Old Wives' Tales by Mary Chamberlain

Author:Mary Chamberlain
Language: eng
Format: epub
Tags: Old Wives’ Tales: The History of Remedies, Charmsand Spells
ISBN: 9780752486796
Publisher: The History Press
Published: 2011-11-18T00:00:00+00:00

DOCTORS AND THE WORKING CLASS

Despite the very limited provision of personal health care, as far as the BMA was concerned there was too much free provision. The expansion of Poor Law infirmaries had increased the numbers of free patients. It had also expanded the role and numbers of hospital consultants who, by the mid-1880s, had succeeded in excluding the general practitioner from hospital service. Similarly, the increase in Friendly Society membership and the formation of Medical Aid Associations in the 1890s further increased the number of patients entitled to ‘free’ medical care.

The doctors, for the most part, were in a dilemma. Throughout the nineteenth century their numbers had steadily grown, and the middle-class market had become saturated. Many doctors were now forced into working-class practice in order to make a living. Yet working-class practices did not pay. Attempts to establish a scale of payment were thwarted by the recognition that allowances had to be made for the very poor, yet failure to treat this class of patient would simply drive them further into the hands of the unqualified practitioners. One ‘means test’ proposed (by the Manchester Medico-Ethical Association in 1879) was based not on the income of the patient but on the rental they paid, and on the thorny question of what was included in the fee the same Association recommended that doctors’ fees were paid only for diagnosis and not for drugs, even if they were included. ‘Of course’, it continued, ‘no extra charge for them is understood as their cost is simply made up by the greater hold the practitioner has on his patient.’ 35 (my italics)

The doctor’s dilemma was recognised and exploited, first by the Poor Law Board and then by the Local Government Board which, in 1879, commented that:

the facility with which, when the office of medical officer becomes vacant, competent medical men are found to fill the vacancies, affords a strong presumption that on the whole remuneration is not deemed to be insufficient. 36

Such attitudes did not incline the general practitioner to State employment, whether centrally or locally administered. Similar forms of exploitation were also employed by the Friendly Societies, who equally underpaid and overworked their medical officers.

Any moves which attempted to undercut private practice were likely, therefore, to be strongly opposed by the BMA. Their opposition to the registration of midwives is indicative of this. Similarly, moves to establish a Central Board of Health were opposed.

The bulk of the profession showed interest in the subject only when it held out hope of strengthening their economic position. What they wanted most of all was protection against the competition of unqualified practitioners. Here, however, the 1858 Medical Act and the 1911 National Health Insurance Act satisfied much of their needs – the former, by confining Friendly Society (as well as public) posts to registered doctors; the latter, by extending this protection from one-tenth to one-third of the population. After 1911, medical interest in a Ministry weakened and it revived in 1918 only after the profession saw how much protection could be extended further without running risk of bureaucratic control.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.