ADDRESS BY PRESIDENT McALEESE AT UNIVERSITY OF LIMERICK GRADUATE ENTRY MEDICAL SCHOOL
ADDRESS BY PRESIDENT McALEESE AT UNIVERSITY OF LIMERICK GRADUATE ENTRY MEDICAL SCHOOL PUBLIC LECTURE SERIES 2011
Dia dhibh a cháirde. Is mór an onóir agus pléisúir dom bheith anseo anocht. It gives me great pleasure to be in such distinguished company here in the University of Limerick tonight. I would like to thank Professor Don Barry and Professor Paul Finucane for the invitation to address you.
The University of Limerick Graduate Entry Medical School is as we know the first new medical school established in Ireland in over a century. Founded as it was on the back of the most significant review of medical education and training ever undertaken in Ireland its focus is firmly on the future, on infusing a spirit of pioneering freshness and innovation in medical training. But for all its newness this medical school is umbilically linked to a broader Irish narrative which tells of this island’s long history and tradition of excellence in medical education and practice. It’s a rich and fascinating narrative much too detailed to do justice to in one lecture but worth dipping into for the time we have together this evening.
It is entirely fitting that this University and this area should play a contemporary part in the development of that narrative. Limerick was part of the historic kingdom of Thomand where the Ó hÍceadha family were physicians to the ruling Ó Briain clan. County Clare, where this School is sited, was also the nineteenth-century birthplace of Sir William Brooke O’Shaughnessy who made such advances as the first use of intravenous fluids to counteract the cholera epidemic that was sweeping London and the medicinal use of cannabis for pain relief.
We know that medicine and surgery were studied and practiced in Ireland from the very earliest of times. The ancient Irish god of healing Dian Cécht had marvelous healing power and his blessed well was said to heal any wound apart from decapitation – I’m not sure that even UL graduates can offer such an impressive warranty! The first physicians were a branch of the Druidic priesthood and were held in high social esteem. Brehon law tightly regulated the practice of medicine and the rights of physicians and patients – right down to the right of the convalescent patient not to be bothered by “dogs and fools and talkative noisy people”![1]
With the coming of Christianity, medicine became closely linked to monasteries and their schools of learning. The belief in the miraculous powers entrusted to the followers of Christ gave hope to the sick, while the Christian ethos of caring gave physical comfort. The care of the sick was one of the key functions of the monasteries in those times of great pestilence and disease. Treatment was carried out by physician priests and cures were mainly herbal, with extensive herb gardens attached to each monastery. As we know, the monasteries were also major centres of education that attracted thousands of scholars from across Europe to study various disciplines, including medicine. Irish physicians were held in high regard in Europe and were seen as the main repository of botanical knowledge.
Scholarly literary medicine spread throughout Europe via the universities and reached Ireland between the 14th and the 15th centuries. It is evident from the Irish medical manuscripts, written between 1400 and 1600, that the Gaelic physicians of Ireland and Scotland travelled abroad for study, often to Montpellier and adopted the medical systems and traditions they found there. Over a hundred of these medical manuscripts transcribed between 1400 and 1600 survive and are today the subject of fascinating research in Trinity College Dublin, the Royal Irish Academy and elsewhere. In fact the great medical tracts of the time were translated into Irish, one of the leading medical languages of the day.
In medieval and early modern Ireland physicians belonged to the noble classes and theirs was a hereditary profession, linked to the ruling classes with medical dynasties commonplace, some lasting for generations. Standards were high – one foreign observer noted in 1648 that “The Irish nobility have in every family a domestic physician, who has a tract of land free for his remuneration and who is appointed, not on account of the amount of learning he brings away in his head from colleges, but because he can cure disorders”[2]. It seems that even in seventeenth century, without any regulatory bodies, the overriding imperative was optimal patient outcomes.
The 16th and 17th centuries were a time of great turmoil and upheaval in Ireland.
For the vast majority of people, social conditions were shocking and pitiful. Dublin, in common with most of the country, was without a hospital other than a military hospital at Kilmainham and a House of Industry which provided primitive medical care in times of need. The eighteenth century did however see considerable improvement with the establishment of numerous voluntary hospitals, the product of the philanthropy of ambitious and altruistic doctors and a generous public shamed by the awful plight of the poor.
In Victorian times, physicians such as Robert Graves, William Stokes, Dominic Corrigan and the great surgeon Sir William Wilde stand out among an impressive number of distinguished Irish medical scientists of the 19th century, their names still featuring in contemporary international literature, Graves disease, Cheyne-Stokes respiration, Stokes Adams syndrome, Corrigan’s pulse and a long list of others.
Irish doctors of the 19th century were also quick to adopt ground-breaking new techniques and practices developed elsewhere. For instance, surgeon Professor John MacDonnell performed the first Irish operation under ether anaesthesia in the Richmond Hospital in Dublin in January 1847 – just three months after the technique was pioneered in Boston and without the benefit of modern communications. It was of course the advent of anaesthesia that dramatically developed surgery and as my husband likes to remind me and any doctors in the vicinity, the first ether anaesthesia was developed in Boston by a dentist William Thomas Green Morton. But the good news is that doctors were quick to catch on and interdisciplinary communications were clearly healthy even a century and a half ago.
In the 19th century, Irish medicine enjoyed a golden age of development that made it a beacon for medical practice throughout these islands and the pioneering work of its practitioners gained them international stature. It is said that the medical services in the British Empire could not have functioned without the availability of Irish trained doctors.
Perhaps the most important contribution of these world renowned figures to Irish medicine – and certainly the one which has the most immediate impact on every student here today – was the revolutionary new form of medical education whereby students were instructed at the bedside of the patient. This type of practical bedside teaching with a focus on the patient as an individual, rather than just a condition or disorder, continues today where Ireland’s first class instruction in both medical science and clinical expertise has given Irish medical education its deserved reputation as a world leader.
The diverse background of UL students, with undergraduate degrees from a variety of disciplines, serves to enrich the learning experience; it also positively resonates with the medical polymaths of the past who made significant developments in fields beyond medicine – people like Sir William Brook O’Shaughnessy who made significant discoveries in areas as diverse as pharmacology and telegraphy. Your individual and collective diversity also resonates with the current demands from experts for the medical practitioner who “needs to become a sort of ‘neo-polymath’ in a ‘new Renaissance’”. [3]
The University of Limerick’s Graduate Entry Medical School has set the highest of standards designed to ensure the rounded professional formation of highly competent, confident and caring medical professionals. You take seriously the WHO’s espousal of social accountability, making it your own duty to be responsive to the needs of the community and of every strata of society. This very lecture series is part of that mission of integrated outreach to the community and we who are part of that community are now major beneficiaries of the advanced healthcare which is now part of everyday life on this island.
At home, Ireland’s health outcomes are now among the best in the world. Life expectancy is high; diseases that were fatal a few generations ago have been eradicated or are now treatable. In virtually every corner of the globe Irish-trained doctors are putting into practice the training they received in our medical schools and in the developing world Irish medical staff provide life-enhancing healthcare to the world’s poorest and most overlooked of peoples, in a tradition started by Irish missionaries and continues with substantial help from the Irish people through private donations and through Irish Aid, the official development aid programme which gives priority to maternal health, child mortality and the eradication of communicable diseases. As a small country, we can be very proud of the impact we have had on national and global healthcare and proud of the excellent medical schools that enable us to maintain these high standards into the next generation.
Many of the future graduates of the UL Medical School will also go on to serve humanity with great distinction, as so many Irish-born and Irish-trained doctors have done before them. When the very first cohort of students graduates from the Medical School in June this year, it will be a proud moment in the short history of medical education in UL and the long history of medical education in Ireland. Prouder still will be the chapter that UL’s first graduates and staff will help write in the long distinguished narrative of Irish medicine, which for the first time will include the imprint and unique ethos of UL Medical School. I hope it will be the best chapter yet in the history of Irish medicine.
Go raibh maith agaibh go léir.
[1] Joyce P.W., A Smaller Social History of Ireland: Treating of the Government, Military System, and Law; Religion, Learning and Art; Trades, Industries, and Commerce; Manners, Customs, and Domestic Life, of the Ancient Irish People 1906
[2] J.B. Van Helmont “Confessio Authoris” in Ortus Medicinae, Amsterdam 1648, as quoted in Eyewitness to Irish History by Peter Berresford Ellis 2004
[3] Physicians of the future: Renaissance of polymaths?, B F Piko and W E Stempsey