Patients, Potions, and Physicians: A Social History of Medicine in Ireland, 1654-2004 (review)

This volume is published by the Royal College of Physicians of Ireland to commemorate its 350th anniversary. This venerable College contains a remarkable archive, underused as far as medical historians are concerned, which forms the basis of much of the narrative in the book. To these documents Tony Farmar has added further material from the census and newspapers. He also uses fictional accounts of doctors to illustrate attitudes toward the medical practitioner in the past. For the final chapters, information from interviews with leading protagonists in Irish medicine from the 1950s onward has been added. The result is a lively, interesting, and accessible book.

The author was not going to be able to produce a definitive account of the social history of medicine in Ireland in 218 pages. The social background to, and the health of, the Irish people is treated in rather a snapshot fashion, and the theme of the book could be described more accurately as a social history of the medical encounter between doctors and patients. In this respect, however, it is excellent. Farmar provides a strong sense of the complexities of medical practice and the changing relationship between doctors and patients over the years. The difficulties of earning a medical living, the etiquette governing medical examinations and the discharge of bills, the relationship between medical students and their mentors, and all the odd and sometimes amusing encounters in the course of dispensing physic are recounted here. John F. Fleetwood's classic account of the history of Irish medicine is strong on institutional change; this book humanizes that story, providing all kinds of insights into the relationships and practical day-to-day concerns of patients and doctors.

Farmar is nevertheless a shrewd observer of the medical scene. He avoids many of the traps into which putative historians of Irish medicine fall, of which one, which he describes as "boosterism," is sometimes found among those writing mainly for a medical or general audience. In contrast, Farmar does not underestimate the tensions and failures in Irish medicine, including the sectarian dimension. He incorporates recent research on the problems of the medical profession during the Troubles in Northern Ireland. The survival of fairy and folk medicine is interposed with a down-to-earth account of the popularity of patent medicines in the late nineteenth century, of which the Irish were inordinate consumers. The rather stodgy state into which Irish medical schools had drifted by the middle of the twentieth century is frankly discussed.

There are problems in some places. In covering such a wide period, Farmar has relied, at certain crucial points, on a rather scissors-and-paste approach. Thus the arrival of the National Health Service in Northern Ireland is based upon a series of jaundiced accounts from disaffected medics, including stories about patients approaching the new Health Service for pills for their pets. This is supplemented by a tendentious extract from a sociology textbook on state versus private models of health care. The introduction of the NHS was a defining moment for Irish medicine both north and south, and it needs more extensive treatment than this. Yet Farmar interviewed Robert Collis, a representative of the "new generation" of socially conscious medics emerging in the 1940s, and the opportunity to tell a more rounded story of this period was there.

Despite these reservations, Patients, Potions, and Physicians is a welcome addition to the literature of Irish medicine. It has great appeal to the general audience, but there are also many gems along the way for practitioners of the history of medicine. As an account of the texture of the patient-doctor relationship it is a significant contribution to the historiography of Irish medicine.