It’s a long way to the top

Irish General Practice – The Long Story
Michael V. Hanna
ICGP and A.A. Farmar, Dublin, 2024, 304 pages.

Even though many of my 1970s classmates would devote their lives to the discipline, the one kind of doctor we never saw in our undergraduate training was the general practitioner; we had no lectures from GPs, and we never visited a GP’s surgery. According to Michael V. Hanna in Irish General Practice – The Long Story, when John Fleetwood was invited to give a single lecture to the final year medical students in UCD in the early 1950s, the Dean chose to introduce him as a lecturer in geriatrics: ‘it will give you more status than as a GP’.

Back then GPs ran single-handed, isolated practices often in competition with each other; until 1971 many were dispensary doctors. They usually lived over the shop, were available at all hours and frequently visited patients at home in all weathers. Fifty years on all has changed. Much medical student education now takes place in multi-practitioner general practices or primary care centres where the students are immersed in the practice team and learn a great deal of their medicine by doing as well as observing.

Academic departments of general practice hold their own with the more traditional departments in medical schools, and an Irish College of General Practice (ICGP) has statutory responsibility for postgraduate vocational training, continuing medical education (CME) and professional development in general practice.

Commissioned by the ICGP to celebrate its first forty years, Irish General Practice is in two parts. Part One presents a narrative history of the evolution of Irish medicine and society from the Gaelic physicians of late medieval Ireland through the emergence of the medical professions in the long eighteenth century, the evolution of dispensaries in the nineteenth, and the ideological battles between church and state over medical care in the twentieth.

Reflecting Michael Hanna’s expertise in local and institutional history, the narrative is interspersed with fascinating ‘case studies’ reflecting the experiences of several remarkable individuals and institutions over the last four hundred years. For example, Dr Mary J Farrell (1892-1973) MD, MAO, Dip Public Health, who graduated from UCD in 1916, had treated British First World War casualties and victims of the 1918/19 influenza epidemic in England before travelling to work in West Africa in the 1920s.

In 1930 she was appointed dispensary doctor to Longford town. There, one night, she delivered a Traveller woman of a healthy baby boy in a field under a canvas shelter by the light of an oil lamp held by the woman’s husband. Apart from treating her many patients – in the dispensary and wherever they happened to live – she was required to keep several registers, report monthly to the Board of Health and Assistance, vaccinate her dispensary patients and, as Medical Officer for Health, carry out sanitary inspections which often resulted in litigation and attendance in court.

Loved by all, she retired in 1963 and died in 1973. She is remembered by a plaque in her native Longford and a student medal in UCD. The world of the apothecary and the dispensary doctor was full of similar stories.

Part Two is devoted to the history of the ICGP. In the teeth of opposition from the established Royal Colleges, a College of General Practitioners (CGP) was launched in the UK in 1952; it became the RCGP in 1967. In 1953 an Irish faculty of the CGP was established and over the next ten years three more Irish faculties followed.

In 1975 the Irish Institute of General Practice was founded, its remit to oversee vocational training of GPs, support CME and encourage research in general practice. It was a short hop from there to establishing the ICGP in 1984. Since then, the ICGP has developed its membership examination (MICGP), launched a very successful journal, Forum, developed a nationwide network of faculties to support postgraduate education, collaborated with the universities in creating departments and chairs of general practice, and established a purpose-built headquarters in Lincoln Place in Dublin.

This is a handsomely produced book with excellent footnotes, bibliography and appendices. The chapters are short, informative and easily read. Each part of the book contains a series of beautiful, coloured illustrations including, in Part One a page from the 15th century Book of the O’Lees, and several photographs from the superb 2012 TCD tercentenary exhibition illustrating the day-to-day work of general practitioners in Part Two.

This book brings to life the story, past and present, of general practice in Ireland and is a wonderful tribute to the ICGP and a celebration of the men and women who look after most of us most of the time. This book is a good read and will be of interest to Irish medical practitioners of all kinds.

Author
Prof Pierce A. Grace is Adjunct Professor of Surgical Science, Graduate Entry Medical School, University of Limerick.