29 114.
In the foregoing paragraphs on the treatment of the sick in Poor Advantages of Law hospitals, we referred to the necessity, if the best possible results are reorganizing the to be obtained, of arranging so that the medical practitioners to be placed
Medical Seryioe* in charge of hospitals should be possessed of such professional knowledge and experience that, at their appointment or selection, they would be fit to manage a general hospital, or to act as an operating surgeon, according as the circumstances of the particular institution might require.
115.
We do not at all suggest corruptness in the motives that influence Considerations a local body m any county, country, or continent in the disposal of patron-respecting local age.
But the fact will, we think, be generally admitted that, as a rule, a
aPPoilltments-local candidate all over the world gets from a local body a preference.
The practical result generally is that everywhere the local candidate is almost always successful, even against a man who would be regarded as superior, having regard to qualifications, experience and recommendations.
Xor should we regard the discretion of an unfettered central body as satisfactory in this matter.
We consider it a vitally important matter, that the best and most suitable man should be selected by an absolutely impartial test in order that only experienced physicians and skilful surgeons should be appointed respectively to the hospitals where their services would be required.
In making recommendations for the carrying nut of this change, our object is to avoid, as far as possible, any suggestion that would not commend itself to the judgment of those who are simply anxious that the best arrangements possible should be made for the sick who are obliged to become inmates of rate-supported hospitals.
116.
If the Infirmary and Hospital Medical Service in Ireland were
state Medical being organised anew, and indeed even as circumstances are at present, it Service.
seems that the best and most impartial test would be one that should provide for entrance into the Service by competitive examination (*), open to students educated in Ireland, with a representative Medical Council, to assign the successful candidates to suitable places, and to deal with all important questions of promotion, removal, censure, or dismissal, and of remuneration and superannuation, subject to Treasury approval of scales of payment.
Such a system, it would appear, involves the payment by the State of the whole, instead of half, of the salaries of medical officers, as at present—or, in other words, that there should be a State Medical Service, with local bodies to assist in the administration of relief to the sick.
We would not suggest this most important change unless the Govern¬ ment were willing to defray the whole cost of the Service in lieu of their contribution of half the cost, as at present.
If a State Service of the kind were established, the Government could (subject to rights and customs affecting existing Medical Officers) require the Medical Staff, as part of their ordinary duty, to attend Constabulary, Coastguards, Soldiers, Post-Office Officials, and such other persons in the Prison or other Public Service, as now receive Medical attendance at the Public expense.
Doctors in the State Service would, of course, also act as Medical Officers of Health.
It is, we may state, contemplated that the pre¬ set privileges as to private practice should continue.
In some populous districts, however, we think it would be desirable that on the occurrence of fancies the State Medical Officers should be required to devote their We time to their public duties.
Itf.
We consider it proper and equitable that the proposed Irish Medical state Service, should, at all events for the present, be restricted to candi¬ dates educated in Ireland.
Practically all existing Irish Poor Law «dical Officers are Irishmen; and, having regard to the very few modes ^earning a livelihood in Ireland, otherwise than by agriculture, we think 11 would be unjust to take away these appointments from Irishmen and (1«) Dr.
Warnock (Donegal Workhouse Infirmary), 1137 ; Dr.
E.
C.
Thompson, M.P.,
5652-7 aasa 5796.
