Family Research – English, Scottish and Irish Genealogy


The Case for State Medical Services for the Poor-The Highlands & Islands 1850

In 1845 the potato blight, Phytophthora Infestans, descended on Ireland destroying the essential source of nourishment of a whole population. The famine that followed profoundly changed the demography and even the history of that country. In the late summer of 1846 the same fungus spread to Scotland. The potato crop in many parts of the country was ‘all but a complete failure.’

The calamity was felt most severely in the Western Highlands and Islands where the mass of the people, dependent on the potato and living constantly at subsistence level, were never more than one harvest away from scarcity and hunger. For almost ten years the suffering of the people was made worse by the lack of medical aid. A medical service only recently put in place proved to be entirely inadequate.

In August 1845 an Act for the Amendment and better Administration of the law relating to the Relief of the Poor in Scotland became law. For some three centuries responsibility for the administration of the Poor Law in Scotland had been devolved to the Kirk and almost nothing had been spent on medical aid even for those registered as paupers on the parish rolls.2 Under the new Act the state set up Parochial Boards in every parish to ‘have and exercise all the Powers and Authority hitherto exercised by the Heritors [landlords] and the Kirk Sessions.’

In the nineteenth century, the need for some new provision for the poor had become compelling. The remorseless industrialisation of Britain had destined to poverty an ever-growing proportion of the population – the new overworked, poorly paid and badly housed urban industrial workforce. In the years of economic depression that had followed the Napoleonic Wars the poverty of the working poor deepened further and become even more widespread. There was a growing fear in the country that ‘the condition and disposition of Working Classes is a rather ominous matter at present; that something ought to be said, something ought to be done, regarding it.’3 In the 1834, Parliament responded to this increasing public anxiety. A Poor Law (Amendment) Act was passed for England and Wales, based on the Utilitarian ideas that had become influential in England. The greatest good of the greatest number was to be achieved by reducing the threat that pauperism and its attendant evils presented to the general public and by containing the financial burden that increasing pauperism forced on the productive and self-supporting majority.

Since Elizabethan times, the Poor Laws in England had determined that a small number of the poor – those whose poverty was so absolute that they had been obliged to surrender the normal privileges of citizenship in order to become officially designated as paupers – were entitled to support from the community in which they lived. In 1834 Edwin Chadwick, the Benthamite architect of the new Act, aimed to contain the rising cost of the every increasing numbers maintained under the old laws. Relief was to be administered with greater economic efficiency but even more important, the year on year increase in the number entitled to relief was to be halted. Chadwick identified the diseases and disabilities of the working poor as the chief cause of the decline of so many of their number into destitution and pauperism. He was persuaded by the belief, then common in England, that the chief cause of the pauperising diseases of the poor was miasma, the noxious effluvium from urban filth. He was confident that by eliminating miasma from the country’s towns and cities by a program of sewerage and drainage, the chief cause of urban pauperism would be removed. Not only would the numbers, and therefore the cost, of the paupers be contained but the slums which harboured the urban poor would no longer be the breeding grounds of disease and the source of a constant threat to the health of the community at large. The English Act of 1834 made no provision for the personal medical care of paupers, even where their pauperism was due to sickness.4 Chadwick, the chief architect of the Act, looked only to prevention; doctors were ‘necessary evils not likely to last,’ destined to become redundant as his sanitary measures to remove miasma took effect.5

For over a decade there was well argued objection to the government’s intention that the provisions of the English Act should also be made to apply in Scotland. Opinion in Scotland was unconvinced by Utilitarian ideology and the medical profession discounted miasma as a significant cause of pauperism. The accepted model of the relationship between disease and poverty was an inversion of that held in England. From Cullen and Buchan in the eighteenth century,6 physicians in Scotland had held that poverty – through poor diet, inadequate clothing and shelter, overwork and overcrowding – led to ‘debility.’ In the nineteenth century medical students at Glasgow and Edinburgh were taught that it was the ‘debility’ of poverty that was at the root of the health problems of the urban working class.7 Led by W. P. Alison, then the Professor of Medicine at Edinburgh University, social reformers in Scotland argued that any new Poor Law must include support for the able-bodied poor so that, when deprived of employment for whatever reason, the worker and his family would not necessarily be reduced to destitution, debility, depression and disease.8 Equally, the sick poor must have access to the medical treatment that might make it possible for them to return to work and to provide for their families.

Alison, and his follow reformers were only partially successful. Since the sixteenth the century, the Poor Law in Scotland had not required parish authorities to provide for the able-bodied and that ancient principle was continued in the Poor Law (Amendment) Act in 1845. The Act did not extend the reponsibities the new Poor Law to include the able bodied; ‘poor,’ in this context, continued to mean only ‘pauper’. Although the new legislation did nothing to prevent the able bodied from falling into pauperism, it did offer those pauperised by ill health some assistance to recover their ability to work. In the Bill presented to Parliament Parish Boards were to be obliged to raise ‘Funds for the Relief of the Poor’ from within the parish either by voluntarily offerings or by assessment and were required, out of these funds ‘to provide for Medicines, Medical Attendance, nutritious diet, Cordials and Clothing for such poor and in such a manner and to such an extent as seem equitable and expedient.’

In the House of Commons, Scottish members continued to object that this proposed enabling legislation did not go far enough. They demanded that the Poor Law must ensure that every parish had the services of a resident medical officer and that, to provide the necessary funds, assessment should be made compulsory. The Home Secretary, Sir James Graham, agreed that ‘general assessment must be desirable but considering the difference of opinion he thought it infinitely more wise to leave the public of Scotland, by a voluntary act, to adopt assessment themselves rather than by an enactment to make it compulsory.’9 The Prime Minister, Sir Robert Peel considered that the provision of a paid medical officer in every parish was impractical and that Scottish members were being over ambitious. ‘He entertained a strong objection to giving the people of Scotland a positive assurance that the poor should at all times be supplied with medical relief. He thought there should be caution in how they excited expectation which could not be realised. Everything that was possible ought to be done but fallacious hopes should not be raised.’10

Nevertheless, after the Act was passed, Scottish pressure continued11 and in 1848 the government offered a compromise. An annual grant of £10,000 was made to the Board of Supervision of the Poor Law to finance a subsidy for any parish that agreed to finance the formal appointment of a medical officer. Sir John McNeil, the Chairman of the Board, was confident that, with this inducement, a full complement of medical officers would be recruited throughout Scotland.12

On first introducing his the Poor Law (Amendment) Bill in 1845, the Lord Advocate had referred to the problem of increasing poverty in the towns and cities to which there had previously been ‘perhaps some indifference – or rather a want of attentive observation.’13 He also drew attention to the very different, but equally pressing, problems of poverty in the Highlands and Islands.

In many districts a great change of circumstances has been occasioned by the alteration in the system of management of land. Small farms have been thrown together into large farms and the consequence is that there are fewer people able to contribute to the relief of the poor now than formerly. Then again in some extensive locations along the coast the entire annihilation of kelp manufacture has thrown many persons out of employment and while the means of the contributors has decreased and the fund for reliving the poor has become lessened. The poverty and misery of the labouring classes has naturally increased.

It was appropriate that although the people of the Highlands and Islands made up little over 10% of the population of Scotland their poverty should have special attention. Although communications by sea had recently improved with the introduction of steamboat services from the Clyde, the Western Highlands and Islands were still remote from the main body of Scotland. In 1845, the way of life and the usual language of the people, as much as geography, set the community apart and its social problems were it own.

Since the seventeenth century the old military Gaelic society and its clan structure had been disintegrating. In theory the lands occupied by the clan had been communal but in practice the clan was ruled by a hereditary aristocracy in what was in effect a ruler-owns-all society. Traditionally the economy had depended on the rearing and exporting of cattle and by the communal farming of scattered and intermingled holdings and open fields.

The destruction of this ancient Gaelic society was purposefully accelerated by government fiat in the aftermath of the Jacobite rising of 1745.14 It was now legally recognised that the tradition of common ownership of the clan lands had long been a myth. Clan chiefs were now to be regarded as no more than landed gentlemen, legal owners of vast estates that were grossly overpopulated and burdened by an obsolete agricultural economy. Many estates were soon bankrupt and almost all urgently required new investment to make them commercially viable. Some of the old aristocratic families raised the necessary funds by selling part of their estates; others sold out completely, usually to men who had made fortunes overseas or in the new industries of the south. This new generation of owners introduced modern agricultural practices to the best of their arable ground and gave over other vast acres to profitable sheep runs. In this restructured agricultural system there was a place only for landowners, their large tenants and a limited agricultural workforce. Employment could only be found for the few; the great majority of the population of Highlands and Islands was now redundant. A few of the minor gentry became large tenant farmers but most found that they could only maintain their life style by moving away. Numbers of the ordinary people – those who could find the means – also moved away, emigrating in the hope of a new and better life in the south or in North America. Those who remained were displaced from the inland glens to peripheral coastal land and settled on crofts too small to provide a livelihood for a family. In the early years of the nineteenth century almost every crofter had to rely on additional income from employment in the local kelp industry or from the earnings of those of the family who could find seasonal work in the fishing fleets operating from the east coast or temporary employment in the industrial south.15 The Highlands and Islands made an essential contribution to nineteenth century Britain by supplying wool for the expanding industry in the south, labour for the expanding economy and, as ever, manpower for the country’s armed forces. But the society that had emerged in the Highlands and Islands was not one in which a professional middle class could flourish. There were few people of substance; the overwhelming majority of the people now belonged to a crofting community that was poor almost by definition and, as its numbers continue to increase during the first half of the century, so also did its poverty.

Dr Morrice McCrae

Royal College of Physicians of Edinburgh

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