While the well-off in urban areas could call directly on a physician and surgeon in the event of ill health, medical care to the depleted rural population was the preserve of the general practitioner.
These men (the first women to qualify as doctors did so in 1877) were qualified in medicine, surgery and obstetrics; because of the large numbers graduating from the Dublin medical schools there was stiff competition for posts as dispensing doctors. Doctors were elected by boards of guardians made up of local worthies.
This was often a corrupt process. Farmar writes: "In July 1924, the newly elected dispensary doctor from Kiltoon, Co Roscommon, was displaced after it was found that several of his electors had offered their votes to the highest bidder." At the time when IR£50 was a labourers annual wage, one doctor recalls being offered a vote in return for a cheque for IR£20.
The average Irish dispensing practice covered a population of just over 6,000 people. Much of their work was carried out in the patients home. Somerville and Ross memorably referred to weather "fit for only a snipe or a dispensary doctor". The workload was heavy: In 1854 Dr Joseph Edmundson audited the previous two years work at the dispensary in Carrick-on-Suir. He made 4,200 visits to patients homes, while he provided 18,700 consultations in his dispensary during the two-year period.
Some 20 per cent of Edmundson's cases were scabies. The next commonest ailment was "fever". Dysentery and diarrhoea were relatively frequent diagnoses. Bronchitis and pneumonia also featured and the 200 cases of sexually transmitted disease was high by modern standards. The biggest single cause of death was phthisis (tuberculosis), with fevers of various types carrying others to the grave.
Dispensary doctors invariably died young. Between 1843 and 1848, some 443 general practitioners passed away, the majority succumbing to fever. Typhus killed many. A report by the Royal College of Surgeons at the time noted that dispensary doctors died from "labouring among the poor in wild and thinly populated districts, while the medical man has often to ride or drive for many hours, exposed to cold and wet, suffering from great fatigue and then becoming exposed to concentrated contagion in some of the wretched isolated hovels of the peasantry".
The dispensary system continued until 1970. While the quality of medical care was high, having to seek an admission "ticket" from a local honorary assistance officer led to increasing levels of stigmatization for those looked down upon as too poor to pay for medical treatment.