The Status of Workhouse Medicine

In England and Wales the Poor Law Amendment Act (1834) required all unions to appoint a medical officer to attend the sick in the workhouse. The 1842 General Medical Order required poor law medical officers to be doubly qualified in both medicine and surgery, which often meant that they were better trained than other local private practitioners, who may have had only one qualification. The requirement to be doubly qualified did not, however, bestow a high status on the post, nor was it rewarded by a significant or even standard scale of remuneration. Despite working in a profession that gradually rose in esteem during the nineteenth century and despite being the only trained and qualified workhouse officers, medical officers remained subservient to lay poor law guardians. Furthermore, medical relief orders for paupers were made by nonmedical relieving officers. As Irvine Loudon points out, the status of an individual general practitioner was dependent on his income and the class of patient he treated. Consequently, the lack of medical autonomy experienced by workhouse medical officers, along with their acceptance of lowly paid posts and their willingness to treat the poorest patients, undermined their status among the medical profession, which was itself concerned to establish its authority within hospitals and society in general.