Select Committee on Medical Poor Relief

In 1844 a Parliamentary Select Committee investigated medical poor relief. One of the witnesses was John Fox, a disgruntled former Poor Law Union medical officer.  In his evidence, extracts of which are below, he accused the medical staff at the Dorset County Hospital of only wanting curable cases which would do them credit.

Source: Select Committee on Medical Poor Relief, Minutes of evidence, 1844 (531), page 402

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… I beg leave to draw the attention of the Committee to a calculation I have made.   On looking over an abstract of the report of the Committee of Management of the Dorset County Hospital, an infant institution, where I have no doubt the officers of the institution are anxious to control the expenses as much as possible, I observe in the year 1842 the total number of patients amounted to 452, for which the prime cost of medicine, not including dispensary expenses, but the mere cost of medicine was £119 6s. 3d.  For 1843, the total number amounted to 528 cases, and the cost of medicine £159 7s. 2d.  Now I have attended 857 cases, that is 300 more than the cases in the hospital during the past year ; and for the expenses of one horse, at least, and for all the toil and labour, the remuneration I am allowed is £67 only, whereas medicine alone in the hospital, for the treatment of 528 patients amounts to £159 7s. 2d.  Now one of two things must follow, either that the medical staff of the hospital are most extravagant and inattentive in the use of the medicine, or else I must be very niggardly and not do justice to my patients, or I must be a great deal out of pocket.  If I treat my patients upon the same principle as they do in the hospital, if I give them the same expensive drugs when necessary, I must be a good deal out of pocket.  I am quite sure that for the past year I have not received about £10 or £12 for having attended 857 cases, having ridden 2,000 miles. …

But a vast majority of your cases are not such cases as are sent to an hospital?  No, decidedly not ; those sent to an hospital are generally chronic cases ; cases that are likely to continue for some time.

Is it not the fact that the hospital at Dorchester is exceedingly small, and cannot take in by any means all the cases that ought to go to an hospital?  Not half.

And the only hospital within a great many miles?  Yes.

The nearest hospitals are at Salisbury and Exeter?  Yes. …

… The medical officers have requested me, whenever I had a case to send into the hospital, to select cases that are curable ; cases that will do them credit, because as an infant institution they wish to have as few fatal cases as possible, and to have as many sent out cured as possible.

And to leave the incurable cases for the union officers?  Yes.

Is the union-house a good one for sick people?  I have not been in it since I resigned in 1841, but there were many objections to it …

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