Practitioners' income and provision for the poor: Parish doctors in the late eighteenth and early nineteenth centuries

Social History of Medicine

Volumn 18, Issue 2, 2005, Pages 159-186

  Williams, Samantha ^a  

^a UNIVERSITY OF CAMBRIDGE   (United Kingdom)

Author keywords

Competition; Payments for medical care; Poor law; Practitioners' practices; Surgeon apothecaries

Indexed keywords

EID: 26644451409     PISSN: 0951631X     EISSN: None     Source Type: Journal    
DOI: 10.1093/sochis/hki031     Document Type: Article

References (95)

1. S. K. Williams, 'Poor Relief, Welfare and Medical Provision in Bedfordshire: The Social, Economic and Demographic Context, c.1770-1834' (unpublished Ph.D. thesis, University of Cambridge, 1999), ch. 6;
2. S. King, Poverty and Welfare in England (Manchester, 2000), chs 6 and 7.
3. M. Fissell, The "Sick and Drooping Poor" in Eighteenth-Century Bristol and its Region', Social History of Medicine, 2 (1989), 35-58;
4. idem, Patients, Power and the Poor in Eighteenth-Century Bristol (Cambridge, 1991).
5. B. Reay, Microhistories: Demography, Society and Culture in Rural England, 1800-1930 (Cambridge, 1996), ch. 3.
6. G. W. Oxley, Poor Relief in England and Wales 1601-1834 (Newton Abbot, 1974), pp. 65-73;
7. M. Pelling, 'Healing the Sick Poor: Social Policy and Disability in Norwich 1550-1640', Medical History, 29 (1985), 115-37;
8. M. Fissell, 'Charity Universal? Institutions and Moral Reform in Eighteenth-Century Bristol', in L. Davidson, T. Hitchcock, T. Keirn, and R. B. Shoemaker (eds), Stilling the Grumbling Hive: The Response to Social and Economic Problems in England, 1689- 1750 (Stroud, 1992), 121-44, pp. 123-4;
9. A. Berry, 'Patronage, Funding and the Hospital Patient c.1750-1815: Three English Regional Case Studies' (unpublished D.Phil. thesis, University of Oxford, 1995), pp. vi, 208, 221-7.
10. I. Loudon, Medical Care and the General Practitioner 1750-1850 (Oxford, 1986);
11. A. Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720-1911 (Cambridge, 1994);
12. D. Porter and R. Porter, Patient's Progress: Doctors and Doctoring in Eighteenth-Century England (Cambridge, 1989);
13. A. L. Wyman, 'The Surgeoness: The Female Practitioner of Surgery 1400-1800', Medical History, 28 (1984), 22-41.
14. King draws a very different picture for the north and west compared to the south and east. In the north, fewer people were in receipt of poor relief and lower sums were generally given out. King, Poverty and Welfare, chs 6 and 7.
15. Bedfordshire, Huntingdonshire, Norfolk, Suffolk, Essex, Sussex, Buckinghamshire, Oxfordshire, Wiltshire, Berkshire, and Northants all spent at least 15s per capita on poor relief in 1831-2. G. R. Boyer, An Economic History of the English Poor Law, 1750-1850 (Cambridge, 1990), p. 111.
16. Pelling, 'Healing the Sick Poor';
17. idem, 'Illness among the Poor in an Early Modern Town: The Norwich Census of 1570', Continuity and Change, 3 (1988), 273-90.
18. Pelling, 'Healing the Sick Poor', pp. 121-2.
19. P. Rushton, 'The Poor Law, the Parish and the Community in North-East England, 1600-1800', Northern History, 25 (1989), 135-52, p. 146.
20. A. Tomkins, 'Paupers and the Infirmary in Mid-Eighteenth-Century Shrewsbury', Medical History, 43 (1999), 208-27, pp. 214-16.
21. A. Wear, 'Caring for the Sick Poor in St Bartholomew's Exchange: 1580-1676', in W. F. Bynum and R. Porter (eds), Living and Dying in London (1991), Medical History Supplement 11, 41-60, pp. 45-53;
22. J. Boulton, 'Miniature Welfare States? Medical Care of the Poor in the Parishes of Seventeenth-Century Westminster', unpublished seminar paper given at the Cambridge Group for the History of Population and Social Structure, pp. 8-13.
23. Wear, 'Caring for the Sick Poor', pp. 45-53.
24. A. Fessler, 'The Official Attitude Towards the Sick Poor in Seventeenth-Century Lancashire', Transactions of the Historic Society of Lancashire and Cheshire, 102 (1951), 85-113.
25. Loudon, Medical Care, p. 231.
26. Digby, Making a Medical Living, p. 225.
27. Loudon, Medical Care, pp. 78-9, 231;
28. idem, 'The Nature of Provincial Medical Practice in Eighteenth-Century England', Medical History, 29 (1985), 1-32, pp. 10, 12.
29. H. Marland, Medicine and Society in Wakefield and Huddersfield 1780- 1870 (Cambridge, 1987), ch. 3.1.
30. Tomkins, 'Paupers and the Infirmary', pp. 214-16;
31. S. and B. Webb, English Local Government: English Poor Law History: Part I. The Old Poor Law (London, 1927), pp. 304-8.
32. F. G. Emmison, The Relief of the Poor at Eaton Socon (Bedfordshire Historical Record Society, XV, Bedford, 1933), pp. 71-6.
33. Ibid., p. 4.
34. J. R. Smith, The Speckled Monster (Chelmsford, 1987), p. 54;
35. A. F. J. Brown, Essex at Work (Essex Record Office Publications, 49, Chelmsford, 1969), pp. 139-42.
36. M. Barker-Read, 'The Treatment of the Aged Poor in Five Selected West Kent Parishes from Settlement to Speenhamland (1662-1797) (unpublished Ph.D. thesis, Open University, 1989), ch. 3.
37. It is probable that medical care for the poor was given in many other places. F. M. Eden, The State of the Poor: Or an History of the Labouring Classes in England, 3 vols (London, 1797), vols 2 and 3;
38. R. P. Hastings, Poverty and the Poor Law in the North Riding of Yorkshire c. 1780-1837 (Borthwicke Papers, York, 61, 1982), pp. 13-14.
39. In some cases, where the poor were farmed out, it was up to the contractor to make arrangements with the doctor and for any other medical assistance. See Webb and Webb, English Poor Law History, ch. IV.
40. Bedford and Luton Archives and Records Service [hereafter BLARS,] P64/18/6.
41. Digby, Making a Medical Living, p. 225.
42. E. G. Thomas, 'The Old Poor Law and Medicine', Medical History, 24 (1980), 1-19, pp. 7-8.
43. Smith, The Speckled Monster, p. 54;
44. J. Lane, 'The Provincial Practitioner and his Services to the Poor, 1750-1800', Bulletin for the Society for the Social History of Medicine, 28 (1981), 10-13, p. 11.
45. Cited by M. W. Flinn, 'Medical Services under the New Poor Law', in D. Fraser (ed.), The New Poor Law in the Nineteenth Century (Basingstoke, 1976), 45-66, p. 47.
46. The New Poor Law in the Nineteenth Century, Ibid.
47. Rushton, 'The Poor Law in North-East England', p. 146;
48. Marland, Medicine and Society, section 3.1;
49. Hastings, Poor Law in the North Riding of Yorkshire, pp. 13-14.
50. S. Hindle, The Birthpangs of Welfare: Poor Relief and Parish Governance in Seventeenth-Century Warwickshire (Dugdale Society Occasional Papers, Stratford-on-Avon, 40, 2000);
51. P. Slack, English Poor Law 1531-1782 (London, 1990);
52. T. Wales, 'Poverty, Poor Relief and the Life-Cycle: Some Evidence from Seventeenth-Century Norfolk', in R. M. Smith (ed.), Land, Kinship and Life-Cycle (Cambridge, 1984), 351-404;
53. King, Poverty and Welfare.
54. Oxley, Poor Relief, pp. 65-73.
55. Slack, English Poor Law, p. 30;
56. J. P. Huzel, 'The Labourer and the Poor Law, 1750-1850', in J. Think (ed.), The Agrarian History of England and Wales, vol. VI, 1750-1850 (Cambridge, 1989), 755-810, pp. 760, 762.
57. C. Feinstein, 'Pessimism Perpetuated: Real Wages and the Standard of Living in Britain during and after the Industrial Revolution', Journal of Economic History, 58 (1998), 625-58, app. table 1, pp. 52-3.
58. Oxley, Poor Relief, pp. 65-73.
59. There are examples of the issue of price versus quality for Dorset and Essex, but I have found none for Bedfordshire. G. Body, 'The Administration of the Poor Law in Dorset 1760-1834, with Special Reference to Agrarian Distress' (unpublished Ph.D. thesis, University of Southampton, 1968), pp. 193-7;
60. Thomas, 'Poor Law and Medicine', pp. 7-8.
61. Digby highlights a strong tradition of medical altruism. Digby, Making a Medical Living.
62. A. Berry, 'Community Sponsorship and the Hospital Patient in late Eighteenth-Century England', in P. Horden and R. M. Smith, The Locus of Care: Families, Communities, Institutions, and the Provision of Welfare since Antiquity (1997), 126-50;
63. Thomas, 'Poor Law and Medicine'.
64. BLARS, HO:B/A1.
65. E. G. Thomas, 'The Treatment of Poverty in Berkshire, Essex and Oxfordshire, 1723-1834' (Ph.D. thesis, University of London, 1971);
66. Tomkins, 'Paupers and the Infirmary', pp. 216-17;
67. Thomas, 'Poor Law and Medicine', p. 4.
68. Whitbread Collection, BLARS, W1/773-805. London used this source in his assessment of the medical incomes of surgeon-apothecaries, but only drew on part of the table W1/773 (see Table 1 in the text below) and refers to only a few of the letters. Loudon, Medical Care, pp. 231 -5.
69. Digby refers to this part of Loudon's analysis in her discussion of contract payments in rural areas, Making a Medical Living, p. 226.
70. Dictionary of National Biography.
71. BLARS, Bedfordshire Directory, 1847.
72. S. K. Williams, 'Poor Relief, Labourers' Households and Living Standards in Rural England c.1770-1834: A Bedfordshire Case-study', Economic History Review LVIII(2005), 485-519.
73. J. Godber, History of Bedfordshire 1066-1888 (Bedford, 1984);
74. BLARS, W1/762-772, W1/736-740, W1/741, W1/814-825.
75. Williams, 'Poor Relief, Welfare and Medical Provision'.
76. A. F. Cirket (ed.), Samuel Whitbread's Notebooks, 1810-11, 1813-14 (Bedfordshire Historical Record Society, Bedford, 50, 1971), p. 8.
77. It is probable that Whitbread was more influential in his jurisdiction as a magistrate than other JPs. For excellent county-based research on local government, see D. Eastwood, Governing Rural England: Tradition and Transformation in Local Government 1780-1840 (Oxford, 1994).
78. Eden, The State of the Poor.
79. BLARS, W1/773. It is not known who compiled this table, but presumably one of Whitbread's clerks. The format provides an easy-to-read summary of the letters. Amendments and additions are footnoted in Table 1.
80. This includes the three parishes of Haynes, Gravenhurst, and Clophill, which were just outside, but bordering on Whitbread's jurisdiction. BLARS, P45/12/1-2, P17/12/1, P6/12/1.
81. BLARS, Directory for Bedfordshire 1785.
82. BLARS, P18/12/1-2, X514/1-3.
83. BLARS, W1/799.
84. Lane finds that 34 of the 89 parishes (30 per cent) she researched had contracts by 1800. Those parishes (89) represented 41 per cent of total parishes in Warwickshire. Lane, 'The Provincial Practitioner', p. 11.
85. Smith, Speckled Monster, p. 54.
86. Lane, 'Provincial Practitioner', pp. 10-11.
87. 1811 Census;
88. Godber, Bedfordshire, p. 84.
89. s = 0.64, significant at the 0.001 level. Whitbread sample (W1/773-805);
90. 1811 census. 31 parishes, towns, and cities in Eden, The State of the Poor, vols 2 and 3;
91. 1801 census.
92. s = 0.696 or 0.746. W1/773-805, 1811 census, numbers of paupers for 1813 from P.P. 1818 XIX, Abstract of the Poor [1813- 1815]. There are no similar sources to estimate the number of poor in Eden's towns and cities in the late eighteenth century.
93. The national population totals rose from 8,285,852 in 1801 to 14,860,783 in 1841, an increase of 79 per cent. Shefford's percentage increase is 87 per cent, whereas Campton's is only 58 per cent. For national totals, see E. A. Wrigley and R. S. Schofield, The Population History of England 1541-1871 (Cambridge, 1989), Appendix 6, table A6.7, total (1).
94. J. Howlett, 'On the Population and Situation of the Poor in England', Annals of Agriculture, vol. XVIII, 105 (1792), 573-81.
95. Williams, 'Poor Relief and Living Standards'.