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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 05-May-2006, Vol 119 No 1233

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.
Roger M Ridley-Smith
Retired GP
Wellington
(r.sdekka@actrix.gen.nz)
     
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