1898 The Lancet  
1423 restrictions the new councils will possess complete control of all institutions devoted to the care of the sick and lunatic poor. The powers of the Lord Lieutenant as regards appointments are reduced but not altogether abrogated and some of these powers will be still further curtailed as time goes on. The administration of Poor-law medical relief has been hitherto one of the most democratic parts of Irish local administration, and though'it has not been a failure, neither has it been a
more » ... r has it been a great or unqualified success. In the election of dispensary medical officers political and sectarian feeling has often had very considerable play, yet it would be untrue to allege that bad appointments have been common or that the electors have disregarded professional fitness in making their choice. The worst that can be said is that the system itself is so imperfect that it would be a miracle if it worked really well. The dispensary medical officers are as a class overworked and underpaid. Their districts are too large and the amount of work is such that it is often quite beyond the powers of any man to discharge it with thoroughness and fidelity while finding time for private practice, which the exiguity of the fixed remuneration makes it indispensable for him to cultivate. It is much to be regretted that for even the worst paid and most laborious appointments there has too often been a shoal of candidates. While such is the case it is almost idle to complain of the disproportion between the salaries and the work. The medical profession has in such matters the remedy in its own hands. If it were once made clear that suitable candidates could not be obtained for these dispensary appointments the elective bodies would soon recognise the necessity of better salaries and a more reasonable adjustment of duties. The Poor-law infirmaries and fever hospitals in Ireland are often overcrowded and the medical service is deficient in quantity though often good in quality. Cases are not unknown where a medical officer is responsible for 500 or 600 patients. It need hardly be pointed out that under such circumstances adequate medical care and supervision are simply physically impossible. The asylums are, on the whole, among the best managed institutions in Ireland and their fortunes under the new regi7yze will be a crucial test of the practical value of democratic methods in administration. They are at present controlled by boards nominated by the Lord Lieutenant and usually composed of the local gentry together with some of the leading merchants and professional men. Hence the changes efeected under the Bill will be particularly manifest in connexion with asylum administration. Almost the only case in which the Bill tends in a direction not increasingly democratic is in the election of coroners.
doi:10.1016/s0140-6736(01)77478-8 fatcat:ig7jjwxjbfewlhxyvt7pqcf74a