lue. The elections are made by the Guardians, and it is a
fact so notorious as even to be acknowledged by Mr. Birrell that
flagrant canvassing and bribery are a common feature of these elections.
Candidates have been known to distribute sums of L400 or L500 to
Guardians, in order to secure appointments of L150 or L160 a year.
Another serious and extending feature of the present system is the
boycotting by the Guardians of all candidates who have not graduated at
the new Roman Catholic University. The most highly qualified men from
the University of Dublin have now practically abandoned competition for
these Dispensary offices outside the Protestant counties of Ulster.
Moreover, throughout the whole country local candidates are consistently
preferred to superior men from outside. Both the Viceregal and Royal
Commissions recognise the necessity of radical reform in this system,
but they suggest different remedies. The Royal Commission proposes that
the election and control of all the Dispensary Medical Officers of a
County shall be vested in the Public Assistance Authority for that
County; and that little or no change be made in the present financial
basis of the payment of salaries. The Viceregal Commission suggests a
bolder and more drastic remedy. It advocates the establishment of a
State Medical service on the lines of the existing services in Egypt and
India. This would require the payment by the State of the whole, instead
of half, of the salaries of Medical Officers. The Commission regards it
as proper and equitable that such a service should be, in the beginning,
at any rate, restricted to candidates educated in Ireland. A
representative Medical Council should elect the candidates by
competitive examination, and deal with all important questions of
promotion, removal and superannuation. The Commission maintains that the
creation of a State Medical service in Ireland would mean a very small
increase in the Parliamentary grant in comparison with the benefits
involved. This I believe to be the ideal system, but one must recognise
that its accomplishment is confronted with many difficulties. The Irish
Local Authorities would not willingly relinquish a privilege which is a
primary element in their influence and prestige. Irish medical opinion
is acutely divided on the question, which is now further complicated by
the prospect that the medical benefits under the National Insurance Act
may soon be extended to Ireland. It w