Access and Engagement: The Medical Dispensary Service in Post-Famine Ireland

Abstract

Historians of medicine and the marketplace in early modern England have emphasised ‘how little is known about health-care in rural areas’. As Ian Mortimer points out ‘the idea of the “medical marketplace”’, which has been central to the conceptualisation of medical provision and access, ‘was developed for London and Florence’. Inherent in almost all discussions of the ‘medical marketplace’ is the assumption that urban-based practitioners ministered to their immediate neighbourhood, leaving the ‘rural hinderland’ reliant on heterodox practitioners.¹ Although the concept of the medical marketplace has proved particularly attractive in the study of the early modern period, understanding of medical provision and patients’ behaviour in rural areas is patchy at best. Furthermore, in studies of the nineteenth century, historians have regarded the operation of the medical marketplace as less significant due to increased state involvement in medical provision, the consolidation of the medical profession and developments in scientific medicine. This has been particularly evident in work on nineteenth-century Ireland. The relatively precocious nature of state intervention in Ireland, originating in the late eighteenth century, has led some historians to assert that by the late nineteenth century, Ireland could boast ‘one of the most advanced health services in Europe’.²

I would like to acknowledge the generous support of the Wellcome Trust and Professor Greta Jones in the preparation of this article.