Prof. Greta Jones
Emeritus Professor, Ulster University
The origins of this book are in 2004. In that year, due to the generosity of the Wellcome Trust, I received a grant allowing two years respite from teaching and administration at Ulster University to investigate the history of Irish doctor emigration from Ireland. The period chosen was roughly commensurate with two central pieces of legislation in the history of medical practitioners. The first was the Medical Act of 1858 which applied across all the nations of the United Kingdom and which created the Medical Register. Entry on the Register meant that graduates of recognised medical schools, including ones in Ireland, had the right to practice everywhere in the British Isles and in her colonies and dominions. This did not create doctor migration – this was taking place long before the Medical Act – but it did facilitate it. Even in countries outside the British Empire, entry on the Medical Register often predisposed a community to accept a doctor in their midst.
Then, in 1978, a measure was adopted into the law of the Republic of Ireland and other nations of the EEC (the future European Union) which allowed for mutual recognition of medical qualifications. Though many Irish doctors, routinely in Northern Ireland, continued to place their names on the UK Medical Register, it diminished as the most important step for a newly graduated doctor in the Republic of Ireland.
The research set out to answer at least three questions: How many Irish medical graduates went outside Ireland to earn their living, where to and why? The last question took longer to answer than the first two because, eventually it became research into the construction of family fortunes and the rise of the Irish middle class: the part of that class which sent its sons (and later daughters) into a medical education.
There was a personal dimension. My mother in law’s family were relatively prosperous farmers located in County Cork. A son and three daughters went on to practice medicine after graduating in Ireland. Two practised abroad; one in north east England and one in St Louis, Missouri, USA. Another spent some time in the USA before returning to be a dispensary doctor in County Cork. The fourth graduated towards the end of the Second World War and joined the Indian Medical Service (IMS).
The book puts the often interesting and noteworthy experiences of these doctors into context. There is an Appendix in the book which goes into detail about methodology but, briefly, the research tracked cohorts of graduates every five years from five medical schools in Ireland between 1860 and 1960 and followed their careers in the Medical Register, using the Medical Directory to fill out details. This is the conclusion. Around forty percent of Irish medical graduates emigrated to practice outside Ireland between 1860 and 1960. The majority went to the UK but a substantial number into the armed or colonial services of which the IMS was a particularly important destination. A smaller number went to places outside the British Empire. Apart from earning a living, a near universal impulse for our cohorts, motives were various and often contrasting. A smaller number of medical emigrants were missionaries, those who worked as company doctors for British firms abroad, those who chose destinations for health reasons and an even smaller minority attracted by the novelty and adventure of travel.
The pattern of doctor migration shifted over time. Before the First World War, around fifty percent practised outside Ireland but this fell in the years after, largely because of the gradual decline in importance of Empire and the development in areas of European settlement of their own indigenous doctors. In the late 1930s, and especially after 1945, there was a rising popularity of North America as a destination for Irish educated doctors
There was no religious divide in doctor emigration. Doctors from Queens College, Belfast emigrated as much as their confreres from University College Dublin and in much the same directions. Certain schools were particularly attuned to patterns of emigration. The Royal College of Surgeons in Ireland traditionally sent graduates to the Navy, Trinity College to the Army. But graduates from other schools also had doctors in the navy or army. The majority of migrating graduates from all schools, however, tended to end up as GPs in practices in England. Here they were joined by graduates from Scotland who, in numbers of exported doctors, rivalled the Irish medical diaspora.
It is clear that the admirable breed for whom I developed deep respect during the course of this research, the University Registrars and their colleagues, were well aware they were educating for export. The students knew too that not enough opportunities existed in Ireland for medical graduates and that for some of them leaving Ireland was often the only option. This did not deter entrance to medical school and therefore the question arises just what relationship existed between the medical school and the parents of the graduates? Medical education cost in the period we are examining (less so for Northern Ireland students after 1945), so the family must have made some calculation about its value. For the school the advantages were clear. More students meant more fees. The medical school was the largest faculty in every Irish university until after the Second World War and one, the Royal College of Surgeons, educated nothing but doctors. In fact, many universities would have struggled to survive without their medical faculty and discussion about the possible demise of Queens College Galway at one point at the turn of the last century was attributed to its failure to attract medical students. Cork, its sister college, avoided that danger because, as Bertram Windle its President said it was ‘little more than an excellent medical school which manufactured doctors for export’.[1] The book discusses what the broader social benefits were for Irish universities and for the intellectual resources of Ireland.
An emigrant Irish medical graduate might expect, after some struggle, to acquire a reasonable practice in England (a few in Wales but hardly any in Scotland which produced its own surplus of doctors). The work which I did suggests that there was pretty much equivalent status and income between Irish medical practitioners in England and those who remained in Ireland. There were even those who, as the Registrars proudly pointed out, reached a very favourable place in their profession. But there were those on the Medical Register who after a few years disappear, on the whole never to return, and this may tell a more dispiriting story. If the rate of drop out was larger for Irish medical graduates than those educated in England, this might signal that there were casualties of the medical school practice of packing their schools with more doctors than could be found work. Certainly in terms of the income for doctors remaining in Ireland, there is a longer tale of those on the lower income scale which may illustrate the difficult years spent trying to set up practice in Ireland. Nonetheless there was also a strong cohort of Irish doctors on comfortable medical incomes.
The history of medical emigration in this book is also the social history of a significant section of the Irish middle class. A medical education meant either the maintenance of a good social standing for a member of the family and, in many interesting cases, the raising up of a family’s social status. Medicine, the book argues, was a ladder of social mobility for many, particularly for the Catholic middle class. For Irish families in trade, shop-keeping or small farming, minor civil service posts it was a route into the professional classes. In some, much rarer instances, it could even provide a means of raising oneself into gentility –of sorts- for even more humble families. There were also some modest financial gains for the families the emigrants left behind. Repatriation of income to Ireland was not noticeable among doctors who married and had a family in England but it did happen. It was higher for those in the armed or colonial services partly because the rate of return to Ireland was higher in this case.
Of course this happy position for some disguised a lot of inequality in the profession. Medical graduates without access to the larger country towns or cities either in Ireland or England found it harder to make a medical living. Without family money or connections settling oneself in a practice took longer and the road to success was harder. This was less so in the colonial or military services which provided a steady income not dependent on a patient list. The Indian Medical Services proved for the active and ambitious Irish a very significant ladder of advancement for those who put their mind to it. Most medical schools in Ireland, including the Queen’s College Cork and Galway and Belfast, could point to the success and fame of their graduates in the IMS.
More serious inequality was generated in the West. Rural poverty and depopulation made it harder to make a good medical living there. Thus, those forced by circumstance to work in the West found public appointments in the poor law and dispensary system an important source of income especially at the start of their career. Doctors in the west of Ireland were the strongest advocates for more generous remuneration for these public posts and doctor militancy in the hundred years examined was usually driven by the Western doctors. This sometimes included caustic criticism of the advantages of their more fortunate confreres in Dublin and other prosperous areas and in later years, when recognition of Irish degrees, met resistance in the United States, criticisms of the stretched resources of over packed medical schools.
In our own times medical migration has increased dramatically. Work done on the topic is showing up the varied economic and social pressures behind it. Some resemble the Irish pattern: migration driven by middle class concerns and by schools geared up to overproduction of doctors. But every pattern of medical migration has its own story. The book is a contribution to one part of the jigsaw of migration.
Further Reading
Greta Jones, ‘Doctors for Export’: Medical Migration from Ireland C.1860 to 1960 (Leiden; Boston : Brill, 2021)
[1] John J. Horgan: Sir Bertram Windle an appreciation.’ Cork University College sessional lists 119-28. Windle died in Canada in 1929,
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