Practitioners' Income and Provision for the Poor: Parish Doctors in the Late Eighteenth and Early Nineteenth Centuries

Abstract

By the beginning of the nineteenth century, contracts between surgeon-apothecaries and parishes to provide medical care for the poor were replacing bills by item of service. Such agreements were not only an important source of income for practitioners, but also provided a means by which parishes could predict and limit medical spending. This article is a regional study of provision for the poor in east Bedfordshire in the later eighteenth and early nineteenth centuries. By the beginning of the second decade of the nineteenth century, almost three-quarters of parishes in east Bedfordshire were engaged in contractual arrangements with local surgeon-apothecaries to provide a range of services. Remuneration of practitioners, the geographical concentration of poor law practices, and the changing nature of contracts, are all assessed. Interpretation is also undertaken in relation to the status of practitioners, length of service, levels of competition, and how much the contract was worth in real terms to practitioner and parish. It is concluded that the medical market in east Bedfordshire was competitive and that many practitioners used poor law contracts as a means to keep out rivals.