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| Journal of the New Zealand Medical Association,
05-May-2006, Vol 119 No 1233
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The Finsbury Dispensary
Thomas Wakley (1795–1832) was born in Somerset. He
came to London, where he founded and edited the eminent medical journal,
The Lancet, in 1827. On his death, the
business remained in the family.
Wakley was a fiery and aggressive man, associated with many
reforms, both within the medical profession, and on the broader political stage.
Early targets were the teaching schedules in the hospitals, the Royal College of
Surgeons, and restrictive practices in the profession. He was Member of
Parliament for Finsbury, a London borough, from 1835 to 1852, and it may be
that, as MP for the area, he took an interest in medical practice in his
constituency.
Something of what went on in Dr Wakley’s electorate
can be gleaned from The History of
Clerkenwell, published by J and HS Storer in the year 1828.
On page 119, we learn that the
Finsbury Dispensary occupied “a large and handsome house” in St
John’s Street, Clerkenwell. It was a privately owned and run charity.
The district was “of
greater extent, and comprised a population of labouring and necessitous poor
more numerous than that of any other establishment of a similar nature in the
metropolis. It was first projected in the year 1780. The want of gratuitous
advice and medicines for the labouring poor had long been felt in this extensive
and populous district, and at length induced a few benevolent gentlemen to
consider establishing an Institution to supply it. Their first meeting was on 29
April 1780; on the 12 August following they were enabled to open this
Dispensary.”
The Dispensary had a resident
Apothecary, and visiting physicians and surgeons, who were willing to do house
calls. A patient had to apply at the Dispensary with a recommendation from one
of the Governors, and there were 40 of them, the Patron being Prince Leopold of
Saxe-Coberg. The Governors met frequently, and it was they who found the
money.
“From the increased
population of the district, the number of patients has progressively advanced.
Since its establishment, nearly 150,000 persons have been the subjects of the
Institutions attention. During each year, upwards of 4000 are admitted; and the
average number under cure rarely falls short of 600.”
“The advantages that result
from such institutions as these must be apparent to all who consider that the
expense attending medical advice is not to be afforded, is not to be afforded,
perhaps, by one-third of the inhabitants of this extensive metropolis.
“Though hospitals are
excellent establishments, they are difficult to access, patients are admitted to
them only on one day of the week, fees are required, the patient is taken from
the bosom of his family, and the nurses are strangers.
“The blessings to the poor
themselves are many and important. Application for medical aid, on the first
feelings of indisposition, prevents the spreading of many contagious disorders,
and pestilence...is strangled in it birth.”
More dispensaries started up in London in the nineteenth
century. One of them specialised in the fitting and supply of trusses for people
with hernias.
The following points emerge from this glimpse of medical
practice in the constituency of Thomas Wakley, editor of
The Lancet, and Member of Parliament
for Finsbury.
The scene is a complete inversion of what we see in New
Zealand. In Wakley’s day, almost the whole of the funding of health care
was a charitable exercise. Rich men, taking a direct and personal philanthropic
interest, and frequently engaged in drives to raise extra funds, managed it all.
Government intervention was nil.
In Finsbury, it was the GP care that cost nothing. The
hospitals maintained charitable beds, but they could charge fees if they wanted
to. Contrast the situation here, where hospitals are clogged with patients
seeking and demanding free attention, and GPs are perpetually putting up their
fees to deal with inflation and risings costs.
Poverty in Finsbury was poverty indeed. The Dispensary did
not have much to offer, and, by some accounts, up to half of the prescriptions
provided in London were for opium in some form or another. It is hard to believe
that either the doctor or the treatment cost much in 1780, but inability to pay
established a tradition for mendicity that has persisted to the present day.
Everyone, it appears, believes in primary medical care, but
nobody wants to restore the Finsbury of 200 years ago, where GP attention was
free to the indigent, and the hospital charged whatever the Governors thought
they needed to keep the doors open.
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