The old poor law and medicine

Abstract

THIS ARTICLE is a survey of the treatment of the sick poor in the counties of Berkshire, Essex, and Oxfordshire from c. 1720 to 1834 based on parish records.Its general argument is that the sick poor received sympathetic and humane consideration bearing in mind contemporary medical knowledge and the limited facilities available.General medical aid is first considered -broken limbs, midwifery, eye complaints, etc.This is followed by a section on the use of provincial hospitals and those in London.Parishes readily availed themselves of these institutions and it is suggested that they were not as great a menace as has been often maintained.The role of the dispensaries is also considered.A short section follows on the treatment ofthe mentally deranged pauper and the use of private asylums.A brief comment is made on the medical contract system.The problem of smallpox in the parishes is examined.It is argued that the effects of the disease were so serious and the use of inoculation so widespread, particularly in the rural areas -that this treatment might well have had some effect on mortality trends in the second half of the eighteenth century.Vaccination also became very popular in the parishes after the first decade of the nineteenth century.This, it is also maintained, made an important contribution to mortality trends -particularly when local authorities were able to treat the whole of the poor.The action against typhus and cholera is then considered.Examples are cited of progressive authorities who made strenuous attempts to secure a healthier environment and which might, in a small way, have made a contribution towards improving the health of the local communities.A concluding section attempts to compare the achievements in these three counties with findings in other areas and makes some tentative conclusions.Much more work of this nature clearly needs to be carried out at local level before an overall and definitive picture emerges. I. GENERAL MEDICAL CAREThe Elizabethan legislation referred to the care of the "Lame, Impotent, Old and Blind",1 though subsequent statutes made little reference to this aspect of poor relief.The Poor Law Commissioners of 1834 merely refer to doctors' contractual salaries.However, medical treatment became an essential part of the overseers' duties and a fair

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