded as retired from practice.

33 Figures from the Irish Medical Directory for 1875 and 1895. These list the salaries of all doctors in various branches of the public system in Ireland.

34 These were not the only opportunities for collecting public appointments for Irish doctors or their counterparts in England. In factory districts posts as certifying surgeons were available, coroners’ courts paid fees to doctors, there were medical officers for military camps and naval bases, appointments at county infirmaries and fever hospitals (an MO at an Irish county infirmary could be paid from £40 to £250 per annum in 1875). The pay for MOs in prisons ranged from £60 to £415 averaging around £150 in 1897. See Irish Medical Directory, 1897, p. 335. Registration of births and deaths involved fees. Added to this was part-time work for Friendly Societies and insurance companies, and medical work for the Royal Irish Constabulary.

35 Annual report of the Local Government Board (Ireland), PP 1890–1, vol. XXXV (35), p. 216.

36 Ibid., p. 269.

37 J Henry May, Medical practitioners’ accounts, London, Gee, 1903.

38 Banquet of the Irish Medical Schools' and Graduates' Association, Journal of the Irish Medical Association, April 1905, 5: 88. Sir Thomas Lough, Liberal MP and Home Ruler, was the author of various pamphlets on Irish finances.

39 See Irish Medical Register, and Vaughan and Fitzpatrick, op. cit., note 29 above (using Census of 1911). Bangor's population rose from 2,560 in 1875 to 7,776 in 1908. It had four doctors in 1875 and twelve in 1908.

40 Archives and Manuscripts, Wellcome Library, London, MS 3170, B W Lara & Co. Letter-book (dealing with the sale of medical practices) 1881, p. 443.

41 The same point has been made by Irvine Loudon in relation to hospital outpatient departments; see I S L Loudon ‘Historical importance of outpatients’, Br. Med. J., 15 April 1978, i: 974–7.

42 ‘A retrospect of the Irish Poor Law dispensary, lunatic asylum and workhouse systems: I. The Poor-Law dispensary system’, Br. Med. J., 3 Jan. 1903, i: 27–8, p. 27.

43 Digby, op. cit., note 22 above, p. 145.

44 ‘Notes on Ireland’, Br. Med. J., 14 Jan. 1905, i: 91.

45 The breakthrough came in new scales of salaries for the North Dublin Union sanctioned by the Local Government Board (Ireland) and reported in October 1904. This was a signal of a relaxation on the upper limits to salaries in the Poor Law service which, after that date, spread throughout the system. Issue after issue of the journal of the IMA began publishing evidence of a general rise in salaries among the Poor Law service. See Greta Jones unpublished paper. ‘The doctors’ strike’, given to the Glasgow Conference of the Society for Social History of Medicine, 3–5 Sept. 2008.

46 J. Irish Med. Assoc., Jan. 1905, 6 (1): 4–5.

47 Janet Browne, Charles Darwin: voyaging, 2 vols, London, Jonathan Cape, 1995, vol. 1, pp. 6–9.

48 See Crowther and Dupree, op. cit., note 10 above, Table 10.1, p. 357, for estate values for their cohort of graduates from Scottish schools.

49 Report, op. cit., note 2 above, p. 246.

50 Charles B Keetley, The student's guide to the medical profession, London, Macmillan, 1878, p. 81.

51 Meenan, op. cit., note 5 above, p. 44.

52 John J Horgan, ‘Sir Bertram Windle: an appreciation’, Cork University College sessional lists 1928–9, pp. 119–28. Windle died in Canada in 1929.

53 In independent Ireland the numbers of full-time students rose from 4,978 in 1938–9 to 8,653 in 1959–60 and 13,006 in 1964–5. Report, op. cit., note 2 above, vol. 1, Table 12, p. 31.

54 In 1938–9 medical students formed 30.19 per cent of those studying in the universities in independent Ireland. Report, op. cit., note 2 above, calculated from vol. 1, Table 73, p. 242, and Table 23, p. 47. These figures are an underestimate for they do not include the College of Surgeons which educated between 300 students annually during the twenty years for which figures are calculated.

55 ‘The existing professional prospects of young men entering on practice’, J. Irish Med. Assoc., 27 May 1868, no. 23: 89–91, p. 90.

56 The process was often carried out by an agency specializing in this kind of transaction and in a surviving book from a such an agency—B W Lara & Co. in London for the year 1881—we get some idea of the value of practices. The prices quoted for practices in England were £600 for a practice in York which “yields nearly £700 a year”. Others passed hands at prices of over £1,000. Shares are offered in practices from £300 to £600 at half or one third. A practice could be had for £500 down and the remainder at the end of the year taken out of the receipts.

57 Robert Esler MD, ‘On some experiences of medical practice in the metropolis’, Transactions of the Ulster Medical Society, Session 1890–1: 68–75, p. 69.

58 Percival Turner, Hints relating to the sale and purchase of medical and dental practices and partnerships, London, [1932?], p. 22.

59 Report … into the causes … to prevent eligible candidates … to the Medical Department, op. cit., note 24 above, Appendix D, ‘Selection from replies on the probable average earnings of civil medical practitioners’, p. 304.

60 John Baxter Langley, Via medica: a treatise on the laws and customs of the medical profession in relation especially to principals and assistants with suggestions to students on preliminary education, London, 1867, p. 35.

61 J. Irish Med. Assoc., 27 May 1868, no. 23: 90. Reproduced from a supplement to the Medical Press and Circular.

62 Mark Harrison has noted the predominance of Irish medical school graduates in the Indian Medical Service. Those claiming Ireland as their birthplace comprised 10.5 per cent of the total for 1837–54, 26.2 per cent for 1855–84, and 12.6 per cent for 1885–96. See Mark Harrison, Public health in British India, Cambridge University Pess, 1994, p. 31, Table 1.3. Scotland had more in the IMS in the first period, 22.7per cent in 1855–84, but was overtaken by Ireland in the last two, 19.1 and 8.3 per cent respectively. Spencer H Brown estimates that between 1840 and 1909 45 per cent of surgeons in West Africa and the West Indies were Irish. See Spencer H Brown, ‘British army surgeons commissioned 1840–1909 with West Indian/West African Service: a prosopographical evaluation’, Med. Hist., 1993, 37: 411–31, Table 2, p. 419. This compared to 12.1 from Scotland and 32.6 from England.

63 According to the Report of 1878–9 (see note 24 above) on remuneration of doctors in the services, an assistant surgeon could obtain £200 per annum on appointment rising to £273 after ten years, and a surgeon major £529 after fifteen. After ten years an honorium of £1,000 was payable, which meant that it was possible to contemplate setting up in practice.

64 Rosemary Stevens and her colleagues studied doctor immigrants to the USA in the 1960s. Among them were a high proportion from the developing world whom, it was assumed, were driven by poverty. They pointed out, however, that the typical doctor immigrant was often from the better off and well connected medical family. James N Haug and Rosemary Stevens, ‘Foreign medical graduates in the United States 1963 and 1971: a cohort study’, Inquiry, 1973, 10: 26–32, and Rosemary Stevens, Louis Wolf Goodman and Stephen S Mick, ‘What happens to foreign trained doctors who come to the United States?’, Inquiry, 1974, 11: 112–24.

65 The 11th annual meeting was on 24 March 1888, which takes us back to 1877 as the year of its foundation. The second annual meeting was recorded in Cork 1879.

66 ‘Irish Medical Schools’ and Graduates’ Association’, Br. Med. J., 24 March 1888, i: 659.

67 ‘Irish Medical Schools’ and Graduates’ Association’, Br. Med. J., 5 Aug. 1899, ii: 385.

68 In 1888: “Much satisfaction was expressed at the success of Sir Thomas Crawford in inducing the British Medical Association at its annual meeting last August in Dublin to pass a resolution condemnatory of monopoly in hospital appointments. The Council is now in communi-cation with the Irish qualifying bodies and hopes, with their aid, in time to remove some of the disabilities at present affecting Irish degrees and qualifications in England.” ‘Irish Medical Schools’ and Graduates’ Association’, Br. Med. J., 24 March 1888, i: 659.

69 ‘Irish Graduates’ Association’, Br. Med. J., 4 Sept. 1880, ii: 407–9, p. 408.

70 Robert Esler MD, ‘Early history of medicine in Belfast’, Transactions of the Ulster Medical Society, Session 1885, pp. 17–28. The ‘Guide to Belfast, the Giant's Causeway and the North’, 1884, was prepared as a guide-book for the visit of the British Medical Association to Belfast.

71 Esler, op. cit., note 57 above, p. 75.

72 Thomas Myles, President of the RCSI 1900–2, ‘Military and dispensary appointments’, address to the RCSI, J. Irish Med. Assoc., 1901, 1 (12): 89–91, pp. 90–1.