The London Medical Gazette 1837-8 Vol 21 1053 pp p 068 7th October 1837 Medical Attendance on the Poor - letter from William Hill of Wotton under Edge. dated 19th Sept 1837. Sir :- If you think your readers are not quite tired of every thing appertaining to the poor-laws, more especially that part of them connected with medical attendance, perhaps you may find room for the following observations. It appears very clearly that the medical profession is to look for no support from the government, or any of its officers; I think, therefore, they must look to their own interests, and by a combination of action produce that beneficial result which they can never obtain by individual exertion alone. I believe every one who is capable of judging - that is, every one who knows the extent of attendance, and the quantity of medicine required for the poor - considers that the medical attendant, as at present paid, is very badly remunerated. This, I believe, is allowed by all; but it is stated in answer, that the grievance cannot be remedied; that it arises out of the absolute necessity of lessening the poor-rates; that the attendance is not compulsory, and that if the resident practitioners do not like the terms offered, the Assistant Commissioner will send a person to take the office. This is not only threatened, but it has been acted upon in several instances; and the medical practitioner who, after a regular and necessarily expensive education, has by a great outlay of money, and by assiduous and active exertion, established a connexion just sufficient to obtain the necessaries of life for his wife and family, has found his future prospects blighted by the introduction of a young man, (perhaps who has just finished his education) under the influential interest of the Commissioner and his officers. There appears to me but one remedy for this grievance, which is the following:- Let every gentleman who is eligible and desirous of serving the office of medical attendant to a Union, send in his name to any of his brethren who may be fixed on; and when the names are collected, let them be drawn from a box in the presence of the whole, and then let the gentleman whose name is first drawn be considered the person who is to have the appointment for a year. Now, as to terms of remuneration, I propose that in a wide agricultural district, the practitioner be paid sixpence a head; in towns and manufacturing districts, fourpence. I should be willing that a gentleman thus appointed should be under the directions of the Board of Guardians, for I know no other authority to which he could be responsible; and should the Board find him incompetant or unwilling to perform his legitimate duties, they might remove him, and let the names be drawn again to supply his place. Should the Commissioners absolutely refuse to appoint a gentleman thus presenting himself for their approval, and send a stranger to fill the office, I think the best method of counteracting this would be the following :- I should have it publicly known that every person who allowed himself, under these circumstances to be appointed to a Union, should be sent to Coventry, by his brethren, and have his name advertised in every medical periodical. I fear that there are some few in our profession, as there are in all professions, who prefer their own personal advantage, however obtained, to upholding the character of that branch of science to which they unfortunately belong; but I trust they are not sufficiently numerous to interfere with the plan I have proposed. Here I naturally expect to be asked this question - Will the Commissioners permit this ? Most certainly not, if they can prevent it, for it will take away their power of authority, which authority they have exercised in several instances in a most ungentlemanly and shameful manner. I am speaking from facts; they have treated many gentlemen of equal, if not superior education to themselves, as if they belonged to the lowest class of tradesmen, who were waiting on their high mightinesses with a tender for shoes or bread - refusing to hear any observations they may have wished to make - telling them, "totidem Verbis" they may either take the contract or leave it - that if no resident practitioner will take it, they can procure one immediately who will be glad of it. No doubt there are many young men who know not where to settle, who would jump at an introduction by a Commissioner for the smallest stipend - almost for nothing - as there are many briefless barristers of equal talent, who would congratulate themselves at the appointment to the poor-law commission at one-fourth of the emolument the present possessors enjoy; and as economy is held forth as the attribute of the present ministry, I wonder they have not had recourse to this expedient. But no; this would save money to the country, it is true; but it would lessen their patronage, by diminishing the value of one of their numerous commissions. Should a Commissioner read this, I have no doubt he will laugh at the presumption of a country doctor in giving advice on laws which "work so well" Truly they do work well for the Commissioners and the rate-payers, but how do they work for the poor ? The poor alone can tell; they, miserable creatures, know that they must become beggars, absolutely naked and starved, before they can claim, or at least obtain any relief, except by the sda alternative of giving up their all, I believe their very clothes, and then their only resource is the workhouse; and when they have once entered that abode, they have no prospect of a return to their cottage, having previously disposed of every article of clothing and furniture. I should think much might be done for the poor by a tax on the funded property, in the form, for instance, of one-eighth % on every transfer, which might be held for circumstances of peculiar distress in different parts of the country. By this tax many would contribute their quota to the support of the poor, who now do not pay a farthing. There are thousands who live in hotels, chambers, and lodgings, whose door is never knocked at by the tax gatherer, nor timidly tapped by the poor - men with no fixed habitation, but with plenty of money to feed their imagination in the hoarding of it, or to squander in personal gratifications. I know not why the man who possesses one thousand a year in land should pay fifty pounds to the poor, when the fundholder pays nothing. The property of both are equally protected by the laws and military force of the country, the latter of which is drawn almost exclusively from the labouring poor. Moreover, the land-owner affords relief to his neighbouring poor in many acts of charity, more especially in time of sickness, which they who live as I have mentioned have not even the opportunity of doing. I beg pardon for this extra-professional lucubration,and remain, sir. Yours obediently - William Hill.